How Understanding Proprioception Can Reduce Pain, Improve Performance, and Keep You Healthier Longer
Aristotle may have identified the five senses of sight, smell, taste, touch, and hearing in his treatise, On The Soul, in 350 BC, but science has come a long way since then. It’s not just the fab five anymore. Your body also has its own sensory Global Positioning System, something Nobel Prize-winning neurophysiologist Charles Scott Sherrington labeled proprioception in 1906. It’s derived from the Latin words proprius— “one’s own,” and percepio– “perception.” Put simply, it’s your ability to sense your body’s position in space.
Proprioception is dropping your feet on the floor when you get out of bed in the morning without having to look down; keeping your eyes on your laptop at work while you reach for your coffee without spilling it; switching your foot seamlessly from the gas pedal to the brake in the car without bending over to look at the floorboard. You don’t need to think about it, and you don’t need to see your arms, legs, or feet for any of it to occur without incident— it happens automatically, outside of your conscious thought. And though proprioception occurs on a subconscious level, there are things you can do consciously to assess your proprioceptive sense and identify ways to improve it.
Proprioception can be diminished for a number of different reasons, from aging to chronic pain to poor postural habits, leaving you at greater risk of falls or injury. The good news is that there are simple, practical things you can do to develop and strengthen it, enabling you to move and feel better in your own body. But first, what is proprioception?
What Is Proprioception?
Tune Up Fitness co-founder Jill Miller has been studying proprioception her entire career, but the easiest explanation for the concept came in an impromptu conversation with her daughter Lilah, who was four years old at the time. “We were in the car and I said ‘Lilah, isn’t it cool that you can just think about your knee, and you can feel it without even touching it?’ There was a pause for several seconds, and then she said, ‘Yes. Pretend your brain is a finger.’ It was incredible. I said, ‘You’re right. That’s proprioception.’”
Count on kids to find easier ways to talk about concepts neuroscientists have been grappling with for centuries.
Whether or not to categorize proprioception as an add-on to Aristotle’s five senses depends on who you’re talking to. Structural Integrator David Lesondak, author of Fascia: What It Is And Why It Matters and host of the podcast “BodyTalk with David Lesondak”, shares the view of many when he refers to it as a sixth sense. “Culturally and colloquially we’ve talked about ESP as the sixth sense forever, but proprioception is the legit sixth sense,” he says. “It’s related to touch, but it’s not the same thing. It underlies every movement and gesture.”
Physical therapist Adam Wolf, founder of The Movement Guild in Chicago and author of Foundations of Movement: A Brain-Based Musculoskeletal Approach, thinks of it a little differently. “I don’t think proprioception is the sixth sense,” says Wolf. “I think it’s one of three systems in the body, the other two being the visual (eyes) and vestibular (balance) systems. Those three sensory systems give the various parts of your brain information, and it interprets it so everything can work together. In that way your brain is like the ultimate virtual reality machine.”
When listening to different professional and scientific perspectives on the concept of proprioception, it can sound more confusing than it actually is, because it often comes down to semantics. Jennifer Milner, Pilates trainer and host of the Bendy Bodies podcast, puts it succinctly and humorously when she says “This is absolutely a conversation that can devolve into a fist fight if you’re having it in the right group of scientists. It’s a complicated conversation, but to me, it’s just your body’s awareness of where you are in space.” Even better, Millner comes through with a Star Wars metaphor everyone can understand; “In the original movie, Luke is training on the Millennium Falcon with the lightsaber. Obi-Wan puts the helmet over Luke’s head so he can’t see and says ‘Just sense it. Sense what’s going on around you.’ That’s Luke’s proprioception getting stronger.”
So why should you care about proprioception?
Whether it’s a sixth sense as David Lesondak believes, or one of the three sensory systems that drives brain-based movement as Adam Wolf describes, it’s foundational to how we understand and use our bodies. “Can you imagine living in a house and not knowing what the couch or dining room is for?” asks Lesondak. “That’s often how we approach our bodies. But the more we’re in touch with what we’re feeling, the more likely our body will become our friend instead of something we have to fight or struggle with to have it do the things we want. And to me, that’s the real benefit of understanding proprioception. It gives you confidence about how to improve it.”
