Proprioception sounds like one of those complicated science terms to most people but really it is quite easy to understand for it is something we use all the time. It refers to a sense of body positioning in space and is similar to being our “sixth sense“. A good example of this being used is when you try to walk around in the dark and you use your hands to feel your way around as you cannot use your eyes to see. This is where the mechanoreceptors in your body, specifically your arms and fingers are enhanced to become the eyes of the body to give feedback as to where you are. Unfortunately, this is also one of those systems that is vulnerable to weakness and dysfunction if it is not regularly used and trained and when this happens it exposes the body to injury and inefficient movement. In this article, I will explain this in more detail and share some of the best exercises to ensure you maintain great proprioception in your body.
What Is Proprioception?
Proprioception is critical for efficient movement and safe interactions with our surrounding environment.
The technical explanation of this is that it is a neurological program that comes primarily from sensory receptors that are found in your skin, joints, and muscles. These receptors allow for the identification of limb position and movement via neural signalling of a change in muscle, skin or joint stretch.
To ensure the body is maintained in efficient and safe positions this system runs in a continuous loop of feed-forward and feedback inputs between sensory receptors throughout your body and your nervous system.
I have referred to mechanoreceptors before when discussing the role of the feet for providing movement and I regularly use tools like the Sensa mat to help engage these receptors which is shown in the picture above.
In a recent study conducted by the Oregon Research Institute (ORI), textured surface for the feet exercise has demonstrated an improvement in physical function and reduction in blood pressure to a greater extent than conventional walking in older adults. This was mainly due to the effect the sensa mat has on what are known as mechanoreceptors in the sole of the feet in the skin. These mechanoreceptors have a large impact on balance and postural control.
As we age, we experience DECREASED information from foot sole skin input. You can read more about this in the article – How the sensa mat improves foot stability and the ability to walk
In sports proprioception is used at an exceptionally high level in order to complete complex movements often at high speeds and avoid collisions or creating serious injuries. A good example of this is seen in baseball or cricket where someone is running to catch a ball with their eyes on the ball as opposed to where they are running. Their body enhances the proprioceptive system to provide a sense of where they are on the field so to not run into the barrier or another person and keep the visual system on the ball so they don’t drop the catch.
However, it is not limited with sports as playing musical instruments also demonstrate high levels of this where multiple senses are elevated to complete a complex task easily seen with drummers using multiple limbs without needing to look at what they are doing.
Okay this makes sense for sports but do we still use this system with everyday tasks? Absolutely!
In the introduction I provided a good example of this system when it works correctly when you are walking in a dark room.
A good example of when it doesn’t work very well is when someone is drunk and the proprioception mechanism is significantly impaired. A person who is drunk is extremely unstable, easily stumbles into things, and is completely unaware of anything in their surrounding environment. Their muscles and joints are still able to move but with very poor efficiency and their reactionary skills are almost non-existent.
This shows you that our proprioception awareness is working all the time but like anything it needs to be trained to ensure it works efficiently as it is supposed to.
Without the appropriate integration of proprioceptive input it would be impossible to drive a car because you would not be able to steer or use the foot pedals while looking at the road ahead. We use this system all the time without even realizing it but it does need training to preserve its optimal function or cracks will begin to appear.
The take away message here is that our sense of proprioception is important to train and develop, as it allows us to interact with our environments without the dependence on visual feedback for a reference point.
What Causes This System To Become Dysfunctional?
It is clear that if you have poor proprioception at a joint it dramatically increases your chance of an injury for joints will be placed in highly compromised positions. There are a number of potential reasons for proprioception impairments with the most common factor coming from a lack of movement. This is another reason why inactivity is such a big problem in modern society for many people do not move anywhere near enough to keep systems like this running at optimal levels.
However, other factors such as aging also affect proprioception and this is a big factor to be addressed with falls prevention for older adults.
The risk of proprioception loss increases as we age due to a combination of natural age-related changes to the nerves, joints, and muscles but this loss can be slowed down considerably via a good strength training program that emphasizes functional movement. This is another reason why it is so important to keep exercising in your older years to avoid the loss of proprioception.
Injuries or medical conditions that affect the neuromuscular system can cause long-term or permanent proprioception impairment such as brain injuries, multiple sclerosis, strokes and Parkinson’s disease.
I have worked with many clients suffering with Multiple Sclerosis, spinal cord injuries, stroke and even cerebral paulsy and there is a significant loss of proprioception with their body that is noticeably seen when walking. Using exercises to enhance this can be very difficult and are often very scary to them as they feel vulnerable putting their body in those positions which helps to explain why they find walking so difficult.
