Let’s start this conversation with a healthy discussion. What are the two most important organs in the human body? Importance in the manner of sustaining life functions in its full expression. If one or both of these organs cease to function, the entire human system will dysregulate hormonally, disorient the psyche, and would ultimately destroy that person’s existence as they know it. You guessed it!
The Heart & The Brain
Taking a reductionist approach and dismissing the importance of the heart and brain connection with overall health, especially in rehabilitation, will create incomplete healing and/or promote reinjury. Incorporating heart and brain rehabilitation is essential in the total rehabilitation of all joints. If a patient has a swollen knee, low back pain, shoulder injury, etc., both the brain and heart are needed in rehabilitating because they innately perform the roles of information acquisition, transmission of information, and storage of movement patterns.1 To best consider these two systems with a rehabilitation program, we focus on joint position sense and proprioception training. What is proprioception? Proprioception is the sense, or conscious awareness of joint position, which is very important in preventing injury and rehabilitating an acute or chronic condition. Once this awareness is restored, the body can maintain stability and orientation during static and dynamic activities. Impaired joint position sense is often overlooked and may be a major risk factor for recurrent injuries after the integrity of the muscles and ligaments are restored.3
As chiropractors, when focusing on heart health and rehabilitation we look to the cervical spine. There is an abundance of receptors in the cervical muscles that directly connect to and influence the vestibular, visual, and postural control systems.2 For example, the deep suboccipital muscles have the highest cervical receptor density and have a specific role in reflex and central connections to the brain. A patient may have an issue in this area if you find deficits in cervical range of motion, muscle dysregulation, and lack of postural control resulting in altered proprioception.1 Exercise programs that focus on cervical proprioception help to reduce the nervous system dysafferentation, which in turn improves proprioception.
Cervical proprioception training exercises
- Head relocation practice
- Gaze stability
- Eye-head coordination
According to The Physician and Sports Medicine Journal, injury to a joint has the ability to cause direct or indirect alterations in sensory information that the body directly interprets from mechanoreceptors. For example, direct trauma can create an impact to a joint that causes the ligament and capsule to tear, thus severing nerve fibers, and destroying the carriers of messages to and from the joint receptors. In contrast, indirect trauma such as effusion swells around receptors causing them to become muddled in communication and emit incorrect information back to the rest of the brain-body. A small knee infusion of 20mL can inhibit up to 60% of the effort produced by the quadriceps.3 When these pathways aren’t acknowledged and addressed, neuromuscular pathways become inhibited and muscle groups become uncoordinated.3 This results in an immediate danger zone for health and welcoming for reinjury.
As health care practitioners, controlling this inflammatory pathway is essential to restoration and improved mobility. This can be done by simple, specific and intentional exercise training.
Lower extremity proprioception training exercises
- Balance training: One-legged standing balance and progress to wobble board
- Kinetic chain exercises: Leg press, squats, single-leg hops, vertical jumps, carioca
- Dynamic lumbar stabilization: Quadruped with alternate arm/leg
By performing the series of proprioceptive exercises for upper and lowering extremities, for 10 weeks, in conjunction with rehabilitative chiropractic care, the patient may significantly reduce the incidence of reoccurring injuries and the chiropractor can continue their focus on promoting health.
This article first appeared in the February 2020 issue of Lifelines, the Life West student magazine.
- Abbott-K. J.- Adamson- Burke- Grobstein-R. H.- Anderson-W. R.- Ashby- Burggren-G. J.- Chaitin- Dressler- Eldredge- Goldman-Rakic- Goldstein- Grobstein-S. K.- Kostyk- Grobstein- Grossberg- Holtfreter- Hebb- Hollyday- Grobstein- James- Kauffman-M. L.- Kirby- Kohler-K. S.- Lashley- Lehky-T. J.- Sejnowski- Luria- Malsburg-J. R.- Newsome-J. L.- McClelland- Rummelhart- Moore-Ede- Sulzman- Root-Bernstein- Rummelhart-J. L.- McClelland-R. W.- Udin- Fawcett- Waddington- Weiss-E. B.- Wilson- Wolpert- Sperry – https://link.springer.com/article/10.1007/BF01939890
- Jull G, Falla D, Treleaven J, Hodges P, Vicenzino B. Retraining cervical joint position sense: The effect of two exercise regimes. Journal of Orthopaedic Research. 2007;25(3):404–12.
- Laskowski ER, Newcomer-Aney K, Smith J. Refining Rehabilitation With Proprioception Training. The Physician and Sportsmedicine. 1997;25(10):89–102.