Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning proprioception:
Understand the role of the somatosensory system in human movement
Understand the components of proprioception and neuromuscular control
Have a basic understanding of motor control
Have an understanding of the sensorimotor system
Know the mechanoreceptors that play a role in motor control and proprioception
Be able to assess balance and sensorimotor control
Be able to prescribe and progress proprioceptive techniques for the upper and lower extremity
The term proprioception first gained acceptance in the rehabilitation community during the 1980s. Prior to this period, rehabilitation practices focused on reducing pain and inflammation and restoring range of motion and strength. Incorporating proprioceptive or balance training into the rehabilitation programs made sense, although little was understood regarding the physiological process that the body was undergoing during this retraining. Today clinicians and researchers have a much better understanding of the impact of proprioceptive training on neuromuscular control and the ability of the injured patient to return to activity.
The principles of improving proprioception to facilitate enhanced neuromuscular control can benefit a wide range of patients (e.g., improving performance in the high-level athlete, preventing falls in older adults, or alleviating symptoms associated with osteoarthritis). In each case, improved neuromuscular control can result in better performance and decreased risk of injury. This chapter will include information on proprioception's relevance to motor control, proprioceptive processes and structures, methods to assess proprioception, and techniques to improve proprioception following injury.
Clinical Pearl 13-1
Proprioceptive information is necessary for proper neuromuscular control.
PROPRIOCEPTION AND MOTOR CONTROL
The somatosensory system is a key component of the sensory information from our musculoskeletal system provided to the central nervous system (CNS) (Fig. 13-1). This system includes the conscious and unconscious recognition of joint position in space (proprioception), the detection of joint movement (kinesthesia), and the detection of the amount of force being applied to the limb (sense of tension force).2 For example, if you close your eyes and position your right elbow joint at 90 degrees and then 45 degrees, because of your proprioceptive sense you should be able to recognize joint position differences and detect the movement that occurred at your right elbow joint. Furthermore, if you lifted a 5-pound weight versus a 10-pound weight, you should be able to recognize that 10 pounds is greater than 5 pounds, or more muscle tension is required for the former. Our ability to perceive this somatosensory information is important to proper motor (muscle) functioning and dynamic joint stability during athletic events and activities of daily living. Dynamic joint stabilization relies on the ability of receptors to transmit afferent (sensory) impulses to the CNS regarding joint proprioception and kinesthesia and muscle tension to help create an efferent (muscle) response.2