Gait Issues: When Proprioception is Lost … What we lose when we wear “the wrong” shoes …

You have heard us use this word proprioception a million times (OK, some, maybe not a million). Proprioception is our ability to be aware of and orient our body or a body part in space.  Poor proprioception can result in balance and coordination difficulties as well as being a risk factor for injury (Like this poor pooch). *Note: there is no such thing as a “proprioceptor”. All receptors have a more specific name but there are no receptors in the body actually called a proprioceptor, it is a rough classification if that.

Think about people with syphilis, who lose all afferent (sensory) information coming in through the dorsal root ganglia at the spine level. This ultimately leads to a wide based ataxic gait (due to a loss of position and tactile sense) and joint destruction (due to loss of position sense and lack of pain perception). The same consequences can occur, albeit on a smaller scale, when we have diminished proprioception from a joint or its associated muscle spindles.  Just like when we put shoes on our feet, proprioception is lost. Just as it would be lost if we wore oven mitts on our hands all day long; there is a cost to optimal functioning of those muted joints.

To review, proprioception is subserved by both cutaneous receptors in the skin (pacinian coprpuscles, Ruffini endings, etc.), joint mechanoreceptors (types I,II,III and IV) and from muscle spindles (nuclear bag and nuclear chain fibers) . It is both conscious and unconscious and travels in two main pathways in the nervous system.

Conscious proprioception arises from the peripheral mechanoreceptors in the skin and joints and travels in the dorsal column system to ultimately end in the thalamus, where the information is relayed to the cortex. Unconscious proprioception arises from joint mechanoreceptors and muscle spindles and travels in the spino-cerebellr pathways to end in the midline vermis and flocculonodular lobe of the cerebellum.

Conscious proprioceptive information is relayed to other areas of the cortex and the cerebellum. Unconscious proprioceptive information is relayed from the cerebellum to the red nucleus to the thalamus and back to the cortex, to get integrated with the conscious proprioceptive information. This information is then sent down the spinal cord to effect some response in the periphery. There is a constant feed back loop between the proprioceptors, the cerebellum and the cerebral cortex. This is what allows us to be balanced and coordinated in out movements and actions.

Thankfully a fashion trend of wearing oven mitts on our hands has never hit the runways, but in a way we continue to do a similar disservice to our feet wearing shoes. Watch the video again and think about this next time you are contemplating, at the very least, a motion control shoe for yourself or a client.  If we all walked like this when we put shoes on we would never have done this disservice of footwear to ourselves long ago.

Ivo and Shawn….Good Looking and Proprioceptively different.