Volume 6, Issue 3 (12-2020)                   J Sport Biomech 2020, 6(3): 170-179 | Back to browse issues page


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Amiri M R, Golpayegani M, Moradi Vastgani F, Mirghasemi M. Effect of Proprioception Training on Pain and Knee Joint Position Sense of Athletes With Genuvalgum. J Sport Biomech. 2020; 6 (3) :170-179
URL: http://biomechanics.iauh.ac.ir/article-1-236-en.html
1- Department of Sport Medicine and Health, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
2- Department of Sport Pathology and Sport Physiology, Faculty of Sport Sciences, Arak University, Arak, Iran.
3- Department of Physical Education and Sport Sciences, Faculty of Humanities, Borujerd Branch, Azad University, Lorestan, Iran.
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1. Introduction
roprioception is the ability to feel or perceive spatial position and body movements without using the eyes. The joint position’s sensory receptors include the muscular spindle’s receptors, the Golgi tendon organ, and the articular receptors, which transmit information about this sense to the central nervous system [1]. These receptors are responsible for creating awareness of the state of motion and coordination of different body parts relative to each other [2]. In other words, proprioception is a broad term for the sensation of movement, which receives sensory input from the receptors of the muscular spindle, tendon, and joints, and determines the position and motion of the joint, and regulates the direction, intensity, and velocity of the joints [3].
It should be noted that knee disorders, such as knock-knees, reduce the knee joint’s proprioception, increasing the possibility of injury and pain [1]. This study aimed to evaluate the effect of proprioception exercises on knee joint reconstruction and alleviation of knee pain in athletes with genu valgum.
2. Materials and Methods
In this quasi-experimental study, 30 female athletes (referred to a medical clinic in Arak city) in the age range of 20-30 years were randomly divided into “experimental” and “control” groups. In the pre-test and post-test, the standard knee pain questionnaire was used to measure the subjects’ pain. Then the joint diagnosis test was used to assess the knee’s proprioception with digital images (by AutoCAD software). In the experimental group, athletes performed proprioception reinforcement exercises for 8 weeks (three sessions per week, 20 minutes per session). The Kolmogorov-Smirnov test and paired t-test were used to check the data normality and analyze it, respectively. Data were calculated using SPSS software v. 16 and a 95 (P≤0.05) confidence level.
3. Results
The results of this study indicated that a period of proprioception exercises reduced joint reconstruction error and knee pain in female athletes with genu valgum (Table 1). 


4. Discussion and Conclusion
This study aimed to investigate the effect of proprioception exercises on knee joint reconstruction and alleviation of knee pain in female athletes with genu valgum. In the functional test of knee condition diagnosis, which was performed to check the knee’s proprioception, the pre-test and post-test information were compared, and the differences were significant. This significance indicated a reduction in angle reconstruction error compared to the pre-test. This information confirms that the training program significantly improves knee proprioception in athletes with knock-knees.
According to the mean in the pre-test and post-test, the results revealed that in the control group, there was no change in the situation of the subjects at the end of the study compared to the beginning. Based on the comparison of the two groups, we concluded that the exercises performed improved knee proprioception in female athletes with painful genu valgum. This study was consistent with the research conducted by Ghaffarinejad (2007), Hakan et al. (2005), and De Bolt (2004) and was not consistent with the study of Larsen et al. (2005) [2, 345].
The cause of knock-knee deformity cannot be definitively limited to one factor. Still, it seems that among athletes, repetitive movements that are performed to a large extent can cause the joint to deviate from the average direction and be inclined to be in a specific position [6]. Being in this particular position is a kind of adaptation to the pressures that put the joint under repetitive force. Of course, it should be noted that genetic factors or the presence of underlying diseases such as osteoporosis can also cause the joint to deviate from its average direction [5]. 
No different results were obtained from what others have already mentioned, but we looked at these exercises’ effect on people with a knock-knee in this study. No research has been done in this field. Simultaneously, as mentioned earlier, in these subjects, we noticed a decrease in proprioception of the knee due to deviation from the average direction [6]. The advantage of our research over other studies was its preventive aspect. 
This study confirmed that proprioception reinforcement exercises could increase the sense of diagnosis in the knee joint. Based on the above explanations, it can be concluded that if performed by athletes with a knock-knee, these exercises can strengthen their proprioception, save them from complications that may occur in the future, or at least reduce the possibility of joint problems in the knee.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This article is extracted from the MSc. thesis of Mohammad Mirghasemi at the Department of Physical Education and Sport Sciences, Faculty of Humanities, Borujerd Branch, Azad University, Lorestan. 

Authors' contributions
Conceptualization: Mohammad Mirghasemi; Supervisor: Masoud Golpayegani; Methodological assistance: Mohammad Rahim Amiri; Resources and writing – review & editing: Fariba Moradi Vestagani.

Conflicts of interest
The authors declared no conflict of interest.


