No correlation between joint position sense and force sense for measuring ankle proprioception in subjects with healthy and functional ankle instability

doi:10.1016/j.clinbiomech.2014.08.017

Clinical Biomechanics

Volume 29, Issue 9, November 2014, Pages 977-983

https://doi.org/10.1016/j.clinbiomech.2014.08.017 Get rights and content

Highlights

•
Our study was the cross-sectional laboratory study.
•
Our study investigated the correlations between joint position sense and force sense.
•
Angle reproduction and force matching methods of ankle were used for this study.
•
No correlations between the joint position sense and force sense of ankle were found.
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Joint position sense and force sense of ankle should be applied at the same time.

Abstract

Background

In general, ankle proprioception is most often evaluated by assessing joint position sense and force sense. However, in contrast to observational studies of joint position sense and force sense, no studies have examined the correlations between joint position sense and force sense. Therefore, the objective of this study was to investigate the correlations between joint position sense and force sense in subjects with healthy and functional ankle instability.

Methods

Of the sixty nine subjects enrolled in the cross-sectional laboratory study, 35 had functional ankle instability and 34 were healthy subjects. Angle reproduction and force matching methods were used to quantify joint position sense and force sense of the ankle proprioception. These methods were also measured by using a flexible twin axis electrogoniometer and linear force, respectively. Three trials were performed at each angle and force. And then, absolute errors were calculated.

Findings

Significant differences between the functional ankle instability and healthy group were found for absolute errors of plantar flexion, dorsiflexion, inversion, and eversion (P < 0.05). No significant correlations between the joint position sense and force sense were found in subjects with both healthy, except for absolute errors of the eversion (r = 0.652, P < 0.05, r² = 0.425), and functional ankle instability group (P > 0.05).

Interpretation

These findings suggest that it could be explained for deficits of ankle proprioception when angle reproduction and force matching tests to quantify joint position sense and force sense were applied and presented at the same time, not individually.

Introduction

The ankle bears more weight per unit area than any other joint in the body. The ankle joint is one of the most commonly injured joints in the body. Seventy-five percent of all ankle injuries are ankle sprains which occur commonly (Hertel, 2008, Morrison and Kaminski, 2007, Nakasa et al., 2008). Ankle sprain, specifically lateral ankle sprain, is also a frequent injury in sports activities and occupational settings that mostly concern young physically active individuals.

Previous studies reported that 10% to 30% of individuals with all lateral ankle sprain exhibit functional ankle instability (FAI) (Docherty et al., 2006, Reeves et al., 2006). FAI is defined objectively as repeated ankle inversion sprain and subjectively as a “giving way sensation” in the ankle (Nakasa et al., 2008). Occurrence of residual dysfunction following FAI has been attributed to a number of factors, including proprioceptive deficits (Konradsen and Magnusson, 2000, Vaes et al., 2002), decreased range of motion (Konradsen and Magnusson, 2000, Lephart et al., 1997), and muscle weakness (Munn et al., 2003). Furthermore, to measure and evaluate these factors following FAI should be primarily accompanied for the identification of ankle proprioceptive capabilities.

Ankle proprioception is believed to be critical for maintaining the balance of the human body during functional activities such as standing, walking, and running (Lee and Lin, 2008), especially sports activities in athletes. In general, ankle proprioception is most often evaluated by assessing joint position sense (JPS) and force sense (FS) (Hertel, 2008, Riemann and Lephart, 2002). The JPS was defined as “the ability to accurately reproduce a given angle” and FS was defined as “the ability to accurately reproduce a given force”. In addition, the angle reproduction (AR) (Bernier and Perrin, 1998, Jerosch and Prymka, 1996) and force matching (FM) (Docherty and Arnold, 2008) methods have also been used to quantify JPS and FS of the ankle, respectively. The several previous studies reported that AR (Piriyaprasarth et al., 2008) and FM (Docherty and Arnold, 2008, Docherty et al., 2006) methods were used to identify the deficits of ankle proprioception in FAI subjects. However, in contrast to observational studies of JPS and FS, no studies have examined the correlations between JPS and FS in FAI subjects.

