This report will look at evidence to support the statement that balance and proprioception are seen to be the main components in rehabilitation of an injured athlete. However there are other alternatives to this type of rehabilitation that have been studied by many researches the main being strength training. Strength training is seen as one of them main components to any rehabilitation program but within this report I will look at how proprioception and balance are used in a positive way and benefit an injured athlete.

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Balance is when an individual is able to maintain a stationary position with their body in the environment they are situated in. Proprioception is the process in which the central nervous system provides information about the joints movement, position and pressure by impulses originating from the joints, muscles, tendons and within the bodies tissues. Proprioception defefined by Lephart & fu (2000) as a specialised variation of the sensory modality of touch that encompasses the sensation of joint movement and joint position. Proprioception can be devided into two categories sense of static position and sense of movement.
Proprioception and balance retraining subsequent to an injury is an important component of the rehabilitation process of any injured athlete. It also is being used to prevent injuries in many sports and being built into an athletes everyday training programs due to the risk of injury or risk of re- injury being related to balance impairements.
Why is proprioception important for athletes?
The reason proprioception is so important for an athlete is to carry out during their training and during the rehabilitation process is that all the athletes athletic movements their muscular activity, the range of motion around their joints and their bodies posture are all connected to the central- nervous system where their are three subsystems that control an individuals movements these are called somatosensory system, vestibular system and the visual system.
The somatosensory system detects touch, pressure, pain and joint movement and position from nerves that are located within the skin, bones, muscle-tendons and joints. Nerve endings called mechanoreceptors are found within the joints and these detect physical actions. This system is very commonly known as the proprioceptive system as it collects the sensations found as the joint moves. The visual system and vestibular system are connected to balance this system provides the central-nervous system with signals to detect where the body is in relation to space.
Balance and Exercises
Balance training is an extremely important part of many sports training programs to help enhance performance and to help reduce injury occurrence and re- occurrence. One of the first study to assess balance and to see if improvements were made by using equipment was in 1987 where they examined a group of Swedish soccer players by using a wobble board where the exercises were simple but could be progressive if need be the results were looked at over 10 plus weeks. The exercises involved were standing on the wobble board with one leg for ten minutes each foot five times a week for ten weeks which was then reduced to five minutes, three times a week the following weeks. Results showed that after six weeks of the first block of exercises the soccer players were more stable performing the exercise and after the ten weeks the stability level improved in all participating players with the control subjects having no improvement in stability. However within this study they tell us that when the exercises are cut right down the stability gained reduces this would therefore show that it would be a positive effect to use these continuously throughout a training period and not for only 10 weeks. As well as wobble boards studies such at Odd-egil et al (2005) and Kidgell et al (2007) use a variety of equipment as part of their programs Odd-egil uses foam mats during a warm up routine which had a large amount of balance exercises involved compared to strength exercises to prevent knee and ankle injuries. Kidgell uses dura disks and mini trampolines within her study to find that 6 weeks of balance training using these two pieces of equipment improved postural sway amongst individuals with ankle instability and also that both types of equipment are just as effective as each other.
Proprioception
It is very likely that many athletes will have to overcome several injuries during there sporting carrier. Fong Dt et al(2007) explains there in an increase risk of injury when participating in sports however ankle sprains are the most common. Subsequent to injuries such as ankle and ACL, damage or stretching to ligaments may result in a decreased proprioceptive mechanisms responsible for balance. Despite treatment for an ankle sprain it is very common to see a high risk of recurrence. Ankle injuries acute or chronic have been found to increase balance instability and postural sway the loss of balance that may occur could be due to an altered biomechanical alignment of the body or instability found along the kinetic chain. When an athlete sprains their ankle it is very common for them to damage the somatosensory system’s mechanoreceptors which are located within the ankle joint this causes a disruption to detect movement within the joint.
There are a large number of studies to indicate that proprioceptive training can improve many things such as strength, muscular balance and co-ordination. The three studies below look at the effectiveness of using propriocetive exercises and activities on injured athletes. Two study looks closely at a specific sport whereas the others look at more general view of a variety of sports and levels. They both however show a positive effect of using proprioception as their main component within their rehabilitation programme.
Hupperets et al (2009) evaluates the effectiveness of an unsupervised proprioceptive training programme on recurrences of ankle sprain after usual care in athletes who had sustained an acute sports related injury to the lateral ankle. These injuries varied in severity due to using medically and non- medically treated subjects. By using a large sample size of a varied age group and sex they were able to show that the use of a proprioceptive training programme after usual care of an ankle sprain is effective for the prevention of self reported recurrences the results also showed that the proprioception based training program was specifically beneficial in athletes whose original sprain was not medically treated. By this researcher using such a large and varied age and sex sample size it enables us to see that that there are improvements in the range of athletes however its a very general study and does not look at specific ankle injuries or specific sports.
This has also been researched by Verhagen where the aim of the tests was to look at lowering the increase risk of re-injury of the ankle by a proprioception based rehabilitation program on a group of top level volleyball athletes. Results showed that after the introduction of a proprioception training program the recurrence of ankle sprains were reduced by 50% as well as over 90% of athletes completing the full rehabilitation program for their ankle injury. This supports that by approaching a proprioception based program after an ankle sprain or injury that the reassurance of the injury would be reduced greatly.
The third study looked at soccer players where 300 players took part in a proprioception programme which lasted over three seasons where as another 300 players were control measures. The training program in this study was progressive over the period of three seasons starting with no equipment and adding equipment as the perfected the exercise. The results from this study showed that the player who maintained to take part in the proprioception training programme had reduction of incidences of anterior cruciate ligament injuries than the control group.
The results in these three studies indicate that by using proprioception and balance training has a great likelihood to reduce and prevent injuries within general sporting activity and specific sports. By looking at each of the studies I believe they all have a very positive outcome when using a proprioceptive program and that they can be specific to a certain sport such as the soccer study or more general like Huppert’s study. However there have been many studies that have looked at strength training as being the main component when rehabilitating an athlete
Conclusion
With the information gathered from all the studies it is clear that proprioception and balance are main components of a rehabilitation programme and should be introduced into athletes training programs as it has proven to decrease the risk of injury and re-injury but also can be incorporated as a preventative measure in many situations from a general activity to a professional sport. As well as having the studies facts I also have my own experience as a professional athlete having many problems with my knees due to overuse on breaststroke as a swimmer. A number of physiotherapists gave me strength exercises to do before and after training sessions however I always felt pain towards the end of the training sessions. However following the re- occurrence of this injury several times proprioception techniques were advised by a Scottish Swimming physiotherapist these seemed to help me personally and put less pressure on my injury before a session and I was able to complete a larger amount of full sessions in a week compared to previous experiences with strength exercises. Proprioception and balance training also have a fun factor within the training with the use of a variety of different pieces of equipment this having an advantage of athletes sticking to there rehabilitation program as it does not have to be repetitive. There has been no studies looking at long term athlete development of proprioception and balance over years of using it within a training program however by the studies looked at it does suggest that it would have a positive effect on the athlete reducing injuries and even enhancing performance in the future.