Proprioception

Proprioception, also referred to as Kinaesthesia, is the general term used for a sense of position, movement and action of the body or body parts relative to the environment. Some people may even refer to it as the “sixth sense”. This sense allows us to safely navigate our environment without having to consciously focus on it as well as protects us from injuries.

In fact, proprioception is an umbrella term, and may at times also referred to as kinaesthesia but it is in fact, a combination of different senses:
● Proprioception (joint position sense) – sense of the position body or limbs at any time, allows us to know the angle in which our joints are at a certain moment.
● Kinaesthesia – sense of position and movement of the body or body parts.
● Sense of effort – sense of how much effort, force or tension is invested in a certain
activity, it gives us indication of heaviness of things and allows us to match forces used.
● Sense of change in velocity – self explanatory, allows us to sense any changes in the velocity of our limbs and body.
● Exteroception – sense of position of the body or body parts relative to the surrounding environment.

Anatomy
Proprioception is mediated by special sensors called mechanoreceptors, these are receptors that are located in our skin, fascia, muscles, tendons and joints. These receptors can perceive multiple senses such as touch, pressure, vibration, stretch, hair movement, joint motion as well as force and load. The information from these senses is then sent to the Central Nervous System (CNS) where it is integrated with information from other sensory systems such as vision and hearing, etc., which is then used to give us a representation of the body’s position, movement, and action. This representation allows us to respond and adjust accordingly if we
need to.

For example:
In driving, proprioception allows us to keep our eyes on the road while steering the car, changing gears (in a manual car) as well as applying pressure to the pedals, without having to look at any of these components.

In many sports, athletes are able to run, dribble and navigate different environments dodging their opponents all while keeping their focus on the goal.

In the visually impaired, proprioception allows for navigation and learning of the environment through tactile cues, or cues from body and joint position..

Importance of Proprioception
Proprioception plays an important role in the following:

● Awareness of body and joint position in static positions or movement;
● Postural control;
● Planning and coordination of movements;
● Maintaining and regaining balance, and;
● Motor learning

Once we know and understand this we can see how impaired proprioception may affect many areas of our life, from learning how to dance, play sport, to prevention of injuries and falls. While most of us may overlook optimal proprioception and take it for granted, it is important for athletes to always be aware of proprioception, as small deficits that may be negligible in a normal population, may lead to poor performance or increased risk of injury or re-injury.

Causes of Impaired proprioception
Damage or injury to any of the areas where proprioceptive receptor are may cause impaired proprioception, these can be from:
● Natural age related changes
● Brain injuries
● Neurological disorders
● Musculoskeletal injuries
● Post surgery
● Intoxication from alcohol or other drugs and medication
● Other health conditions such as arthritis, diabetes, herniated discs, etc.

Symptoms of Impaired Proprioception
● Poor balance, unstable walk or increased falls.
● Difficulty or inability to accurately reach and hold different objects.
● “Clumsiness”, walking and bumping into things, dropping things, etc.
● Difficulty copying movements or positions observed.
● Difficulty gaging the strength needed for certain activities, using too much or too little force.
● Poor or unstable postural control.
● Poor accuracy and correction of movement and aim.

Proprioceptive tests
● Field Sobriety Test – these are a set of tests that police officers, in some places, may use to test the sobriety of drivers. These include: consecutively touching your nose with your index fingers, walking in a straight line or standing on one leg.
● Rhomberg test – this test involves standing with the feet together, eyes closed, for 30 seconds to 1 minute. The examiner observes the movement of the body for any signs of swaying or loss of balance.
● Finger-to-nose test: in this test the task is to touch the examiner’s finger, then the subject’s nose, repeatedly and as fast as possible.

● Heel-slide test: In this test the task is to slide the heel of the foot on the opposite leg’s shin, all the way down and back up again, without sliding off.
● Distal proprioception test: the examiner performs a set of movements on the big toe, knee or hip of the subject being tested while they watch, then the subject has to repeat the same movements with their eyes closed.
● Contralateral joint matching test: the examiner places a limb or joint in a certain angle, and the subject being tested as to reproduce the same angle on the opposite side, the differences in the angle are measured.
● Single leg stand – the task in this test is to stand on one leg, with eyes closed for 30 seconds to 1 minute. The examiner will observe the balance reactions or loss of balance in this test.

Treatment of Proprioceptive Impairments
Proprioceptive rehabilitation is dictated by the cause of the impairment, so it may require medical treatment, surgery, physiotherapy or a combination of these, and in some cases, as in the case of intoxication, simply waiting for the effects of the substances to wean off. However, it is important to note that in some cases, though the underlying condition has already been treated or cured, the proprioception may not be fully restored, and may need to be addressed separately.

● Physiotherapy uses a combination of exercises of balance, motor retraining as well as strength to retrain proprioception. This also includes sports or activity specific exercises according to the assessment done.
● Occupational therapy is helpful in retraining proprioception as well as adjusting the how daily activities are performed in cases where the impairment is permanent or chronic.
● Exercise modalities such as tai-chi and yoga have been shown to improve overall
proprioception.
● Exercises on unstable surfaces have been shown to improve proprioception, but these are controversial in how they are used. Studies show that they contribute to
proprioception by the effect they have on core muscles and assisting local stability in the trunk, thus assisting in balance, rather than the muscles of the ankle as previously believed.

Proprioception is an important component in our everyday lives and how we navigate our environment. It not only helps us keep balance and be stable but also helps improve our quality of life, giving us the ability to dance, run and play sport as well as explore the world around us.

If you would like to know more or have any questions, please feel free to contact us.