Literature reviewEffects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis
Introduction
Proprioception is an integral component of the motor control and coordination process in which the body identifies inputs from various mechanoreceptors, nociceptors, and muscle afferents and further integrates the information attained into the motor programming that is required for perception of movement, force and joint position (Baumeister et al., 2008, Grigg, 1994). It also possesses important prophylactic properties for preventing musculoskeletal and neuromuscular injuries by avoiding excessive joint movements (beyond the physiological and anatomical range of motion) (Jerosch & Prymka, 1996).
Likewise, incorporation of joint stabilizers (JS: brace, bandage, compression garment, taping and corsets) in modern clinical and sports settings as a rehabilitative, prophylactic and performance enhancement measure is primarily attributed to their beneficial capabilities of enhancing proprioception (Bottoni, Herten, Kofler, Hasler, & Nachbauer, 2013; Fu, Liu, & Fang, 2013). Several physiological mechanisms have been suggested for this effect (Birmingham et al., 1998; Herrington, Simmonds, & Hatcher, 2005). Researchers primarily hypothesize that JSs enhance proprioception by enhancing the cutaneous stimulation and by pressurizing the underlying musculoskeletal structures (Janssen & Kamper, 2013; Perlau, Frank, & Fick, 1995). These cutaneous receptors convey high fidelity information for joint positioning (Edin, 2001), and have also been shown to play a major role in postural stabilization (Krishnamoorthy, Slijper, & Latash, 2002). Moreover, JS have also been reported to play a significant role in the rehabilitation of various musculoskeletal injuries, such as osteoarthritis, patellofemoral pain syndrome, and low back pain (Birmingham, Kramer, Kirkley, Inglis, Spaulding, & Vandervoort, 2001; Callaghan, Selfe, McHenry, & Oldham, 2008). Lee, Lim, Jung, Kim, and Park (2013) suggested that injury to musculoskeletal structures leads to blockage of afferent inputs from the mechanoreceptors located on the articular and musculoskeletal structures of the joint. Furthermore, the enhancement of proprioception accuracy post application of JS occurs as a result of increased afferent sensory inputs from the cutaneous mechanoreceptors and the imitation of normal joint biomechanics that the injured musculoskeletal structures are subjected to. Likewise, enhanced perception of stability and confidence has also been reported amongst participants post application of JS in some studies (Bernhardt & Anderson, 2005; Callaghan et al., 2012, Lien et al., 2014; Michael, Dogramaci, Steel, & Graham, 2014). Callaghan et al. (2012) confirmed this effect and reported an associated decrease in BOLD (Blood oxygen level dependence) response in the anterior cingulate cortex and cerebellum post application of taping. Similarly, modulation of musculoskeletal activation and neurological activity has been reported in some studies post application of JS. Lin, Hung, and Yang (2011), for instance, in their electromyography (EMG) study reported differential activation levels of the underlying musculoskeletal structures post application of scapular taping. Likewise, Callaghan et al. (2012) in their functional magnetic resonance imaging (fMRI) analysis asserted that the application of JS (tape) causes subtle changes in brain centres associated with sensation, coordination, decision making, planning of complex coordination tasks and coordination of unconscious tasks. Similarly, enhancement of cerebral haemodynamics has been reported after the application of JS in the primary sensorimotor cortex, cerebellum and ventral tegmental area of the brainstem, signifying enhanced regional brain perfusion in areas related to motor control and coordination (Thijs, Vingerhoets, Pattyn, Rombaut, & Witvrouw, 2010).
In addition to the abovementioned factors, one of the most critical and least researched components of different methods of JS are its structure, material, and fitting. Several studies have discussed the importance of comfortable fitting, application of JSs for enhancing proprioception and performance (Bernhardt and Anderson, 2005, Fu et al., 2013, Lien et al., 2014, Michael et al., 2014). For instance, Bernhardt and Anderson (2005) suggested that increased resistance offered by elastic stabilizers (compression garments) when lengthened, results in a progressive resistive force that limits the joint movement to an optimal physiological range of motion. This function may be crucial for injury prevention. Likewise, studies have also suggested that lack of comfort and poor fit can adversely affect performance as it might lead to differential activation of the underlying musculature and/or might not provide optimal support to weak musculoskeletal structures. According to Fu et al. (2013), an ideal JS should provide optimized compression, comfort, fit, and skin contact. Incorporation of these factors is crucial not only for optimal sports performance but also for efficient injury prevention and rehabilitative approaches.
The present literature aims to identify the beneficial capabilities of JSs for enhancing proprioception, stability at various joints amongst athletes, sedentary individuals of both sexes and across all age groups. In the current review, the authors have also attempted to generate a comprehensive understanding of the underlying mechanisms and function of various JS amongst different population groups.
Section snippets
Methods
This review was conducted according to the guidelines (Appendices) outlined in Preferred Reporting Items for Systematic Reviews and Meta-analysis: The PRISMA statement (Moher, Liberati, Tetzlaff, & Altman, 2009).
Characteristics of included studies
Data from the included studies have been summarized in (Table 1 and Supplementary Table 2). In the 50 included studies 6 were RCTs, 42 were CCTs and 2 were observational neuroimaging studies. The studies were conducted in Europe (18), USA (13), Australia (5), Canada (4), Iran (4), South Africa (2), South Korea (2), Hong Kong (1) and Taiwan (1). The sub-classification for representation of various JS methods on different parameters was made under nine categories; postural stability (4),
Discussion
This systematic review and meta-analysis aimed to further our understanding of the effects pertained by different JSs on postural stability, and joint proprioception among different population groups. The present literature, meta-analysis and PEDro level of evidence shows that JSs have demonstrated beneficial capabilities for enhancing proprioception and stability. The prominent role of proprioception in maintaining postural stability and motor control has been emphasized in several studies (
Conflict of interest
None declared.
