What alters proprioception

WHAT ALTERS PROPRIOCEPTION

1)      Tissue Injury, 2) Inflammation, 3) Pain, 4) Loss of Motion, 5) Degeneration.

Parkhurst, M.S., P.T., Burnett, M.S., P.T.  JOSPT   1994: 19(5):  282-295.  Musculotendinous junction is the weakest link in the muscle-tendon unit.  This region fails first when exposed to excess tension.  This is the site of golgi tendon organs and may expose them to structural derangement or denervation resulting in possible proprioceptive impairment.  Intramuscular bleeding can lead to increased pressure and local ischemia.  The muscle spindle may be susceptible to these types of trauma.  Spindles surviving mechanical disruption, denervation and tenotomy have evidence of abnormal afferent impulses.  These can alter proprioception.

Johansson, (Dept. of Physiology).  Neuro-orthopedic.  1990; 9:  1-23.  An injured joint is likely to cause persistently disturbed sensory feedback to the central nervous system and therefore existing motor programs have to be modified.  Sensory receptors in the joint can influence muscle tone.  This produces and interdependence between biomechanical and neurological mechanisms.

Wyke, M.D., Aspects of Manipulative Therapy.  1985:  67-71.   Patterns of normal proprioceptive input are profoundly distorted when articular nociceptive activity is added.  This interferes with the precise continuous input necessary for coordinated multisegmental reflexes, which are required for normal patterns of motion, balance, coordination and equilibrium.

Lachman, M.A., M.D.  Soft Tissue Injuries in Sport.  2^nd ed.  London, Blackwell Scientific Publications 1994:  12-31.  Proprioceptors provide information at the conscious level about position and movement and subconsciously eliciting spinal reflexes that alter muscle action to control posture and prevent excessive deformation of joints and tissues.  Its failure results in the loss of control of posture and complex movements.  The end organs cease to function in the presence of inflammation or after prolonged immobilization of a joint.  This loss of afferent input results in failure of postural reflexes so that the joint gives way, known as functional instability.  When treating injuries involving structures around a joint it is very important to stimulate the proprioceptive endings from an early stage of treatment.  This appears to prevent atrophy of some endings and probably also recruits resting proprioceptive organs in surrounding tissues.

Caranasos, M.D., Israel, M.D.  Gait Disorders in the Elderly.  Hospital Practice 1991; June 15: 67-94.  Mechanoreceptors in cervical facet joints provide major input regarding the position of the head in relation to the body.  With aging, mild defects impair mechanoreceptor function.  Loss of proprioception can also involve the legs, especially with diabetes.  With decreased proprioception, body positioning in space is impeded and the patient becomes reliant on vision to know the location of a limb.  To compensate for loss of proprioception in the legs, the feet are kept wider apart than usual.  Steps become irregular and uneven in length.  As impairment increases the patient becomes unable to compensate.  With severe loss of proprioception, the patient is rendered unable to get up from a chair or rise after a fall without assistance.

Dickinson, M.D.  Clinics in Sports Medicine.  1985; 4(3):  417-429.  The quality and precision of motor performance is partly determined by information received from proprioceptors in the joint and surrounding tendons and ligaments.  Immobilization dampens proprioceptors discharge.  Loss of feedback control may be the cause of reinjury to the same joint.

Shutte, M.D. and Happel, Ph.D.  Clinics in Sports Medicine.  1990; 9(2):  51-517.  Many joint injuries alter joint innervation.  Direct alterations include joint deafferentation as in ligament disruption.  Indirect effects may be due to post-proprioceptive deficits.  Deficits in unconscious afferent systems compromise normal postural mechanisms that prevent chronic joint stress and damage.

Guido, P.T., SCS et al.  JOSPT.  1997; 25(3):  208-212.  Effects of Chronic Effusion on Knee Joint Proprioception.  Joint receptors provide proprioception throughout the entire range of motion, but discharge frequency and intensity increases at the limits of motion.  Afferent feedback also arises from muscle spindles in juxta-articular muscles.  Passive joint position sense derives from receptors in joint capsule and ligaments, active joint position sense from receptors in tendons and muscles.  Knee joint effusion causes a reflex inhibition of quadriceps muscles due to capsular distention.  With an effusion the role of mechanoreceptors becomes unclear.  The amount of intra-articular effusion (pressure) and the rate of capsular distention powerfully excites type 1 and 2 mechanoreceptors as well as nociceptors.

Basmajian, M.D., Nyberg, P.T., M.Sc.  Rational Manual Therapy.  William and Wilkins.  1993:  451-467.   Capsular or ligamentous injury results in loss and deactivation of mechanoreceptors.  The proprioceptive role of the affected segment is adversely affected.  Spinal manipulation may help activate inactive receptors and improve postural and kinesthetic awareness.  Reviving inactive mechanoreceptors and restoring proprioceptive control reduces the chance of reinjury and hence is an important consideration in preventive care.