The importance of balance and proprioception training after injury

Proprioception refers to the unconscious stimuli that the body receives in relation to movement and spacial awareness.

The word 'proprioception' is derived from Latin and literally means 'the act of receiving ones own'.

Balance is the body's ability to stay upright or stay in control of movement.

There are many receptors that are found within ligaments, muscles, tendons and joint capsules that feed back a huge amount of information.  This information includes the rate of stretch - acceleration and deceleration - of tissue as well as feedback on compression forces and speeds.

How does the proprioceptive system work on a day to day basis?

Ankle sprain example 

Take this scenario: you are walking down the street and step on the edge of the pavement. You are about to 'roll' your ankle but the receptors within your ligament and muscles realise that they are being stretched very rapidly. They sense danger! This information is relayed through the nervous system at high speed. The system realises that it may get injured and signals are sent to the muscles on the outside of your shin to 'fire'. These muscles contract in an effort to correct the movement. In a system that is working well this will likely save you a nasty ankle sprain. In a system that is not so efficient this process might be too slow - leading to an ankle injury. 

Why is balance and proprioception important?

Following injury it is important to make sure the feedback systems are working correctly to avoid re-injury. In many cases following injury this system has been compromised and is not working at 100%. If, after an injury, for example an ankle sprain, this system is not working correctly then an individual will be significantly more likely to re-roll their ankle in the coming weeks, months or years.

There are many exercises sports therapists will use to help get this system working correctly again - see below.

Example exercises

Below are a number of examples of proprioceptive and balance exercises showing progressions from easy early stage rehabilitation exercises through to harder late stage exercises. As you can see there are many variations of these types of rehab drills!

With most individuals we would leave out many of these, focusing only on a few of the 'key' exercises - most people we see won't have to start with a seated exercise...

Early stage exercises

1. Seated on a chair, both feet balanced on a wobble board
2. Seated on a chair, 1 foot balanced on a wobble board
3. Seated on a chair, 1 foot balanced on a ball
4. Seated on a swiss ball, both feet on the floor
5. Seated on a swiss ball, 1 foot on the floor
6. Sit to stand, both hands on a chair
7. Sit to stand, 1 hand on a chair
8. Sit to stand
9. Standing
10. Standing with eyes closed
11. Standing, weight transfer
12. Standing on 1 leg, both hands on a chair
13. Standing on 1 leg, 1 hand on a chair
14. Standing on 1 leg
15. Standing on 1 leg with eyes closed
16. Standing, throwing and catching a ball
17. Standing, bouncing a ball against the wall and catching
18. Standing on 1 leg, throwing and catching a ball
19. Standing on 1 leg, bouncing a ball against the wall and catching
20. Standing on a wobble board, both hands on a chair
21. Standing on a wobble board, 1 hand on a chair
22. Standing on a wobble board
23. Step ups on a bench
24. Step up and over on a bench
25. Hopping on 1 leg
26. Grid, hopping left to right leg between 2 squares
27. Grid, hopping left to right leg between several squares
28. Grid, hopping on 1 leg between 2 squares
29. Grid, hopping on 1 leg between several squares
30. Jumping on a trampoline
31. Hopping on a trampoline
32. Jump off a bench onto 2 feet
33. Jump off a bench onto 1 foot

Advanced stage exercises 

Below are more example of proprioceptive and balance exercises: