667

Key Words
Proprioceptive system,
proprioception, kinaesthesia,
motor control, balance.

Making Sense of
Proprioception

by Barry C Stillman

The meaning of proprioception, kinaesthesia

and related terms

Summary While people from different backgrounds may

legitimately assign different meanings to the same word, it is
desirable for communication and comprehension purposes if
all who use proprioception, kinaesthesia and related terms
reach a general consensus as to their most appropriate
meaning. This essay represents an attempt to define these
terms in a manner which has validity and relevance for a
broad spectrum of readers. It is also hoped that readers will
gain a better understanding of the nature, functions and
assessment of the proprioceptive system.
The dominant theme of this paper is that the
proprioceptive system has some functions which are sensory
and others which are not. The sensory functions, collectively
termed proprioception (proprioceptive sensation or
kinaesthesia), involve awareness of the spatial and
mechanical status of the musculoskeletal framework. They
include the senses of position, movement and balance.
Proprioceptive sensation is also integral to developing motor
control when learning new skills. Conversely, the contribution
of the proprioceptive system to motor control during learned
skills is largely mediated without sensation; as also are its
roles in reflex protection of joints against potentially harmful
forces and protection of the body against falls (balance).

Stillman, B C (2002).
Making sense of
proprioception: The
meaning of
proprioception,
kinaesthesia and
related terms,
Physiotherapy, 88, 11,
667-646.

Introduction
Semantics, the systematic study of
the meaning of words, should not be
considered an insignificant pastime
mainly undertaken by academics and
pedants. Poor semantics often causes
unnecessary misunderstanding and
disagreements. However, even when
careful attention is given to the meaning of words, communication difficulties
may still remain when the words are used
to represent complex or incompletely
understood concepts, as is the case with
the proprioceptive system. This paper
examines the current use of terms related
to the proprioceptive system, suggests
certain changes, and thereby aims to
improve understanding of the proprioceptive system and its clinical assessment.

Sense and Perception

Sense (sensation) literally means
recognising a single specific type of
stimulus as, for example, touch or
warmth. Perception on the other hand is
a cerebral process designed to clarify the
nature of the source of a stimulus or
stimuli. A typical example of perception is
identifying an object such as a coin or
button held in the hand. Since it is often
difficult to decide whether a given
conscious experience is a simple
(sensory) or more complex cognitive
(perceptual) one, there is a valid
argument for using the words sense and
perception interchangeably; as in this
article. Note, however, that despite their
common designation, the so-called
proprioceptive senses are almost always
examples of perception.
Classification of the Senses
The Scottish physiologist Charles Bell
was first to identify the fundamental
anatomical basis for sense/perception
and movement: Between the brain and
the muscles there is a circle of nerves;
one nerve [ventral roots] conveys the
influence from the brain to the muscle,
another [dorsal roots] gives the sense of
the condition of the muscle to the brain
(Bell, 1826, page 172). Bell included
within this muscular sense the senses of
position and movement, and other senses
evoked by muscle contractions.
In a similar vein the English pathologist
and anatomist Henry Bastian wrote: I
refer to the body of sensations which
result from or are directly occasioned by
movements kinaesthesis. By means of
this complex of sensory impressions we
are made acquainted with the position
and movements of our limbs, we are
enabled to discriminate between different
degrees of resistance and weight,
and by means of it the brain also derives
much unconscious guidance in the
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Table 1: Classification of the senses

Category

Subcategory

Environment

Special senses

Teleceptors

Distant external

Other

Immediate external Taste buds (taste)

Somatic senses Exteroceptors

Receptor (sense)
Eyes (vision),
cochlea (hearing),
nasal mucosa
(smell)

Immediate external Skin (touch,

pressure,
vibration,
warmth, cold, pain)

Proprioceptors

Musculoskeletal

Deep tissue*
(position,
movement, etc),
labyrinth
(posture, balance)

Other

Musculoskeletal

Deep tissue
(warmth, cold, pain)

Visceral

Some viscera
(pressure, stretch,
pain)

