Elsevier

Manual Therapy

Volume 20, Issue 3, June 2015, Pages 368-377
Manual Therapy

Masterclass
Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions

https://doi.org/10.1016/j.math.2015.01.008Get rights and content

Highlights

  • Proprioception can be disturbed due to multiple causes in musculoskeletal disorders.

  • This can lead to sensorimotor control alterations and long term consequences.

  • Tests and interventions targeting proprioception should be considered in the clinic.

  • Any exercise stimulates proprioceptors but various exercises affect CNS differently.

  • Specific proprioception training should not provoke pain, effusion or fatigue.

Abstract

Introduction

Impaired proprioception has been reported as a feature in a number of musculoskeletal disorders of various body parts, from the cervical spine to the ankle. Proprioception deficits can occur as a result of traumatic damage, e.g., to ligaments and muscles, but can also occur in association with painful disorders of a gradual-onset nature. Muscle fatigue can also adversely affect proprioception and this has implications for both symptomatic and asymptomatic individuals. Due to the importance of proprioception for sensorimotor control, specific methods for assessment and training of proprioception have been developed for both the spine and the extremities.

Purpose

The aim of this first part of a two part series on proprioception in musculoskeletal rehabilitation is to present a theory based overview of the role of proprioception in sensorimotor control, assessment, causes and findings of altered proprioception in musculoskeletal disorders and general principles of interventions targeting proprioception.

Implications

An understanding of the basic science of proprioception, consequences of disturbances and theories behind assessment and interventions is vital for the clinical management of musculoskeletal disorders. Part one of this series supplies a theoretical base for part two which is more practically and clinically orientated, covering specific examples of methods for clinical assessment and interventions to improve proprioception in the spine and the extremities.

Section snippets

Role of propcrioception in sensorimotor control

Sensorimotor control refers to central nervous system (CNS) control of movement, balance, posture, and joint stability (Lephart et al., 2000, Franklin and Wolpert, 2011). Well-adapted motor actions require intact and well integrated information from all of the sensory systems, specifically the visual, vestibular and somatosensory systems, including proprioception (Ghez, 1991, Lephart et al., 1997). Proprioception involves conscious or unconscious awareness of joint position (joint position

Assessment of proprioception

A variety of tests have been developed to investigate proprioception in individuals with musculoskeletal disorders. These tests assess which individuals have significant impairment and are valuable for the guidance and evaluation of rehabilitation interventions.

Causes of altered proprioception

Disturbed proprioception has been found to be associated with several musculoskeletal disorders and/or experimental conditions following pain, effusion and trauma as well as fatigue.

Consequences of altered proprioception

In the short term, disturbed proprioception is likely to have adverse influence on feedback and feedforward motor control and the regulation of muscle stiffness. This may explain clinical symptoms such as balance disturbance and clumsiness in musculoskeletal disorders (Treleaven, 2011). It may also explain various sensorimotor dysfunctions (besides increased errors in specific proprioception tests), which have been reported in the research literature. These dysfunctions include reduced drive to

Interventions to improve proprioception

Based on neurophysiology and the causes behind disturbed proprioception, several interventions may be considered for enhancing proprioception. In this paper, the theoretical basis behind general methods that aim to either reduce inhibition of proprioception or to improve proprioception are presented. Part 2 of this Masterclass offers specific clinical examples and research regarding interventions effects to improve proprioception, with specific clinical examples for the extremities and the

Summary

Proprioception is essential for effectual sensorimotor control, with important roles for feedback and feedforward control and the regulation of muscle stiffness, which are important for movement acuity, joint stability, co-ordination and balance. Cervical proprioception is distinctive due to neural connections to visual and vestibular systems, and its specific role for eye–head movement control. Proprioception can be disturbed in musculoskeletal disorders due to multiple causes including pain,

Acknowledgement

Ulrik Röijezon was partly funded by grants from the Swedish Council for Working Life and Social Research (2010-0814).

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