By Dott.Luca Franzon
Power is nothing without control
One of the most gross errors to be seen in the functional re-education of an injured joint is to always and only seek the recovery of joint mobility and muscle tone. Surely they are two physical characteristics that must be re-educated but together with other factors including the fundamental one of proprioception.
The proprioception (from the Latin proprius, belonging to itself) is defined as the sense of position and movement of the limbs and the body that occurs independently of the view. It can be divided in the sense of static position of the limbs and in the sense of movement of the limbs. This is a fundamental quality for controlling movement and standing. The receptors called into question in this capacity of sense of our body are:
- NEUROMUSCULAR FUSES
- TENDON TRENDS OF THE GOLGI
- RECEPTORS OF THE JOINT CAPS (sensitive to their extension)
- SKIN RECEPTORS (Ruffini, Merkel etc.)
These receptors in continuation through the lateral cords of the white substance of the spinal cord send to the superior nerve centers a whole series of information on the state of tension of the muscles, of the ligaments, of the articular capsules. Higher centers process information by becoming aware of the position of various body segments and their displacement during movement. On the basis of the sensations received, the superior nerve centers then send stimuli to the muscles to make the necessary corrections both in static and in dynamics. So this is the system that regulates posture.
The proprioception lives on the continuous exchange of information that reaches the nervous system and of actions induced by the same to ensure that the subject respects at all times the characteristics of balance, comfort and not pain.
Clearly the mechanism described above works correctly when the subject is healthy and therefore has no problems of any kind. At the beginning of the article we talk about subjects who have suffered a trauma. When the subject suffers the articular insult, the receptors on the muscular and articular level are traumatized and the proprioceptive sensations are altered. Since the trauma is an event that comes out of the physiological patterns of the joints, the sensations that will be felt and the answers that will be implemented will certainly be different from those that are felt in a normal situation. Just think of the subject who gets a sprained ankle that is no longer able to walk well on the traumatized foot, which carries weight on the other foot and eventually feels pain in the contralateral knee or back or in other bodily districts. Or the same subject that despite having done the re-education continues to charge more from the non-traumatized side precisely because the proprioceptive system has altered, therefore from altered information and consequently there are altered responses.
Proprioceptive re-education serves to give the subject the ability to feel how their joints are placed in static and dynamic, understanding that the trauma has made the system unstable.
In every gym and fitness center the tools to perform prorpiocezione should never be missing. The proprioceptive training can be done in different ways, but certainly it is necessary to have the tablets with one and two points of support available.
TABLET WITH 2 SUPPORTS | TABLET WITH 1 SUPPORT |
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SEEN FROM BELOW | SEEN FROM BELOW |
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SIDE VIEW FROM THE FRONT OVERLOOK | SIDE VIEW AND OVERHEAD FRONT |
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SIDE VIEW IN POSITION OF USE | SIDE VIEW IN POSITION OF USE |
The guidelines for proper proprioceptive re-education are
- The subject must be collaborative
- Two sessions a day of 20 minutes each must be performed.
- You need to have reached a good muscle tone.
- Joint mobility must be restored.
- it must be done for at least 3 weeks after the trauma has healed.
- It is then necessary to carry out maintenance sessions lasting 30 minutes twice a week.
The rather long duration and the daily repetition of the training are given by the fact that it is working on the nervous system that needs to find again a logic lost in the trauma.
In this article we will see how to train the proprioception of the ankle and knee. Starting from how to correctly arrange the body segments to be re-educated so as not to be counter-productive instead of re-educational.
ANKLE
- The foot must rest above all on the outer edge.
- He must place his fingers in a "gripping" attitude
- Calcaneus and big toe are well fixed to the ground
- The inner arch is raised from the ground
KNEE
- Foot perpendicular to the frontal axis
- Gripping "gripping" fingers
- Tibials in tension to stabilize the structure.
- Knee flexed at 30/60 °, turned 15 °
Of fundamental importance will be the position of the bust which can be:
FRONT SEMIPASS | REAR SEMIPASS |
trunk inclined forward in line with the rear leg | trunk perpendicular to the supporting foot which will correspond to the knee to be re-educated. |
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Below are the tables with the exercises to perform a good re-education.
WEEK | DAY | EXERCISES |
BEFORE | 1st - 2nd | flexed ankle extensions from sitting on a tablet with two supports |
3rd - 4th | flexed ankle extensions standing with bipodalic support on tablet with 2 supports | |
5th - 7th | flexed ankle extensions standing with monopodalic support on a tablet with 2 supports | |
SECOND | 1st - 2nd | Lateralization of the ankle while sitting on a board with two supports |
3rd - 4th | Lateralization of the ankle in feet with bipedal support on a tablet with 2 supports | |
5th - 7th | Lateralization of the ankle in feet with monopodalic support on a tablet with 2 supports | |
THIRD | Same exercises of weeks 1 and 2 adding the rotations. Executed in mop-top support on a tablet with 2 supports with variable executive rhythm. |
WEEK | DAY | EXERCISES |
BEFORE | 1 ° - 2nd | Learning of the position of the foot and of the flexion-extension and varovalgation movements |
3rd - 7th | From knee extended to knee flexed at 30/60 ° and externally rotated 15 ° in front and rear half-steps with 2 support table | |
SECOND | 1st - 3rd | Repetition exercises previous week |
3rd - 7th | Launch and valgus of the knee in front and rear half-steps on a tablet with 2 supports | |
THIRD | Exercises of the first two weeks with tablet at 1 support. Contemporary use of the two tablets. |
These are guidelines and do not want to be a standardized work protocol, because re-educating a subject is something special and above all it is a set of exercises and methods that must take into account who the subject is and what he did before the trauma. What need does it have or what it must do again after re-education (advanced athlete or normal subject). How he took the trauma from a psychological point of view and how he reacts to re-education (constant and motivated or the opposite). The path to follow is therefore difficult and extremely personalized, so everything we read about must be interpreted in the right way.
My intention is to bring your attention to a key factor of successful re-education. If it is true that the human body can be compared to a machine then it is useless to try to repair the peripheral parts of the machine if the central computer that has to adjust them has problems. Before the nervous system is able to regain control of the situation before the subject will be able to return to do what he did before the trauma, clearly within the limits of the possible.
To keep in mind that the proprioception would be trained also in subjects that are not traumatized with the purpose of making them more and more masters of their body and perhaps prevent future traumas. A dutiful reference should also be made to the proprioceptive sensation and postural alterations given that often postural alterations are given by bad proprioceptive sensations. This wants to be another reason to train proprioception. In detail in future articles.
