By Patricia Quinn
Proprioception—a sensory nerve ending in muscles, tendons, and joints that provides a sense of the body’s position by responding to stimuli from within the body nerve endings in the joint spaces.
In other words, Proprioception is the perception of one’s own body-areas in relation to each other.
These nerve endings send messages to the brain about where your body parts are ‘in space’.
Proprioceptive – not always Central Nervous System
Studies have indicated that Central Nervous System (CNS) dysfunction frequently occurs in patients with Fibromyalgia, although proprioceptive disturbances might also explain some of the abnormalities observed. Loss of proprioception has been reported by people with pain disorders, urinary tract infection, pneumonia, multiple sclerosis, and depression, resulting in bumping into things, misjudging spaces, maybe bumping into the doorframe, or knocking things over and falling.
Hypermobility the Cause of Faulty Signals
Some people living with Fibromyalgia tend to have problems with laxity, or looseness, in the joint spaces (Joint Hypermobility Syndrome) and so the messages are faulty. This is one of the reasons we fidget – unconsciously, the brain is trying to get accurate messages from the joint spaces. I’ve always been a “fidgeter”, I just thought it was “just being me”….being hyper?
Observation of the patient’s mannerisms and postures during history-taking may give an indication of hypermobility. Contact of the hand to the face may reveal hyperextension of the digits, constantly changing position or fidgeting and/or sitting in an unusual posture (legs wound round each other, slumped to the side or resting on the lateral border of the feet) are familiar sightings of the hypermobile patient.
Effect of exercise on the Hypermobile Patient
This following study is the first to investigate the effect of an exercise intervention on proprioception in hyper-mobile patients. The principal aims of the study were to establish whether a home-based program of exercises could lead to symptomatic improvement and, more significantly, to determine whether improvement in objective parameters such as proprioception is achievable. Some evidence suggests that physiotherapy can be an effective management mode for many of these patients.
There was a noticeable trend for the largest improvement of proprioception to occur in subjects showing the poorest initial performance. It is unclear whether JHS patients exhibit proprioceptive deficit from birth or whether this develops during childhood. Arthritis & Rheumatism Volume 50, Issue 10, pages 3323–3328, October 2004
I have found help with balance issues from attending a weekly Chair Yoga class. We incorporate balance postures along with strengthening the core muscles. Being hyper-flexible, I need to remember not to over-stretch, which could lead to a flare-up of pain.
Hypermobile patients may be considered a hypochondriac
Hypermobile individuals tend to look and move well even if they have pain. During active range of movement, testing their reports of symptoms are often at odds with the physical examination.
I found this extremely interesting – It is possible to see how misunderstandings may arise; the person who complains of widespread debilitating pain affecting several joints can, when asked, bend forward to touch their toes. This tends to go against medical wisdom and may lead to the individual being dismissed or considered a hypochondriac.
Scand J Rehabil Med. 1996 Dec;28(4):225-32
Do you “sway”?
It can be difficult to measure proprioception accurately in the clinic and tests are generally linked to function. The ability to stand on two legs with eyes closed, or on one leg with eyes open and closed as in the Romberg test, will reveal exaggerated swaying and/or loss of balance once the eyes are closed. Pain may contribute to the increased sway observed due to poor stability/control around the ankle, knee,hip and/or sacro-iliac joint.
I have always “swayed”. In the past, I worked in direct care, visiting people in their homes. I was with a client that had Alzheimer’s and was assisting her with her bath as she sat on the edge of the bed. I always “swayed” when waiting patiently for my clients to perform their morning routines. My client grabbed me by the shoulders, catching me completely off-guard. She wanted me to stay still, as I unknowingly rocked back and forth. Just another day in the life of someone living with Fibromyalgia.
Also, my husband is repeatedly asking me to walk a straight line when walking aside of him. I tend to sway out of my line.
Supportive tight garments have been reported as helpful in improving Proprioceptive
When I read this evaluation, I thought, no way can I stand a tight garment living with Fibromyalgia. When I come home, off come the regular clothes and on come my sweats!
“It is known that proprioceptive acuity is diminished in individuals with Joint Hypermobility Syndrome (Mallik et al 1994,Hall et al 1995)
This can have a significant effect on the way an individual moves. The research shows that both joint position sense and threshold to detection of movement are impaired such that they have less awareness of approaching the end of joint range (Chapter 6.4).
The reason for this impairment is not known but may be related to increased laxity and elasticity in the tissues, which may explain why the supportive, tight garments have been reported as helpful in improving proprioceptive feedback (Simmonds & Keer 2007).”
I hope this has helped with understanding why we move the way we do. Keep moving!
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