Acting on impulse

Throwing a ball in the air while standing on a balancing board is one example of proprioceptive retraining.

Photo by CPL Simone Liebelt

By Captain Gina Tilbrook

Proprioception is the general term used to describe the feedback loop and reactions to nerve impulses originating from joints, muscles, tendons and associated deep tissues.

These nerve impulses are processed in the central nervous system (brain) to provide information about joint position, motion, vibration and pressure. The resulting outgoing impulses from the brain trigger corrective reactions.

Proprioceptive retraining after injury is an important component of the rehabilitation process, particularly in the prevention of recurrence.

The ligaments and other structures in and around the joint have receptors within them which are an integral part of the proprioceptive system. Disrupting this system through injury can often result in reduced position and movement sense and a predisposition to further injury.

Basically, you cannot feel where your body part is in space without looking at it. This places you at greater risk of re-injury due to decreased compensation for awkward landings and poor foot placement on unpredictable or rough surfaces. Wandering around out bush in the dark can really test this system.

Proprioception can be retrained and facilitated in many different ways, but it must be appropriate to the stage of recovery of the injury.

As with all physical activity after injury, too much too soon can be harmful.

It is best to see your physiotherapist to make sure you are doing the right things at the right time and not disrupting tissue repair.

Sometimes the application of tubigrip or a bandage in the initial stages can give the tactile stimulus necessary to assist with joint position sense in the short term.

This can have the added advantage of reducing swelling through compression.

Proprioception exercises are a common means of retraining this vital system. These can be started with minimal weight-bearing, so this aspect of rehabilitation can begin relatively early on.

When early and comprehensive proprioceptive retraining is undertaken, objective improvement in proprioception can be demonstrated and there is a reduced rate of recurrence of injuries.

Balance exercises form part of proprioceptive retraining. Removing the input of other senses such as sight is a way of continuing these activities. Making the surface more unpredictable and decreasing the base of support are other ways we continue these exercises.

Double or single leg stance on the floor, gym mat, pillow, mini-tramp or balance board with concurrent tasks such as throwing a ball or hop and stop are examples of this progression.

The patient must use their proprioception to maintain balance and the reactions must occur in time, therefore the timing of these activities relative to the stage of recovery is vital to the success of the program and avoidance of further injury.

Early activities used to retrain proprioception can start from the most simple exercises such as standing on one leg or minimal weight-bearing activities like moving a tennis ball around in a pattern with your eyes open/closed while sitting.

The key to these activities is starting at the right point and gradual progression.

Hopping on a mini tramp and throwing a ball or running and weaving can progress on to stop/start or sport-specific activities and the final, more functional stages of rehabilitation.

Taking your recovery to these late stages of rehabilitation minimises the risks of re-injury and has you performing sport-specific, multidirectional tasks which closely mimic those performed during your chosen activity and training.