Proprioception

Proprioception is the sense of where your body parts are and how they are moving, without having to look. It includes the sense of position and movement of the limbs and trunk, and also the sense of effort, force and heaviness (Proske & Gandevia, 2012).

How does proprioception work?

The signals come from receptors in the skin, muscles and joints. No single receptor tells the brain where your arm is: groups of nerve fibres do it together, and the brain matches their signals to an internal map of the body (Proske & Gandevia, 2012).

Three findings from that research are useful to know:

• The brain takes part, not just the receptors. Experiments that block the nerves to a limb show that the motor areas of the brain can create a sense of the limb moving with no input from it at all.
• Exercise can disturb it, which has implications for injuries.
• It declines with age, and that decline is linked with a higher risk of falls in older people (Proske & Gandevia, 2012).

Proprioception and neck pain

Clinicians test proprioception in the neck with joint position sense: how accurately someone can bring the head back to a set target after moving it (de Vries et al., 2015).

A systematic review of 14 studies compared people with and without neck pain:

• Four studies found larger position errors in people whose neck pain followed an injury such as whiplash.
• Of the eight studies of neck pain that came on without an injury, four found a difference.
• Method mattered. Every study that averaged the error over at least six attempts found a larger error in the neck pain group, and the authors concluded that the number of attempts is a major part of doing the test properly (de Vries et al., 2015).

Proprioception in the lower back, and why sitting matters

For the lower back, a meta-analysis pooled 22 studies with 1,203 people. People with low back pain were worse at actively repositioning the lower back when they were tested sitting. Tested standing, or when the back was moved for them while sitting, there was no clear difference. Another measure, how small a movement people could detect, was worse in those with pain. The authors suggested clinicians pay attention to sitting in particular (Tong et al., 2017). For what long sitting does to the lower back more broadly, see lower back pain from sitting.

What this research cannot say is which comes first. Almost all of it compares people at one point in time. The only prospective study in that review found no link between lumbar proprioception and later low back pain (Tong et al., 2017). Poorer position sense may be a result of pain rather than its cause.

Can proprioception be trained?

One well-known trial randomised 64 women with persistent neck pain and measurable position errors to six weeks of either proprioceptive training or training of the deep neck flexors, with a physiotherapist once a week. Both groups improved in position accuracy, pain and disability. The proprioceptive group improved slightly more when returning from turning to the right, and there was no other difference (Jull et al., 2007).

Two limits: there was no group that did no exercise, so part of the change may be time, and both groups had personal instruction. The fair reading is that targeted exercise of more than one kind can improve neck position sense. Exercises for the neck and head position are shown on forward head posture exercises, and the wider picture is in neck pain from desk work.

Proprioception and posture reminders

Proprioception is your own internal sense. A device that tells you when your head has drifted forward gives an outside cue instead, which is a different thing: how that works with AirPods is explained in AirPods posture tracking. Bavelu’s posture tracking uses this kind of outside cue, noticing when your head leans forward and letting you know.

When to see a doctor

A vague sense of stiffness is common. A real loss of feeling or control is not. See a GP if you have pins and needles all the time or they keep coming back (NHS). Call 999 if you suddenly have problems walking, a sudden lack of co-ordination (for example, trouble buttoning a shirt) or loss of bladder or bowel control (NHS).