Visceral senses Interoceptors

* All subcutaneous structures other than viscera; including muscles, joints,

bones, fascia and interosseous membranes

performance of movements generally

(Bastian, 1887, pages 5, 6).
In 1906, the English physiologist
Charles Sherrington introduced his
classification of the senses, which every
physiology text since has adopted
or closely paralleled (table 1). In
Sherringtons classification proprioceptors are those afferent nerve endings
(actually beginnings) which are activated
by and transmit afferent information
about mechanical stimuli generated
within the musculoskeletal framework.
Because this afferent information does

Proprioception/kinaesthesia
Position, movement, force, weight,
effort, pressure, vibration,
body segment size/shape,
balance

Musculoskeletal

Temperature
Warmth, cold

Nociception
Pain

Fig1: Classification of the musculoskeletal senses

Physiotherapy November 2002/vol 88/no 11

not always reach the cerebral cortex,

it does not always produce sensation. Accordingly, the generic term
(neuro)receptor is preferable to sense
organ. Sherringtons other categories of
sensation are exteroception and
teleception, where the sources of the
stimuli are the immediate and distant
external environments respectively, and
interoception where the viscera are the
stimulus source.
As the above quotation from Bastian
indicates, kinaesthesis (kinaesthesia),
while focusing on movement sense, does
not exclude position sense or the other
muscular senses redefined almost a
decade later by Sherrington. Indeed,
given the minimal distinctions that can be
made between Bastians kinaesthesia and
Sherringtons proprioception, it seems
appropriate now to treat both words as
synonyms; as in figure 1. This view is also
held by several other authors from
different disciplines (eg Clark and Horch,
1986; Schmidt, 1991).
Common variations in the definition of
proprioception and kinaesthesia in
current published literature are to define
proprioception as in figure 1, while
defining kinaesthesia either as the same as
proprioception, except for the exclusion
of balance (Fitzpatrick and McCloskey,
1994), or as movement sense alone
(Jerosch and Prymka, 1996). Although
not this authors preference, these alternatives are not conceptually harmful.
However, problems do arise when
kinaesthesia is defined as movement
sense, and proprioception as either
position sense (Barrack and Skinner,
1990) or position and movement sense
(Warner et al, 1996; Gardner et al, 2000).
The concern here is that all the other
senses listed under proprioception/kinaesthesia in figure 1 are left unclassified and apparently (but incorrectly)
unrelated to position and movement
sense.
Moreover, little value can be derived
from having two words with the same
meaning. Hence kinaesthesia should not
have the same meaning as the simple
relatively self-explanatory movement
sense, nor should proprioception mean
just position sense.
Likewise, pallaesthesia and piesesthesia are redundant alternatives for
vibration sense and pressure sense
respectively.

Scholarly paper

Position versus Movement Sense

Without looking, normal individuals can
accurately sense the position of a limb
segment even after it has been motionless
and unattended consciously for a long
time. This position sense is served by
slowly adapting mechanoreceptors;
mainly secondary spindle endings and
tendon organs in muscle, and tendon
organs and Ruffini spray endings in other
deep tissues. For reviews of the various
types of proprioceptor see Grigg (1994)
and Hogervorst and Brand (1998).
When an unobserved limb is passively
moved at sufficient speed, its owner can
normally sense attributes of the movement as it occurs; for example its
direction, amplitude and velocity. This
movement sense stems from the more
rapidly adapting proprioceptors; mainly
the muscle spindle primary endings, and
lamellated corpuscles in other deep
tissues. However, since every position is
arrived at through a movement and every
movement causes a change in position
(McCloskey, 1978, page 806), position
and movement sense are commonly
linked during daily activities. Information
gained during movement to a position
may help localise the end position,
while information gained about the start
and end positions can be used to deduce
features of the interposed movement.
Clinicians may assess position sense in
isolation from movement sense by
passively moving the joint to (and from)
each test position using an indirect path
with several random changes in direction
(Remedios et al, 1998). By contrast, clinicians cannot isolate movement sense
without sophisticated equipment; that is
they cannot prevent patients from gaining
movement cues from the postures at
the start and end of the movement.
Nevertheless, since spindle primary
endings are partly slowly adapting, and
secondary endings and Ruffini endings
partly rapidly adapting, there is
substantial overlap in the receptors
responsible for position and movement
sense, and a high probability that
movement and position sense will be
equally affected in most patients.
Muscle versus Joint Sense
The question may be asked: Is there a
true muscle sense and a true joint sense,
and if so what are they? Following
Kellgrens (1939) seminal studies of

