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The Role of Proprioception in Motor Control and Functional Joint Stability Bryan L

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Journal of Athletic Training 2002;37(1):80±84 q by the National Athletic Trainers' Association, Inc www.journalofathletictraining.org The Sensorimotor System, Part II: The Role of Proprioception in Motor Control and Functional Joint Stability Bryan L. Riemann; Scott M. Lephart University of Pittsburgh, Pittsburgh, PA Bryan L. Riemann, PhD, ATC, and Scott M. Lephart, PhD, ATC, contributed to conception and design and drafting, critical revision, and ®nal approval of the article. Address correspondence to Bryan L. Riemann, PhD, ATC, Georgia Southern University, PO Box 8076, Statesboro, GA 30460± 8076. Address e-mail to [email protected]. Objective: To discuss the role of proprioception in motor proprioception as a whole is an essential component to con- control and in activation of the dynamic restraints for functional trolling activation of the dynamic restraints and motor control. joint stability. Enhanced muscle stiffness, of which muscle spindles are a cru- Data Sources: Information was drawn from an extensive cial element, is argued to be an important characteristic for dy- MEDLINE search of the scienti®c literature conducted in the namic joint stability. Articular mechanoreceptors are attributed areas of proprioception, motor control, neuromuscular control, instrumental in¯uence over gamma motor neuron activation, and mechanisms of functional joint stability for the years 1970± and therefore, serve to indirectly in¯uence muscle stiffness. In 1999. Data Synthesis: Proprioception is conveyed to all levels of addition, articular mechanoreceptors appear to in¯uence higher the central nervous system. It serves fundamental roles for op- motor center control over the dynamic restraints. Further re- timal motor control and sensorimotor control over the dynamic search conducted in these areas will continue to assist in pro- restraints. viding a scienti®c basis to the selection and development of Conclusions/Applications: Although controversy remains clinical procedures. over the precise contributions of speci®c mechanoreceptors, Key Words: neuromuscular, stability, motor control his is Part II of a 2-part series discussing the current lar), speci®c unique roles are associated with each source that understanding surrounding peripheral afferent infor- may not be entirely compensated for by the other sensory Tmation acquisition, processing, and levels of motor con- sources. For example, proprioceptive information plays an in- trol as they relate to functional joint stability. In Part I, the tegral role in the ability to modify internal models used with sensorimotor system and the mechanisms responsible for pro- feedforward control5,6 that has been demonstrated to be only prioception and neuromuscular control as they relate to func- partly compensated for by visual information.7 tional joint stability were addressed. The purpose of Part II is The role of proprioceptive information in motor control can to build upon and apply the concepts developed in the Part I. be separated into 2 categories.2 The ®rst category involves the Speci®cally, we will address the contribution of proprioception role of proprioception with respect to the external environ- in controlling the activation of the dynamic restraints and mo- ment. Motor programs often have to be adjusted to accom- tor control. modate unexpected perturbations or changes in the external environment. Although the source of this information is often largely associated with visual input, there are many circum- The Role of Proprioception in Motor Control stances in which proprioceptive input is the quickest or the Critical to effective motor control is accurate sensory in- most accurate, or both.1 In the above example, modi®cation formation concerning both the external and internal environ- of the motor program for walking was required in response to mental conditions of the body.1±4 During goal-directed behav- the uneven support surface. If the person's vision was ®xed ior, such as picking up a box while walking, provisions must on the box to be picked up, he or she might not have visually be made to adapt the motor program for walking to changes noted the uneven support surface. In addition to alterations in occurring in the external environment (uneven ground) and the plantar cutaneous receptors, muscle and joint mechanore- internal environment (change in center of mass because of the ceptors would have reported the degree of altered ankle joint additional load). These provisions are stimulated by sensory position and stimulated the motor program modi®cation re- triggers occurring in both feedback (mechanoreceptor detec- quired. The planning of movements also requires attention to tion of altered support