The Neuro 15-Minute: What Tests?

Introduction

Hello everyone, and welcome to the Neuro 15-Minute! Today, we will address two crucial questions in neuroscience and physical preparation: the evaluation of a good initial assessment and the relevance of proprioception work on unstable surfaces.

These topics are essential for anyone interested in optimizing performance and preventing injuries, whether as a professional or practitioner. Our answers, though concise, aim to provide you with a comprehensive overview and deep avenues for reflection.

What is a good initial assessment?

A relevant initial assessment must first and foremost be meaningful for the individual being evaluated. If a person consults for shoulder pain or to improve their sprint performance, the tests must directly relate to these specific goals. For example, trying to correct "poor posture" is not an end in itself since posture is merely an entry point; it is the biomechanical consequences that need to be addressed.

Tests should not be conducted merely for the sake of testing, but to facilitate the development of a clear intervention strategy. Whether in physical preparation, neurology, or posturology, the results of the assessment guide the construction of a personalized program tailored to the needs and objectives of the athlete or patient. Planning, programming, and periodization directly stem from this.

A holistic approach to identifying causes

In neuro-postural reprogramming or re-athleticization, it is crucial to adopt a holistic approach. One must not focus solely on the symptomatic area (for example, a painful shoulder). It is imperative to evaluate all the main inputs that may cause postural disruptions. This includes observing the feet, eyes, jaw, and other proprioceptive sensors. The history of injuries is also an important factor to consider.

In our online assessment for athletes, we have integrated over 50 tests. In training, this number rises to about a hundred, as we add observations. This multitude of tests allows for a comprehensive view and helps identify the root causes of imbalances. However, the number of tests can be adjusted based on the context and the practitioner’s experience.

The importance of observation and questioning

Field observation and direct questioning of the athlete are valuable tools. A sports coach, for example, can already conduct a "pre-assessment" by observing their athlete during training and discussing their pain or sensations in daily life. If an athlete complains of neck pain every morning, this will guide the practitioner towards evaluating certain sensors. Similarly, pain experienced during or outside of activity, in the morning or evening, are key pieces of information.

These elements help target relevant tests and avoid systematically performing all 50 or 100 tests. An effective assessment should integrate static and dynamic analysis and the specifics of the practiced sport activity.

Adapting the assessment to the duration of follow-up

The depth of the assessment will also depend on the type of intervention. For a single session, the tests should be immediate and meaningful. For a year-long follow-up, evaluations can be spaced out, thus providing more sense and the ability to observe corrections over time.

Proprioception on unstable surfaces: a false good idea?

The second question concerns proprioception work on unstable surfaces. It is crucial to clarify the definition of proprioception: it is the awareness of one’s body and limbs in space. It should not be confused with balance. Confusing the two can lead to methodological errors in the construction of sessions, and missing fundamental aspects.

Limitations in strength and specificity

From a physical preparation viewpoint, working on an unstable surface can reduce your ability to generate strength, which is typically the opposite goal in training. Furthermore, studies have shown that balance gains are very specific to the tool used. Being good at balance on a slackline does not mean being good on a proprioceptive cushion, and vice versa. This material dependence raises questions about the usefulness of certain exercises.

A broader approach to the nervous system

Proprioception is a complex system that involves many sensors. There is often confusion between balance exercises on unstable surfaces and true proprioceptive reprogramming work. Neuro-specific exercises may be more effective at engaging the brain areas involved in proprioception before considering unstable surfaces.

Indeed, it is important to revisit neuro-developmental evolution. Certain primitive reflexes and neuro-targeted exercises specifically address proprioceptive sensors and deserve to be prioritized. The use of unstable surfaces is highly context-dependent. For example, being effective on sand does not guarantee the same skill on a paddleboard. Methodologically, these are two different approaches.

In summary, before opting for proprioception work on unstable surfaces, there are numerous steps to consider for optimal and tailored neuro-proprioceptive training.