Proprioception As The First Step To Recovery
One of the first exercise programs that I give chronic pain patients is single-leg balance training. This may seem odd, but there is a method to the madness. Studies show that those suffering from chronic pain, such as low back pain, consistently have worse proprioception than the pain-free subjects. In fact, the more research done on proprioception, the stronger this link between poor proprioception and musculoskeletal problems.
Proprioception refers to the system your muscles and joints use to know where they are in space. For example, you can close your eyes but still touch your nose. You can do this because, even without looking, you know exactly where your arm is and the path that it needs to take to get to your nose. This ability is possible through proprioception.
The trouble is that proprioception does not appear to work as well in individuals with muscle and joint problems, especially if these problems are chronic. As just one example, studies have shown that those suffering from fibromyalgia rely more heavily on their visual system than on their proprioceptive system for body positioning sense. Similarly, some of the major muscles responsible for proprioception in the low back are atrophied (shrunk) in those suffering from chronic back pain. This contributes to the finding that those with back pain have significantly worse balance when the eyes are closed (eliminating the visual system) than those without low back pain.
The body uses this proprioceptive system to provide stability. For instance, if your brain interprets instability at your pelvic region, it will increase the stiffness of the muscles around that region to provide the needed stability. But what if your balance and stability is significantly asymmetrical? I often have patients stand on one leg to determine if their balance is better on one side versus the other. In patients with a lot of musculoskeletal problems, there is always a dramatic difference. This makes sense. If the body feels less stable standing on your right leg than on your left, it will increase the stiffness of your muscles on the right more so than on the left. The result is significant left-right muscle imbalance.
You may be thinking, “but I don’t spend much of my time standing on one leg, so who cares?” But in truth, you spend quite a bit of time on one leg. Every step you take in your gait cycle involves a stance phase that requires supporting yourself primarily on one leg. This phase makes up 60% of your gait cycle. Granted, each stance phase does not last very long relative to our time, but in “nervous system time” it is significant. If every time you walk, your nervous system is getting asymmetric signals regarding stability, muscle imbalances become inevitable. As discussed in another article, these muscle imbalances can lead to all sorts of problems.
There are a lot of complex programs to re-train proprioception. Many can involve expensive equipment and in-depth instruction; however, I find it is best to start with the basics. Most all my chronic musculoskeletal pain patients are placed on a simple, at-home proprioceptive program that does not require any special equipment. It progresses slowly, with the end-goal being a stable, symmetric foundation at the ankles, knees, hips, and pelvic girdle. This alone can provide quite a bit of relief for those suffering lower extremity, pelvic, and low back pain, but at the very least, better proprioception allows patients to handle more advanced home exercises without the risk of worsening muscle imbalances.
Because the signals from your muscles to your nervous system are so extensive and play such a major role in your musculoskeletal health, a proprioception program is one of the most important steps on the path to recovery. See a musculoskeletal specialist to learn how to begin this valuable retraining process.