By Dr. Stephen Ford

Categories: Sports Injury & Performance; Recovery & Mobility

Tags: Sports Injuries, Therapeutic Exercise, Injury Recovery

Joint instability may improve with progressive strength training, proprioception exercises, and sport-specific neuromuscular training. The strongest evidence is in chronic ankle instability, where exercise programs may improve balance, joint-position awareness, muscular control, and a person’s confidence in the joint. However, exercise does not necessarily reverse structural ligament laxity, and the right plan depends on the joint involved, the cause of instability, symptom severity, and whether medical or surgical care is needed.

Key takeaways

• Joint instability can be mechanical, functional, or a combination of both.
• Strength training helps muscles produce and control force around an unstable joint.
• Proprioception and balance exercises may improve joint-position awareness and neuromuscular coordination.
• Combined programs are generally more useful than strength or balance exercises alone.
• The evidence is strongest for chronic ankle instability, with additional rehabilitation research involving the knee and shoulder.
• Recurrent dislocations, significant swelling, locking, deformity, or inability to bear weight should be evaluated by a qualified medical professional.

What does joint instability mean?

Joint instability describes a reduced ability to control or safely tolerate movement. Some people experience instability as a joint that “gives way,” shifts, buckles, or feels unreliable during sports or daily activities.

Instability can involve several factors:

• Mechanical instability: Ligaments, capsules, cartilage, or other passive structures may be stretched, torn, or otherwise unable to provide normal restraint.
• Functional instability: The joint may have reduced strength, balance, timing, reaction speed, or coordination.
• Pain-related inhibition: Pain or swelling may change how muscles activate, reducing a person’s ability to stabilize the joint.
• Movement and load-management factors: Fatigue, poor landing mechanics, sudden increases in training, or inadequate recovery may expose weaknesses in the system.

Normal mobility is not the same as instability. A healthy joint needs enough mobility to move well, but it also needs sufficient control to manage force. The goal of rehabilitation is not to make every joint rigid. It is to help the person use the available range of motion with better strength, coordination, and confidence.

How can strength training support a less stable joint?

Strength training may improve the joint’s functional support by increasing the ability of surrounding muscles to absorb force, produce force, and control movement.

The exercises used depend on the joint:

• Ankle: Calf, peroneal, tibialis, and foot-intrinsic strengthening may support control during walking, cutting, jumping, and landing.
• Knee: Quadriceps, hamstrings, gluteal, and calf strengthening may improve lower-extremity force management.
• Shoulder: Rotator-cuff and scapular-muscle strengthening may support the humeral head and improve control during reaching, lifting, and throwing.
• Hip and trunk: Proximal strengthening may help athletes maintain alignment and distribute load during single-leg tasks.

Strength training should be progressive rather than random. A program may begin with isometric or low-load exercises, then progress toward resistance-band work, free weights, closed-chain exercises, deceleration, and sport-specific movements.

Research involving chronic ankle instability suggests that strengthening can improve muscle performance and patient-reported function. However, strength training by itself may not fully address balance or joint-position deficits. That is one reason combined strength and proprioceptive programs are commonly used.

What is proprioception, and why does it matter?

Proprioception is the body’s ability to sense joint position and movement. Information from muscles, tendons, ligaments, skin, and the inner ear helps the nervous system determine where the body is and how it is moving.

For an athlete, proprioception contributes to the ability to:

• Detect changes in joint position
• React to an unexpected surface or perturbation
• Maintain balance during single-leg movement
• Coordinate muscle activation around a joint
• Adjust technique when fatigued or changing direction

Proprioceptive training may include single-leg balance, controlled reaches, landing-and-hold drills, reaction exercises, changes of direction, and perturbation work. The exercise does not need to be performed on an extremely unstable surface to be effective. In many cases, the most useful progression is to make a movement more challenging while preserving good alignment and control.

A 2020 systematic review found proprioceptive deficits in people with chronic ankle instability, while a 2023 systematic review and meta-analysis evaluated whether exercise therapy could improve joint-position sense. These findings support the use of balance and neuromuscular training, while also reinforcing that the program should be tailored to the person’s specific limitations.

Why combine strength, balance, and neuromuscular training?

Strength and proprioception address different parts of movement control.

Strength training may improve the joint’s ability to produce and absorb force. Proprioceptive and neuromuscular training may improve the timing and coordination of that force. Combining the two may help a person progress from isolated exercise to real-world movement.

A typical progression might look like this:

1. Restore comfortable movement: Address swelling, pain, and restricted range of motion when appropriate.
2. Build local strength: Train the muscles that directly support the joint.
3. Develop balance: Begin with stable-surface positions and progress to controlled reaches or movement.
4. Add perturbations and reactions: Introduce changes in direction, visual challenges, or light external disturbances.
5. Practice force absorption: Use step-downs, landing-and-hold drills, and deceleration work.
6. Return to activity: Progress toward running, cutting, lifting, throwing, or sport-specific tasks based on objective criteria.

The 2021 ankle clinical practice guideline from the Journal of Orthopaedic & Sports Physical Therapy and the American Physical Therapy Association emphasizes exercise therapy that includes range-of-motion work, strengthening, balance, and neuromuscular training. The appropriate dosage and progression still need to be individualized.

What does the research show for different joints?

Ankle instability

The most consistent evidence in this area involves chronic ankle instability. Research suggests that exercise therapy may improve:

• Dynamic balance
• Patient-reported ankle function
• Perceived stability
• Inversion and eversion strength
• Joint-position awareness
• Confidence during movement

The ankle literature also suggests that combined programs may offer broader benefits than using strength or balance work in isolation. These improvements generally reflect better functional stability. They do not necessarily mean that a previously stretched or torn ligament has returned to its original structure.

