A.L. Ager1, J.-S. Roy2,3, A. Cools1
1Ghent University, Department of Rehabilitation Sciences, Ghent, Belgium, 2Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Motor Control Laboratory, Quebec City, Canada, 3Université Laval, Department of Rehabilitation / Faculty of Medicine, Quebec City, Canada

Background: Proprioception, or our sense of joint positioning and movement, is an important bodily sense for the avoidance of injury and the coordination of every day activities. Proprioception deficits contribute to persistent and recurring physical disability, particularly with shoulder disorders. Proprioceptive training is thus often prescribed during shoulder rehabilitation in clinical practice. It is unclear however, whether non-surgical rehabilitation strategies can actually optimize the sense of shoulder proprioception.

Purpose: To present the best evidence-based approaches for conservative rehabilitation (i.e. non-surgical) for shoulder proprioception amongst individuals with shoulder disorders.

Methods: An exhaustive review of the literature was conducted up to 24 November 2019, using PubMed, Web of Science and EBSCO. Selected articles were systematically assessed and the methodological quality was established using the Dutch Cochrane Risk of Bias Tool and the Newcastle-Ottawa Quality Assessment Scale. The PRISMA guidelines were utilized during this review. The conservative treatments were categorized as follows:
i) Conventional therapy,
ii) Proprioceptive training,
iii) Elastic kinesiology tape (KT) and
iv) Other passive therapies.

Results: Twelve studies were included, yielding 58 healthy control shoulders and 362 shoulders affected by shoulder impingement syndrome, glenohumeral dislocations, non-specific shoulder pain, rotator cuff dysfunction or subluxation post-stroke. The level of agreement between the evaluators for methodological quality was excellent (84.9%) and the included studies were evaluated to be of fair to excellent quality. Our review suggests, with moderate evidence, that proprioceptive training (flexible foil / wobble board training / specific proprioceptive training), can improve proprioception in the mid-term. No decisive evidence exists to suggest that conventional therapy (movement training / manual therapy / stretching / strengthening / scapular stability exercises / patient education) is of added value to enhance proprioception of the shoulder. Conflicting evidence was found for the improvement of proprioception with the application of elastic KT; while moderate evidence suggests that passive modalities (microcurrent electrical stimulation [MENS], transcutaneous electrical nerve stimulation [TENS], hot packs, non-elastic tape or bracing) are not effective for proprioceptive rehabilitation of the shoulder.

Conclusion(s): Proprioceptive training demonstrates the strongest evidence for the effective rehabilitation of individuals with a shoulder proprioceptive deficit. Elastic KT does not appear to affect the sense of shoulder proprioception, nor does passive modalities. This review suggests a possible specificity of training effect with shoulder proprioception, theorizing that specific shoulder pathologies exhibit specific proprioception deficit patterns. Potentially supporting that targeted proprioception training may be indicated for specific shoulder pathologies.

Implications: This is the first examination of the literature addressing rehabilitation strategies for the improvement of shoulder proprioception. Our findings suggest that further research is warranted to develop shoulder proprioception deficit profiles for different shoulder pathologies. This review has a positive impact on the current understanding of rehabilitation strategies for suspected shoulder proprioception deficits and will help guide clinicians with their rehabilitation management and exercise prescription strategies. Moreover, this review provides practical and clinical recommendations for the treatment of suspected shoulder proprioception deficits for health care providers.

Funding, acknowledgements: No funding was awarded for this project.

Keywords: Shoulder, Proprioception, Rehabilitation

Topic: Musculoskeletal: upper limb

Did this work require ethics approval? No
Institution: Ghent University
Committee: Ghent University
Reason: This is a systematic review, no ethical approval was required.

All authors, affiliations and abstracts have been published as submitted.

Back to the listing