Proprioception and Core Flashcards
1
Q
What is proprioception?
A
The body’s ability to transmit joint position sense, interpret the information, and respond consciously or unconsciously to stimulation through appropriate execution of posture and movement.
Interpret info coming from joints and then consciously or unconsciously manipulate the body
2
Q
What is kinesthetics awareness?
A
Joint movement sense
Knowing where joint is in space without seeing them.
3
Q
What are the 4 parameters of proprioception?
A
- Sense of movement
- Sense of position
- Sense of effort
- Sense of force
4
Q
What are the proprioception sensory players?
A
Visual, vestibular, mechanoreceptors lead to proprioception which goes into motor control.
5
Q
What is feedback control?
A
Desired state –> Comparator which goes to either actuator sensor
- Feedback controlled – certain task you want to achieve. You tell your brain this is the action I want to do to pick this up. Need to balance, extend arm, grip and pick it up. Area in brain understands desired state have the plan which is sent to the actuator and the sensors tell us if the task was done.
- Comparator is the plan.
- If you don’t do it you try again.
6
Q
What is feedforward control?
A
Input –> Intention –> Controller –> comparator and then actuator or sensor
- In athletics you see this more. Don’t have time to be saying I am reaching out, I am grabbing, I am lifting. Happens too fast.
- Have an input to an intention (task I need to achieve) goes to control center which says you need to execute program – comparator turns on that path and then actuator and sensor feedback into input
- Sensor sends info back to comparator and then you can redo the plan.
7
Q
What are the central control pathways?
A
Cerebrum
- Planning, initiation
- Slow
Brain stem, cerebellum and basal ganglia
- Comparator
Spinal Reflex
- Protection, splinting, fast
- Motor control centers in cerebrum send a neuron down into the brain stem, and then it crosses over from right side to left side and synapses at spinal cord level which then that motor neuron goes on to muscle fibers it innervates.
- Comparators – blueprint storage areas. mainly cerebellum is this. Cerebellum says this is the plan to execute (what I want to achieve). Premotor areas are managers – you go and execute the task.
- Then the sensation comes up and back through the cerebellum and evaluates if you did the task – reinforce and store that or reevaluate and modify.
8
Q
What are the 3 types of motor output?
A
- Cognitive/conscious
o Unconscious incompetence
o Conscious incompetence - Associative
o Conscious competence - Automatic/autonomous
o Unconscious competence - Associative – more feedback control
- Automatic – feed forward
- Need to go through feedback control before feedforward control.
9
Q
Proprioceptive Mechanoreceptors
Class of cutaneous - what is the description?
A
Ruffini
10
Q
Proprioceptive Mechanoreceptors
Class of joint what is the description?
A
Ruffini
Pacinian
GTO-like
Free nerve endings
11
Q
Proprioceptive Mechanoreceptors
Class of muscle what is the description?
A
Spindle
GTO
12
Q
How do muscle receptors - spindles work?
A
- Afferent impulses from stretch receptor to spinal cord
- Efferent impulses to alpha motor neurons cause contraction of the stretched muscle that resists/reverses the stretch
- Efferent impulses to antagonist muscles are damped (reciprocal inhibition)
- Muscle spindle reflex – myotatic stretch reflex. In the muscle body have these small muscle fibers wrapped in sensory neuron called a muscle spindle (intrafusal muscle fibers). When muscle contracts these are on and when stretched those nerves fire (depolarize) sending a message to spinal cord.
- Blue neuron turns on which stimulates red neuron to contract. Neg inhibitory interneuron so inhibits opposite action? Stretch reflex is a fast way to respond to a perturbation in muscle length.
- Use patellar hammer. This stretches the muscle and you get a kick response.
13
Q
How do muscle receptors GTO’s work?
A
Pressure receptors embedded in the tendon. When under pressure it squishes those endings which turns them on. blue neurons turns on and goes into spinal cord which goes to inhibitory neuron which turns off the quads. Safety mechanism if over exerting it shuts the muscle down which is a problem if trying to exert a lot of force. Muscle says you’re about to tear so need to stop.
- Pain receptors are similar.
14
Q
How do joint receptor Ruffini work?
A
- Located in joint capsule (flexion side)
- Detect loading of the capsule
- Fast conducting
- Slow adaptation rate
- Most active at full extension and rotation
- Back of joint capsule and turn on when legs are extended. Are under pressure so leg is straight. Tells you where joint is in space. Keep telling you your leg is straight. Don’t turn off very quickly.
15
Q
What are joint receptors - pacinian ?
A
- Located in joint capsule, cartilaginous surface
- Pressure receptors
- Fast conducting
- Greatest density at end ranges
- High adaptation rate
- Also in joint capsule and on cartilaginous services. Detect pressure. Tell you you are moving but quickly can tell you you aren’t moving anymore.
16
Q
What are the 5 ways to access proprioception?
