Effects of Innovative Aquatic Proprioceptive Training on Knee Proprioception in Athletes with Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

Document Type : RESEARCH PAPER


1 Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran

2 Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran - Brain and Spinal Cord Injury Research Center, Institute of Neuroscience, Tehran University of Medical Sciences (TUMS), Tehran, Iran


Background: Proprioceptive training in the aquatic environment is more beneficial owing to water properties. The
primary goal of the present study was to investigate the effectiveness of the incorporation of innovative aquatic
proprioceptive training into conventional accelerated land-based rehabilitation protocol in knee function and joint
position sense in male athletes after anterior cruciate ligamen t reconstruction (ACLR).
Methods: A total of 38 athlete male athletes with ACLR were randomly assigned to two rehabilitation groups. The
conventional therapy group (CT) (n=19) received conventional rehabilitation for 6 weeks, while the hydrotherapy
group (HT) (n=19) received the same conventional rehabilitation, in addition to 12 sessions of innovative aquatic
proprioceptive training. The outcomes included the joint position sense (JPS) errors, visual analog scale (VAS), and
international knee documentation committee (IKDC). Repeated measures analysis of variance (ANOVA) was used
to compare the means between the two groups. Cohen’s d from an independent t-test was used to calculate the
effect sizes for all variables after the intervention for both gr oups.
Results: Base on the results, there were a significant difference in absolute errors (AE) (FAE=56.231, p <0.001)
and variable errors (VE) (FVE=60.245, p <0.001) between the two groups. No significant differences were detected
in constant error (CE), VAS, and IKDC between the two groups (P>0.05). Both groups displayed a significant
difference in terms of AE, VE, VAS, and IKDC after the intervention (p <0.05). Percent changes after the intervention
for AE(69.19%), VE (68.20%), CE (65.20%), VAS37.50%, and IKDC (38.61%) were greater in the HT group,
compared to the CT group.
Conclusion: As evidenced by the obtained results, innovative aquatic proprioceptive training incorporate into the
conventional rehabilitation accelerated protocol offers the improvement of proprioception efficiency for individuals
with ACL reconstruction. Therefore, it could be useful to clinicians when designing rehabilitation protocol to ensure
the optimal engagement of proprioception.
Level of evidence: I


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Volume 9, Issue 5
September and October 2021
Pages 519-526
  • Receive Date: 01 July 2020
  • Revise Date: 13 November 2020
  • Accept Date: 19 November 2020