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Altered proprioception can be a part of ankle osteoarthritis and can impact ankle function and balance. Exercises are one way to improve proprioception and balance for those with ankle osteoarthritis.
This article covers nine exercises to aid proprioception with ankle osteoarthritis. This article includes exercises as seen in the video Ankle Osteoarthritis Exercises Part 3: Ankle Proprioception Exercises and is part of the series Ankle Osteoarthritis Exercises.
1. Weight shift. With your feet shoulder width apart, lean from one side to the other. Repeat eight times. When living with ankle osteoarthritis, balance may not be as good as it once was. This is because balance impairment can occur with ankle osteoarthritis. Some signs of balance impairment include reaching for a railing walking up and down the stairs, looking down at the ground more often when walking, or taking wider or shorter steps. Proprioception, as part of the somatosensory system, contributes to balance alongside the vestibular system and visual system. Exercises to improve balance, aim to improve proprioceptive feedback mechanisms and subsequent balance reactions.
2. Feet together stance. Standing next to a stable object such as a table or chair, place your feet side by side as close together as possible. Hold for as long as you can up to around thirty seconds. If you need to, place your hand near the chair to assist with balance.
3. Feet together stance eyes closed. Again place your feet side by side as close together as possible. Hold for as long as you can up to around thirty seconds. Proprioception is the sense of body position and movement in space The proprioception sense is the focus of this video because of its contribution to balance, which can be impaired for those with ankle osteoarthritis.
4. Tandem stance. Standing with your feet shoulder width apart, take a step forward with your right leg. Hold for thirty seconds. If you feel yourself losing balance, hold on to the chair or stable object next to you. The receptors that sense proprioception are called proprioceptors and are primarily found in the muscles, joints, and tendons. These receptors detect changes in muscle length, the speed of changes in muscle length, the load or resistance placed on a limb, and joint position. Repeat, this time taking a step forward with your left leg.
5. Tandem stance eyes closed. To progress tandem stance, close your eyes. Closing your eyes increases the difficulty of the exercise by removing the input from visual system, placing more reliance on feedback from proprioceptors to maintain balance.
6. Lunge. Standing in a tandem stance position with your right foot forward, bend at your knees, then rise. Repeat eight times. Complete either a mini lunge or a full lunge. Lunges are a progression of tandem stance, with the addition of movement. Movement adds an element of functionality and specificity, as day to day activity requiring balance often involves movement of the joints and muscles above the ankle.
Switch your feet to position your left foot forward. Again, bend at your knees, then rise. Repeat 8 times. When completing ankle proprioception exercises, it is beneficial to practice the exercise for both sides. This is because research has found that proprioception can be impaired on both ankles, where one ankle is injured and the other is intact. Links to research articles on ankle osteoarthritis and proprioception are listed below.
7. Clocks. Standing with your feet shoulder width apart, step your right foot forward, then to the starting position. Then out to the side, then backward, coming to the middle after each step. Repeat four times on each side. When completing clocks picture yourself standing in the middle of a clock face, stepping to six o'clock, three o'clock, and twelve o'clock. Clocks similar to lunges are a dynamic exercise involving movement. Unlike lunges clocks also have the added challenge of working across multiple planes of movement, the sagittal plane when stepping forward and back and the frontal plane when stepping to the side.
8. Clock taps. This time tap your toes lightly on the ground rather than stepping. Repeat two times each side. When completing toe taps, you should not feel weight through your foot doing the taps but rather your stabilising foot. This is where you are maintaining balance.
Once proprioceptive information is sent to the brain from receptors, the brain combines the information with information from the visual system and the vestibular system to interpret where our body is in relation to our environment and how the body is moving. For instance, when completing the clock exercise, the vestibular systems senses we are standing upright, the visual system identifies we are standing on grass, and proprioception tells us when our foot lands on the ground beneath the grass. This is an oversimplistic example but hopefully demonstrates how these systems can work together. Again, steeping forward, then to the side, then backward.
9. Clock lunge. Continue, this time lunging rather than stepping. Lunge forward, out to the side, then backward. Similar to the lunges earlier, this could be a mini lunge or a full lunge. Repeat two times each side.
Once proprioceptive information is interpreted in our brain, signals are sent back to the muscles to provide adjustments in our position to maintain balance. This process is repeated so that proprioceptors are continuously monitoring posture with subsequent adjustments in muscle activity as needed to maintain balance.
Proprioception exercises form part of a rehabilitation program for ankle osteoarthritis, alongside range of motion exercises, strength exercises, and functional exercise. Video’s on these exercises can be found in the ankle osteoarthritis exercises series found on the Age Fit with Tess Youtube channel.
If you have osteoarthritis and are unsure if you have the right exercise program put together, make sure to get your complimentary self-assessment to identify if you are meeting 10 key components of a successful exercise program. Head to www.agefitwithtess.com to get your copy.
Research Articles
Al-Mahrouqi, M.M., MacDonald, D.A., Vicenzino, B. and Smith, M.D. (2018). Physical Impairments in Adults With Ankle Osteoarthritis: A Systematic Review and Meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 48(6), pp.449–459. doi:https://doi.org/10.2519/jospt.2018.7569.
Han, J., Anson, J., Waddington, G., Adams, R. and Liu, Y. (2015). The Role of Ankle Proprioception for Balance Control in relation to Sports Performance and Injury. BioMed Research International, [online] 2015, pp.1–8. doi:https://doi.org/10.1155/2015/842804.
Jeong, H.S., Lee, S.-C., Jee, H., Song, J.B., Chang, H.S. and Lee, S.Y. (2019). Proprioceptive Training and Outcomes of Patients With Knee Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials. Journal of Athletic Training, [online] 54(4), pp.418–428. doi:https://doi.org/10.4085/1062-6050-329-17.
Queen, R. (2017). Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty. Journal of Orthopaedic Research, 35(11), pp.2345–2355. doi:https://doi.org/10.1002/jor.23609.
Smith, M.D., Rhodes, J., Al Mahrouqi, M., MacDonald, D.A. and Vicenzino, B. (2021). Balance is impaired in symptomatic ankle osteoarthritis: A cross-sectional study. Gait & Posture, 90, pp.61–66. doi:https://doi.org/10.1016/j.gaitpost.2021.08.002.
Bestwick-Stevenson, T., Wyatt, L.A., Palmer, D., Ching, A., Kerslake, R., Coffey, F., Batt, M.E. and Scammell, B.E. (2021). Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol. BMC Musculoskeletal Disorders, 22(1). doi:https://doi.org/10.1186/s12891-021-04230-8.
Yeowell, G., Samarji, R.A. and Callaghan, M.J. (2021). An exploration of the experiences of people living with painful ankle osteoarthritis and the non-surgical management of this condition. Physiotherapy, 110, pp.70–76. doi:https://doi.org/10.1016/j.physio.2020.04.008.