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referred pain from deep tissues, it is now

clear that localisation of all sensations to
their point of origin is greatest at the body
sur face, and increasingly limited in
deeper structures. Although some senses
such as ache, pain, tension and pressure
may be experienced in a muscle or
joint, or even a smaller component such
as a tendon or ligament, rarely does
such an experience allow the person
to conceptualise sharply the involved
structure. Experiments using normal
conscious co-operating subjects have
confirmed that when surgically exposed
tendons are pulled so as to stretch the
muscle belly (McCloskey et al, 1983), or
afferents from muscular proprioceptors
electrically stimulated (Gandevia, 1985),
or muscle spindles stimulated by
externally applied mechanical vibrations
(Roll et al, 1989), the resulting sense is
always of position or movement of the
skeletal segments on which the muscle
acts. In none of these studies was any
sense experienced in the muscle bellies
or their tendons. Similarly, electrical
stimulation of finger joint proprioceptive
afferents by Burke et al (1988) and
Macefield et al (1990) mainly produced
illusions of finger movement.
In summary, for the most part
proprioceptive senses are derived from
muscles and joints rather than experienced in muscles and joints. For this
reason it is questionable whether
physiotherapists can train patients to
sense individual contracting muscles
more than vaguely, especially deeply
placed muscles such as transversus
abdominis and multifidus. More detailed arguments along similar lines are
provided by Bosco and Poppele (2001).

Author and Address

for Correspondence
Barry C Stillman
MCSP PhD(Melb)
FACP is a senior
Fellow in the School
of Physiotherapy,
The University of
Melbourne,
Victoria 3010,
Australia.
E-mail:
b.stillman@unimelb.e
du.au
This article was
received on
September 13, 2001,
and accepted on May
14, 2002.
Acknowledgments
I wish to acknowledge
Joan McMeeken and
Richard MacDonell,
my PhD supervisors;
and Trevor Allen,
Claire Delany,
Michelle King,
Doris Malcolm,
Stephen Martin
and Beverley Phillips,
who read the essay
and provided helpful
suggestions. Stephen
Martin also helped
construct figure 2.

Part-time Proprioceptors
If the corpuscular musculoskeletal
receptors and vestibular apparatus are
considered full-time members of the
proprioceptive system, then skin receptors and the retina of the eye may be
characterised as part-time proprioceptors.
While table 1 shows the primary role of
the skin receptors and retina as reacting
to stimuli derived from the external
environment, sometimes they provide the
central nervous system with proprioceptive information about the musculoskeletal framework, as elaborated below.
During standing, afferent information
from skin receptors in the soles of the feet
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can be used by the proprioceptive centres

of the brain to help clarify the posture of
the more proximal limb and axial joints
(Kavounoudias et al, 2001). The same
applies in standing when there is even the
lightest fingertip contact with an external
surface (Clapp and Wing, 1999; Lackner
et al, 2000). If a standing subjects eyes are
open, vision can also help identify body
segment positions (Fitzpatrick and
McCloskey, 1994). These proprioceptive
roles of the skin and retina also apply
during other postures and many dynamic
functional activities such as reachto-grasp. Of course this does not stop
the skin receptors and retina from
undertaking their more usual duties;
that is responding to the external
environment.
Skin mechanoreceptors in the hand
function almost as often proprioceptively
as they do exteroceptively. Thus Erik
Moberg, the renowned Swedish exponent
of sensory hand assessment, wrote: In the
unique combination of explorative and
manipulative performances of the fingers,
with their refined motor control and
dense cutaneous inner vation, the
distinction between proprioception and
exteroception seems almost to vanish
(Moberg, 1990, pages 133, 134).
If we actively move a fingertip across the
sur face of an unseen object, we may
perceive the texture and temperature of
that sur face. This is a purely tactile
(exteroceptive) activity, sometimes called
active touch (Kalaska, 1994; Craig and
Rollman, 1999). However, if we touch
and grasp the object, the skin and
musculoskeletal receptors can provide
proprioceptive afferent information about
the object; that is information about the
objects size, shape, hardness and weight
(Jones, 1996). The proprioceptive role of
hand skin receptors was proven by Edin
and Johansson (1995) when they showed
that when skin surrounding finger joints
is experimentally strained in the manner
which would naturally occur during
finger movements, that is stretched
over one side of the joint and relaxed
over the other, normal subjects sense
finger movement even if the joint is not
moved. In the published literature this
manipulation-precipitated concurrence of
exteroception and proprioception is often
referred to as stereognosis (Bennett and
Karnes, 1998) or haptic sense (Appelle,
1991).
Physiotherapy November 2002/vol 88/no 11

