Proprioception

What is proprioception?

Proprioception is your body’s ability to sense its own position and movements. It’s an automatic or subconscious process. Proprioception allows your brain to know the position of your body in space without having to rely on visual input alone. It’s also crucial to maintaining balance.

Kinesthesia, or kinesthesis, is the ability to use proprioception and other functions to generate body movement and learn a variety of physical skills. Kinesthesia is a behavioral process that allows your body to detect a movement and learn how to improve on the movement.

Proprioception and kinesthesia make it possible to do a variety of tasks, like tossing something in the trash or eating food with a spoon. It’s also essential for complex skills, like doing a backflip on a balance beam. Without this complex sense, life would look and feel pretty different.

Examples of proprioception

Examples of automatic proprioception and kinesthesia include:

• If you’re walking on a gravel driveway that has large, uneven stones, your body adjusts the muscle tension in your feet and legs to maintain your balance and walk smoothly
• If you have an itch on your nose, your brain and body know how to effortlessly bring your arm and hand to your nose to scratch it without looking at your arm or needing to see your nose
• If you’re holding a heavy object, your body knows how much strength (force) you need to hold it while maintaining your overall balance

Kinesthesia plays an important role in learned movement patterns, like those necessary to play various sports or do physical hobbies. It takes conscious effort and practice to fine-tune these skills. Some people refer to it as “muscle memory:”

• Learning to ride a bike involves various coordination skills (like pedaling and steering) and maintaining balance.
• A skilled pianist can move their fingers and play a song without looking at the keys.
• Soccer players learn how to kick and manipulate the ball in very particular ways using specific muscles and amounts of force in their legs and feet.
• Bowlers learn how to hold, throw and spin a bowling ball in certain ways to knock over various patterns of pins.
• A skilled gymnast can keep track of their position as they’re flipping or spinning in the air so they can land properly.

What body systems are involved in proprioception?

Proprioception is a very complex process — and it happens without you realizing it. Parts of your body involved in proprioception include your:

• Brain: Several parts of your brain work together to process sensory information, especially the cerebellum, brainstem and sensory cortex. Your brain interprets how you perceive your body’s position and acts on it.
• Peripheral mechanoreceptors: Mechanoreceptors are in your skin, muscles, ligaments and tendons, and near your bones and joints. They can detect various forms of stimuli, like touch, pressure, stretching, vibration and motion. They sense the internal forces acting on your body and send this information to your brain.
• Peripheral vestibular system: You have five organs in your inner ear that sense information your body needs to maintain balance, like your posture, position and movement. They send this information to your brain.
• Eyes: Through your vision, your eyes send information to your brain about your position in space and objects around you. But you can have effective proprioception without vision. For example, people with a healthy sense of proprioception can close their eyes and accurately touch their fingers to their noses.

What are the signs of poor proprioception?

Signs and symptoms of proprioception dysfunction or poor proprioception may include:

• Balance issues, which can lead to frequent falls.
• Clumsiness, like accidentally running into objects around you.
• Dizziness.
• Issues with spatial awareness.
• Uncoordinated movements.
• Using too little or too much force for actions (like using too much pressure when writing).
• Under- or over-shooting actions (like missing an object when you reach for it).

These symptoms and behaviors can affect people at any age. But in general, your risk of proprioception issues increases as you age due to the natural deterioration of your joints, muscles, nerves and brain.

What conditions affect proprioception?

Some examples of injuries, conditions and situations that can affect your sense of proprioception include:

• Alcohol intoxication
• Ataxia
• Autism spectrum disorder (ASD)
• Joint injuries (like a sprain) or conditions (like arthritis and joint hypermobility syndrome)
• Joint replacement (arthroplasty)
• Limb loss (amputation)
• Neurodegenerative conditions, like multiple sclerosis (MS), Parkinson’s disease and Huntington’s disease
• Neuromuscular conditions, like amyotrophic lateral sclerosis (ALS) and muscular dystrophy
• Peripheral neuropathy
• Sensory processing disorders, including dyspraxia, postural disorder and sensory under-responsivity (SUR)
• Traumatic brain injuries (TBIs) and stroke
• Vestibular disorders, like vertigo and Ménière’s disease

These conditions may cause temporary or long-term (chronic) proprioception issues.

Testing for proprioception

Healthcare providers and sports therapists can use several tests to assess different aspects of proprioception. Some examples include:

• Romberg test: This is a simple physical test to determine if the dorsal column pathway of your brain and spinal cord, which controls proprioception, isn’t working properly. The test involves standing with your feet together and your arms at your side or crossed in front of you. Part of the test is with your eyes open, and the second part is with your eyes closed. Your provider observes you during the test and notes any signs of imbalance, such as swaying.
• Heel-to-toe test (tandem gait): Your provider will ask you to walk in a straight line so that the toes of your back foot touch the heel of your front foot at each step.
• Heel-to-shin test: For this test, you place the heel of one foot on the shin of the other leg and then slide your heel down your shin in a straight line toward your foot.
• Finger-to-nose test: Your provider asks you to reach for their finger with an outstretched arm and then touch your own nose with the same arm/hand. You repeat this process several times.

Physical therapists and sports therapists may use specialized equipment to assess specific joints for proprioception. The names of these testing techniques include:

• Threshold to detection of passive motion (TTDPM)
• Joint position reproduction (JPR), also known as joint position matching
• Active movement extent discrimination assessment (AMEDA)

What are exercises that can improve proprioception?

Whether you’re an athlete wanting to prevent injuries or fine-tune certain skills or someone with a condition that affects your proprioception, physical therapists may be able to give you specific exercises to improve this sense.

Proprioception involves many body systems and, essentially, all the skeletal muscles and joints in your body. Because of this, physical therapy exercises to improve your proprioception will target specific joints and muscles. They may also strengthen your sense of balance, like one-legged balance or walking in a straight line (like on a balance beam).

Physical therapy may not be able to help some causes of proprioception issues, like permanent brain damage. If proprioception issues affect everyday activities, an occupational therapist can help you find new ways of doing tasks.