surface) and feedforward (anticipating environmental constraints.8 This is especially true with respect center-of-mass change from previous experience) manners. Al- to the selection of strategies for the maintenance of postural though some of the afferent information may be redundant control.9±11 For example, sensory detection of an unstable across the 3 sensory sources (somatosensory, visual, vestibu- handrail from peripheral signals (kinesthesia, changing joint 80 Volume 37 x Number 1 x March 2002 positions) would alter the motor program used to avoid falling of electric stimulation on afferent nerve ®bers to document on a slippery staircase. During the planning stages of a move- cortical projections, the applicability of these ®ndings to nor- ment, visual images are used to create a model of the envi- mal physiologic function remains speculative and uncertain.27 ronment in which the movement will occur. Proprioception has Speci®c to the mechanical stimuli, the loading required to elic- been described as essential during the movement execution to it a-MN responses has been criticized as exceeding normal update the feedforward commands derived from the visual im- physiologic loads.22,28,29 Even assuming that the ligament- age.5,6 muscle re¯ex exists, one must question its effectiveness in The second category of roles proprioceptive information contributing to joint protection because of the latency plays in motor control is in the planning and modi®cation of times22,29,30 and weak response magnitudes,31 especially in internally generated motor commands.2 Before and during a comparison with re¯exes stimulated from muscle spindles.28 motor command, the motor control system must consider the Despite the controversial basic science and empirical support, current and changing positions of the joints involved to ac- in vivo human studies involving ankle and knee joint pertur- count for the complex mechanical interactions within the com- bations in conjunction with electromyography have been con- ponents of the musculoskeletal system.2 Proprioception best ducted and have produced varying results.17,18,32±40 For ex- provides the needed segmental movement and position infor- ample, at the ankle, the number of investigations mation to the motor control system.1,2 In the situation of a demonstrating increased latencies with mechanically or func- single joint moving through a 108 arc of motion, the precise tionally unstable joints (or both)32±35 is matched by just as muscle force required to perform the task depends upon the many studies failing to elicit differences.36±40 Several factors joint angle. As one can surmise, the task of determining how must be considered with respect to the conclusions that can be much tension in a muscle is required for a movement becomes drawn from this experimental model. These are reviewed in a extremely complex and important with movements involving subsequent paper describing sensorimotor measurement tech- several joints.2,4,12 Accompanying each angular change in niques.41 joint position are changes in the mechanical advantages as- In contrast with the seemingly controversial activation of a sociated with all the muscles that traverse the joint. Many tasks MNs, joint afferents are more unanimously credited with elic- involve a sequence of overlapping joint movements. The mo- iting similar effects on gamma motor neurons (g tor control system must consider the multiple motions occur- MNs).21,22,29,42,43 Interestingly, and in opposition to what ring as both a direct function of muscle activation and indi- many have claimed, Freeman and Wyke43 attributed increases rectly from intersegmental dynamics (movement of one joint in muscle activity in response to joint mechanoreceptor stim- inducing movement of another). Proprioception provides much ulation to activation of g MNs, not a MNs. Since their study, of the information required to solve all these movement prob- many investigations have demonstrated re¯exive action of lems.2,4,7,12,13 joint afferents on g MNs through electric stimulation44 and tissue traction using force levels below those associated with tissue damage and nociception.21,22,42,45,46 Increased g-MN ac- Role of Proprioception in Sensorimotor Control of tivation, which may occur from input arising from cutaneous Functional Joint Stability or muscle sources as well as descending supraspinal com- Motor control for even simple tasks is a plastic process3 mands, serves to heighten muscle spindle sensitivity. What that undergoes constant review and modi®cation based upon does increased muscle spindle sensitivity have in connection the integration and analysis of sensory input, efferent motor with sensorimotor control of functional joint stability? The an- commands, and resultant movements. Proprioceptive infor- swer to this question will become evident
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