Proprioception and Motor Skill

Learning
Proprioceptive awareness of postures and
movements is most required during the
learning of new skills. For example, when
first learning to touch-type there is a high
consciousness particularly of wrist and
hand movements. By being conscious of
what is happening an individual can more
readily (ie consciously) change how it is
happening. As learning proceeds and the
typing movements are refined, afferent
feedback signals from the participating
body segments are systematically stored in
the brain as templates of properly
executed typing movements. Research
employing functional magnetic resonance
imaging and positron emission tomography indicates that the cerebellum and
pre-frontal cerebral cortex are the main
sites for this learning process (Jenkins et
al, 1994; Flament et al, 1996).
Once fully learned, typing involves
minimum proprioceptive consciousness of the participating body segments,
and maximum use of stored afferent
templates. That is, at a subconscious
level afferent signals fed back from
proprioceptors in the periphery are crosschecked against the stored afferent
templates to help verify correct performance. The great advantage of shifting
control of learned activities from a
conscious cerebral process to a largely
subconscious propriocerebellar one, is
that instead of focusing on the process we
are freed to concentrate on its outcome.
Some movements are so fast that
proprioceptive feedback is only possible
before the movement begins (to help
planning), and after the movement is
completed (to help verify the outcome)
(McCloskey and Gandevia 1993). With
slower movements the proprioceptive
system can monitor and even adjust
the movement as it occurs. Especially
useful is the ability of the proprioceptive
system to trigger immediate, rapid and
precisely-tailored compensatory muscular contractions reflexively in response
to unexpected changes in external or
internal forces; for example as required
during standing balance. See Hasan
and Stuart (1988) for other examples.
Typically, these adjustments are nearcomplete or complete before there is any
sense of the triggering stimulus. While
some simple unperturbed movements
are possible without propriospinal and

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671

propriocerebellar verification, such

movements always rapidly deteriorate
(Nougier et al, 1996). For an absorbing
story of life without a functioning
proprioceptive system see Cole (1995).

Sensory
3

Neuroanatomical Components of the

Proprioceptive System
Three main destinations of the proprioceptive afferents and a related motor
neuronal connection are outlined in
figure 2. Afferent destination 1, the spinal
cord, represents proprioceptive afferent
connections on to A and especially A
motor neurones for producing reflexes
designed to protect joints against
potentially harmful stresses. Notwithstanding their undoubted importance, it

Motor

Cerebral
cortex

Cerebellum

3c

3b

3a

2a
1

2b

1. Arthrokinetic (subconscious) protective reflex

2. Spinocerebellar (subconscious) motor control pathways
a = dorsal
b = ventral
3. Sensory pathways
a = spinomedullary (lower limb proprioception)
b = cuneate (upper limb proprioception/exteroception)
c = gracile (lower limb exteroception)
4. Corollary discharge
sense of effort
facilitates interpretation of sensory/asensory information
suppression of redundant senses

Fig 2: Components and destinations of the proprioceptive system. On the left, proprioceptive afferent
pathways from skin, muscle and joint enter the spinal cord via the dorsal roots. The three derived
pathways (1-3) pass to the ventral grey matter of the spinal cord, the cerebellum, and the sensory
cerebral cortex respectively. A hypothetical pathway for corollary discharges from the upper motor
neurones is also shown (4). The transverse section of the spinal cord on the right provides greater
detail of the spinal connections