Before we take a deep dive on all things proprioception, let’s take a quick look at how it compares to three other terms commonly used in the same conversation as proprioception. They are all different processes, but work together to try to achieve homeostasis in physiological function.
- Proprioception (one’s own): The body’s sense of its position in motion or stillness. Knowing where we are in space.
- Interoception (inside): Sensations that originate inside the body. Originally was narrowly defined as sensations from the viscera (the organs in the cavities of the body, primarily the abdominal and chest cavities), but has now become more inclusive of other sensations including heart rate, breath, and even the felt experience of emotions.
- Exteroception (outside): Sensory inputs that originate outside the body, including sight, smell, touch, hearing, and taste.
- Kinesthesia: A subtype of proprioception, but instead of position sense, it detects movement or acceleration in the body.
Source: Meredith Stephens, DPT, MS, PT, LMT, ATSI, BTSI
Proprioception and Daily Activities
Proprioception is part of every move we make, every minute of every day, and no anatomical part may be a better example of this than the ankle. The retinaculum of the ankle— or the fascial band around your ankle— has five times as many proprioceptive nerve endings as anywhere else in your body. Jennifer Milner describes how this plays out in something as simple as stepping off of a curb onto the street. “If you’re walking down the street at night and it’s late, maybe the curb is bigger or higher than you thought it was going to be, so you start to twist your ankle. If you have a lot of proprioceptors down there, then you have a lot of voices shouting back up at your brain, ‘Hey, you’re about to twist your ankle. Right yourself, and fix it before anything happens.’ Your brain thinks ‘Oh my gosh, I’m about to sprain my ankle,’ and fixes it. If you have poor proprioception, then you don’t have a lot of guys down there ready and willing to work, so the message gets to your brain too late and you twist your ankle. It’s the difference between having a 5G network and the Pony Express.”
Are you worried you might have the Pony Express in your ankle instead of a 5G network? Here are some easy things you can do at home to support proprioception in your foot:
When Proprioception Goes Wrong
One of the easiest ways to understand proprioception is to hear the stories of those who’ve lost it, through injury or other causes. The most famous case is Ian Waterman, an Englishman who was the subject of the 1997 BBC documentary, “The Man Who Lost His Body.” Waterman was a 19-year-old employee at a butcher shop when a flu-like infection landed him in the hospital, and he woke up with a total loss of proprioceptive sense. The virus attacked his central nervous system and destroyed all proprioceptive sensory neurons, but left the motor neurons intact.
Neurons: Cells in the central nervous system that send and receive information to and from the brain.
The result was that Waterman’s muscles and limbs still worked, but he couldn’t feel where they were in space. “My limbs were dead to the touch,” he told the BBC documentary crew. Doctors told him he would likely never walk again, but he spent 17 months in a rehabilitation center, determined to avoid the wheelchair he was told he needed. Since Waterman couldn’t depend on proprioception to sense motion from his arms and legs, he had to figure out a workaround, and his eyes became his most valuable asset to regain the life he lived before the virus. In order to move any part of his body, he had to be able to see it while he moved it. “I had to look at everything to control it.” That meant looking at the floor and his feet every time he took a single step; it took him a full year to be able to stand safely. The damage to the nervous system was permanent, so to this day, Ian must focus intently on every move he makes with his body. Nothing happens automatically, the way it does for most people. The lights must be on at all times (if he can’t see what he’s doing, he may collapse), and his days are full of endless readjustments to his surroundings. Even something as simple as picking up an item at the grocery requires him to alter his stance for stability, otherwise a heavy piece of produce can throw off his physical orientation in space and lead to a fall. Despite all of this, Waterman has gone on to lead a full life, and has proven to be an inspiration to others who experienced sudden loss of proprioception.
