What proprioception is and why it is essential for the shoulder
Proprioception is the body’s ability to perceive the position and movement of its joints, even without visual input. It allows us to perform complex gestures with precision and safety—such as grasping an object or throwing a ball—without visually monitoring every movement.
Although it is widely discussed, the scientific literature still offers a limited amount of robust quantitative data on proprioception, highlighting how complex and partly unexplored this field remains.
In the case of the shoulder, this function plays an especially intricate role: it is the most mobile joint in the human body, and for this reason its stability cannot rely solely on anatomical structures but requires constant and refined neuromuscular control.
Shoulder proprioceptive control involves brain mechanisms and articular sensors that integrate information from muscles and tendons, particularly from dynamic stabilizers such as the rotator cuff. When injuries or instability occur, rehabilitation focuses on enhancing these compensatory mechanisms to restore performance and dynamic stability.
Efficient proprioception keeps the humeral head centered within the glenoid cavity—preventing micro-instability or subluxations during movement—and ensures precise coordination between the scapula and the humerus. It is essential in throwing sports, swimming, weightlifting, and all activities requiring rapid and controlled movements.
In clinical and rehabilitative settings, proprioception becomes a true indicator of joint health: it underpins dynamic stability and serves as a sensitive parameter for post-traumatic or post-surgical recovery.
In sports medicine, the ability to accurately reproduce a gesture—such as throwing a ball to the same point regardless of body position—results from refined neuromotor control and efficient proprioceptive function.
What the literature says: recent evidence and perspectives
Over recent years, scientific literature has increasingly explored the role of proprioception in shoulder function, providing stronger evidence of its importance in prevention and rehabilitation.
One of the earlier key studies in this field is by Laudner et al. (2012) [1], who assessed joint position sense using an isokinetic machine in healthy individuals with anterior glenohumeral hyperlaxity. They found slightly reduced proprioception in more hyperlax subjects, suggesting that the human body has a complex system capable of perceiving and compensating for variations in joint stability.
One of the most interesting research areas concerns the relationship between glenohumeral laxity and proprioceptive sensitivity. Studies on young athletes—particularly baseball players—show that individuals with greater laxity often display altered joint position sense [1]. This suggests that when structural stability decreases, the sensory system attempts to compensate by increasing proprioceptive control as a protective mechanism against instability and subluxations.
Other works, such as those by Tsuda et al. (2021) [2], examined proprioception in patients undergoing arthroscopic Bankart repair. In these cases, proprioceptive deficits improved progressively after surgery and throughout rehabilitation, confirming that proprioception is not a static function but a trainable and recoverable ability.
More recent studies, such as those by Ager et al. (2024) [3] and Alexandrov et al. (2025) [4], highlighted the link between pain, instability, and proprioceptive accuracy, showing that improved sensorimotor control correlates with reduced pain and more efficient motor performance. Rehabilitation programs specifically targeting proprioception—such as those proposed by Yoon et al. (2020) [5] —have also demonstrated reduced instability symptoms and improved athletic performance.
Collectively, these findings confirm that proprioception is a key parameter of joint function and that its assessment and training should be systematically integrated into shoulder rehabilitation programs.
Challenges in assessing proprioception
Despite significant progress, assessing shoulder proprioception remains challenging. There is no universally accepted clinical standard, and many commonly used tests—such as the Joint Position Sense (JPS) test—rely on the patient’s ability to reproduce specific joint angles.
However, these methods are highly subjective, influenced by patient cooperation, operator experience, and environmental conditions. Inter-session and inter-rater reliability are often limited, and the resulting data are difficult to compare.
Additionally, there is a lack of objective tools capable of providing continuous quantitative measurements. In clinical practice, this often means being unable to clearly determine whether a clinical improvement corresponds to an actual recovery of sensorimotor control.
As Fox et al. (2024) [6] also observed, proprioceptive assessment is still too often overlooked despite its relevance for stability and recurrence prevention.
Without the ability to quantify patient progress—as is done for strength, power, or range of motion—it becomes difficult to plan a rehabilitation pathway that is truly personalized and data-driven.
From research to clinical practice: toward standardization of measurements
Research and clinical practice agree on one point: to improve rehabilitation, it is essential to measure what you want to improve. This is one of the needs addressed by AuReha, the wearable device developed by DigitalRehab for proprioception measurement and training.
Standardizing proprioception assessment is a crucial step toward consolidating scientific evidence and translating it into clinical practice.
Having objective and comparable data would make it possible not only to validate new therapeutic protocols but also to define clinically meaningful parameters for monitoring recovery and personalizing treatment.
Different studies demonstrated how shoulder proprioception is not an accessory parameter, but a real functional indicator of motor recovery [7]. Investing in this field, then, represent a concrete opportunity to study relationship between pain, instability and recovery in a rigorous way. Digital tools like AuReha pave the way for data-driven rehabilitation—more precise, motivating, and aligned with the needs of both patients and therapists.
Conclusions
Proprioception is a fundamental component of joint health and motor control. Measuring it objectively means better understanding dynamic stability, personalizing rehabilitation, and preventing recurrences.
The experience shared by DigitalRehab at XII International Congress Sport Traumatology “The Battle”, held on October 24th-25th 2025, confirms that the combination of science, technology, and clinical practice represents the future of rehabilitation.
Through tools like AuReha, proprioceptive assessment becomes finally quantifiable, trainable, and scientifically validatable, guiding rehabilitation toward a truly data-driven and patient-centered approach.
Authors:
Gabriele Fiumana, Shoulder Elbow Team
Elisa Tongiani, Shoulder Elbow Team
Lorenzo Valente, DigitalRehab
Silvia Sciamanna, DigitalRehab
References:
- Laudner K, Meister K, Noel B, Deter T. Anterior glenohumeral laxity is associated with posterior shoulder tightness among professional baseball pitchers. Am J Sports Med. 2012 May;40(5):1133-7. doi: 10.1177/0363546512437522. Epub 2012 Feb 17. PMID: 22343757.
- Tsuda Y, Amako M, Takashima K, Kawaguchi M. Preoperative and postoperative shoulder position sense in patients who underwent arthroscopic Bankart repair for traumatic shoulder joint instability. JSES Int. 2021;5(2):190-193.
- Ager AL, Roy JS, Dubé MO, Cools AM, Borms D. Relationship between pain and proprioception among individuals with rotator cuff-related shoulder pain. J Hand Ther. 2024;37(2):224-233.
- Alexandrov A, Morton A, Molino J, Pelusi J, Chrostek CA, Crisco JJ, Arcand MA. Investigating the Effect of Elevation and Sex-Based Differences on Shoulder Proprioceptive Accuracy. Orthop J Sports Med. 2025;13(2):23259671251315524.
- Yoon JH, Song KJ, Ji MY, Lee BS, Oh JK. Effect of a 12-Week Rehabilitation Exercise Program on Shoulder Proprioception, Instability and Pain in Baseball Players with Shoulder Instability. Iran J Public Health. 2020;49(8):1467-1475.
- Fox JA, Luther L, Epner E, LeClere L. Shoulder Proprioception: A Review. J Clin Med. 2024 Apr 3;13(7):2077. doi: 10.3390/jcm13072077. PMID: 38610841; PMCID: PMC11012644.
- Sayaca C, Unal M, Calik M, Eyuboglu FE, Kaya D, Ozenci AM. Scapular Dyskinesis, Shoulder Joint Position Sense, and Functional Level After Arthroscopic Bankart Repair. Orthop J Sports Med. 2021;9(8):2325967120985207.
