The Importance of Proprioception in Physical Therapy
Proprioception uses sensory cues from your eyes, ears (as a part of the vestibular system), the injured area, and the brain processing the information and communicating back to the injured area (such as the shoulder).
Proprioception is like a computer system- constantly sending out information and processing feedback as every action, each second, is taking place.
Proprioception is a term that describes muscle memory, balance (compared to the uninjured side) and the communication between what your brain “wants the injured area to do” and what the injured area “actually does”.
Does the PT Involve Proprioception Exercises/Therapy?
After an injury (and often after surgery), the area of the body that gets injured not only has the obvious abnormal physical findings(such as swelling, inflammation, damage to muscles (or ligaments or tendons or bone) that can be examined or seen on xray/MRI), but likely also has disrupted proprioception(tested with functional tests but not seen by looking at the injury or an xray). Essentially the injured area “forgets” what to do (or “the muscle memory goes to sleep” or “slows down”) - even if the skill to be accomplished was “seemingly easy” for the athlete before the injury.
For instance (a knee injury in a gymnast), a straddle jump on beam and the landing may be “simple” for a Level 10 gymnast. After an injury though (due to quads not firing correctly, joint swelling, kinetic chain compensation, and decreased proprioception) that “simple” straddle jump may result in worsening the knee injury and even a secondary injury to the ankle. What the coach and athlete may think is “easy” could be a predicted catastrophe if the PT says the athlete’s proprioception isn’t ready yet. It’s the case that “has had such bad luck this season, she hurt her knee and then the next week she injured her ankle” (that may not have been “bad luck” after all…) perhaps it could have been predicted knowing about proprioception, and with the PT understanding the sport they may efficiently and safely progress the athlete back with less risk for re-injury.
Proprioception exercises for a lower extremity injury might include balance skills, one legged skills with your eyes open, the same one legged skills with your eyes closed (if safe), and if the sport is in different positions (a gymnast is often upside down for instance) then the proprioception skills should be in all the positions the athlete will be expected to do during practice as well!The PT should not only be looking at the site of the injury (to see how it responds)- but also the speed, strength, and ability for the athlete to respond safely to altering challenges and at the skill level that will be expected for the athlete during a practice and eventual competition.
A football lineman should be able to get out of a three point stance and protect himself (function and proprioception!), a soccer player should be able to symmetrically lunge to the right and to the left while kicking a ball (function and proprioception!), and a gymnast should be able to balance on each foot symmetrically on a beam before progressing to a series!
Does the Physical Therapist Involve Multi-Planar Exercises/Therapy?
Most sports involve movements in all planes- a sprinter is mostly competing in the sagittal plane and a swimmer is mostly working in the sagittal plane as well as some rotation/oblique movements.Most athletesthough (a gymnast, dancer, wrestler, soccer, volleyball, baseball, football athlete) use ALL THREE planes ALL THE TIME!
- Forward and Backward (sagittal)
- Side to side (coronal)
- Rotation right and rotation left (rotatory or oblique)
Driving analogy: If you went to driving school and only worked on going straight (slowly and quickly) and then after school went on the road by yourself and had to park, turn onto a different street, or merge onto the highway without any practice with theses challenges in the class room (like the PT clinic) before “going live in traffic” (like practice or competition)- don’t you think your chances for a car accident (or a re-injury) would be huge!?
If the PT is working all three planes with exercises/therapy- then the athlete is preparing to return to practice/competition with the least risk of re-injury or a secondary injury. If the PT is only doing exercises in the sagittal plane (for instance) then the day the athlete returns to practice and is required to do a skill to the right/left or rotates- they likely won’t be prepared (and the injury will not have been fully tested in the safe environment of the PT clinic beforehand) and a re-injury / new injury is much more likely.
Not only must the PT (and athlete and coach) consider the injury and the necessary healing time and exercises required for recovery- the PT must consider the rest of the athlete’s body (the kinetic chain), proprioception (muscle memory), and the strength and mental readiness of the athlete to return to a certain skill and eventually competition– each decreases the risk for a second injury and increases the probability for success!
Using a team of quality specialists that communicate well together and each understanding the injury, the sport, and the individual goals is the best way to get back to sport as quickly and safely as possible.
Saint Luke’s Sports Medicine Specialists
Board Certified Pediatrician with an interest in Sports Medicine
Concussion Management Team