Famed neurologist Oliver Sacks wrote about a similar experience he had with a patient in his 1986 bestselling book about neurological disorders, The Man Who Mistook His Wife For A Hat. Sacks treated a woman named Christina, who lost her sense of proprioception after a standard-protocol dose of antibiotics before gallbladder surgery caused acute inflammation, damaging some of her sensory nerves. While one hospital psychiatrist initially dismissed Christina’s condition as “anxiety hysteria,” Sacks and his team did a series of sensory tests that revealed a near-total proprioceptive deficit, similar to Ian Waterman’s experience. After Sacks explained to Christina the interdependence of the three systems of vision, vestibular (balance), and proprioception for body movement, the patient came to the same conclusion that Waterman did; her eyes must step in where her proprioception left her. She told Sacks, “This proprioception is like the eyes of the body, the way the body sees itself. And if it goes, as it’s gone with me, it’s like the body’s blind. My body can’t ‘see’ itself if it’s lost its eyes, right? So I have to watch it — be its eyes. Right?” As with Waterman, Christina’s damage was permanent, but as time went on, she was able to do many of the things she did before her hospitalization and injury, with accommodations.
While Waterman and Christina are good examples of people who have healthy limbs but no proprioception, neuroscientist V.S. Ramachandran has done groundbreaking work with patients who’ve lost a limb in an amputation or traumatic accident, but still maintain proprioceptive sense in that missing part of the body, a phenomenon known as phantom limb syndrome. Some of these patients experience the feeling of movement or pain in the spot where the limb was, and may complain that the missing limb feels locked in place, causing intense discomfort and cramping. In order to understand how this happens, we first need to understand that our brain has a sensory map that is spatially organized around the way we use our body. Certain parts of our body have more or less “space” in our brains, according to the level of activity. Dr. Meredith Stephens, a specialist in physical therapy, scoliosis rehabilitation, and healthy aging explains it this way: “If you’re a very good piano player, the representation of your hands in the brain map is going to be much bigger than it would be for me, because I don’t play a single instrument. If we think of it from a motor control perspective, when we stop moving things, we lose real estate in the brain. The map in our brain that helps us with the dexterity and movement of that part will shrink. Conversely, if we use something a lot, it gets more real estate in the brain.”
In his book The Tell-Tale Brain: A Neuroscientist’s Quest for What Makes Us Human, Dr. Ramachandran connects the phantom limb experience to the brain map. “Think of what happens when an arm is amputated. There is no longer an arm, but there is still a map of the arm in the brain. The job of the map, its raison d’être, is to represent its arm. The arm may be gone but the brain map, having nothing better to do, soldiers on. It keeps representing the arm, second by second, day after day. This map persistence explains the basic phantom limb phenomenon— why the felt presence of the limb persists long after the flesh-and-blood limb has been severed.”
Victoria C. Anderson-Barnes and her colleagues at Walter Reed Army Medical Center in Washington, DC hypothesize that this phantom experience is a result of something they call proprioceptive memory, suggesting that “the memories of the limb’s position prior to amputation remains embedded within an individual’s subconscious, and pain memories that may be associated with each limb position contribute not only to phantom limb pain, but to the experience of a fixed or frozen limb.” They propose that daily tasks and physical activity become part of a person’s proprioceptive memory bank, still embedded in the subconscious and easily accessible after amputation.
Dr. Ramachandran developed a technique to address the phantom limb experience called Mirror Visual Feedback (MRV), which he details in his book. “I placed an upright mirror in the center of a cardboard box whose top and front had been removed. If you stood in front of the mirror, held your hands on either side of the mirror and looked down at them from an angle, you could see the reflection of one hand precisely superimposed on the felt location of your other hand. In other words, you would get the vivid but false impression that you were looking at both of your hands; in fact, you would only be looking at one actual hand and one reflection of a hand.” Dr. Ramachandran instructed patients to move their hand, which “tricked” the brain into believing the phantom limb was moving as well, which often led to a reduction in phantom limb pain, or helped free the feeling of a frozen phantom limb. Though the exact mechanism for what produces the pain relief or unlocking of the phantom limb is unknown at this point, Ramachandran says in his book that he suspects the brain gets so many conflicting sensory inputs that it gives up and says “To hell with it; there is no arm.”