Based on the above research background, therefore the present study aimed to investigate the correlations between JPS and FS in subjects with healthy and FAI. This study established a hypothesis that JPS and FS would show high correlation at a certain ankle movement in subjects with healthy and FAI.

Section snippets

Subjects

Sixty nine subjects (34 women, 35 men) volunteered from the community college for this study and gave informed consent. Sample size estimate was based on data collected from previous studies (Docherty and Arnold, 2008, Docherty et al., 2006, Piriyaprasarth et al., 2008). An a priori power analysis determined that a sample size of 27 subjects in each group at least was required to obtain a statistical power of 0.85 using General power analysis program 3.1 (University Kiel, Germany). This was

Comparison of the AE values of AR and FM tests between FAI and healthy groups

Table 2 presents the results obtained for the AE values assessed in the AR and FM tests to identify the deficits of ankle proprioception between the FAI and healthy groups by using the independent t-test. Significant differences between the two groups were found for errors of plantar flexion, dorsiflexion, inversion, and eversion (P < 0.05).

Correlations in AE values between AR and FM tests in healthy and FAI groups

Table 3 and Fig. 3 present the results of the correlations in AE values between AR and FM tests in healthy group using the Pearson correlation analysis with a

Discussion

Residual FAI dysfunction following lateral ankle sprain leads to proprioception deficits of the ankle. Ankle proprioception has a prime role in postural stability (Lee and Lin, 2008). Therefore, the use of precise and discriminative measures to identify ankle proprioceptive deficits in FAI subjects is crucial to evaluate ankle instability reasonably through biomechanic processing. To the best of our knowledge, this study was the first with an application protocol to investigate the correlations

Conclusion

It is important to establish the effective evaluation approaches that are appropriate for measuring ankle proprioception. In conclusion, our study reported that JPS and FS deficits are present in individuals with FAI compared to the healthy group. However, no significant correlations between the JPS and FS were found in subjects with both healthy and FAI since they had a different mechanism in each other. By obtaining several significant findings in this study, it could be explained for

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this article. No funding for research has been used.

Ethical approval

All procedures used in this cross-sectional study were reviewed by the Community University of Human Ethics Committee in Daejeon and received full ethical approval for human participant research.

Acknowledgments

Authors are grateful to all subjects involved in this study as well as authors/publishers/editors of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

