Proprioception and Chronic Pain

There appears to be a link between proprioception and chronic pain. Non-specific low back pain and neck pain are two of the most common chronic pain complaints¹ with reasons often being a lack of muscle (and functional tissue) balance in the body coupled with muscle activation problems.²

Chronic painful conditions are the source of 42% of emergency department visits adding to the overloaded hospital crisis.^1,2

With pain also being a leading cause of opioid-seeking behaviors on the street or via prescription, it’s critical to understand the causes of chronic pain and better ways of its management. In addition, proprioception dysfunction is becoming recognized as a source of pain that, if trained, may be used to fight back against back pain and other common pain complaints.

What is proprioception

Proprioception is our sixth sense and involves the musculoskeletal system (MSK), the brain, and the central nervous system.³

Proprioception is primarily recognized as a bottom-up form of communication.

Bottom-up communication means that sensation is presented to the MSK and that is communicated up the nervous system to the brain for interpretation of what to do.

What is nociception

There are many sources, types, and experiences of pain. Still, one consistency is that pain is a problem and is a symptom of something gone awry in the body and/or the brain.

Pain is also a protective mechanism that keeps us from injury or death.

Nociception is an experience of pain where unspecialized nerve cell endings called nociceptors are triggered to create the sensation or perception of pain.⁴

These pain triggers can be from external stimuli like touching a hot stove, internal stimuli like the brain’s trained idea of (intensity) pain, internal stimuli like noxious chemicals accumulating in organs and tissues, or pH changes in the blood. ^3,4

The proprioception and nociception relationship

Deficits of proprioception have been correlated with pain⁵, which makes sense from a logical standpoint. However, the story behind the association still needs to be fully understood.

Imagine that you are unaware of how important it is to walk, jump, run, or sit a certain way.

This “certain way” involves alignment and movement of joints by muscles so that your body and brain can work properly and keep you feeling good — think of the game of Jenga and recognize the importance of the blocks being lined up a certain way.

Think of walking near a cliff and not realizing that if you step just a little to your left, you will contact a rock, lose your balance, and fall.

One idea of how proprioception and pain are aligned is that with time (chronic), the lack of awareness creates poor movement or static patterns creating mechanical stress like muscle shortening and tightness on a nerve pathway.

This roadblock in an essential pathway creates deficits in critical chemical and biological flow throughout the body, triggering nociceptors.

Training proprioception

While the evidence is not conclusive on proprioception deficits being correlated with pain,⁵ there is a history of benefit to training proprioception through neuromuscular exercise modalities relating to movement and balance paired with core control. ^3,7

Essential exercises

It is highly recommended to seek a personalized assessment, program, and coaching to address training proprioception for chronic pain.

As a general guideline, the following therapeutic exercises done progressively every second day or a minimum of four times per week over a 6–8-week period are an option.

Each exercise will be done ten times each or each side for ten seconds with a ten-second break between each exercise unless otherwise listed.

1. Static Quadruped Hold
2. Bird Dogs
3. Glute Bridge Hold with Alternating Arm Overhead Reaches
4. Side Plank
5. Prone (laying on your stomach) Contralateral (opposite arm and leg) Raises
6. Single-Leg Balancing (no side leaning)
7. Lunge Hold with Stable Core Upper-Body Rotation
8. Mini Squat Hop (three of these sequentially followed by a 20-second break done five times)
9. Athletic Position Chest Pass (five of these sequentially followed by a 20-second break done five times)

Alternatively, another option can be found here.

Improving the quality of life, improving the healthcare crisis

Chronic pain wreaks havoc on the quality of life of many worldwide. It is one cause of the overburdened emergency healthcare system.

Understanding the various mechanisms and theories of pain and pain perception can help develop better prevention and treatment options.

Proprioception is just one of many important aspects that must be trained frequently and consistently throughout the entire lifespan.

Now, with some additional information and guidelines learned herein, it is time for policymakers and stakeholders to promote and support healthy living and access and for everyone to do their part and get support or put the guidelines into action!

References

1. Blind F, Melton J, Karp J, et al.. Evaluation of the use of individualized patient care plans in frequent emergency department visitors with pain complaints. International Journal of Emergency Medicine. 2022;15(1). doi:10.1186/s12245-022-00440-6
2. Meier ML, Vrana A, Schweinhardt P. Low back pain: The potential contribution of supraspinal motor control and proprioception. The Neuroscientist. 2019;25(6):583-596. doi:10.1177/1073858418809074
3. Hoogenboom BJ, Voight ML, Prentice WE. Musculoskeletal Interventions: Techniques for Therapeutic Exercise. 4th ed. New York: McGraw Hill; 2021.
4. White LE. Pain. In: Purves D, Augustine GJ, LaMantia AS, Hall WC, Fitzpatrick D, eds. Neuroscience. 5th ed. Sunderland (Mass.): Sinauer; 2012:209-226.
5. Lin J, Halaki M, Rajan P, Leaver A. Relationship between proprioception and pain and disability in people with non-specific low back pain: A systematic review with meta-analysis. Spine (03622436). 2019;44(10):E606-E617. doi:10.1097/BRS.0000000000002917
6. Meehan E, Carter B. Moving with pain: What principles from somatic practices can offer to people living with chronic pain. Frontiers in Psychology. 2021;11. doi:10.3389/fpsyg.2020.620381
7. Hlaing SS, Puntumetakul R, Khine EE, Boucaut R. Effects of core stabilization exercise and strengthening exercise on proprioception, balance, muscle thickness and pain related outcomes in patients with subacute nonspecific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2021;22(1):998. Published 2021 Nov 30. doi:10.1186/s12891-021-04858-6