He discusses the mirror box experiment in more detail in his widely viewed 2007 TED Talk, 3 Clues to Understanding Your Brain.
How Does Proprioception Work?
So now we know what proprioception does, but how does it work? “You have these nerve endings called mechanoreceptors that are peppered throughout your fascial tissues at different depths,” says Jill Miller. “And they transmit information very quickly to your brain about where your parts are in relationship to each other.”
Mechanoreceptors: The nerve endings that relay specific touch and pressure-sensing information to the central nervous system.
“The mechanoreceptors are a system of five different sensory nerves, and they all have different functions,” says David Lesondak. “Some only engage when, let’s say you’re trying to lift a heavy object, and those mechanoreceptors that live near the joint spaces signal your brain about danger so you don’t overdo it. Some of the mechanoreceptors respond to fast, sudden movements and vibration, and some respond to long, slow traction or stretching. Others have a wide range of sensations from itching, to burning, to stinging, to the stroke of a paintbrush or feather, so they are sensations that are physical feelings. They’re not touch, per se, but they’re things we feel physically, and it’s all in the domain of the fascia and connective tissue. And what seems to happen is that when there is pressure or some kind of physical engagement of the mechanoreceptors, there is a very small piezo electric charge that causes the collagen fibers in the fascia to unwind in a particular way that transmits the signal to the brain. It’s a feedback loop that gives us a real-time assessment of how our limbs are working or not working.”
Piezoelectricity: the ability of certain organic materials to produce an electrical charge in response to mechanical stress. Piezo2 is one of the mechanoreceptors central to proprioception.
Scientists only recently discovered a very small number of people worldwide who are missing this piezo receptor— piezo2—which leaves them with very similar experiences to Ian Waterman and Oliver Sack’s patient, Christina, except the people without the piezo2 receptor are born with this genetic condition, instead of losing proprioception later in life due to an infection or other acute injury. According to an article published in Vox in 2019, a team of researchers at the National Institutes of Health and their colleagues around the world have only identified 18 cases, with the first two documented in the New England Journal of Medicine in 2016.
Dr. Wilbour Kelsick is a chiropractor and rehab specialist who works with private clients and athletes, and has been a member of the official staff of the Canadian National and Olympic teams for over 25 years. He says the key to optimizing proprioception is understanding it as something that doesn’t just live in the joints. “It’s a body-wide, integrated mechanosignaling system. That’s the most important thing to understand,” says Dr. Kelsick. “The way we’re taught anatomy and physiology is to look at the body in a very segmented way, but everything is connected. We move as a unit, and the gravitational field is acting on us as a unit. If a golfer is going to hit a ball, his vision is coordinating, but how much force is going to be in the feet? What is the arm going to be doing? The elbow has to talk to the knee, and the knee has to talk to the foot. The communication system has to work as a unit, and that’s what proprioception does.”
A key component of the “knowing where your body is in space” is adjusting to your environment. Jennifer Milner works with a lot of dancers, and noticed something about the way they move through rooms that broadened her understanding of how proprioception dictates how we interact with our surroundings. “I noticed when they’re not dancing, they’re hugging the furniture in the room; they’re walking close to a desk or chair,” says Milner. “I commented on that to a doctor friend of mine and he said, ‘Well, that’s proprioception. It’s just the body instinctively looking for something to tell them where they are. You put anybody into a room and they’re going to walk close to the table or close to the chair. Very few people are just going to wander through the open space.’ So it was fascinating to me to think of something bouncing off of myself, like sonar or radar.”