A
- Replicating joint angle
- Replicating movement
- Detecting movement
- Balance and sway
- Latency of reflex activation
- Need to find things that evaluate movement, joint angle and force. Maybe pressure?
- Can they sense the movement? If you move them, can they tell you where they are and when to stop at a given angle target.
- Do you know how to control your body in a ground-based activity – balance and sway
- Does the muscle activate when you stim it?
17
Q
What are the 3 proprioception offshoots?
A
Balance
Coordination
Agility
18
Q
What is balance for proprioception?
A
Balance – can you stand up? Pass/fail. weight shift – pass/fail, 1 leg balance, and balancing while moving in diff directions. All pass/fail. Balance needs to relate to activities you’re going to do.
- The body’s ability to maintain equilibrium by controlling the body’s center of gravity over its base of support
- Static or dynamic
- Utilizes visual, vestibular and peripheral mechanoreceptors
- Injury impairs
- Aging impairs – weakness, sensory deficit, mobility deficit
- Balance training may not have carryover in sport
19
Q
What is proprioception coordination?
A
Coordination – do you have the ability to grip something and move something. Can you follow a series of instructional tasks that are complex and achieve them
- The complex process by which a smooth pattern of activity is produced through a combination of muscles acting together with appropriate accuracy, intensity and timing.
- Motor learning: whole-part-whole
- Avoid fatigue
- Process involving smooth patterns of activity that are purposeful where you have a target and a goal.
- Do they perceive what needs to be done and know where body is in space to do it? Are they getting feedback? Do it a bunch and limit inhibition of performance.
20
Q
What is proprioception agility?
A
Can you do this stuff with high rates of speed and unpredicted environmental change.
- the ability to control the direction of a body or segment during rapid movement
- requires flexibility, strength, power, speed, balance, and coordination
- Is best trained in a sport-specific fashion
- Coordinated complex motor tasks done under higher rates of speed and some cases unpredictable conditions
21
Q
What 4 things does coordination training involve?
A
Coordination training involves:
1. Activity perception
2. Feedback
3. Repetition
4. Inhibition
22
Q
What are the 6 different training approaches?
A
- Non-weight bearing
- Weight bearing
- Single limb activities
- Functional activities
- Object manipulation
- Return to activity
23
Q
Explain non-weight bearing movements
A
- Traditional ROM
- OKC strengthening exercises
- Varied loads, contraction types, ROMs
- Repositioning exercises
24
Q
Explain weight bearing exercises
A
- Weight shifting
- CKC
- Perturbations
- Unstable surfaces
- Eyes open or closed
- Manipulating objects
25
Explain single limb stance exercises
- Stable
- Unstable
- Perturbations
- Movement of other limbs
- Manipulating objects
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Functional activities examples
- Specific tasks
- Walking, jogging, running
- Forward, backwards
- Stairs, ramps
- Hopping, jumping, cutting
- Agility
27
What are the 4 stages of proprioceptive training progression?
1. Proprioception/Kinesthetic Awareness
2. Dynamic Joint Stability
3. Reactive Neuromuscular Control
4. Functional motor patterns
28
What is Stage 1 – Proprioception/Kinesthetic Awareness?
* Repositioning tasks (passive, active)
* Weight bearing in functional positions
* Walk on stable surface
* Two feet on unstable surface
* Eyes open or closed
* Simple to Complex
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What is Stage 2 – Dynamic Joint Stability?
* Running
* Lateral slides
* Mini-trampoline
* Active repositioning
* Sway techniques
* Planned perturbations
30
What is Stage 3 – Reactive Neuromuscular Control?
* Running with direction change
* Cutting drills
* Carioca
* Plyometrics
* Unplanned perturbations
31
What is Stage 4 – Functional Motor Patterns?
Functional Motor Patterns
* Vulnerable positions
* High speed
* Sport-specific movements
* Four corner running while dribbling
* Carioca while defending
32
What is core stability?
The capacity of the stabilizing system to maintain the intervertebral neutral zones within physiological limits
33
What are the 3 subsystems of core stability?
- Control (CNS)
- Passive (ligaments, facets)
- Active (muscle contraction)
34
What does the passive subsystem do?
* Allows lumbar spine to support limited load (approx 10 kg)
* Far less than body weight!
It just runs like a connective tissue sheath up anterior or posterior side of the vertebrae. Connective tissue is strong but it’s thin and has a low load tolerance.
This system helps but isn’t strong enough to prevent it from snapping under force
35
What does the active subsystem do?
* Provides support for body mass
* Also provides resistance to external loads and propulsion for dynamic activities
Have little muscles that go segmental spine to spine and then longer guide muscles – erector spinae, rectus abdominus, large wires that help anchor the outside then deep down we have the small segmental ones keeping things balanced vertebrae to vertebrae.
36
What is the neural (control) subsystem?
