“What is real? How do you define real? If you’re talking about what you can feel,
what you can smell, what you can taste and see, then real is simply electrical
signals interpreted by your brain.” – Morpheus, from The Matrix
Ever wonder how you are able to walk in the dark, brush your hair, or put in contacts without a mirror? What about jumping on a trampoline or running through the woods without twisting your ankle? Or how about throwing a Frisbee with your dog or a throwing a football during Thanksgiving without injury to your arm or shoulder? Much like getting into your car in the morning and trusting it to get you to work, people rarely ask HOW things work; we only care that they DO work. The human body is no different; however, curious minds want to know: what is this ability? How does the body accomplish these activities seamlessly, without error or mistake? The answer is straightforward, but certainly not simple: proprioception.
Many contemporary authorities define proprioception as “a specialized variation of the sensory modality of touch that encompasses joint movement (kinesthesia) and joint position (joint positional sense), [spatial orientation and sense of force].”1 These processes are controlled via the central nervous system, which receives afferent input from receptors found in several tissues including muscles, tendons, ligaments, skin, and joints regarding tissue deformation to promote optimal movement acuity, joint stability, coordination, and balance2. The role of proprioception is vital to planning specific motor commands, assessing the accuracy of completed commands, and ensuring safety from tissue damage during said command. When the system functions properly, there is a harmonious interaction throughout the body resulting in pain-free and optimal human movement patterns.
Unfortunately, there are several factors that contribute to altered proprioceptive feedback leading to increased risk for injury. These factors include pain, effusion, trauma, fatigue, joint hypermobility, stenosis, and immobility3. These factors alter reflex activity and reduce proprioceptor sensitivity; moreover, trauma and effusion significantly disrupt musculoskeletal tissue leading to muscular inhibition. Poor proprioception has also been linked to persistent pain disorders and the onset and progression of peripheral joint osteoarthritis4.
There are several interventions that have been shown to enhance proprioception in the injured and uninjured patient. The following is a list of interventions that
have been validated in the literature for improving proprioceptive feedback2:
- Employing techniques to reduce or eliminate pain, effusion, and fatigue. These factors impair proprioceptive return so interventions should be utilized to augment these issues. Furthermore, interventions for proprioception should avoid pain, effusion, and fatigue.
- Manual therapy techniques: Joint mobilizations / manipulations, passive range of motion techniques, soft tissue mobilizations, myofascial release,
- These interventions create controlled stretch / compression stimulation mechanoreceptors in the skin, muscle, fascia, or joint capsule.
- Joint repositioning techniques: with the patient’s eyes closed, place the joint in a particular range of motion and have the patient recreate the position with the same limb or opposite limb. Repositioning can occur following the movement or concurrently with the movement. Research suggests “positions of vulnerability” in specific joints where injuries are more likely to occur: ankle – 9 and 22° of plantarflexion; knee – 10 and 60° of flexion.
- Unstable surface training: closed-kinetic chain activities involving the upper and lower extremity have shown to significantly improve proprioceptive feedback in multiple joints. Wobble boards, foam pads, and trampolines are traditionally used with other methods (swiss ball, BOSU) becoming more mainstream. Narrowing the base of support (i.e. feet together, tandem, single leg) and eliminating vision increase the proprioceptive demand on said extremities.
- Plyometric training: utilizing the stretch-shortening cycle to simulate joint mechanoreceptor functioning is crucial for return to higher functional demands without the increased injury risk. Quick, reciprocating joint movements with elastic bands, jumping-landing activities with single or double legs, and rebounder tossing are all examples of implementing plyometric training into your proprioceptive program.
When things work, they rarely get attention. The same is true for the human body: when all parts work together, the end product is smooth, functional, pain-free movement. Proprioception is one of many processes in the body that allow for this to occur. The above interventions are not only useful when injury occurs, but they are also beneficial as prophylactic intervention to prevent damage before it occurs. And as we all know, the best way to solve a problem is to prevent it from happening!
Contributing Author Credit: W. Evan Stringfellow, PT, DPT, CSCS, Cert. DN
Edited by: Ashley Theobald, DPT
Photo by: Sharon McCutcheon on Unsplash
- Lephart SM, Pincivero D, Giraldo J, Fu F. The Role of Proprioception in the Management and Rehabilitation of Athletic Injuries. Amer J Sports Med.1997; 25(1): 130-137.
- Clark N, Roijezon U, Treleaven J. Proprioception in Musculoskeletal Rehabilitation. Part 2: Clinical assessment and intervention. Man Ther. 2015; 20: 378-387.
- Clark N, Roijezon U, Treleaven J. Proprioception in Musculoskeletal Rehabilitation. Part 1: Basic science and principles of clinical assessment and interventions. Man Ther. 2015; 20(3): 368-377.
- Segal N, Glass N, Torner J, Yang M, Felson D, Sharma L, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthr Cartil. (2010); 18(6): 769-777.