Proprioception

What is proprioception?

It is the body's ability to sense movement in and around our joints. Receptors within various structures basically detect things such as of stretch, compression, tension etc.

Interesting proprioceptive fact:

There are more mechanoreceptors in the cervical spine (neck) than in the lumbar spine (low back)

What is the basic reason for proprioception?

Proprioception enables us to know where our limbs are in space without actually looking, which is important for all everyday movements that we perform. When we perform complex movements such as sporting movements, proprioception needs to be enhanced, as precise coordination is essential to improve performance and to minimise injury risk.

How does it work?

The system is subconscious and often reflex, meaning that we don’t have voluntary control over it. Although we can consciously utilise the proprioceptive system and therefore we can train it and improve it.

What is a good example of proprioception in day to day actions?

If our body leans to the side for any reason our proprioceptive system will work to involuntarily keep the head level.

Another example is, if we are walking on a surface that leans off to one side and it suddenly changes to the other direction then we don’t notice but our joints, such as the ankle adjust in position and certain muscles change in their activity etc.

Hamstring activity uses feed forward mechanisms around toe off & feedback mechanisms during the rest of swing phase in walking (Blanchette & Bouyer 2009).

What affects proprioception?

Following injury to joints and ligaments the receptors are also damaged, which means the information that is usually sent to the brain is impaired. As a consequence the joint feels odd or just doesn't feel right.

Swelling will reduce the proprioceptive reactions. If you think about it logically swelling stretches and compresses the structures, which will confuse the system as the information being detected won’t match the position that the joint is actually in.

Pain also has an inhibitory effect on muscle activity, which is part of the proprioceptive system.

For example:

Lumbar spine proprioceptive awareness in sitting is reduced in patients with non-specific chronic lower back pain (Verschueren et al 2012)

What is the relevance of proprioception in sport and injury?

Does it prevent injury?

Some research has found a 7 times lower incidence of ACL injury with proprioceptive training.

4 to 6 weeks of balance training enhances static & dynamic stability in Chronic ankle instability (Wortmann & Docherty 2013)

The issue is that some injuries happen too quickly to prevent:

Most sports injuries occur in less than 10 ms. For example ankle sprains occur in 17ms but the shortest spinal monosynaptic reflex response is less than 20 ms (Pope et al 1982).

But:

Knee joint proprioceptive deficits were observed in established osteoarthritis (OA) but not in early OA. This suggests the lack of proprioception is as a result of the OA rather than a cause (Isabel et al 2013).

It is important to maintain good form and technique whilst training as exercise can disturb proprioception through fatigue. This increases the risk of musculoskeletal injury (Proske & Gandevia 2012). So make sure not to over train especially with higher impacts sports. It’s quality not quantity!

Does training proprioception get you back from injury or help you while you are injured?

Consideration should be given to the lumbar spine, pelvic alignment & postural control when managing hamstring injuries (Mason et al 2008).

Non-weight-bearing proprioceptive & strength training significantly improved outcomes in OA knee (Lin et al 2009).

Significant decreases in pain levels were detected in hypermobility syndrome patients who did proprioceptive exercises (Sahin et al 2008).

Neuromuscular training alone appears effective in the short term for chronic ankle instability (de Vries et al 2011).

but:

There is lack of high-quality evidence for the effects of proprioceptive exercise & taping in ankle instability (Hughes & Rochester 2008).

Does age impact proprioception?

Proprioceptive senses, particularly that of limb position and movement, deteriorate with age and are associated with an increased risk of falls. So proprioceptive exercises as you age are important (Proske & Gandevia 2012).

What type of exercises improves your proprioception?

Balance and control orientated exercises challenge the system making it adapt and improve.

Rozzi et al (1999) found 3 sessions of single leg balance per week for 4 weeks significantly improved joint proprioception.

The aim is to start at a level that is hard but not too hard and as can do longer and it becomes easier then you need to increase the difficulty of the exercise.

Once can do basic level exercises then you advance to sport specific exercises.