Physiotherapy November 2002/vol 88/no 11

672

is inappropriate for Hurley et al (1998),

Beard et al (1993) and others to have
included these reflexes within their
definition of proprioception. These
reflexes do not depend on, and are
invariably complete before there is any
sense of either the stimulus or muscular
response; that is they represent one of
the subconscious (asensory) functions
of the proprioceptive system. Given the
established usefulness of Sherringtons
classification of the senses, at least
in physiology and psychology, those
who would redefine proprioception
as anything other than a category of
sensation will need a very good reason.
Destination 2 represents the cerebellar
connections, which are so important for
(subconscious) regulation of postures,
balance, and movement in general.
Destination 3, the cerebral cortex, is the
only proprioceptive afferent destination
which allows perception; that is which can
result in proprioception. The cerebral
cortex receives proprioceptive information from the lower limbs almost
exclusively by way of the spinomedullary
tract in the dorsolateral white column
(3a in figure 2) (York, 1985; Nathan et al,
1986), whereas proprioceptive (and
discriminative cutaneous) information
from the upper limbs is transmitted
largely via the cuneate tract in the dorsal
white column (3b in figure 2).
The corollary discharge is upper motor
neurone information which is transmitted to the proprioceptive regions of the
cerebral cortex. In figure 2 it is represented as a corticocortical connection,
however its exact neuroanatomy is
presently unknown. It could just as easily
be a brainstem branch from the upper
motor neurones that reaches the cerebral
cortex via the cerebellum and thalamus.
Whatever its exact pathway, the corollary
discharge has an important role in active
as compared to passive position and
movement sense. During voluntary
muscle actions the corollary discharge is
made available to the proprioceptive
cerebral cortex for analytical purposes. In
simple terms the proprioceptive cerebral
cortex is better able to discern/sense
position and movement if it has access to
both the corollary discharge (which
represents the intended movement) and
peripheral proprioceptive afferent
feedback (which is generated by the
actual movement). Since upper motor
Physiotherapy November 2002/vol 88/no 11

neurone and hence corollary discharge

signals are not produced during passive
movement, and since passive movement
does not generate the same volume of
peripheral afferent information (especially from muscles), passive position sense
is generally worse than active position
sense.
For the above reasons, and because
active movements are more functional
than passive movements, there is a good
argument for clinicians using active
position sense tests wherever possible
(Stillman, 2000).
Assessment of Proprioceptive System
Functions
Clinicians cannot expect to examine the
proprioceptive system with the precision
and detail possible in the research
laboratory. Nevertheless, there are several
different clinical tests, summarised in
table 2, which can be used to investigate
the different parts of this system.
First note that every test in table 2
depends on, and therefore investigates
the integrity of the proprioceptors and
their afferents. Even the senses of effort,
fatigue and weight, which are largely
derived from the corollary discharge
(Gandevia, 1996), depend in part
on feedback from the proprioceptors
via their afferents. Thus, for example,
Fleury et al (1995) demonstrated a
markedly diminished capacity for weight
discrimination in a person with no
functioning peripheral proprioceptive
system. Each individual test in table 2
will now be considered in more detail.
The first tests in table 2, passive position and movement sense, involve the
proprioceptive pathways from the periphery to the cerebral cortex, but do not
necessarily characterise the proprioceptive systems asensory joint reflex
and motor control functions. Although
active position sense tests are arguably
more relevant to everyday functions, like
passive tests they provide only limited
evidence of the proprioceptive systems
motor control functions. In large part
the reason is that active position sense
tests involve only simple motor tasks that
do not challenge a persons capacity to
control skilled activities.
Before administering active position
sense tests it is important to check that a
patient has enough voluntary motor
control to be able to move the part to,

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673

Table 2: Clinical assessment of proprioceptive system functions

Test type

Procedure*

Outcome measure

Comments

Position/movement sense
(passive)

Passive positioning/movement
of joint with patient describing
or replicating the test position/
movement using same or
contralateral joint

Accuracy of description
or replication

Involves proprioceptive sense derived

from skin, joint and muscle

Position sense (active)

Patient isometrically holds

examiner-selected position,
then replicates the position
using the same or opposite limb

