Diane Gold helps players stay on the field.

Diane Gold has been a licensed physical therapist for more than 25 years and works with SD United as its physical therapist. She shares her professional advice with XK San Diego.

For example, when a person is walking along and hits an uneven surface, which causes the ankle to begin to roll to the outside, the proprioceptors fire, telling the brain the joint is going outside the normal range of motion. The brain then responds by firing the appropriate muscle to correct the situation.  This happens automatically, without conscious thought. The person may stumble or feel their ankle wobble or may not notice anything at all.

When an injury occurs, such as an ankle sprain, besides ligaments being stretched and muscles becoming strained, the proprioceptors are damaged as well.  They become sluggish and respond slowly to what is occurring in the injured area.  It has been shown that even a small amount of swelling in a joint can cause the proprioceptors to be inhibited.

So imagine our scenario above.  An athlete who has had a previous ankle injury goes back to training without having retrained the proprioceptors and hits uneven ground. The ankle starts to roll but the proprioceptors don’t fire quickly enough and the muscles don’t respond soon enough to correct the situation. The player then re-sprains the ligaments and is out of soccer for an additional week or two.

An easy way to assess the effectiveness of proprioceptors in the lower extremity is to check the player’s ability to single-leg balance.  I have the athlete start with their “healthy” leg and ask them to stand on it, first with their eyes open, then have them close their eyes.  This takes away the eyes' role in helping them balance and puts more stress on the inner ear and proprioceptors to help keep balance.  I do a slow count to see how long they can hold the position with eyes closed.

Using this as a baseline for their normal ability to balance, I then have them repeat the test on their injured limb.  If they cannot hold the position or if they do wild upper body movements to try to hold the position, then I have them work on proprioceptive activities until they balance equally well on each leg.  Obviously, a younger athlete does not balance as well as a high caliber adult athlete, but a general rule I use with youth players is that they should be able to single-leg balance with eyes closed for 30 seconds on each limb. 

An easy way to get children to work on balance is to have them do it while watching TV.  I tell them that during the commercials they need to stand up and work on single-leg balancing with eyes closed. With roughly one-third of a program being commercials, they will have worked on proprioception for roughly 20 minutes of an hour show! To make it even more challenging, they can do the exercise while standing on a sofa pillow. 

Other ways to work on proprioception are with the very popular balance discs found at gyms and sporting good stores.  I have players stand on them with one leg and then have them work on ball-agility activities by tossing a ball at them and having them knock it back to me with their laces or their instep or simply have them catch and toss the ball back with their hands.  Obviously, they do these exercises with their eyes open!  The Wii fit game system also has many balance activities that promote improved proprioception and kids, as well as adults, enjoy playing them.

Coaches can promote improved proprioception in their athletes by incorporating balance activities during the cool-down portion of training by doing standing static stretches for 20-30 seconds such as the “flamingo” stretch of the quadriceps and the yoga “tree” pose.  Young players like to compete as to who can hold the poses the longest.

In summary, all injured athletes need to be assessed by their coach or parent regarding their ability to balance on the injured limb before returning to play.  If discrepancies exist between the two legs, then the player should do simple balance exercises before getting back on the training field.

To see Diane's previous article about warming up and cooling down, click here. And check back next week for her article on how to know when an injured player is ready to return to training with the team.