Tuesday, September 7, 2010

Proprioception - What's that???

Sourced from The Sports Injury Doctor Isuue 5/06/September, authoured by Chris Mallac who has been head of sports med at Bath Rugby and head physio at Queensland Reds Super 14.


There is a bit of talk about "Proprioception Training" among coaches / trainers / conditioners, but mostly physiotherapists because they seem to know more about it and make more sense on this one. If your coach is a physio or has coached at the elite level you have a much better chance of being introduced to this training at club level. Everyone is looking for an edge in Football and this form of training is no doubt resident in the top echelons of football around the globe. Its not news to the AIS and probably not to ACTAS. There are a couple of clubs in the ACT that have introduced this form of training to assist the development of the players. So if you hear about it, this short article will assist you in knowing what it generally means.


Dear Sports Enthusiast,

Try this little experiment. Place a coin on the floor. Stand about 30cm away from the coin. With your eyes open, attempt to touch the coin with your big toe (it doesn't matter which foot). Now close your eyes and try it again.

If your ‘proprioception’ is in tune, then you should be able to touch the coin or at least get very close to it. However, if your proprioception is not functioning, then you will miss it by miles.

So what is ‘proprioception’? Why is it important, and how do we train it?

Proprioception can be defined as “… an unconscious perception of movement and spatial orientation arising from stimuli within the body itself.”

The word proprius is Latin and means ‘one’s own’. Perception pertains to the human senses – in the case of proprioception, the sense of movement. (Out of interest, balance is not an example of proprioception. Balance control comes from the inner ear and not the body senses. However, the balance systems are intertwined heavily with the proprioceptive systems.)

Common examples from everyday life:
  • Walking in a dark room in the middle of the night
  • Catching a ball
  • Eating whilst reading the paper

 Where does proprioception come from?
Our muscles, ligaments and tendons are stacked with free nerve endings and receptors that allow us to perceive where our limbs are in space. These receptors then feed into the central nervous system (CNS) and the CNS in turn relays information to the brain – both the cerebrum (big brain) and cerebellum (little walnut shaped thing at the bottom of the cerebrum). To make it really complex, the information from these body receptors is then compared to information received from the eyes and ears that allows us to co-ordinate hand/foot-eye coordination and also balance.
"Proprioception can always be improved through training. The learning of any new skill involves training our proprioceptive sense and re-organising the nervous system to suit the new activity."
Why do people have poor proprioception?

The two cohorts of the population that suffer from altered proprioception are the injured/ill and the elderly. As we injure ourselves and damage tissues, the pain mechanisms that feed into our brains tend to ‘fog’ up the nerve cells in the brain so that we don’t have such a defined appreciation of position sense anymore. Furthermore, some anatomical structures play keys roles in proprioception. The Anterior Cruciate Ligament (ACL) in the knee has numerous nerve endings that contribute to proprioception, as does the major ankle ligament – the ATFL. That is why injury to these structures tends to make us feel unstable. The elderly have ageing nerve endings and their nerves do not conduct information as effectively as younger people. They have more trouble with activities requiring body awareness and as a result often bump themselves easily and fall easily.

Can we improve our proprioception?

Absolutely! Proprioception can always be improved through training. The learning of any new skill involves training our proprioceptive sense and re-organising the nervous system to suit the new activity. The nerve endings and sensory fibres in our muscles, ligaments and tendons become more effective at picking up changes in body position. In turn, the nerves become more efficient at transmitting the information to the brain, and the brain becomes better at responding to this information.

Practical examples of proprioceptive re-training in the world of sports medicine include balance board and BOSU ball exercises for post ankle/knee injuries; medicine ball catching drills for post-operative shoulder reconstructions, and laser pointer guidance exercises that post-whiplash patients perform to retrain head rotation and neck rotation position sense.

An example of the laser drill for whiplash is to strap a laser pointer to a patients head and have them focus on a point on a wall or screen. They then turn their head (rotation) and then attempt to rotate back to where the laser was pointing. Research shows that this position sense of being able to bring the laser back to that point is severely compromised in patients who have whiplash injuries. This is because the nerve endings that allow this position sense have been affected so the ability to 'sense' where the head should be directed becomes compromised. They can then perform this drill repeatedly to retrain this sense.

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