BIRMINGHAM, T. B., J. T. INGLIS, J. F. KRAMER, and A. A. VANDERVOORT. Effect of a neoprene sleeve on knee joint kinesthesis: influence of different testing procedures. Med. Sci. Sports Exerc., Vol. 32, No. 2, pp. 304-308, 2000.
Purpose: Objectives of this study were to examine the perceived sense of knee joint position during selected test situations, and to evaluate the proposed kinesthetic effect of a neoprene knee sleeve during these test situations.
Methods: Fifty-nine young healthy subjects (39 females and 20 males) attempted to replicate target knee joint angles using active and passive knee extension movements completed in sitting (nonaxially loaded) situations, and during active knee extension movements completed in supine while applying a load of 15% body weight through the long axis of the tibia (axially loaded). The criterion measure used was the absolute difference between target and reproduced angles, averaged over five attempts (Average absolute difference: AAD).
Results: A three-way ANOVA (two genders by three test situations by two sleeve conditions), with repeated measures on the last two factors, indicated a significant main effect for test situation and sleeve condition (P < 0.05), but not for gender. There was also a significant test situation by sleeve condition interaction (P < 0.05). Post-hoc analysis indicated that the AAD score during the active nonaxially loaded test situation without the sleeve was significantly greater than AAD scores for all other tests (P < 0.01).
Conclusions: Pre-existing differences in knee joint kinesthesis observed during different contexts of limb movement must be recognized before various interventions, including the effect of knee supports, can be adequately interpreted. Because knee joint position sense was attenuated during voluntary active movement, and because this attenuation was ameliorated by the use of a sleeve, future studies evaluating the kinesthetic effects of knee bracing may benefit from using active movements. However, since the sleeve did not affect performance during the axially loaded test situation, future studies should also evaluate the relationship between tests of knee joint kinesthesis and other more functional tests of neuromuscular performance.
A variety of external knee supports, such as braces, sleeves, and elastic bandages, are commonly used in many sporting and clinical settings with the assumption that these devices promote improved and safer performance during strenuous activities (13,23,25). A frequently suggested mechanism underlying postulated improvements in performance is that external knee supports enhance joint proprioception (1,2,10,11,15,17,18). Knee joint proprioception has been investigated in healthy (1,2,10,11,18) and patient (1,9,11,15) populations by determining the threshold for detection of passive movement of the knee joint (15), and by testing the ability to replicate target knee joint angles during passive or active limb movements (1,2,10,11,15,18). Because these testing protocols have quantified aspects of subjects' perceived sensations of knee joint movement and angular position, they may be more correctly termed tests of kinesthesis (7,16). Proprioception has been described as a broader sense than kinesthesis, and may also include vestibular sensations, as well as inputs from skin, muscles , and joints that are not necessarily perceived (7,16). Regardless of the terminology used, the effect of external knee supports on the conscious perception of knee joint position and movement has been studied using a variety of testing protocols, and conflicting results have been reported (1,2,10,11,15,17,18).
The sense of knee joint position and movement arises through activity in mechanoreceptors located in muscle, skin , and joint structures (7,8,16). As a result, the relative contribution of these different sensory channels may vary depending on the specific contexts of limb movement. For example, passive movement of the knee joint may provide different kinesthetic information compared with active movement involving voluntary muscular contractions. In addition, the weight-bearing conditions present during movement will result in varying loads applied to muscle, skin , and joint structures, may excite various mechanoreceptors to different degrees, and are likely associated with alterations in the gain of different reflexes (7). Despite the functional importance of this type of information when evaluating neuromuscular performance, few studies have investigated kinesthesis during various tasks involving different contexts of limb movement (4,26).
Testing kinesthesis during different contexts of limb movement may be particularly important when evaluating the proposed kinesthetic effects of external knee supports. Evaluating the perceived sense of knee joint position during different situations may provide information regarding which tests most readily reveal the effects of external knee supports, as well as their possible underlying mechanisms. Such information may also be useful when interpreting the functional importance of improvements observed during laboratory measures of knee joint kinesthesis. In this regard, tests involving active movement situations may be more similar to functional activities than passive tests. Similarly, movements involving an axial load applied to the lower limb may better mimic weight-bearing functional activities. Alternatively, passive and active movements performed without an axial load applied to the limb, presumably characterized by less kinesthetic input, may reveal more subtle kinesthetic effects of knee supports, which may be manifest in other activities and tests of neuromuscular performance. Objectives of the present study, therefore, were to examine the perceived sense of knee joint position during active, passive , and axially loaded limb movements, and to evaluate the effect of a neoprene sleeve during each of these test situations.