Proprioception and Balance
Proprioception; The unconscious perception of movement and spatial orientation arising from stimuli within the body itself
Balance; The ability to stay upright or stay in control of body movement
Proprioception and balance are different, but are very closely linked in human function. Both are hugely important in daily life, but become even more important in the sporting environment. Every movement we do in any position involves a massive amount of sensory feedback between the central and peripheral nervous system, this gives us the ability to maintain control whilst performing advanced skills at high speed.
A traditional approach to balance and proprioception in the therapy setting, involved exercises such as standing on one leg and then decreasing support by standing on a unstable surface. This is almost the opposite of what the nervous system requires, and provides very different information compared to upright functional activities. We are looking at an activity that has little to do with our end game and saying that this provides information to help? This is a very big gap as the joint position, motions and drivers and completely difference. The brain desires information, information is derived from movement, traditional balance exercise seeks to decrease movement, therefore decrease information.
We need to think about ‘What information’ we are giving to the body and is it authentic to the task. Standing on one leg and saying that it provides proprioceptive input and test balance is true, what is also true is that any movement the human body goes through requires these two attributes. Our aim when looking to emphasize these two areas should be, ‘how can I provide information to the nervous system to improve function?’
To understand proprioception further we need to look at what provides the information? MOVEMENT
Pacinian corpuscles – found in the joint capsule with a greater distribution in the distal joints, respond to high velocity changes in deceleration and acceleration.
Golgi-mazzoni corpuscles – found in joint capsule and respond to joint compression and stretch.
Ruffini endings – located in joint capsule, sensitive to amplitude and velocity of joint changes particularly in the transverse plane.
Golgi ligament endings – dense in the ligament to bone attachment respond to tension and stretch
GTO’s – respond to contraction and stretch of muscles
Muscle spindles – sensitive to the amount and rate of length change in muscle
– Gary Gray (Proprioceptors)
How many of these proprioceptors are we turning on when we stand still on one leg??
Maybe a more effective way is to look at the biomechanics of the action or movement we are trying to assist and attempt to work on those tri-planar real and relative joint motions.
If we take a look at the back hip in the golf backswing, we see that the hip has to go through the tri-plane motions of flexion, adduction and internal rotation to load the posterior hip muscles This motion creates a huge eccentric lengthening to the muscles, joint capsule, ligaments of the back leg and creates real and relative joint motions that all provide huge amounts of information to the CNS and PNS. If we want to feed into this proprioceptive motion and increase the demand with a balance task, an example could be a right leg stance (with hip and knee flexion) and left toe touch then driving motion top-down from the trunk to create the desired motions at the hip. Raising the left foot, tweaking the speed, adding weight, changing the driver to emphasize one plane etc, can increase the demand of this balance exercise.
In conclusion, standing on one leg is a commonly used balance exercise but, does it tell us much about the activity or movement, which we are trying to assess? How many of our peripheral proprioceptors are we ‘turning on’? Is it task specific and related to the individual client?
Balance should be looked at as the ability to control your centre of mass in all planes, by moving and returning to starting position.
-Gary Gray – www.GrayInstitute.com. FVDS proprioceptors
-Nike Golf 360 Performance program