Take a minute and notice your own habits when you walk through a room. Even if the room is big, do you find yourself walking close to the wall, or near objects or furniture in the room? Do you bump your leg on the coffee table in the living room even if there’s plenty of space for you in all directions around it and you didn’t need to be so close to the table in the first place? That’s your body looking for something to tell it where it is.
Proprioception and Pain
Another practical reason to understand the concept of proprioception is its connection to pain. An increase in one inevitably leads to a decrease in the other. “Increase of pain is going to result in a loss of proprioception, period,” says Jill Miller. “Even if you don’t think you’re losing coordination, as your pain levels increase, your proprioception decreases. That’s just the way they work.”
Think of the brain map outlined earlier (the sensory homunculus), and the amount of space each part of your body takes up in that map. Pain has a direct impact on it. Adam Wolf summarizes it this way: “We know that immediately upon pain, the chemistry in your brain changes, and over time, that results in less representation of that body part in the brain. So that means if you have pain at a joint, either from a sprain or surgery, you’re going to have less proprioception at that body part.”
Part of the reason the brain chemistry changes is because pain changes the way we use our body, so the feedback loop between the mechanoreceptors and the brain is interrupted. “When we feel pain, we tend to not want to move the area because we don’t want to jar it and make it worse. It’s instinctive,” says David Lesondak. “And, unfortunately, if we do too much of that, it shuts down the proprioception. But if we can slowly induce more proprioception, the pain starts to recede and new opportunities for movement are created.”
A natural consequence of having a good proprioceptive sense is that you are better able to avoid situations that lead to pain or injury. “Proprioception is like a pain gate,” says Dr. Wilbour Kelsick. “If you think about proprioception in terms of maintaining kinesthetic sense, dynamic stability, and control, it prevents the body from getting to the extreme range. Because if the body has no sense of how far it’s going or how much things are being stretched, there is pain right away. Proprioception is like the guard that says ‘I’m here, because if I’m not working, things are going to go crazy and the body will send disinformation into the central nervous system.’”
Things That Can Negatively Impact Proprioception
- Poor postural habits
- Chronic pain
- Musculoskeletal injuries like sprains, broken bones, or torn ligaments
- Neurological or movement disorders like Parkinson’s Disease and Multiple Sclerosis
- Conditions that can result in neuropathy (nerve damage), like diabetes, infection, or vitamin deficiency
- Diseases of the fascia like Ehlers-Danlos Syndrome
Ehlers-Danlos syndrome is an inherited disorder that causes hypermobility of the joints because of an abnormality related to collagen protein. Collagen is a key component of fascia, and if it’s not producing or processing normally, the mechanoreceptors can’t effectively participate in the feedback loop with the brain to support healthy proprioception. Not everyone who is hypermobile has EDS, but many still experience hypermobility in their joints and struggle with proprioception. “Some with hypermobility don’t always sense when enough is enough,” says David Lesondak. “They might go too far because they’re not getting enough feedback in the mechanoreceptors of the fascia.”
Jill Miller has been hypermobile her whole life, culminating in a total hip replacement at the age of 45 in 2017. The dramatic surgery upended everything she thought she understood about her own proprioception. It set her on a course that would bring her back to herself, and help others who have been in similar situations.
Desk Life and Proprioception
Even if you don’t have hypermobility or another underlying condition that negatively impacts proprioception, modern work life can have a dramatic impact on your proprioceptive sense. If you sit all day long at a desk, it’s important to be proactive about enhancing proprioception so you can reduce the risk of injury.
Dr. Aracelly Latino-Feliz is the founder of The Movement Therapy Institute in Florida and sees how this impacts her clients. “Even if you’re a healthy person, if you’re sitting in a chair for six or seven hours, your body is adapting to being in that position,” says Dr. Latino-Feliz. “Your proprioception will be altered after sitting that long. So you need to understand how it affects your performance so you don’t get injured when you go for a run after work.”