 References
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Type of Study: Research | Subject: Special
Received: 2020/09/13 | Accepted: 2020/11/4 | Published: 2020/12/1

References
1. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by months after surgery. The American journal of sports medicine 2011;39(3):538-43. [DOI:10.1177/0363546510384798] [PMID]
2. Ruzik K, Waśniewska A, Olewnik Ł, Tubbs RS, Karauda P, Polguj M. Unusual case report of seven headed quadriceps femoris muscle. Surgical and radiologic anatomy: SRA 2018 ;21(1):112-79.
3. Bonfim TR, Paccola CAJ, Barela JA. Proprioceptive and behavior impairments in individuals with anterior cruciate ligament reconstructed knees. Archives of physical medicine and rehabilitation 2003;84(8):1217-23. [DOI:10.1016/S0003-9993(03)00147-3]
4. Bohdanna T, Zazulok, Timothy E, Hewett. The Effects of core Proprioception on knee Injury, A Prospective Biomechanical- Epidemiological study. The American journal of Sport Medicine, 2007;26(3):321-36.
5. Risberg MA, Grindem H, Øiestad BE. We need to implement current evidence in early rehabilitation programs to improve long-term outcome after anterior cruciate ligament injury. Journal of Orthopaedic & Sports Physical Therapy 2016;46(9):710-13. [DOI:10.2519/jospt.2016.0608] [PMID]
6. Setuain I, Izquierdo M, Idoate F, Bikandi E, Gorostiaga EM, Aagaard P, et al. Differential effects of 2 rehabilitation programs following anterior cruciate ligament reconstruction. Journal of sport rehabilitation 2017;26(6):544-55. 5. [DOI:10.1123/jsr.2016-0065] [PMID]
7. Suarez T, Laudani L, Giombini A, Saraceni VM, Mariani PP, Pigozzi F, et al. Comparison in joint-position sense and muscle coactivation between anterior cruciate ligament-deficient and healthy individuals. Journal of sport rehabilitation 2016;25(1):64-69. [DOI:10.1123/jsr.2014-0267] [PMID]
8. Furlanetto TS, Peyré-Tartaruga LA, Pinho ASd, Bernardes EdS, Zaro MA. Proprioception, body balance and functionality in individuals with ACL reconstruction. Acta ortopedica brasileira 2016;24(2):67-72. 7. [DOI:10.1590/1413-785220162402108949] [PMID] [PMCID]
9. Gokeler A, Welling W, Zaffagnini S, Seil R, Padua D. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee surgery, sports traumatology, arthroscopy 2017;25(1):192-99. [DOI:10.1007/s00167-016-4246-3] [PMID] [PMCID]
10. Ordahan B, Küçükşen S, Tuncay I, Sallı A, Uǧurlu H. The effect of proprioception exercises on functional status in patients with anterior cruciate ligament reconstruction. Journal of back and musculoskeletal rehabilitation 2015;28(3):531-37. [DOI:10.3233/BMR-140553] [PMID]
11. Zhang Y, Huang W, Yao Z, Ma L, Lin Z, Wang S, et al. Anterior cruciate ligament injuries alter the kinematics of knees with or without meniscal deficiency. The American journal of sports medicine 2016;44(12):3132-39. [DOI:10.1177/0363546516658026] [PMID]
12. Zhang Y, Yao Z, Wang S, Huang W, Ma L, Huang H, et al. Motion analysis of Chinese normal knees during gait based on a novel portable system. Gait & posture 2015;41(3):763-68. [DOI:10.1016/j.gaitpost.2015.01.020] [PMID]
13. van Meer BB, Meuffels DD, Reijman MM. A Comparison of the Standardized Rating Forms for Evaluation of Anterior Cruciate Ligament Injured or Reconstructed Patients. 2014;32(2):176-59.
14. Dhillon MS, Bali K, Prabhakar S. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction. Indian journal of orthopaedics 2011;45(4):294. [DOI:10.4103/0019-5413.80320] [PMID] [PMCID]
15. Gokeler A, Benjaminse A, Hewett TE, Lephart SM, Engebretsen L, Ageberg E, et al. Proprioceptive deficits after ACL injury: are they clinically relevant? Br J Sports Med 2012;46(3):180-92. [DOI:10.1136/bjsm.2010.082578] [PMID]
16. Brindle TJ, Mizelle J, Lebiedowska MK, Miller JL, Stanhope SJ. Visual and proprioceptive feedback improves knee joint position sense. Knee Surgery, Sports Traumatology, Arthroscopy 2009;17(1):40-47. [DOI:10.1007/s00167-008-0638-3] [PMID] [PMCID]
17. Van der Harst J, Gokeler A, Hof A. Leg kinematics and kinetics in landing from a single-leg hop for distance. A comparison between dominant and non-dominant leg. Clinical biomechanics 2007;22(6):674-80. [DOI:10.1016/j.clinbiomech.2007.02.007] [PMID]
18. Ross MD, Langford B, Whelan PJ. Test-retest reliability of 4 single-leg horizontal hop tests. Journal of Strength and Conditioning Research 2002;16(4):617-22. https://doi.org/10.1519/1533-4287(2002)016<0617:TRROSL>2.0.CO;2 [DOI:10.1519/00124278-200211000-00021]
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21. Borsa PA, Lephart SM, Irrgang JJ, Safran MR, Fu FH. The effects of joint position and direction of joint motion on proprioceptive sensibility in anterior cruciate ligamentdeficient athletes. The American journal of sports medicine 1997;25(3):336-40. [DOI:10.1177/036354659702500311] [PMID]
22. Ristanis S, Stergiou N, Patras K, Vasiliadis HS, Giakas G, Georgoulis AD. Excessive tibial rotation during high-demand activities is not restored by anterior cruciate 14 ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2005;21(11):1323-29. [DOI:10.1016/j.arthro.2005.08.032] [PMID]
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