Evidence for proprioception

Question 1

What studies do you want to cite for proprioception?

Answer 1

General role
- Stanczak et al (2025) sys review

Effects of neuro training
- Araumugam et al (2021) sys review
- Dargo et al (2017) sys review
- Ghadari et al (2021) clinical trial

Hopping exercises
- West et al (2023) sys review of 13000+ subjects

Perturbation training
- Madhavan & Shields (2011) clinical trial

Question 2

What role does a healthy ACL have re proprioception?

Answer 2

The body of evidence considers proprioception as an outcome ie being impaired following injury/ surgery, not much using proprioceptive exercises as a targeted intervention… but we can say -

Stanczak et al (2025):

• the ACL is not merely a passive stabiliser, it is an active sensory organ integrated into the central nervous system
• it contributes to dynamic stability of the knee through its dense network of mechanoreceptors
• its receptors inform the CNS about joint position, tension and motion, and coordinate neuromuscular responses to help protect knee from excessive loading

Question 3

What evidence do you have on effects of neuromuscular training on knee proprioception after ACLR?

Answer 3

Araumugam et al 2021 - systematic review
- n=327 with ACLR
- the heterogeneity of interventions, methodological limitations and inconsistency of effects preclude recommendation of one optimal neuromuscular training intervention for improving proprioception following ACL injury in clinical practice
- so we can use whatever exercises we want

Question 4

What evidence do you have on neuromuscular and proprioceptive training and ACL injury rates?

Answer 4

Dargo et al. 2017- systematic review

• total of 24 studies with 1093 participants were included in this review
• neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the ACL. However, no evidence suggested that a specific group of exercises was better than others
• so we can use whatever exercises we want

Question 5

What evidence do you have for neuro training after ACLR compared to no training?

Answer 5

Ghadari et al 2021 – clinical trial
- Twenty-four male athletes who had undergone ACL reconstruction and completed conventional post-op rehab randomly allocated to experimental group (n = 12) who took part in an 8-week neuromuscular training program or a control group (n = 12) in a placebo programme
- The neuromuscular training program included lower extremity strengthening and plyometric exercises, balance training, and movement pattern re-training
- Athletes in the experimental group demonstrated increased trunk, hip, and knee flexion angles and decreased knee abduction, internal rotation angles and knee valgus during landing following the intervention
- Neuromuscular training programs beneficially mitigate second ACL injury risk factors and should be emphasized during and after traditional post-operative rehabilitation

Question 6

What evidence do you have for including hopping exercises?

Answer 6

West et al (2023) systematic review met analysis of over 13000 adolescents & adults
- low certainty evidence that single or repeated hop tests can predict knee related outcomes post ACL injury
- higher single-forward and repeated-forward hop limb symmetry was associated with better self-reported symptoms and function 1-37 years after ACL injury
- achieving high levels of limb symmetry on single forward hop tests associated with reduced odds of knee osteoarthritis 1-37 years after ACL injury
- Hence including lots of hopping exercises
- however, the relationship between hop tests and higher return to sport rates appeared to only be with ACL reconstruction patients, not lower grade injuries

Question 7

What evidence do you have for including a perturbation exercise?

Answer 7

Madhavan and Shields (2011)
- 12 females with ACLR and 12 healthy females performed a single leg squat subject to random perturbations
- ACLR subjects showed impaired response to perturbations and reduced quads contractions (assessed via EMG)
- Disadvantages:
o only a small sample size
o looks at ACLR, not ACL sprain
- Advantages
o one of the minority of studies to consider females
o those with ACL injury responded differently to perturbations so gives some indication that helping retrain ACL to deal with perturbations is useful