* Continuously monitors
* Adjusts muscle forces instantaneously based on feedback from muscle spindles, GTOs and ligaments to maintain posture and produce/resist external forces
* Must balance stability and desired ROM
- Receives feedback about postural position constantly.
37
What are the Divisions of Active Subsystem?
Segmental Stability – “local” stabilizing system
Trunk Stability – “global” stabilizing system
Whole Body Stability – “peripheral” stabilizing system
38
What is local stability (part of active subsystem)?
Small, deep muscles
Control intersegmental motion
Slow-twitch
Involved in endurance activities
Selectively weaken
Activated at low resistance levels
E.g. multifidus, rotatores, interspinals, intertransverse (Tr.A)
Typically isometric contractions
Between each vertebrae
39
What is global stability (part of active subsystem)?
Large, superficial muscles
Transfer forces between thoracic cage and pelvis
Utilized in power activities
Preferential recruitment
Activated at higher resistance levels
Act to increase intra-abdominal pressure
E.g. rectus abdominus, external obliques, erector spinae, QL, psoas major
- Flex, extend, rotate
40
What is hollowing?
* Hollowing = drawing in of abdomen toward the spine (scooping motion up and in) without movement of spine or pelvis
* Emphasizes deep local muscles
* More favorable in contracting TrA, multifidus etc. over global abs
* Some concern about leading to injury if performed during exercise due to decreased activation of other abdominals required for dynamic movement
* Better suited for static exercise?
- Putting finger on belly button and pulling it away.
- Assumed muscles are off and if you turn them back on you fix the problem. Transverses abdominis was thought to be weak in those with back pain so need to train it
41
What is bracing?
* Bracing= coactivation of all abdominals or lateral flaring of abdominal wall
* Considered more suitable for athletes and dynamic movements
- Need to look at whole unit so you do bracing not just the one muscle. Hit yourself. This stabilizes everything.
42
How can we get core injuries?
* Change in local and global control can be the cause or result of injury
* Creates a disruption in kinetic chain
* Important to address with almost any injury to create stable base
- Want to maintain local and global stabilizers to maintain neutral spine.
- Need to train entire kinetic chain as a unit so when you get in positions you maintain neutral spine in the least loads possible while still maintaining the action.
Lumbopelvic stability and injury
43
What is the best core injury prevention strategy?
Endurance has the greatest protective benefit against injury
- Not flexibility or strength alone
Prevention programs should include trunk endurance training.
44
What is a good way to test core stability?
Back extension:1/2 sit up ratio
- A strength endurance ratio of back extension hold compared to a quarter sit up hold for time – that ratio predicted back injury. Whoever had the worse asymmetry between flexion and extension endurance were more likely to be injured.
45
Explain the Sahram test
5 levels
Begins in supine crook lying
Requires pressure cuff (BP cuff works) placed under lumbar curve
Inflate to 40 mmHg
Have patient activate TrA/multifidus using abdominal hollowing
There should be no change or slight ↓ in pressure
To advance to next level, must maintain pressure in cuff within 10mmHg
46
What are the stages of the Sahram test?
1 - bring one leg down at a time
2- lower 1 leg and slide heel out to extend the knee
3 - lower 1 leg to 12cm above ground and slide heel out to extend the knee
4 - Lower both legs to the ground and slide heel out to extend the knee
5 - lower both legs to 12cm above ground and slide heel out to extend the knee
47
What are the 4 Stages of Lumbar Stabilization Program?
* Stage 1: Re-education of stabilizing muscles
* Stage 2: Exercise progressions for static stabilization - anti movements
* Stage 3: Exercise progressions for dynamic stabilization
* Stage 4: Sport/ADL specific stabilization
* * May need to start at different points with different people/injuries
48
Program planning for stages 1-4 of core training
Stage 1: 1-2 exercises, 10 + sets, 5-10 seconds
Stage 2: 2-3 exercises, 1-3 sets, 20-60 seconds
Stage 3 & 4: 2-3 exercises, 2-3 sets, 5-25 reps
- Should be able to fatigue in 10 minutes.
- In stage 1 it’s usually sets of isometric holds. Contract relax 5 seconds on and then 5 off. Might take 5-7 minutes
- 2 – maybe anti flexion, anti extension or anti lateral flexion. Still holding but usually around 30 seconds. Building up to 1 minute.
- Stage 3 – 15-20 reps is common.
- 5-10 minutes is all you need and want to add it twice a week into workouts. Is a tonic muscle (on all the time), endurance (ST dominated), long duration holds with short recoveries, supersets, complexes.
49
Stability ball training
* Does stability ball training improve athleticism?
* No clear answer
* May enhance performance in untrained populations
* No evidence for improved performance in trained populations
* Undue emphasis may hamper strength/power training
- This is useful for core in phase 2 and 3 but not that useful in return to play. Activation goes up in other supplementary muscle groups but total strength goes down when you add instability.
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