Proprioception, the often-forgotten middle child
In the competitive scene, athletes and active people are focused on having strength, power and flexibility. They often forget about the middle child, proprioception, when it really deserves some love and attention.
Proprioception describes one’s ability to perceive our body’s position, movement and force in space. This includes our sense of equilibrium and balance. What provides us this ‘sixth-sense’ is our proprioceptors - the small mechanosensory neurons located within our muscles, tendons and joints.
For instance, your perception of what bending your knee to 90 degrees feels like solely depends on your proprioception. Without them, you are likely to over, or undershoot, your knee movement beyond the intended 90-degree mark. This is why athletes who suffered an ACL injury are more prone to future injuries due to losing this major proprioceptor and misjudging their body movement and position.
Any injuries or disruptions to the muscles, tendons and joints will change our proprioception. Therefore, injuries as severe as an ACL rupture or even a mild ankle sprain can alter our ‘movement sense’ to a certain degree. Perhaps, it is more so the minor injuries, such as an ankle sprain, tend to have a bad outcome and increased rate of re-injury. This is mainly caused by people not doing the full rehabilitation properly due to the mild degree of disability and people simply don’t think they need to.
Figure 1. ACL disruption and inability to detect change in tension, movement and position
Test Your Proprioception
Joint Position Sense can be tested either actively or passively. This determines your ability to perceive a particular joint angle and then, after the body part is moved, can actively or passively reproduce the same joint angle.
Active Joint Position Sense (e.g. for your shoulder)
Use a laser pointer or simply your index finger pointing to a particular point on the wall
Practice a few times with eyes open, elevating your arms up to the exact same point
Now close your eyes and repeat the same thing
Open your eyes at the end position to see if you are close to the desired position
Passive Joint Position Sense (e.g. for your knee)
Lying down on your tummy
Get your partner to bend your knee to 90-degree
Close your eyes and bring your leg down then attempt to return back to the 90-degree mark
Get feedback from another person to see how close you are to the desired position
N.B. trial different angles i.e. 110-degree, 60-degree, etc.
Figure 2. Attempt to go from 0-degree to 90-degree mark with eyes closed. Open your eyes after completion of movement to check if it is at 90-degree.
No matter the underlying cause for poor proprioception, there are ways to rehabilitate to improve our motor skills, strength, balance and coordination. The rehabilitation often includes these major components:
Balance exercise – requires both proprioception and neuromuscular control, meaning that your body needs to ‘feel’ what is happening and where it is in space, and then execute motor patterns required to keep the body in equilibrium.
E.g. standing on a balance board creates an unstable environment to the hips/ knees and ankles. Your proprioceptors detect information on the change in movement and joint position in-real time. Based on this information, your body carries out the appropriate response to keep you upright.
Somatosensory stimulation – your conscious perception of touch, pressure, pain, temperature, movement, position and vibration.
E.g. By changing the type of environment and setting which challenges the balance system and proprioception. This can be done by changing the supporting surfaces i.e. standing on a piece of foam. Alternatively, deliberately eliminate one of the somatosensory systems such as our vision, by shutting our eyes during balance exercise and forcing others to work harder.
Joint repositioning training – as previously mentioned before, try practicing your joint position sense either actively or passively and start challenging yourself with different degrees of movement.
Pilates – focuses on body alignment, core stability and slow-controlled movement. Thus, it provides a good ‘listening environment’ for your body to improve mind and muscle connections. E.g. The side-lying clam requires you to open your hips away from each other whilst maintaining your spine in neutral. In order to keep your spine neutral, you need proprioceptors to ‘listen’ and feel what the leg is doing in order to stabilize itself.
Proprioception is one of many important components in the rehabilitation of injuries and it can be trained concurrently with strength, mobility and power. In your next workout, perhaps try out some of the proprioception exercises to future-proof your body and reduce the risk of re-injury!
By Eric Chao, Senior Physiotherapist, Breathe Physio and Pilates
Shop 5, 66 Slobodian Avenue, Eight Mile Plains Qld Australia