C.A.R.E.N is the best for training both proprioception and balance

Many runners are extremely unathletic. Sure, they can keep plugging along, but they are clumsy, fall easily and can’t manage to stay upright on a difficult cross-country trail. Many cannot sprint at full speed without flailing about and/or spraining something. Others are incapable of playing any kind of sport other than running. While many runners may think this lack of overall athletic ability is unimportant, it is actually a major reason why 50% of runners suffer injuries every single year.

Proper form

It never even occurs to most runners that running properly has to be learned. They figure that everyone knows how to run, and just go for it. In actual fact, many if not most people use their bodies incorrectly while running. Not only does this pre-dispose the runner to injuries, it also slows the runner. A runner using the body correctly, moving in good balance throughout each stride, will move very efficiently and use less energy to cover the ground.


A major skill that runners need to master before they can run with good form is balance. Being in balance throughout each stride means the spine is in alignment and the limbs are moving smoothly regardless of changing terrain underfoot and the motion of the arms and legs.


Proprioception is a fancy word to describe the ability to sense where all of the body parts are. Many people don’t have any idea where their feet are or what their shoulders are doing at any given moment. These people find it very difficult to learn new athletic skills. They are also at higher risk of falls and injuries than people who have finely developed proprioception skills. Before a runner can even begin to learn proper running form, the runner needs to develop their proprioception skills.


The best way to learn both proprioception and balance skills is to visit a physical therapist who has a Computer Assisted Rehabilitation Environment (C.A.R.E.N). These virtual reality systems were originally developed to help rehabilitate individuals after an injury. They are excellent for re-training stroke victims to re-learn balance and proprioception. They are just as wonderful for training runners to learn balance and proprioception.

C.A.R.E.N offers a real-time virtual reality re-training experience. The individual stands, walks or runs on a platform that can move in all directions while viewing visual information on wrap-around screens. While the individual works on learning how to deal with the simulated task, the system captures detailed information about how the individual is using the body to provide feedback to the individual on what to change in future attempts.

The virtual, simulated tasks presented to the runner in C.A.R.E.N are repeatable and allow the runner to practice over and over again until the body and mind have learned proprioception and balance skills. This kind of training is simply not possible in the “real world”, but is easy to do in C.A.R.E.N. Even the clumsiest of runners can quickly master these important skills.

New York Dynamic Neuromuscular Rehabilitation is an industry leader in the use of C.A.R.E.N. Being the first clinic in the U.S. to help athletes prevent injuries and improve performance using a Computer Assisted Rehabilitation Environment.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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