Proprioception: The balancing act for fitness

Many factors work together to help us maintain our balance to move gracefully. Even while walking over rocky or uneven terrain such as a forest trail, we can look straight ahead and move with ease.

Ever wondered what keeps you from falling or tripping over?

Your mind subconsciously registers the unique pattern of stones. The skin, bones and muscles in your feet, together with your visual senses, take careful note of the walking surface and calibrate your joints to move strategically. This sense of balance is known as proprioception.

Improving balance with training 

Balance is the process of maintaining the centre of gravity of the body over any vertical axis, explains Col. Dr Apoorv Dixit, commanding officer at the Military Hospital, National Defence Academy, Pune.

“Balance relies on the body’s feedback coming from visual [eyes], vestibular [inner ear and brain balance] and somatosensory [body sensations] structures, and subsequently culminates into a smooth and coordinated neuromuscular action,” adds Dr Dixit, a specialist in musculoskeletal, sports and exercise medicine in the Indian Armed Forces.

Proprioception, the body’s sense of spatial positioning and movement, is one of the sub-modalities of somatosensation. It is the body’s natural ability to sense location, action, and movement. The different modalities (sensory systems) of balance need to be trained appropriately for healthy functioning. This is known as balance training.

“Balance training is an umbrella term,” says Dr Sudheesh Pillai, a sports medicine physician from Kollam, Kerala. “It is basically coordination (proprioceptive) and movement (vestibular) training.”

This training is an integral part of regular workouts. The impeccable sense of balance observed in athletes, from footballers to boxers, is not a given, but a product of conscious and subconscious training. Balance training is further crucial to make a complete recovery after a musculoskeletal injury.

What is proprioception training? 

Proprioception training is employed in sports training as it improves coordination and prevents falls and re-injuries. When used as a part of injury rehabilitation, it enables the affected cells to regain the lost functional ability of the joint or muscle.

“Most joints have proprioceptive receptors. Basically, they sense touch and other sensations,” explains Dr Pillai. “When there is an injury, the proprioceptive receptors do not act properly. So, we train them with an uneven terrain which is simulated using balance trainers. As a result, the receptors get re-activated, sense the terrain, and send signals to the brain. Then, the brain returns the signal to the foot indicating the uneven terrain and telling you how to place your joint (say, ankle) properly, to avoid further spraining.”

Who is balance training for? 

Studies say that the risk of falls decreased by approximately 15 to 20 per cent in healthy older adults after exercise interventions, including combinations of strength, balance, and aerobic exercises.

“Any kind of mobility is a sum total of movement, flexibility, strength, and endurance,” explains Dr Dixit. “Efficient postural balance contributes to the optimisation of motor performance, not just athletic, but of any kind.

“So, it is for anyone and everyone, even to move optimally while carrying out daily activities such as lifting a bucket, shifting a table, or dragging a trunk or a box requires balance.”

Dr Pillai says “Balance training is beneficial for kids and elderly people alike, and especially for people with injuries or diseases like Parkinson’s disease, multiple sclerosis etc.”

It is especially relevant for ageing. “Any modality that you do not train, you lose,” says Dr Dixit. “Once you age, your modalities [the senses of sight, movement, and coordination], which have not been trained or used properly, tend to age too. So, training them with continuous exercise helps in the later part of life.”

Balance exercises and equipment 

“The training methods that we usually prescribe depend on the modality that we want to address,” says Dr Dixit. “It could include exercises on stable and unstable surfaces, with or without recurrent destabilization or perturbations (maintaining a balance against unexpected inputs — treadmill accelerations, waist pulls, nudge from a therapist etc.) The kinds of motions trained include – tilting, rotating, squatting, hopping, jumping, throwing, etc.”

“We have different equipment for balance training to simulate uneven terrain,” says Dr Pillai. He recommends beginning with balance pads (a normal memory foam pad), gradually progressing to the BOSU ball (half a Swiss ball), followed by wobble or balance board exercises, with an increasing scale of difficulty. This can be further clubbed with activities like catching a ball or kicking a football while standing on the balance trainers.

“Apart from using all these contraptions [equipment], exercises like heel-to-toe walking, side-to-side walking doing scissors (you cross your legs on one side and continue sideways), single and double leg stances, squats, etc. are effective too,” adds Dr Dixit. The next step is to cut the visual feedback – training with eyes closed.

“Plyometric training improves balance too since you have jumping movements [squat jump, line jump, etc] along with feedback regarding propulsion,” says Dr Dixit.

He further recommends core stability training (e.g., plank variations).

Safety considerations for balance training 

Balance exercises can feel challenging, at first. Someone training their balance post-injury or surgery may be afraid of falling again. For this, there are certain safety measures to keep in mind.

“Balance training is done in the last phase of rehabilitation,” says Dr Pillai. “We make sure all the aspects of strength and endurance are in place before prescribing balance exercises. We don’t give it during the acute stage [of an injury], or the early phase of rehabilitation.”

Both doctors emphasize supervised or accompanied exercises, wherein an attendant is readily available to lend support.

“By having proper progression, you automatically ensure safety,” says Dr Dixit. “Choose the equipment (training surfaces and shoes) carefully. Ensure support initially, then let go of the support. Do a double-leg stance, and only then try a single-leg stance.

“Exercises also depend on a person’s physique and fitness levels. So, any exercise program needs to be individualised. Nutrition levels and the time of the day you are training in, are equally relevant in ensuring safety.”

Takeaways

• Proprioception or balance training is an important component of regular workouts.
• It is essential in injury rehabilitation, to gain back complete function.
• Balance exercises are recommended for all, ensuring optimum movement quality, and prevent falls and injuries.