Knee instability

Knee rehabilitation depends heavily on the cause of instability. An ACL injury, meniscus injury, patellar instability, osteoarthritis, and a recent surgical procedure require different considerations.

Following ACL reconstruction, rehabilitation commonly includes progressive quadriceps and hamstring strengthening, hip strengthening, balance work, landing mechanics, and sport-specific neuromuscular training. A 2021 systematic review examined neuromuscular training and knee proprioception after ACL injury, while a 2024 review evaluated proprioceptive training after ACL reconstruction.

These findings support a criterion-based approach, but they should not be interpreted as a guarantee that exercise alone can replace surgical follow-up or restore a damaged ligament.

Shoulder instability

Shoulder instability may involve a dislocation, subluxation, labral injury, ligament injury, or movement-control issue. Rehabilitation often focuses on rotator-cuff strength, scapular control, closed-chain loading, rhythmic stabilization, and gradual exposure to overhead or sport-specific positions.

An evidence-based review of rehabilitation for athletes with glenohumeral instability supports structured exercise and progressive return to activity. However, repeated dislocations, significant structural injury, or instability that continues despite rehabilitation may require evaluation by a sports-medicine physician or orthopedic specialist.

When might bracing, imaging, or medical referral be appropriate?

A brace or taping may provide external support during an early rehabilitation phase, higher-risk activity, or return to sport. It should generally complement: not replace: progressive exercise and movement retraining.

Medical evaluation and possible imaging may be appropriate when there is:

• A suspected fracture or major ligament injury
• Visible deformity or a joint that will not relocate
• Recurrent dislocation or subluxation
• Significant swelling, bruising, or inability to bear weight
• Locking, catching, or a sudden loss of motion
• Numbness, weakness, color change, or circulation concerns
• Persistent instability despite an appropriate rehabilitation program
• Symptoms following surgery that do not match the expected recovery plan

People recovering from surgery should follow the restrictions and progression provided by their surgical and rehabilitation team. High-level jumping, cutting, or contact activity may not be appropriate until strength, balance, movement quality, and medical clearance have been addressed.

Research, clinical experience, and practical expectations

Research: Current evidence most strongly supports combined exercise approaches for chronic ankle instability. Knee and shoulder rehabilitation research also supports strengthening and neuromuscular control, but the correct program depends on the diagnosis and treatment history.

Clinical experience: In practice, athletes often need more than one type of exercise. A person may have adequate isolated strength but lose control when balancing, reacting, landing, or performing the movement while fatigued.

Practical expectation: Strength and proprioceptive training may improve functional stability, movement confidence, and performance capacity. They cannot guarantee that an unstable joint will never give way again, and they may not correct structural laxity on their own.

At Dynamic Spine & Performance Center, rehabilitation should be selected around the individual’s goals, examination findings, training demands, and medical history. Chiropractic care or soft-tissue treatment may be used as part of a broader plan when appropriate, but adjustments alone should not be presented as a stand-alone correction for joint instability.

How Dynamic Spine & Performance Center can help

If instability is affecting your training, work, or daily movement, a structured evaluation may help identify which factors are limiting performance. Depending on the situation, care may include therapeutic exercise, mobility work, strength progression, movement retraining, sports-performance coaching, and coordination with other medical professionals when referral is appropriate.

You can learn more about Dynamic Spine & Performance Center and explore additional education in the clinic blog. Athletes may also benefit from related information about CrossFit rehabilitation pitfalls and strength training for long-term joint mobility.

Sources

1. Martin RL, et al. “Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains Revision 2021.” Journal of Orthopaedic & Sports Physical Therapy. Read the clinical practice guideline

2. American Physical Therapy Association. “Ankle Stability and Movement Coordination Impairments: Ankle Ligament Sprains Revision Clinical Practice Guideline.” View the APTA CPG+ resource

3. “Do Exercise Therapies Restore Joint Position Sense in Chronic Ankle Instability? A Systematic Review and Meta-Analysis.” 2023. Read the PubMed abstract

4. “Chronic Ankle Instability and Proprioception Deficits: A Systematic Review and Meta-Analysis.” 2020. Read the full article

5. “Effects of Neuromuscular Training on Knee Proprioception After ACL Injury: A Systematic Review and GRADE Assessment.” 2021. Read the full review

6. “Proprioceptive Training After ACL Reconstruction: A Systematic Review and Meta-Analysis.” 2024. Read the PubMed abstract

7. “Evidence-Based Rehabilitation of Athletes With Glenohumeral Instability.” 2015. Read the PubMed abstract

8. Aspetar. “Clinical Practice Guideline on Rehabilitation After ACL Reconstruction.” 2023. Read the PubMed record

Clinical disclaimer: This article is for educational purposes only and does not diagnose or treat a specific condition. Joint instability can have different causes and may require in-person examination, imaging, medical treatment, or surgical follow-up. Seek prompt medical care for severe pain, deformity, suspected fracture, recurrent dislocation, significant swelling, numbness, or inability to bear weight.

About Dr. Stephen Ford

Dr. Stephen Ford is a chiropractor serving Katy, West Houston and the Greater Houston area. His practice focuses on ARPwave NeuroTherapy, sports injury care, chiropractic, soft-tissue therapy, mobility, recovery and performance. He earned his Doctor of Chiropractic and B.S. in Human Biology from Texas Chiropractic College and completed a sports-injury rotation at Rice University.