Proprioception : What is it?

Proprioception, also known as proprioceptive acuity or proprioceptive sensitivity, refers to our ability to sense the position, movement, and orientation of our body parts without relying on visual or auditory feedback. This ability relies on the proprioceptors, specialized sensory receptors located in our muscles, tendons, and joints, that send signals to the brain about the position and movement of our body parts.

Proprioception is crucial for many everyday activities, such as walking, standing, reaching, and grasping objects, as well as for more complex movements like playing sports or dancing. Proprioception allows us to make precise and coordinated movements, adjust our posture and balance, and respond quickly to unexpected changes in our environment. Without adequate proprioception, we may struggle with basic movements, have difficulty coordinating our movements, or be more prone to injury.

Athletic trainers (ATCs) and physical therapists can assess proprioception in a variety of ways. Proprioception is the sense of the body's position and movement in space, and it is an important factor in balance, coordination, and athletic performance. Here are a few methods that ATCs and physical therapists can use to assess proprioception:

1. Joint position sense testing: Joint position sense testing involves moving a joint to a specific position and asking the patient to identify the position without looking. For example, the ATC or physical therapist may move the patient's ankle to a specific angle and ask the patient to identify the angle without looking. This test can be used to evaluate the patient's ability to sense joint position, which is an important component of proprioception.
2. Balance testing: Balance testing involves assessing the patient's ability to maintain balance in different positions and on different surfaces. There are several tests that can be used to assess balance, including the single-leg stance test, the Romberg test, and the tandem stance test. These tests can provide information about the patient's ability to use proprioception to maintain balance.
3. Movement assessment: Movement assessment involves evaluating the patient's movement patterns and coordination. The ATC or physical therapist may ask the patient to perform specific movements or exercises and observe their form and technique. This can provide information about the patient's ability to use proprioception to control their movements.
4. Muscle testing: Muscle testing involves assessing the patient's strength and stability in different positions. The ATC or physical therapist may apply pressure to the patient's limb or ask them to resist movement in a certain direction. This can provide information about the patient's ability to use proprioception to control muscle activation and movement.
5. Functional assessments: Functional assessments involve evaluating the patient's ability to perform activities that require balance and coordination, such as walking on uneven surfaces or changing direction quickly. These assessments can provide information about the patient's ability to use proprioception to perform functional movements.
6. Video assessments: ATCs and physical therapists can use video assessments to evaluate patients' movement patterns and balance. Patients can record themselves performing exercises or activities that require balance and coordination, and the ATC or physical therapist can analyze the video to evaluate their movement patterns and balance.
7. Self-assessment questionnaires: ATCs and physical therapists can use self-assessment questionnaires to evaluate patients' perception of their own proprioception. These questionnaires can ask patients about their ability to perform activities that require balance and coordination, such as standing on one leg or walking on uneven surfaces. While self-assessment questionnaires are not as objective as other methods, they can provide useful information about how the patient perceives their own proprioception.

It is important for ATCs and physical therapists to use a combination of methods to assess proprioception, as each method provides different information about the patient's abilities. Based on their findings, ATCs and physical therapists can develop treatment plans to improve proprioception and enhance the patient's balance, coordination, and athletic performance.

Improving our proprioception can help us enhance our physical performance, prevent injuries, and improve our overall quality of life. Here are some ways to improve proprioception:

1. Balance training: Practicing balance exercises, such as standing on one leg, walking on a balance beam, or using a balance board, can help improve proprioception and reduce the risk of falls. Several studies have shown that balance training can improve proprioception in older adults (Bressel et al., 2007; Granacher et al., 2010). Additionally, a review of randomized controlled trials found that balance training can reduce the risk of falls in older adults (Sherrington et al., 2019).
2. Joint mobilization: Gentle movements that move your joints through their full range of motion can improve proprioception by stimulating the proprioceptors in your joints and increasing your awareness of your body's position. Joint mobilization has been shown to improve proprioception in individuals with knee osteoarthritis (Collins et al., 2017) and individuals with chronic ankle instability (Cornwall and Murrell, 2011).
3. Tactile stimulation: Using textured surfaces or objects, such as foam rollers, massage balls, or therapy bands, can provide tactile feedback that enhances proprioception and improves body awareness. Foam rolling has been found to improve ankle proprioception in healthy individuals (Okubo et al., 2017), while using a wobble board with tactile stimulation improved balance and proprioception in individuals with ankle sprains (Halim-Kertanegara et al., 2021).
4. Yoga and tai chi: These practices involve slow and controlled movements that challenge balance, coordination, and body awareness, making them effective ways to improve proprioception. A meta-analysis of randomized controlled trials found that yoga and tai chi can improve balance and proprioception in older adults (Kumar et al., 2016). Another study found that practicing tai chi for six months improved proprioception and balance control in individuals with Parkinson's disease (Li et al., 2012).
5. Visual imagery: Visualizing movements in your mind can improve proprioception by strengthening the neural connections between your brain and body. A study on tennis players found that visual imagery improved proprioception and accuracy in serving (Moran et al., 2012). Another study found that visual imagery can improve balance and reduce falls in older adults (Sibley et al., 2015).
6. Sport-specific drills: Practicing movements specific to your sport or activity can improve proprioception in those movements and enhance overall performance. A study on soccer players found that sport-specific drills improved proprioception and balance in individuals with ankle sprains (Barela et al., 2011).

In conclusion, proprioception is an essential aspect of our physical functioning, and improving our proprioception can benefit our overall health and performance. Incorporating exercises and activities that challenge our proprioception can help us improve our body awareness, coordination, and balance, and reduce the risk of injuries.

References:

Barela, A. M., Rocha, N. A., and Okazaki, V. H. A. (2011). Effect of sport-specific practice on sensorimotor abilities and proprioception of the ankle in soccer players. Journal of Sports Sciences, 29(7), 711-718.

Bressel, E., McNair, P. J., and Cronin, J. B. (2007). Stability and balance measures for subjects with ankle instability. Journal of Athletic Training, 42(3), 364-371.

Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., and Roos, E. M. (2017). Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care & Research, 69(11), 1848-1865.

Cornwall, M. W., and Murrell, P. (2011). Postural sway following joint mobilization of the ankle: A pilot study. Journal of Athletic Training, 46(3), 245-251.

Granacher, U., Muehlbauer, T., Bridenbaugh, S. A., Wolf, M., and Roth, R. (2010). Effects of balance and resistance training on balance, strength, and neuromuscular activation in older adults. Journal of Aging and Physical Activity