Have you heard of proprioception?
Nicola Cook - AHTA Accredited Hand Therapist
Proprioception simply put is the fine movement control that occurs when the muscles in your body coordinate themselves in complete symphony. Proprioception is based on the joint(s) and their ligaments telling your brain what they are doing and what position they are in, and the brain responding by telling the muscles which teams to work in to create stability and controlled movement at those joint(s). Proprioception is not grunt strength. It is the fluid, beautiful, fine control of lots of muscles working together. Some muscles create movement, some control or slow down that movement. This allows movement that is coordinated and balanced. We know that in the wrist and the base of the thumb proprioception is fundamental to how they are controlled during movement and function.
We know that proprioception is reduced through injury, diseases and swelling, and that it doesn’t always come back on its own. The other thing that we know about proprioception is that it is impeded by pain. Proprioception relies on the brain ‘hearing’ the messages from the body part, to be able tell the right team of muscles to work together. Pain causes a lot of background noise in the brain and can in effect ‘block’ the brain from hearing the messages from the body part, and then it will not send out the right movement messages.
Long term reduced proprioception can lead to pain and loss of use. This can explain why some people, with what feels like a minor problem, get years of ongoing loss of use. By retraining proprioception, we CAN improve how your wrist or thumb work, and in many cases can improve pain and how you use your hand.
Rehab starts with basic control of pain, swelling and motion. Next it works on conscious control of the joint and recognising joint position. Then strengthening of specific muscles to enhance joint stability, and progressing to reactive muscle activation.
How do we retrain these muscles? Advanced research has shown that for specific joints there are muscles that help control the joint optimally and muscles that can decrease the joint being stable and working well. Therapy to retrain the muscles is aimed at increasing baseline conscious muscle contractions – starting with static controlled muscle activity called isometric exercises. We can then progress to more movement based strengthening.
Finally we move on to what we call unconscious muscle control and use exercises that ask your muscles to respond to external forces. Examples of these exercises are using a slosh pipe, balancing balls on a tray or a ball on a racquet, or using a powerball – there are MANY more options available. These advanced levels of exercises are difficult for your body to perform if you don’t do the more basic (sometimes boring) exercises first. But, doing the groundwork is really worthwhile and will pay off in the end. Even elite sportspeople often have to re-educate proprioception from the ground up after a hand or wrist injury.
If you have a hand or wrist injury, please contact your local Practitioner of Hand Therapy who will be able to assess you and work out where the problem is. This will help target your rehab to get the right balance back and see you functioning well again.