Proprioception and personal training: Part I

There are words that float around the movement world that end in e-p-t-i-o-n. I say movement world, because often personal trainers ignore the ones that deal more with mind and body, while most of the movement world does not. Hopefully, I can shed some light on some of theses words including their relevance to movement and exercise, and how they can be applied in an individualized or group setting, beginning with proprioception.

Proprioception can be defined simply as body position (Johnson and Stuccos, 2010). Sensory receptors provide information to the brain via the afferent branch of the nervous system, allowing recognition of where the body is located in space. Sensory receptors are found in the joints, skin, and muscles, giving our brain an idea of where our body is located. Proprioception generally refers to both static limb position and kinesthesia. which is defined as the conscious recognition of the rate at which movement occurs (J&S, 2010). As most people involved with any form of movement practice know, sometimes our perception of where our limbs are located and the actuality of where our limbs are located are not the same thing. (“Place your feet so they are parallel with each other.” Clients moves feet from extremely duck footed to moderately duck footed. “Does that feel parallel?” “Yes.” “Glance down at your feet.” Client looks giving me a slightly incredulous look, as though I somehow rigged the floor). Since proprioception is dependent upon joint position, it will be affected by degrees of freedom in the joint. Degrees of freedom of a joint simply refers to the amount of ways a joint can move; this becomes interesting in more complex movements (Magill, 2011). The amount of ways one can throw a baseball, for instance, is dependent upon the amount of movement that can occur at the individual joints that make up the throwing motion. Since this is a total body movement, variability is dependent on many different joints. If movement is restricted at one joint, this affects the degrees of freedom available at that joint and the proprioceptive awareness available to the individual. For instance, if you ask someone that lacks the mobility/triceps strength to straighten the elbow and straighten the arms completely, there will still be a slight bend in the elbow. The person will sense it is straight; it is as straight as that joint position will allow. Again, this is an example of proprioceptive perception versus proprioceptive reality. 

Something else that influences proprioceptive awareness is injury. Lephart et al., (1997) suggest the neuromuscular feedback mechanism associated with proprioception is altered with injury and abnormalities. When looking at joints with multiple degrees of freedom, such as the shoulder joint, the ability of the humeral head to return to proper alignment in the glenoid fossa is dependent upon mechanical factors (joint capsule and labrum) and sensorimotor sense (proprioception, joint position sense, and neuromuscular control). (Myers, J.B., et.al, 2006). This means that if you are working with someone who has suffered any past injury, if you want to improve coordinated movement, at some point you will have to address sensing how movement is taking place. In the case of the shoulder, for example, teaching someone to feel shoulder blade movement versus glenohumeral movement will begin to tap into the body’s internal map of how things move. Giving alternative ways to perform the same movement can be effective forms of neuromuscular training.* For instance, ask someone to lift the arm by allowing the hand to guide the movement, and then have the same person lift the arm with the shoulder initiating the movement. The person’s experience will be different in both scenarios. Another example would be having the person keep the shoulder blade still versus allowing it to move as the arm raises. These types of drills enhance body sensing and begin to improve proprioception. (I will discuss interoception, or the internal sense of what is happening, in my next blog). 

One way to improve motor control is via cognitive programming, or bringing conscious awareness to an area. Examples given by Glenna Batson (2008) in an excellent paper on dancers and proprioception can be easily applied in the personal training world. Have your client lie down on his back with his legs extended and his eyes closed. Place his right arm in a specific position. Ask him to do place his left arm in the same position as his right. If this poses a challenge, working on improving neuromuscular coordination via proprioceptive training might be indicated. You can also ask the person to sit down and close his eyes. Move the foot down. Ask the client what way the foot is moving. Again, this seems simple, but if there has been any sort of injury, including an ankle sprain, this will be difficult. If you work with anyone in a post rehabilitative setting that has experienced nerve damage, including disc herniations or repairs, this type of work can begin to help the client recognize how his previously painful limb moves in space. You can improve the subtlety, working on areas like toes or fingers, once the person connects with how the wrists or ankles move. 

