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