All About Proprioception

By Jim Brown

Overview
If you can run without watching your feet, hit a baseball without focusing on the bat, or pass a basketball without looking at your arm, you're using a “sixth sense” called proprioception. Proprioception is the capacity of the body to determine where all of its parts are positioned at any given time, and it plays an important role in the world of sports.

Think of it as a subconscious internal computer software that complements your conscious effort to stabilize everything, whether you're moving or standing still. It triggers muscles to contract and relax to fit the situation. For example, close your eyes and balance on one foot. Notice how your leg muscles contract and relax to help you maintain balance.

You don’t have to think about it because your internal software is reacting to the situation and sending instant messages to help your body make the necessary adjustments. Proprioception is also a factor in speed and direction of movement. Proprioception helps us perform better in sports and avoid injuries. Losing it because of an injury or lack of use requires a period of re-training to get it back.

How Proprioception Works
Many exercise scientists aren't certain about the mechanism of proprioception, and those who claim to understand it don’t always agree on how it works. But they do agree that we have a system of receptor nerves (proprioceptors) located in the muscles, joints and ligaments.

These receptors can sense changes just as other receptors monitor pressure, sound, heat, light, etc., and pass that information to the brain. The brain fires a return message to the affected muscles telling them what to do. This can happen so fast that it is, at times, referred to as a reflex, rather than a reaction.

There's a fine line between proprioception and kinesthetic awareness. Although some people use the terms interchangeably, there is a difference. Kinesthetic awareness is a conscious effort to react to the situation, while proprioception is an unconscious or subconscious process.

The two mechanisms work together to allow a smooth, efficient, and safe platform for movement and athletic performance. For example, a skier whose body acts subconsciously (proprioception) to stay upright while the person’s mind (kinesthetic awareness) processes data regarding slopes, bumps, trees, speed and anything else he or she needs to make necessary adjustments.

Losing Proprioception
Proprioception can be lost when an athlete sustains an injury. If a nerve fiber is severed at the same time damage is done to soft tissues such as muscles, tendons and ligaments, then the messages that part of the body needs for protection either go undelivered or get through to the brain with incorrect information. It isn't a coincidence that people at highest risk for sprained ankles are the ones who've previously suffered sprained ankles.

The problem can escalate into faulty mechanics or loss of coordination. The longer you stay out of training and competition following an injury, the greater the loss of proprioception. Regaining flexibility, strength and muscle balance isn't enough, in terms of rehabilitation. Proprioception training should be the next step, even with relatively mild injuries that don’t require medical attention. Just because you're pain-free doesn't mean you're ready for serious training or competition. Proprioceptive mechanisms have to be tested.

Getting It Back
"Proprioception is very important when rehabbing an injury,” says Sue Falsone, vice president of performance physical therapy and team sports at Athletes' Performance. “The good news for athletes and exercisers is that it's similar to flexibility and strength in that if you work on it, it can get better. Regarding the risk of reinjury, several studies of the ankle found that reinjury wasn't necessarily due to a lack of strength, but to a lack of proprioception."

Part of the proprioception / kinesthetic awareness formula is balance. Wobble boards are used by physical therapists and trainers to help athletes redevelop a sense of balance. Leg presses, squats, vertical jumps, running figure-eight patterns, change of direction drills, and crossover walking are other routines that help establish the connection between muscles and nerves. Successfully completing these kinds of exercises is the last step before sport-specific movements that complete the rehabilitation process.

Controversy: Improving Proprioception to Prevent Injuries
An increasing number of injury prevention programs now include proprioception activities. There seems to be a consensus of opinion, although in the absence of conclusive evidence, that well-designed movement drills might further develop the neuromuscular pathways that enhance performance and prevent injuries.

One example would be a program to focus on the prevention of ACL injuries in female athletes. Instead of something merely to be regained following an injury, proprioception might (and “might” is the key word) be a skill to practice. Those who disagree with this premise have a point. If proprioception is truly a sense, just as touch, taste, sight and smell are senses, can this subconscious reaction be improved?

We know that senses can be restored following an injury or illness, but there is now compelling evidence that they can be improved. Vision training programs, for example, claim that innate visual skills such as depth perception and tracking can be improved. However, while the results of visual tests can be measured, translating those results to the playing field is hard to prove.

What We Know and What We Don’t Know About Proprioception
We know that proprioception is more than a vague sense of where you are in space. It's a combination of three things:
• Balance
• A sense of joint position
• Body awareness

Although an internal, subconscious mechanism, proprioception is real, observable and measurable. When it’s lost, it may or may not come back automatically. Regaining it following an injury requires time, effort, and the expertise of someone who knows how to put it back into operation.

We also know that proprioception is different from kinesthetic awareness, but that both mechanisms are needed for balanced, efficient, and relatively safe movement of body parts, whether the athlete stands in one place (as in lifting weights, golf or archery) or moves (as in baseball, basketball or football).

We don’t know if proprioception can be improved — not just restored — in the absence of an injury, or whether proprioception and kinesthetic awareness work together or independently.

Jim Brown, Ph.D. has written 14 books on health, medicine and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.