The last factor that is very common relates to surgeries or injuries to a specific joint such as a joint replacement surgery, like hip replacements or knee replacements, as well as injuries like ankle sprains, ACL injuries, and shoulder dislocations where significant damage is created to all the supporting ligaments and tendons.
Before you can begin strengthening the muscles of an injured joint you need to work on the stability and motor control first. This is where physiotherapists will often use proprioception exercises to do this which brings me to the most important point about these exercises.
The Best Way To Access The Proprioceptive System Is With Your Eyes Shut
While the proprioceptive system does operate with your eyes open the easiest way to tap into it and try to develop is by closing your eyes.
Remember how I explained in the beginning how this system goes into hyper-drive when you try to walk around in the dark? When you deliberately exercise with your eyes closed you are accessing this system immediately as the main source of feedback to the body is shut down! It has no choice but to enhance the proprioceptive system to provide feedback as to where it is in the environment but like anything it takes a lot of practice to make it perfect.
Obviously you have to be careful about your choice of exercise to ensure it is safe but at the same time still be able to provide the necessary challenge to stimulate the body to make adjustments and adapt.
To help you out here are seven exercises you can use to do this which you can watch in the video below.
Single Leg Balance With Eyes Shut
This is a test often used by Physiotherapists when rehabilitating people who have suffered ankle sprains and a great exercise to improve ankle stability.
It can easily reveal the lost proprioception of the ligaments and tendons supporting the ankle joint and be a great way to begin the process of rehabilitation with minimal risk. It can be very frustrating at first while the body learns from the endless mistakes and also develops some endurance to ensure it does not fatigue too fast. It is also a great warm-up exercise to use before sports or workouts to prepare the body for balance and single leg stance.
Below is a screenshot of this exercise from the video above.
How to do the exercise.
1.Stand on one leg
2.Close your eyes
3.Count how many seconds you can hold it for
BOSU Squat With Eyes Shut
This is one of those exercises that is a lot harder than it looks. On first glance it looks really easy but the unstable surface coupled with eyes shut can force the body to move out of position really quickly forcing you to find the right amount of correction to maintain posture and balance.
This is a great exercises for anyone with lower limb injuries or learning how to squat correctly for the first time as it teaches you the correct position to maintain optimal balance for movement. I use this a lot with knee pain injuries in the beginning of the rehabilitation process to teach good squat mechanics before trying to load the muscles with strength methods.
Below is the screenshot of the exercise from the video at the start.
How to do the exercise.
1.Stand on the BOSU on the dome side
2.Close your eyes
3.Gently lower yourself into the squat position
4.Stand up and repeat
Shoulder Proprioception Test
This is another very simple drill that is more of a test than a specific exercise used to assess shoulder stability and joint control. While it is quite easy to do it can be very difficult for those who have had an injury or significant weakness in the shoulder that has compromised stability and ultimately the proprioception. You can use it as an ongoing exercise but it is unlikely to make any serious changes that are affecting the joint control.
As a test it is great for you cannot cheat on it so it is a reliable indicator of your improvement. Better exercises to improve your joint stability are exercises that improve the function of muscles supporting the scapula like the serratus wall slides, single cable push & pull, and rubber tubing drills.
I have taken a screenshot of this from the video earlier so you can see what minute mark I showed this exercise.
Read this article to see more about those exercises – How to improve shoulder and scapula stability
How to do the exercise
1.Stand about an arm length away from a wall
2.Put some chalk on the tip of your index finger
3.Reach out with one arm and index finger extended and touch the wall with your finger making sure you leave a mark with the chalk that you can see
4.Bring your arm back by side and close your eyes
5.Extend the same arm and finger again trying to touch the same mark you just made
6.If you are right on the same mark your proprioception is good.
Walking Backwards
This is quite an easy exercise to use but it does have an effect on the proprioception system that can be useful for some people.
When we walk backwards, it takes longer for our brains to process the extra demands of coordinating these systems. However, this increased level of challenge brings with it increased health benefits and could be something that helps an older adult or someone with extreme walking impairment that may be vulnerable to a fall.
I like to add the challenge of additional stability by using balance beam to encourage more foot stability at the same time as seen in the video below. There are many benefits to walking backwards for knee stability so it is a very simple exercise you could add to your daily routine.
Inline Stability Lunge With Eyes Shut
This is very similar to the BOSU squat in that at first it looks like a really easy exercise until you start doing it and find out how difficult it can be. This one usually reveals an unstable hip and brings into play reflex movements of the core.
