Proprioception refers to the body’s ability to perceive its own position in space. For example, proprioception enables a person to close their eyes and touch their nose with their index finger.
Other examples of proprioception include:
- Knowing whether feet are on soft grass or hard cement without looking (even while wearing shoes)
- Balancing on one leg
- Throwing a ball without having to look at the throwing arm
In addition, proprioception allows the body to perform simultaneous actions without stopping to think about each one separately, such as running while dribbling a basketball.1
Proprioception is necessary for precise and fluid movements, making it essential to athletes and non-athletes alike. This article discusses how proprioception works, how injuries can impair proprioception, and how to improve proprioception through specific exercises.
Proprioception relies on the relationship between the body’s central nervous system and certain soft tissues, including muscles, tendons, and ligaments.
Within these tissues are sensory organs called proprioceptors. Sensory nerve endings wrap around the proprioceptors to send information to the nervous system. The proprioceptors can sense when tissues are stretched or experience tension and pressure.
For example, the proprioceptors in muscles are called muscle spindles. Muscle spindles are long proteins encapsulated in sheaths that lay parallel to muscle fibers. They work as follows:
- When a muscle is extended, muscle fibers are elongated and the coils of the muscle spindles are stretched. (Conversely, a contracted muscle causes muscle fibers and muscle spindles to shorten.)
- Nerve fibers in the muscle transmit information about the degree and rate at which the muscle spindle is stretched.
- The information is delivered to the nervous system, and a signal to contract or relax is sent to the muscle.
- The desired action is performed.
- The entire process takes less than a millisecond and, in some cases, it happens so quickly that it is referred to as a “reflex.” This feedback loop works continually; even when a person is sleeping the brain maintains some level of sensory input.
- This continual feedback loop is critical to everyone, especially athletes. For example, a runner can seamlessly transition from soft grass to hard concrete and back again, making unconscious, minor adjustments to stay upright and maintain balance. The runner does not have to think about changing leg and feet movements to accommodate the change in terrain.
- The proprioceptors in tendons are called Golgi Tendon Organs (GTOs), and they work similarly to muscle spindles. In ligaments, there is a neural feedback with our muscles that is still being studied and clearly defined by researchers. However, it is been understood that impaired/torn ligaments produce deficits in proprioceptive abilities.
How Can Proprioception Be Impaired?
An injury, such as a torn ACL or a strained Achilles tendon, damages the soft tissue where the proprioceptors are located. Damaged tissues do not function normally and thereby resulting in a loss of proprioception. This loss of proprioception can lead to:
- The recurrence/chronicity of an acute injury
- Joint damage over time, such as tendinopathy and arthritis
- For this reason, healthcare providers emphasize the importance of injury healing and rehabilitation.
- Since proprioception is linked to the central nervous system it can also be impaired by neurological conditions, such as Parkinson’s Disease and Multiple Sclerosis.
- Improving proprioception
For many athletes and non-athletes alike, injuries can cause individuals to avoid exercise altogether. Injured individuals are advised to speak with a health care provider and develop an active physical therapy routine to engage in during their recovery. The next two pages include several exercises that can improve proprioception.
References
- 1.Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997;25(1):130-7.
There are certain exercises that can be done to restore proprioception lost due to injury. The main objectives are to:
- Improve spatial awareness
- Improve balance
- Increase a sense of joint position
Below are step-by-step directions for several proprioceptive exercises. Most of these exercises do not require the use of fitness devices. However, they can be added to increase difficulty in some cases. In general, these techniques are most beneficial when done regularly, over 4 to 6 weeks.
One leg balance
This simple exercise will improve overall stability and ankle proprioception.
- Balance on one leg
- Bend the knee of the opposite leg, so that it remains off of the floor
- Hold for 1 minute, with 10 to 20 seconds of rest in between, 3 to 4 times on each side
To increase the difficulty of this exercise, close your eyes or stand on a pliable surface, such as a BOSU ball or an Airex pad. A BOSU ball is a fitness device that includes an inflated rubber hemisphere attached to a stable platform. An Airex pad is made of soft foam or gel material that helps to challenge one’s balance and joint stability.
Unilateral 3-way kick
This exercise focuses on balance and core strength.
- Begin by standing on one leg
- With flexed toes, raise the opposite leg off the floor, then lower it back to the starting position
- Repeat this to the back and side with each leg
To increase the difficulty of this exercise stand on the edge of an uneven surface, such as a foam pad.
Shoulder wall ball stability
The shoulder is crucial to posture and neck support. This exercise improves strength regardless of an injury.
- Place a large exercise ball against a wall, keeping it in place with one hand
- Maintain an extended elbow but avoid locking it or hyperextended
- Make small circles with arm, moving the ball and keeping the arm extended
- Continue for 30 seconds to 1 minute
- Repeat with other arm
Some physical therapists suggest “drawing” the ABC’s with the ball to keep time and distinguish the movements.
The following exercises focus on strength, balance, and joint stability simultaneously. They are most effective when done regularly, over 4 to 6 weeks.
Single leg squat
Single leg squats engage knee and ankle proprioceptors and exercise the leg and gluteus muscles.
- Stand with both arms extended in front of the body
- Balance on one leg with the non-weight-bearing leg extended forward, with the foot off the ground and as high as comfortable
- Squat down as far as possible while keeping the extended leg off the floor
- Raise the body to the upright position
- Repeat 3 to 5 times on each side
This activity is advanced and should be modified, if necessary. Modifications include resting a hand on a handrail or performing squat with the toes of the non-weight-bearing leg resting on the floor throughout the motion.
Cone pick-ups
This exercise is designed to challenge balance and proprioception while also improving strength.
- Begin in a standing upright position with a cone (or other object) on the floor
- Bend forward at the hips, letting one leg extend backwards while simultaneously reaching down to pick up the object and return to the starting position
- Place object back on the floor in the same way and repeat
To increase quad/thigh strength, a single-leg squat (described above) can be incorporated into this exercise.
Crossover walk
The crossover walk is ideal for people recovering from knee injuries or for those looking to improve knee proprioception.
- Begin with feet a little more than shoulder width apart
- Gently bend the knees to a 45-degree angle
- Cross one leg over the over the other, taking a large step to one side
- Step out so that feet are returned to original position
- Do this 5 to 10 times in both directions
This exercise should be done slowly to concentrate on the movements.
In general, proprioceptive training after an injury should be approached cautiously and under the observation and guidance of a physical therapist.
Many injury prevention programs also include proprioception activities. While there are still some things that are unclear to researchers and medical professionals concerning improvement (versus restoration) of proprioception, most agree that a well-designed functional movement program or treatment plan with some of the mentioned exercises can enhance performance and decrease risk of injury.
Source:DR. Leython Williams,sports-health.com