Proprioception, or our bodily awareness of positioning and movement, is an important bodily sense for coordination, motor control and injury prevention. It falls under the realm of somatosensation, also known as our “sixth sense“. Both researchers and clinicians are becoming more familiar with the concept and are increasingly realizing its importance for rehabilitation following an injury. The term itself is still within its infancy and has competing definitions therefore it can be a challenging concept to apply to clinical practice.
Proprioception is of particular importance to highly mobile joints like the glenohumeral joint, which relies on neuromuscular control for stability. Some clinical treatments such as kinesiology tape and neuromuscular exercises claim to improve shoulder proprioception but is this really the case?
What Does The Research Tell Us?
A recent collaborative systematic review from researchers in Belgium and Canada aimed to clarify this key clinical question: can clinical exercises and/or treatment modalities improve shoulder proprioception in those affected by shoulder pathology?
In the case of this review the included pathologies were; impingement syndromes, unstable shoulders, anterior dislocations, nonspecific shoulder pain, rotator cuff dysfunctions and subluxations following a stroke. Treatment strategies were grouped together into clinical clusters for analysis, including; conventional therapy, proprioceptive training, elastic kinesiology tape, and other passive therapies.
Conventional Therapy: movement training, manual therapy, stretching, strengthening, scapular stability exercises, patient education.
Proprioceptive Training: flexible foil, wobble board training, specific proprioceptive training.
Passive Modalities: micro-current electrical stimulation, transcutaneous electrical nerve stimulation, hot packs, non-elastic tape or bracing.
The review suggests, with moderate evidence, that proprioceptive training can improve proprioception in the medium-term. No decisive evidence exists to suggest that conventional therapy is of added value to enhance the sense of proprioception of the shoulder. Conflicting evidence was found for the improvement of proprioception with the application of elastic Kinesiology Tape, while moderate evidence suggests that passive modalities are not effective for proprioceptive rehabilitation of the shoulder.
There may be a possibility of a specificity of training effect, meaning that specific shoulder injuries could exhibit specific proprioception deficit patterns. It would be interesting to further explore targeted proprioception training for specific shoulder pathologies.
There are a number of important clinical lessons we can take away from this systematic review. These are summarised below:
- Exploring specific shoulder proprioception defecits for specific shoulder injuries is worthwhile.
- Proprioceptive training demonstrates the strongest evidence at this time for the rehabilitation of individuals with a shoulder proprioceptive deficit.
- Conventional therapy alone does not directly improve shoulder proprioception.
- Conflicting evidence exists for the use of elastic Kinesiology Tape for the improvement of shoulder proprioception.
Why not expand on these important clinical lessons with shoulder expert Dr Ian Horlsey in our latest shoulder programme?