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Words of the Week: Perturbation + Proprioception

This week Made 2 Move is going to dive into the meanings and applications of 2 words that play vital roles in injury, rehabilitation, and simply being a human! The words? Proprioception and perturbation.

What is proprioception?

Proprioception is a person’s sense of where their body is in space, including body position, movement, forces, and surfaces. Without getting too sciencey, there are neural receptors located in your ligaments, muscles, and tendons. Think of these receptors as little communicators that let your body know the condition of the surface, where it is in space, or the forces it is experiencing so that the body can quickly react to these stimuli.

If you land on a crack in the pavement on your run, your body says, “Woah, that’s not the smooth surface I expected” and quickly adjusts to allow you to not faceplant or roll your ankle. This is an example of an external stimuli (a perturbation- which we will learn about later) and our proprioceptive ability to recognize this unexpected change. Reaction to this crack in the pavement requires muscle activation (quads turning on), varied joint range of motion changes (knee bending), and change in trunk positioning (leaning, bending forward/backward) to adjust to the external stimuli.

This is unconscious and happens faster than the speed of light. Amazing! This is a component of the mind muscle connection we often refer to at Made 2 Move.

Proprioception helps us balance, move, and navigate in our dailly lives. However, following injury or surgery, one’s proprioceptive abilities may become blunted. The system is not able to do its job as efficiently in informing our body of its positions or movements. The good news? Our proprioception is incredibly trainable and responsive. How do we retrain and improve our body’s proprioceptive abilities? Enter in our second word of the week: perturbation.

What is perturbation?

Perturbation can be defined as a “sudden exposure to conditions that displace the body away from equilibrium” (Chiung-Ling 2014). Perturbation is anything that throws the body for a loop, an unexpected force or surface. We have all experienced perturbations in real life- a slippery surface, a shove by a person on the sidewalk (or the field/court), or a quick jolt forward as the bus slams on the brakes.

You might be thinking, “Cool, I experience perturbations daily,” but how does this apply to my physical therapy? Perturbation and proprioceptive training is a component you may see in your sessions with our Made 2 Move therapists. Whether you are a weightlifter with shoulder instability, soccer player coming back from an ACL injury, or older individual trying to minimize your risk of falls, it is a rehab technique applicable to anyone!

Physical therapist Adam Meakins notes, “Perturbations are simply a therapist, or anyone else for that matter, applying external forces to a patients arm or shoulder [or any body part] that they are not in control of, that try to offset, change direction, and alter the patients shoulders equilibrium” (Meakins 2016).

Perturbation and Motor Adaptations

Perturbation training leads to motor adaptation (McCrum et. al 2022). These adaptations can be predictive, meaning that because of exposure and knowledge of stimuli that have altered your balance responses in the past, you are able to predict and respond proactively. An example of this is sitting down on a bus or holding on before it starts moving because you know your balance will be offset. In running, this could look like avoiding an obstacle or landing in deeper knee flexion to support the difference in surface you are about to experience.

These adaptations can also be reactive, meaning your body is forced to respond to this unexpected perturbation on the spot. This is what we most often experience in sport or life. Slipping, being slide tackled, coming down funny from a jump, are all examples of scenarios that we have to react on the spot.

Perturbation training done in PT can lead to a quicker response of your body to unexpected perturbation you experience in life or sport because your body has felt this before; it's a familiar stimuli, not an entirely novel one, that your body is having to respond to. Your body recognizes it from the repetitions you did of it with your physical therapist. The body says “hey I've felt this shoving sensation midair before, and this is how I need to land,” all without conscious thought.

Why do proprioception and perturbation matter?

Proprioception and perturbations are important for a multitude of reasons. Perturbations can be an unexpected surface or force and proprioception is our ability to recognize and respond to that change in surface or force to avoid injury. Instances where perturbation and proprioception training have been researched include:

  • ACL rehabilitation: “Noncontact anterior cruciate ligament (ACL) injuries are 70% more common than contact ACL injuries and often occur because of a perturbation, such as landing on an unstable surface” (Shultz 2014).

  • Balance and fall risk reduction: “(1) the training should use external perturbations that induce a sudden motor response and, (2) these perturbations should be of sufficient magnitude to induce a loss of stability that would lead to a fall without a sufficient motor response” (McCrum et. al 2022).

  • Shoulder instability: Your Made 2 Move therapist may push and pull your shoulder with varying speeds, forces, and directions. Even greater complexity can be added by closing the eyes, increasing the unexpectedness of the perturbation.

  • Ankle sprains

Our Made 2 Move therapists may apply traditional perturbation training in the form of external, unexpected stimuli, as well as visual perturbation training. Post injury or surgery, there is often an over reliance on the visual system rather than motor control (joint, tendons, ligaments, muscles). While reliance on the visual system is not inherently a bad thing, we want to make sure all systems are working in sync and at optimal levels to allow for maximum function both physically and cognitively. Everything is connected!

What can I expect at Made 2 Move?

You experience perturbations on the field when an opponent slide tackles you or bumps you in the air coming down from a header. Runners experience perturbations when they trip off a curve or are running on an uneven trail. Even weightlifters experience perturbations as they throw the barbell overhead, lose their balance and have to readjust to stand the lift up. Perturbation training at Made 2 Move can aid in the revamping of your motor control, and more importantly your CONFIDENCE!

Regardless of what brings you to Made 2 Move, specificity to YOUR sport, goals, and functionality will be at the forefront of our minds when evaluating your movement and developing a rehab program for you. As always, your rehab will be individualized to your goals and may very likely include some perturbation or proprioception training. Reach out to today to set up an initial evaluation!


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