If you work with the general public, chances are high you at some point will encounter someone that is disconnected with how the body moves. Latash (2012) says in his discussion on proprioceptors, “[The information provided by propioceptors] is vital for planning human actions and their correction in cases of unexpected changes in external forces, motor goals, etc.” External forces and motor goals make up the bulk of any sort of movement session, making proprioception kind of an important component. 

Proprioception appears to often be impaired in those with hyper mobility (Clayton, et.al, 2015). If you work with any group where hyper mobility is favored, such as dancers, high level yogis (this is a thing), or other acrobatic types, working on proprioception can be an excellent way to enhance their movement experience. Have you ever noticed that sometimes when you ask someone to perform a body weight exercise, such as a squat, things don’t always go so well? The understanding of how to move and how to perform the exercise is disconnected. However, if you add an external load such as a kettle bell and have him perform the squat holding load, things suddenly look much better? Proprioceptors are sensitive to physical variables including muscle length, velocity, and force (Latash, 2012). External load sends sensory input to the nervous system, influencing postural control, motor control, and ultimately movement. In my experience, adding a little bit of external load to individuals that are unsure of their spatial orientation and how they are moving can do wonders to improve movement quality. This cuts down on extra cueing and generally keeps both the client and the trainer a little bit calmer (if you have ever tried to cue someone out of what is clearly a motor control issue, you will understand what I mean).

Other forms of proprioceptive feedback that can be easily implemented are using the wall (“move the butt to the wall,” for instance, works well for teaching hip hingeing), teaching movements in supine first, emphasizing the sense of various body parts on the floor, and using any form of tactile object as a reference point. (“Press your forearms into the block,” “press your knee gently into the band without changing your foot position,” and “feel your front hip bones against the tubing,” are all tactile cues I use regularly). Having the client reach towards something or away from something can also be useful ways to emphasize the client’s physical relationship to something in space. If I am working with someone that struggles with proprioception, I generally pick one thing to work on for two or three weeks. This way, I don’t overload the nervous system with input about body parts. Taking the time to improve proprioceptive awareness in clients will not only improve their experience in the gym; it brings awareness into their daily movement patterns, enhancing physical as well as mental well being.

Yours in health and wellness,
Jenn

*Joint position is dependent upon the system. Looking at just shoulder position and not taking into things like rib cage and pelvis position do not address the body as an integrated system. While this is outside the purpose of this specific blog, I felt it worthwhile to note.
**For more blog reading on this topic, check out Aaron Swanson’s series on this topic: http://www.aaronswansonpt.com/coaching-cueing-part-6-proprioceptive-cues/.
Dean Somerset featured a guest post by Travis Pollen on this topic recently. His blog can be found here: http://deansomerset.com/one-weird-trick-to-improve-exercise-technique-instantly-proprioceptive-stimulus/

References:
Johnson, E.O., & Soucacos, P.N., (2010). Proprioception. In: JH Stone, M. Blouin, editors. International Encyclopedia of Rehabilitation. http://cirrie.buffalo.edu/encyclopedia/en/article/337/
Lephart, S.M., Pincivero, D.M., Giraldo., J.L., & Fu, F.H., (1997). The tole of proprioception in the management and rehabilitation of athletic injuries. American Journal of Sports Medicine, 25(1), 130-137.
Myers, J.B., Wassinger, C.A., & Lephart, S.M., (2006). Sensorimotor contribution to shoulder stability: effect of injury and rehabilitation. Manual Therapy, 11(3), 197-201.
Magill
Batson, G., (2008). Proprioception- what is it? International Association for Dance Medicine & Science. https://www.iadms.org/?210
Latash, M., (2012). Fundamentals of Motor Control, Elsevier: New York. 
Clayton, H.A., Jones, S.A., & Henriques, D.Y.P., (2015). Proprioceptive precision is impaired in Ehlers-Danlos syndrome. Springerplus, 7(4), 1-24.