It is impossible to initiate a reflex with conscious thought. For example, if you have to think about contracting your core before you pick up an object off the ground, it is already too late. Even if it was perfect the instant you get distracted, you will mess it up for your brain will lose its focus. Training conscious core control is not the best solution and a poor strategy over the long term. It serves a great purpose in the early days of corrective training, but to truly grasp the concept of stability you need to be exposed to more random and unconscious control.
This is the beauty of the stability lunge drill shown above that features 3 levels of difficulty all requiring this reflex stability skill.
The three levels are as follows.
1.Hands by your side
2.Hands behind your head
3.Hands behind your head and eyes closed
Each of the levels force the body to use greater reflex responses and to find a way to maintain optimal alignment and stability in order to move. Anyone with hip stiffness created by using the hips as the main driver of their stability will find this almost impossible. Why?
The hips can’t remain still and simultaneously move. Something must be sacrificed and it will be your stability so that you can move your leg in front of you. This is such an amazing drill to use with any person who is a risk of falling, as it simulates the falling response but without the risk of serious injury. Trust me when I say the fear of falling is very much the same. This is a key exercise we use with beginners and older adults when they begin training and is part of our assessment process.
It is also a key part of any program I use to improve gait for people with walking impairments.
You can read more about this in the article – The critical movement you need to improve the gait cycle
Kneeling BOSU Medicine Ball Overhead Toss
The BOSU is a great tool to use with all the proprioceptive exercises for it forces a reflex righting reaction that is hard to replicate safely with other exercises and movements. This time you get to keep your eyes open and have to keep your eyes focused on a moving object. This is almost worse as your body moves into extended positions that initiate high levels of instability that you must react to.
How to do the exercise
1.Kneel on a BOSU without your feet touching the ground
2.Hold small ball in one hand with your arm extended out to your right side
3.Slowly raise the ball above your head keeping your eyes firmly on the ball
4.Pass the ball into the other hand and hold it out to the left side
5.Repeat back in the other direction
Hip Airplane
This is easily the hardest of all the exercises as you do require much greater amount of strength than the previous exercises in combination with proprioceptive stability.
Due to the rotation of the hip in the air the body would normally begin to rotate inwards at the foot and the hip to follow. Unfortunately, the single leg stance prevents this from happening as you will fall over instantly. Instead, the body senses the loss of stability and begins to counter the rotation with an opposing rotational force to maintain the single leg stance.
This torsion effect is what engages the glutes, the muscles of the foot and ankle, and most importantly the VMO muscle of the knee. The VMO plays a pivotal role in providing knee stability and is often very weak with those suffering with knee pain.
The proprioception part comes into it when you take your eyes off the horizon. With the traditional single leg exercises you can keep your eyes fixed on a point ahead which enables you to maintain good balance and control. This version takes that ability away from you and forces your ankle and feet to work twice as hard which is fantastic for improving knee stability.
Do You Need More Help?
If you currently have knee pain, hip pain, or back pain I suggest seeking some help from a respected therapist or trainer before trying any of the following exercises. You might need to spend some time with simple exercises to ensure you can activate your inner unit stabilizer muscles. Often these muscles are very lazy or respond too slowly for people with injury exposing their spine to loads.
I do have online programs you can follow for all these types of injuries and I have given you an example of this below with the Back Pain Secrets program and Piriformis program that includes a PDF book and 90 minute online video where I take you through a series of detailed assessments, and a step by step process for addressing the cause of your pain.
Click here to download this online.
Summary
I hope this exercises gives you some great ideas about how to use proprioceptive exercises in your training to improve joint stability and body awareness. Like many advanced systems it needs consistent stimulus in order to remain at a high level of efficiency and once it is lost it is extremely difficult to restore it back to normal. The older you are or if you have an existing injury or illness the importance of these exercises rises significantly as any weakness with this will expose the body to falling or injury. Using exercises like these on a regular basis will ensure you don’t lose it.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Functional Anatomy of the Pelvis and the Sacroiliac Joint – By John Gibbons
•Movement – By Gray Cook
•Corrective Exercise Solutions – by Evan Osar
•Tight Hip Twisted Core – by Christine Koth
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Low Back Disorders – by Dr Stuart McGill
•Ultimate Back Fitness & Performance – by Dr Stuart McGill
•Psoas Solution – by Evan Osar
•Motor Learning and Performance – By Richard A Schmidt and Timothy D Lee
•Assessment & Treatment Of Muscle Imbalance – By Vladimir Janda