Accuracy of replication

Involves proprioceptive sense derived

from skin, joint and (especially)
muscle

Deep vibration, pressure

or weight discrimination

Vibrating tuning fork, pressure

sensor or weights applied to
deep tissues via the skin

Deep vibration, pressure

and weight sense

Results not correlated to other

proprioceptive functions

Tracking and point

location tests (eg heel-shin,
finger-to-nose, thumb
finding tests)

Active limb movement to touch

specified body segment
(eg, nose, thumb)

Accuracy of trajectory
and target location

Involves proprioceptive and

cerebellar motor control
functions; target location
requires position sense

Isometric holding of
upper limb

Upper limb held outstretched

in front of body

Deviation of limb from

initial position,
writhing hand movements

Involves proprioceptive and

cerebellar motor control functions

Proprioceptive joint reflexes Sudden perturbation of actively

held joint position

Latency and EMG activity

of surrounding muscles

Results not correlated to other

proprioceptive functions

Standing balance

Uni-/bilateral stance with

eyes open/closed, different
supporting surfaces, and
with/without perturbations

Duration of maintained
balance, characteristics of
sway, Romberg sign (sway
significantly worse with
eyes closed)

Romberg sign concerns

proprioceptive (including
vestibular) balance-related motor
control, but not proprioceptive
senses; test also involves cerebellar
and visual motor control functions

Stereognosis

Identification of unseen
object manipulated by hand

Accuracy of identification

Involves proprioceptive sense derived

from skin, joint and muscle

Duration, coordination,
ease and success in
completing task

Involves non-specific examination

of the interaction of the visual,
cutaneous, cerebellar and
proprioceptive systems in motor
control

Skilled motor function tests Examiner observation and

of, for example, walking,
measurement of activity
dressing, manipulating tools

*Unless otherwise stated, the patient's eyes are closed throughout the tests and responses.

and briefly hold it at, perceived test

positions. In a study of 33 patients within
2 to 12 weeks of their stroke (or most
recent stroke), the author successfully
administered active tests to 25 patients
(Stillman, 2000). In three patients it was
possible to administer passive tests but not
active tests, and in the remaining patients
no test was possible. In other words, while
pain, paresis and hypertonia may prohibit
active position sense tests, they often also
make passive tests impractical.
Among the least relevant tests with
respect to the motor control functions of
the proprioceptive system are the specific
tests of vibration sense, pressure sense
and weight discrimination. For example,
Cox (1991) found no correlation in normal subjects between forearm position
sense and the ability to distinguish
weights held in the hand. Nevertheless,

since vibration sense in particular can be

precisely instrumented, its assessment is
relatively objective and the results may be
highly diagnostic.
Tests which focus on tracking ability
have more to do with the contributions of
both the cerebellar and proprioceptive
systems to static and dynamic motor
control. Tests which focus on target
location (eg the thumb finding test)
depend more on proprioceptive sense
of the target positions.
Assessment of motor responses
following sudden perturbation of
individual joints requires sophisticated
measuring instruments not generally
available to clinicians. It is also difficult to
interpret the results; that is to resolve
whether the motor responses are a
consequence of proprioceptive or of
other (eg biomechanical) mechanisms.
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Consequently, at present these tests have

little clinical relevance.
The different types of clinical balance
assessment are well-reviewed by Huxham
et al (2001). Only a few points need
stressing here. Standing balance
assessments generally tax the total
body motor control functions of the
proprioceptive system in conjunction with
other control systems. For reasons which
are not easily justified, clinical balance
tests rarely include the sense of balance;
that is examiners rarely ask their patients
whether or not they feel/felt stable or
unstable during the tests. Also, this author
does not agree with the commonly held
view that standing on dense foam
minimises proprioceptive feedback from
the feet and ankles. Increased instability
from standing on foam causes greater
foot and ankle joint motion, and thus
greater proprioceptive feedback from the
foot and ankle proprioceptors. However,
since there is also greater total body sway
when standing on foam, there is greater
stimulation of other proprioceptors
such as the vestibular apparatus. Thus,
standing on foam makes balance more
difficult without biasing the test to any
particular group of proprioceptors.
Finally, since most balance tests are
relatively static, they provide only limited
evidence about the dynamic motor
control capabilities of the proprioceptive
system.
The remaining tests shown in table 2,
stereognosis and skilled motor function