If you’re living the desk jockey life, there are some quick things you can do after work to bring your body back on board, and boost proprioception before you work out. First, show some love to the front of your hips and thighs, which have been curled up in a seated position all day.
Another important area to “wake up” is your glutes, which have borne the brunt of your long days in the same chair, participating in one zoom meeting after the other.
Test Your Proprioception At Home
Are you curious about your own proprioceptive abilities? There are some easy things you can do at home to gauge proprioception, and this allows you to discover parts of your body that need more attention. When you do a proprioception self-test at home, you may find that there are areas that don’t cooperate the way you expect them to. Jill Miller calls these body blind spots. “These blind spots are areas of overuse, underuse, misuse, or body confuse,” says Miller. “And it’s the confusion that I personally find the most intriguing, because it’s a failure of your body to give you feedback about where it is.”
Here’s a simple balance test you can take at home to gauge proprioception:
How To Improve Proprioception
The most exciting news about proprioception is that there are a lot of things you can do on your own to maintain or improve it. It will give you a better sense of how your body is moving, reduce pain, and reduce injuries. “When you think about it, we cultivate our senses, don’t we?” says David Lesondak. “People can cultivate a phenomenal palate for wine, or particular types of spices, or certain kinds of auditory or visual acuity. It’s the same thing with proprioception. It’s a sense you can cultivate, and the more you cultivate it, the more exquisite it can be.”
Tips To Improve Proprioception
- Move. Hike, walk, run, dance, do yoga, or any other physical activity that you enjoy.
- Slow down. If you are trying to correct a movement pattern that has been altered due to injury or surgery, slow it down and take time to really perceive the information coming into your central nervous system.
- Do movement work in front of a mirror. This will give you additional visual input to help with error correction. Seeing yourself out of balance helps you make the right positional change and strengthens the brain/body connection.
- Do weight bearing exercises.
- Try fascial bouncing. Jump up and down 50 times (or stomp your feet if you have arthritis or other pain) to wake up your entire connective tissue system.
- Walk barefoot on uneven surfaces. The beach, sand boxes, or outdoor areas with small pebbles give your feet opportunities to walk on something other than concrete in stiff shoes.
- Challenge your balance. Face the wall and stand on one leg. Hold a small ball or washcloth in your hand and write the letters of the alphabet on the wall with your eyes closed.
- Breathe. Use your breath to heighten awareness of your ribcage, noticing the expansion through your belly and the rest of your body.
- Touch. Bring awareness to any part of your body by touching it with your hands, therapy balls, soft foam rollers, or other props. Dry brushing your skin and tapping also heighten sensory inputs.
If you want to try a proprioceptive exercise that puts all of these concepts together, giving you a practical sense of how your tissues communicate with your brain to move your body, try one of Jill’s favorite moves, propellor arms:
Understanding proprioception and doing the small daily or weekly activities to support it can have a lasting impact on your health and mobility. Aging is unavoidable, but how we age is up to us in more ways than we often understand. You can be your own health care provider today, and reap the benefits for decades to come. “Prevention starts now,” says Jill Miller. “Slips and falls are the most deadly injuries to people over the age of 80. A fractured hip is the leading cause of death in the elderly, and those fractured hips come from slips and falls. And slips and falls happen because of a lack of proprioception and coordination. You can begin building your confidence and your body competence now.”
David Lesondak believes understanding proprioception allows your body to become your best friend. “When I work with my patients, I often hear the word want. ‘I want more confidence in my body to do X.’ And they get to the point where they feel like they have a new relationship with their body, and it’s their friend now. And to me, that’s the secret sauce. That’s the real gift you get from proprioception.” For even more on building proprioception, see Jill Miller’s new book Body by Breath.
Ready for more?
Now that you have a better understanding of what proprioception is, here’s a quick introduction to its sister sense, interoception. If proprioception is understanding what’s happening to your body in space outside, interoception is what’s happening inside. And just as you can take matters into your own hands to improve proprioception, there are things you can do to support interoception. Here’s a look at what it is, and how you can enhance it.
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