Elsevier

Physical Therapy in Sport

Volume 25, May 2017, Pages 65-75
Physical Therapy in Sport

Literature review
Effects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis

https://doi.org/10.1016/j.ptsp.2016.05.006Get rights and content

Highlights

  • We reviewed studies analyzing JS and their effects on proprioception and stability.

  • Cerebral haemodynamics in areas of co-ordination is enhanced post-JS application.

  • Perception of stability, confidence are enhanced post-JS application.

  • Physical, psychological performance are associated with comfort and fitting of JS.

Abstract

Objective

The current review and meta-analysis systematically investigated the effect of joint stabilizers on proprioception, postural stability, and neurological activity.

Methods

Systematic identification of published literature was performed on online databases; Scopus, PEDro, SportDiscus, and EMBASE, followed by a critical PEDro methodological quality appraisal. Data from the studies were extracted and summarized in a tabular format.

Results

Of 2954 records, 50 studies, involving 1443 participants met our inclusion criteria. In the included studies, 60% of studies reported significant enhancements (p < 0.05), 19% of studies reported enhancements (p > 0.05) and 21% of studies reported no effects of joint stabilizers on proprioception and/or postural stability. Meta-analysis of pooled studies demonstrated beneficial effects of joint stabilizers on the knee (95% CI: 0.35°–0.61°) and ankle (at 10: 0.1°–0.65°) joint proprioception, and negligible effects on postural stability (−0.28°–0.19°).

Conclusion

The pooled evidence suggests that application of joint stabilizers enhances joint proprioception and stability by not merely altering the mechanical stability of the underlying musculoskeletal structures but by also causing subtle changes in cerebral haemodynamics and musculoskeletal activation. These findings support clinical implications of joint stabilizers as a prophylactic and rehabilitation measure in modern sports and rehabilitation settings.

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)

  • R.H. Robinson et al.

    Support for a reduction in the number of trials needed for the star excursion balance test

    Archives of Physical Medicine and Rehabilitation

    (2008)
  • S. Spanos et al.

    The effect of taping on the proprioception of the ankle in a non-weight bearing position, amongst injured athletes

    The Foot

    (2008)
  • M. Vaugoyeau et al.

    Proprioceptive contribution of postural control as assessed from very slow oscillations of the support in healthy humans

    Gait Posture

    (2008)
  • V. Armatas et al.

    Psychological aspects of rehabilitation following serious athletic injuries with special reference to goal setting: a review study

    Physical Training

    (2007)
  • G.B. Barrett

    The effects of neoprene sleeve application on knee joint proprioception in adolescent female athletes

    (2003)
  • J. Baumeister et al.

    Changed cortical activity after anterior cruciate ligament reconstruction in a joint position paradigm: an EEG study

    Scandinavian Journal of Medicine & Science in Sports

    (2008)
  • T. Bernhardt et al.

    Compression shorts and sports performance: Help or hindrance

    (2003)
  • T. Bernhardt et al.

    Influence of moderate prophylactic compression on sport performance

    Journal of Strength & Conditioning Research

    (2005)
  • S. Bicici et al.

    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

    (2012)
  • T.B. Birmingham et al.

    Effect of a neoprene sleeve on knee joint kinesthesis: influence of different testing procedures

    Medicine and Science in Sports and Exercise

    (2000)
  • T.B. Birmingham et al.

    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

    (1998)
  • T. Birmingham et al.

    Knee bracing for medial compartment osteoarthritis: effects on proprioception and postural control

    Rheumatology

    (2001)
  • L. Bolier et al.

    Positive psychology interventions: a meta-analysis of randomized controlled studies

    BMC Public Health

    (2013)
  • M. Borenstein et al.

    Comprehensive meta-analysis

    (2005)
  • G. Bottoni et al.

    Effect of knee supports on knee joint position sense after uphill and downhill walking. A test using a hiking simulation method

    Journal of Ergonomics

    (2014)
  • M.J. Callaghan et al.

    Effects of patellar taping on brain activity during knee joint proprioception tests using functional magnetic resonance imaging

    Physical Therapy

    (2012)
  • M.J. Callaghan et al.

    The effects of patellar taping on knee joint proprioception

    Journal of Athletic Training

    (2002)
  • Centre for Reviews and Dissemination

    Systematic reviews: CRD's guidance for undertaking reviews in health care

    (2009)
  • H.-y Cho et al.

    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

    (2015)
  • J. Cholewicki et al.

    The effects of a 3-week use of lumbosacral orthoses on proprioception in the lumbar spine

    Journal of Orthopaedic & Sports Physical Therapy

    (2006)
  • J.C. Chu et al.

    The effect of a neoprene shoulder stabilizer on active joint-reposition sense in subjects with stable and unstable shoulders

    Journal of Athletic Training

    (2002)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • A.T. Collins et al.

    The effects of stochastic resonance electrical stimulation and neoprene sleeve on knee proprioception

    Journal of Orthopaedic Surgery and Research

    (2009)
  • J. Deeks et al.

    Incorporating heterogeneity into random-effects models

    (2013)
  • B.B. Edin

    Cutaneous afferents provide information about knee joint movements in humans

    The Journal of Physiology

    (2001)
  • T.J. Ellapen et al.

    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

    (2014)
  • E. Faraji et al.

    Effects of prefabricated ankle orthoses on postural stability in basketball players with chronic ankle instability

    Asian Journal of Sports Medicine

    (2012)
  • D.L. Feltz

    Self-confidence and sports performance

  • W. Fu et al.

    Research advancements in humanoid compression garments in sports

    International Journal of Advanced Robotic Systems

    (2013)
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