References
Appelle, S (1991). Haptic perception of form:
Activity and stimulus attributes in: Heller, M A
and Schiff, W (eds) The Psychology of Touch,
Lawrence Erlbaum, New Jersey, pages 169-188.
Barrack, R L and Skinner, H B (1990). The
sensory function of knee ligaments in: Daniel,
D M, Akeson, W H and OConnor, J J (eds)
Knee Ligaments: Structure, function, injury,
and repair, Raven Press, New York,
pages 95-114.
Bastian, H C (1887). The muscular sense:
Its nature and cortical localisation, Brain, 10,
1-88.
Beard, D J, Kyberd, P J, Fergusson, C M and
Dodd, C A F (1993). Proprioception after
rupture of the anterior cruciate ligament:
An objective indication of the need for
surgery? Journal of Bone and Joint Surgery,
75B, 311-315.

Physiotherapy November 2002/vol 88/no 11

tests, while non-specific, are of great

importance as they show what the
proprioceptive system is capable of in real
life. Their omission from proprioceptive
assessment is rarely excusable.
In light of the aims of this paper, it was
not appropriate to consider clinical
assessment in detail. The aim was to
highlight the extent to which different
tests focus on different parts/functions of
the system. More detailed discussions of
proprioceptive assessment can be obtained from Dickinson (1974, pages 35-62),
Marks (1998), Stillman (2000, chap 1,
pages 5-17) and Pincivero and Coelho
(2001).
Conclusion
The English language is neither dead or
exact, and the challenge of maximising
trouble-free communication is often
difficult. In this essay an attempt has been
made to clarify the meaning of terms
related to the proprioceptive system, and
to offer arguments in support of their
more general use. Some less satisfactory
terms and concepts have been included
so as to highlight how they misrepresent
the functions of the system as currently
understood. While future research may
lead to a greater knowledge of the
proprioceptive system, it may never be
possible to obtain complete agreement
between the various interested parties.
Nevertheless, the more care and clarity
with which we define our terms, the less
problematic will be the differences.

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connects the voluntary muscles with the brain,
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Key Messages
The
proprioceptive
system is that
ascending part of
the nervous system
which provides for
sense of the spatial
and mechanical
status of the
musculoskeletal
framework, serves
motor control, and
facilitates reflex
defence of individual
joints against injury
and the whole body
against falls.
A proprioceptor
is any receptor
which transmits
information
about the spatial
and mechanical
status of the
musculoskeletal
framework
to the central
nervous system.
This information
may reach
consciousness, but
often does not.
Proprioception
(proprioceptive
sensation or
kinaesthesia) is
that category of
sensations
representing the
spatial and
mechanical status of
the musculoskeletal
framework.
Proprioception
serves body image,
and the
development of
motor control when
learning new skills.
The contribution
of the proprioceptive
system to the motor
control of learned
skills, and reflex
protection of joints
against injury,
do not depend on
and are often
mediated without
significant
accompanying
sensation.

Physiotherapy November 2002/vol 88/no 11

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Additional Reading
Boring, E G (1942). Sensation and Perception in
the History of Experimental Psychology,
Appleton-Century-Crofts, New York.
Gibson, J J (1966). The Senses Considered as
Perceptual Systems, Houghton Mifflin, Boston.
Greger, R and Windhorst, U (eds) (1996).
Comprehensive Human Physiology: From cellular
mechanism to integration, vol 1, Springer, Berlin.
Lephart, S M and Fu, F H (eds) (2000).
Proprioception and Neuromuscular Control in Joint
Stability, Human Kinetics, Champaign.
McCloskey, D I and Prochazka, A (1994). The
role of sensory information in the guidance of
voluntary movement: Reflections on a
symposium held at the 22nd annual meeting
of the Society for Neuroscience, Somatosensory
and Motor Research, 11, 69-76.
Prochazka, A (1996). Proprioceptive feedback
and movement regulation in: Rowell, L B and
Shepherd, J T (eds) Handbook of Physiology: A
critical, comprehensive presentation of physiological
knowledge and concepts. Section 12: Exercise:
Regulation and integration of multiple systems,
Oxford University Press, New York,
pages 89-127.