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Although the use of KT has increased considerably in the clinical practice in the last years, there is limited evidence about the effects of its application in proprioception.
The aim of this study was to determine the effect of KT on joint position sense and force sense on the wrist of healthy subjects.
Fifty-four subjects were analyzed in a randomized, crossover, single-blind study design. To determine the force sense, the subjects had to reach 50% of their maximum grip force. Wrist joint position sense was assessed during active repositioning tests at the target angles of 30° flexion and extension of wrist. A digital dynamometer was used to determine the sense of force and a digital goniometer was used to determine the joint position sense. Subjects were evaluated with KT (I- strip on ventral aspect of forearms from origin to insertion) and placebo (an inelastic tape was applied following the same procedure as KT).
No significant differences have been found in the force sense, neither in the comparisons between control and interventions (p=0.286), nor between pre and post-intervention (p=0.111). For wrist joint position sense, a statistically significant effect (p< 0.05) was found at 30º of extension between the control and experimental group in favor of the control group.
The application of KT did not produce changes in FS and only caused a significant improvement in JPS in extension (30º). The results appear to indicate that the application of KT to improve proprioception in healthy subjects should be reconsidered.
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There was no correlation between sense of position and sense of movement tests.32 This lack of correlation between proprioceptive submodalities is consistent with literature on the limbs10,11 and emphasizes the need to include a battery of proprioceptive tests in clinical assessment. The relative importance of sense of position, movement, and force is unclear due to the lack of studies investigating movement and force in clinical populations.
The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations.
A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies.
Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other.
The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.
Kinesiology tape length and ankle inversion proprioception at step-down landing in individuals with chronic ankle instability
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This result is consistent with our previous finding, where the AIDAL assessment was found to be reliable and able to discriminate between individuals with and without CAI.16 However, there are studies that did not find ankle proprioceptive deficits in individuals with CAI.18,19 One explanation for these conflicting findings is that the ecological validity of ankle proprioception tests may be important in determining if a test is sufficiently challenging to be sensitive, and that different tests may reflect testing posture specificity.20
To determine the effect of different lengths of kinesiology tape (KT) on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI).
A repeated measures study.
Fifteen participants with unilateral CAI and fifteen participants with no CAI volunteered. The Ankle Inversion Discrimination Apparatus for Landing (AIDAL) was used to measure ankle proprioceptive acuity. All participants were tested under four KT conditions: no tape (baseline), short tape length (only foot and ankle complex involved), mid length (below the knee) and long length (above the knee) taping. After the baseline test, participants underwent the 3 different taping tests in a random order.
Repeated measures ANOVA indicated that, compared to those without CAI, individuals with CAI performed significantly worse across the 4 different conditions (F = 8.196, p = 0.008). There was a significant KT main effect (F = 7.489, p < 0.001) and a significant linear effect (F = 17.083, p < 0.001), suggesting that KT significantly improved ankle proprioceptive performance in landing, and with longer tape length there was greater proprioceptive enhancement. Post-hoc analysis showed that for the CAI group, both mid length (p = 0.013, 95%CI = −0.063, −0.009) and long length (p = 0.010, 95%CI = −0.067, −0.011) taping can significantly improve ankle proprioceptive performance compared to no tape, whereas for the non-CAI group, ankle proprioceptive acuity was significantly improved only with long length taping (p = 0.007, 95%CI = −0.080, −0.015).
KT can be used to improve ankle inversion proprioceptive performance during landing in both individuals with and without CAI and increasing tape length may achieve greater proprioceptive improvement.
Chronic ankle instability is associated with proprioception deficits: A systematic review and meta-analysis
2021, Journal of Sport and Health Science
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For plantarflexion, the pooled results of both active JPR (SMD = 1.71, I2 = 97.5%) and passive JPR (SMD = 0.07, I2 = 81.9%) showed no significant difference23,54,55,57–59 (Fig. 5C). For dorsiflexion, the pooled results of both active JPR (SMD = 1.27, I2 = 95.8%) and passive JPR (SMD = 0.15, I2 = 20.2%) also showed no significant difference23,54,57–59 (Fig. 5D). As for the studies with different units, the study with VE did not find a significant difference in inversion (SMD = 0.24, 95%CI: –0.63 to 1.11) or plantarflexion (SMD = 0.23, 95%CI: –0.64 to 1.1).55
Acute ankle injury causes damage to joint mechanoreceptors and deafferentation and contributes to proprioception deficits in patients with chronic ankle instability (CAI). We aimed to explore whether deficits of proprioception, including kinesthesia and joint position sense (JPS), exist in patients with CAI when compared with the uninjured contralateral side and healthy people. We hypothesized that proprioception deficits did exist in patients with CAI and that the deficits varied by test methodologies.