Funding
None declared.
Acknowledgement
The authors would like to thank Education New Zealand for the New Zealand India Sports Scholarship awarded during the study. The authors would also like to thank Mr. Mamadou Diouma Bah and Ms. Ann Mason for their kind comments.
References (78)
- et al.
The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen
Knee
(2013) - et al.
Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome
Manual Therapy
(2008) - et al.
The effect of neoprene shorts on leg proprioception in Australian football players
Journal of Science and Medicine in Sport
(2008) - et al.
Stochastic resonance electrical stimulation to improve proprioception in knee osteoarthritis
Knee
(2011) - et al.
Effect of soft and semirigid ankle orthoses on star excursion balance test performance in patients with functional ankle instability
Journal of Science and Medicine in Sport
(2014) - et al.
Knee bracing: effects on proprioception
Archives of Physical Medicine and Rehabilitation
(1996) - et al.
What is the effect of compression garments on a balance task in female athletes?
Gait Posture
(2014) The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study
Australian Journal of Physiotherapy
(2009)- et al.
Low back pain sufferers: is standing postural balance facilitated by a lordotic lumbar brace?
Orthopaedics & Traumatology: Surgery & Research
(2010) - et al.
The effects of a lumbar support on repositioning error in subjects with low back pain
Archives of Physical Medicine and Rehabilitation
(2001)
Support for a reduction in the number of trials needed for the star excursion balance test
Archives of Physical Medicine and Rehabilitation
The effect of taping on the proprioception of the ankle in a non-weight bearing position, amongst injured athletes
The Foot
Proprioceptive contribution of postural control as assessed from very slow oscillations of the support in healthy humans
Gait Posture
Psychological aspects of rehabilitation following serious athletic injuries with special reference to goal setting: a review study
Physical Training
The effects of neoprene sleeve application on knee joint proprioception in adolescent female athletes
Changed cortical activity after anterior cruciate ligament reconstruction in a joint position paradigm: an EEG study
Scandinavian Journal of Medicine & Science in Sports
Compression shorts and sports performance: Help or hindrance
Influence of moderate prophylactic compression on sport performance
Journal of Strength & Conditioning Research
Effect of athletic taping and kinesiotaping® on measurements of functional performance in basketball players with chronic inversion ankle sprains
International Journal of Sports Physical Therapy
Effect of a neoprene sleeve on knee joint kinesthesis: influence of different testing procedures
Medicine and Science in Sports and Exercise
Effect of a neoprene sleeve on knee joint position sense during sitting open kinetic chain and supine closed kinetic chain tests
American Journal of Sports Medicine
Knee bracing for medial compartment osteoarthritis: effects on proprioception and postural control
Rheumatology
Positive psychology interventions: a meta-analysis of randomized controlled studies
BMC Public Health
Comprehensive meta-analysis
Effect of knee supports on knee joint position sense after uphill and downhill walking. A test using a hiking simulation method
Journal of Ergonomics
Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging
Physical Therapy
The effects of patellar taping on knee joint proprioception
Journal of Athletic Training
Systematic reviews: CRD's guidance for undertaking reviews in health care
Kinesio taping improves pain, range of motion, and proprioception in older patients with knee osteoarthritis: a randomized controlled trial
American Journal of Physical Medicine & Rehabilitation
The effects of a 3-week use of lumbosacral orthoses on proprioception in the lumbar spine
Journal of Orthopaedic & Sports Physical Therapy
The effect of a neoprene shoulder stabilizer on active joint-reposition sense in subjects with stable and unstable shoulders
Journal of Athletic Training
Statistical power analysis for the behavioral sciences
The effects of stochastic resonance electrical stimulation and neoprene sleeve on knee proprioception
Journal of Orthopaedic Surgery and Research
Incorporating heterogeneity into random-effects models
Cutaneous afferents provide information about knee joint movements in humans
The Journal of Physiology
Comparison of the effect of semi-rigid ankle bracing on performance among injured v. non-injured adolescent female hockey players
South African Journal of Sports Medicine
Effects of prefabricated ankle orthoses on postural stability in basketball players with chronic ankle instability
Asian Journal of Sports Medicine
Self-confidence and sports performance
Research advancements in humanoid compression garments in sports
International Journal of Advanced Robotic Systems
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2021, Journal of BiomechanicsCitation Excerpt :With the ST, the devices could act as mechanically efficient external supports against gravitational destabilizing torque. In addition, the stronger pressure, in the ST condition, could amplify the afferent information from mechanoreceptors underneath the devices more than in the LT condition (Ghai et al. 2017). Consequently, the ST might have enhanced somaesthetic afferents by increasing the proprio-cutaneaous stimulation over the ankle.
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2020, Hand Surgery and RehabilitationCitation Excerpt :Although proprioception has been studied in other joints [4,5], few proprioception studies have been performed on the wrist. Ghai et al. reviewed 50 studies on proprioception including studies in healthy subjects and none were related to the wrist joint [6]. One of the treatment modalities after injury is the use of external supports.
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2020, Journal of Clinical NeuroscienceCitation Excerpt :With the difference of results among paired groups of included studies, the result of the studies with a higher PEDro score was given more attention. Inconvenient randomization, non-blinding of assessors, no intention to treat examination, and no measurement of compliance were central threats to biasing [16]. Methodological quality scores for involved studies shown in Table 1.