Where are you, where do you want to go, and how do you get there?
Two posts ago, I explained what our proprioceptive sense is — our subconscious ability to know where we are in space at any given time. We have receptors in our muscles, joints, and skin that are constantly gathering information about the position of our bodies and then communicating this information to our brains so that we can move without thinking.
Proprioception is strongly linked with chronic pain. To better understand the relationship, we have to dive deeper into how proprioception works.
Let’s use GPS as our analogy. GPS has two major components that make it useful to us. First, it tells us where we are at any given moment. Basically, satellites orbit the earth and send signals to a receiver on earth. The receiver processes the information so that your phone can understand where you are. You consequently open Google Maps and see a blue dot that represents where you are in relation to your surroundings.
Second, it provides us with a map to get to where we want to go. There are many methods of data collection such as satellite imaging, cars with cameras taking images as they drive, and collaboration with organizations like city councils to create the maps that you and I use to get around. (Not surprisingly, the biggest method of data collection is actually us. Google Maps is tracking our behavior and using that information to keep its maps constantly updated in real time.)
GPS only works as well as those two components are accurate. The more accurate your location and the more accurate the map of your area, the more likely you are to experience an efficient and successful journey to your desired destination. We’ve all had experiences where this was not the case!
Now imagine that a part of your brain functions like a GPS. Those satellites orbiting the earth and all the cars with cameras driving around creating live maps? Those are your proprioceptors. You have billions of them that are constantly sending signals to your own receiver, the somatosensory and motor cortexes in your brain. Your brain uses this information to help you understand where you are in space at any given moment and to create intricate and expansive maps of your body so you can complete a movement from A to B. Just like GPS, how tuned your proprioceptive system is and and how expansive and detailed your maps are dictate how efficiently, or not, you move around in daily life.
What does this have to do with pain? Chronic pain smudges our maps.
In keeping with our GPS analogy, let’s tell a story. Stacy goes on a traumatically horrible date at a restaurant in the East Village. The date was so bad she never went back to that restaurant (even though the food was really good). She’s actually subconsciously avoided the whole neighborhood because everything about it reminded her of her bad experience. A year later, a friend suggests dinner at a new restaurant in the East Village, a block away from her horrible date experience, and she decides to go. She opens up Google Maps and find a really confusing map where the East Village is supposed to be. There are no street names, a few roads are missing, there’s no icon for the subway stops in the area (she’s Brooklyn-based, by the way). Super weird. Well whatever, Stacy somewhat remembers how to get there but since she couldn’t rely on her map as much as she needed, she took the wrong train, got off at the wrong stop, had to stop and ask for directions, and was 30 minutes late to dinner. She got there, but it was inefficient, and she arrived frazzled and frustrated. At this point, she really doesn’t like the East Village and has since begun to avoid the area. Over time, the neighborhood slowly becomes a vague memory, and she even finds herself avoiding areas around it like the Lower East Side and Union Square. In her Google Maps, the confusing blotchy map has slowly grown to include all of lower Manhattan. It’s a slow and subconscious process—until one day, after a few years, she realizes she stopped going to Manhattan at all. It just became too complicated, the maps too unreliable. She doesn’t even remember how it happened. But—she does still vividly remember that horrible date.
There are three mechanisms at play here.
A smudged map. With an injury or painful event, the communication system between our proprioceptors and our brains gets disrupted. The proprioceptive input collected from the site of injury isn’t always translated into an accurate map. While the reasons for this aren’t totally understood yet, it’s likely to be a form of protection—the more unclear the map of the painful area, the less likely you are to use it. This is a useful mechanism—temporarily.
A viscous cycle. You have a smudged map in relation to your injury so you move that part of your body less. The less you use the body part, the less you will activate its proprioceptors and those of the surrounding areas. The less you activate proprioceptors, the less data input to the system. The less data input, the less accurate the maps, and the less accurate the maps, the less you move. And on and on.
A negative emotional association. You have negative experiences associated with a particular movement or body part that got hurt, like Stacy had negative experiences associated with the East Village. It’s normal to want to avoid those areas and movements temporarily. But oftentimes, we subconsciously avoid them beyond what’s good for us.
What to do about it?
As I mentioned, a smudged map is part of the process of injury or initial pain. But we have a bit more control over the cycle it can create as well as breaking negative associations. Becoming aware of the cycle is the first step. Ask yourself, how am I choosing to move? Am I moving differently because I’m in pain? What movements am I avoiding because of my pain? Then you can input more data into the system in ways that don’t cause pain. Things like massaging the painful area with a massage ball or gently rubbing the skin before moving can help activate your proprioceptors. Safely performing tasks with your eyes closed can allow you to rely on your proprioceptive system more than your visual system. Trying daily tasks in new ways, such as putting on your coat with the other arm first, can provide novel proprioceptive stimulus to your brain. Slowly but surely, the Google Maps of your body will become clearer and more accurate. The more accurate your map, the more efficiently you will move, and hopefully, over time, the less pain you may experience.
Mitigating Pain
There is research to suggest a chicken and egg phenomenon with proprioception and chronic pain. The cycle I described above is about injury happening first, and then proprioception going awry. But weaker proprioception can also be a catalyst for chronic pain. Remember, data creates maps so the more data the better. If you’re not moving in ways that input enough data into the system, some of your maps will be unclear— in terms of human movement, we want to have access to as much of our body as possible to keep some areas from getting unfairly stressed and possibly leading to pain. Imagine an interstate overpass in a metropolitan city being the only route to get from point A to point B. With no backroad options, millions of city dwellers will use that interstate overpass, over and over, day after day. Let’s just say, the interstate overpass might get worn down quickly, need repairs, or even replacements. Making sure we have clear and available maps of various back roads will help evenly distribute the traffic. Mindfulness, novelty, and frequency are the most important qualities of movement to ensure a healthy proprioceptive and mapping system in our bodies. Paying attention to how we are moving, moving in new ways whether to acquire a new skill or just complete the same task in different way, and moving often throughout each day are all simple, yet immensely powerful tools.
Remember that your maps are constantly updating in real time, just like Google Maps! That adaptability is what allows our maps to be restored after years of chronic pain, to learn new skills at any age, and to help us use as much of our bodies as we can during daily life. Every single moment is an opportunity to adapt in a positive direction.
keep moving.
(resources)
Proprioception and Pain
Proprioception and Motor Control
Kinesthesia and Proprioception
Improving Proprioception
Smudging and Corticol Maps
The Proprioceptive System
The Somatosensory System
How Google Maps Works
How Google Maps Works, 2