The study was a systematic review and meta-analysis. We identified studies that compared kinesthesia or JPS in patients with CAI with the uninjured contralateral side or with healthy controls. Meta-analyses were conducted for the studies with similar test procedures, and narrative syntheses were undertaken for the rest.
A total of 7731 studies were identified, of which 30 were included for review. A total of 21 studies were eligible for meta-analysis. Compared with the contralateral side, patients with CAI had ankle kinesthesia deficits in inversion and plantarflexion, with a standardized mean difference (SMD) of 0.41 and 0.92, respectively, and active and passive JPS deficits in inversion (SMD = 0.92 and 0.72, respectively). Compared with healthy people, patients with CAI had ankle kinesthesia deficits in inversion and eversion (SMD = 0.64 and 0.76, respectively), and active JPS deficits in inversion and eversion (SMD = 1.00 and 4.82, respectively). Proprioception deficits in the knee and shoulder of patients with CAI were not statistically significant.
Proprioception, including both kinesthesia and JPS, of the injured ankle of patients with CAI was impaired, compared with the uninjured contralateral limbs and healthy people. Proprioception varied depending on different movement directions and test methodologies. The use of more detailed measurements of proprioception and interventions for restoring the deficits are recommended in the clinical management of CAI.
Judging heel height: A new test for proprioception while standing reveals that young hypermobile children perform better than controls
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Children with Generalized Joint Hypermobility (GJH) have been reported to have poorer proprioception than children with normal mobility. However, they were usually tested under unloaded conditions and in an age-group in which pain starts to play a role.
In contrast, some young children with GJH perform well in motor tasks, suggesting they may have good proprioceptive abilities if assessed more ecologically.
Children with GJH (Beighton score of  ≥ 5; mean age 8.34 years) were compared to children with a Beighton score of 4 or less. A proprioception test was performed using wedges of different heights to evaluate the ability to judge heel height. A pair of wedges of various heights, was placed under the children’s feet at random and they were required to report the higher leg while standing
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Children with GJH do not have inferior proprioception when tested under loaded conditions. The least one can say is that one should be careful in postulating that measuring passive position sense in one particular joint is necessarily the best estimation of proprioception. Body position during standing can be estimated on the basis of knowledge of joint positions (of the ankle in particular in the present test) but also of other information (loading of foot mechanoreceptors for example). In conclusion, the new test may be more suited to evaluate proprioception than the conventional tests, which rely on passive joint position estimation during sitting.
Correlation of force sense error test measured by a pressure biofeedback unit and EMG activity of quadriceps femoris in healthy individuals
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FS is defined as a component of proprioception mainly related to the sense of tension, which is derived from muscle spindles and Golgi tendon organs (Kaynak et al., 2019) (Proske et al., 2004). Kim et al. (2014) described FS as “the ability to accurately reproduce a given force.” However, the mechanism underpinning FS is not yet fully understood (Scotland et al., 2014).
Our study developed a force sense error test (FSET) method for use on the quadriceps muscle, which could be employed in clinical practice to correlate the results of quadriceps muscle activity levels determined by surface electromyography (sEMG).
Twenty-four healthy individuals were included in the study. A pressure biofeedback unit (PBU) placed under the knee joint, was used for force sense error test (FSET) evaluation. First, a maximum contraction value was determined with the PBU. Next, 50% and 65% of the maximum contraction value were used for the analysis. Concurrently, norm values for the quadriceps muscle activity levels were determined by sEMG. Simultaneously, quadriceps muscle activity levels were recorded while testing the FSET using the PBU. Each measurement was repeated in triplicate, and the average constant errors observed by the PBU were recorded in mmHg.
The FSET for both 50% and 65% of the normal mmHg value determined using the PBU positively correlated with activity change levels in the quadriceps muscle determined by sEMG (p < 0.05).
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No correlation between joint position sense and force sense for measuring ankle proprioception in subjects with healthy and functional ankle instability

Highlights

Abstract

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Subjects

Comparison of the AE values of AR and FM tests between FAI and healthy groups

Correlations in AE values between AR and FM tests in healthy and FAI groups

Discussion

Conclusion

Conflict of interest statement

Ethical approval

Acknowledgments

Gait Posture

Clin. Sports Med.

Clin. Biomech.

J. Electromyogr. Kinesiol.

Proprioception of the ankle: A comparison between female teenaged gymnasts and controls

Foot Ankle Int.

Effect of coordination training on proprioception of the functionally unstable ankle

J. Orthop. Sports Phys. Ther.

Force sense deficits in functionally unstable ankles

J. Orthop. Res.

Development and reliability of the ankle instability instrument

J. Athl. Train.

G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences

Behav. Res. Methods

Effects of recurrent lateral ankle sprains on active and passive judgements of joint position

Phys. Ther.

Proprioception and joint stability

Knee Surg. Sports Traumatol. Arthrosc.