SPECIAL ARTICLE: Small nerve stimulation: The future of proprioceptive training - DR. EMILY SPLICHAL

When you hear the words “proprioceptive training” what comes to mind? If you do a Google image search for these two words you will get hundreds of pictures demonstrating balance exercises on unstable surfaces.   Despite the popularity of these unstable surfaces how effective are they for improving balance or proprioception? Surprisingly, not as good as their manufacturers would like us to believe. In this article I challenge you to question the effectiveness of unstable surfaces in improving joint stability and if perhaps there is a more effective technique for improving proprioceptive awareness.

What is proprioception?- Often confused with kinesthetic awareness, proprioception is our internal messaging which drives our movements.For example proprioceptors within our joint capsule provide the nervous system information on joint position which is used to control our movements.Meanwhile kinesthetic awareness refers to our ability to navigate space and an awareness of how we move.One such example would be if you are doing a box jump. To know how high to jump as to not clip the foot requires kinesthetic awareness.

Rate of Nervous System Responses- When it comes to controlling movements our nervous system plays a role in how fast the stimuli or sensory information comes into the central nervous system – as well as how quickly the motor response is sent back down to the peripheral nervous system. We will see that the limiting facto in controlling movement is sensory input. This means that the faster the nervous system can sense the stimuli, the faster and more precise our movements will be.

The Peripheral Nervous System (PNS)- Since it is our peripheral nerves which respond to the stimuli, understanding how this system is broken down is important to creating the most effective programming. The PNS can be broken down into sensory nerves and motor nerves.   If we look at the tibial nerve (the nerve that supplies the skin / muscles of the plantar foot) 3x as many branches off of this nerve are sensory vs. motor. Of these sensory nerves 4x as many branches are small nerves vs. large nerve. Nerve size matters when it comes to rate at which the nerves respond to stimuli.   Research has demonstrated that small nerves create a faster response when detecting inversion ankle moments.   In addition research has shown that these small nerves which are found primarily on the plantar skin play an important role in quiet stance.

The Future of Proprioception Training- As we consider the future of proprioceptive training we want to remember that response time is very important to the precision of movements.   Many of the unstable surfaces we associate with proprioceptive training are actually examples of large nerve (or slower) proprioceptive training. Therefore if we consider time we must think small nerve stimulation for faster proprioceptive responses. To create small nerve proprioceptive programming we must know what tissue contains small nerves and what are the most effective ways to stimulate these small nerves.

Small Nerve Proprioceptive Rich Tissue- For anyone who has ever taken one of my workshops knows that the palms of the hands and the soles of the feet are rich in small nerve proprioceptors.   This is one of the greatest reasons why barefoot training is so important for all individuals.

Interestingly there is an even more dense small nerve proprioceptive tissue.Can you guess what it is?

Your fascia!- Fascia is a highly proprioceptive rich tissue with current research demonstrating that many of the sensory nerves found in fascia are small nerve and free nerve endings.   This is quite fascinating as it feeds into the speed at which are fascia is able to help control and stabilize for movement. Another interesting fact about fascia is that it has 10x as many sensory nerves when compared to our muscles.   This means that when we exercise and move we are actually “feeling our fascia” – not “feeling our muscles”. The baseline tone of our fascia actually allows us to better perceive movements and what is referred to as joint position sense.

Small Nerve Barefoot Fascial Training- This is the foundation to all barefoot movements taught through the EBFA Certifications. By integrating the barefoot stimulation with foot to core fascial tensioning we are able to more effectively train and rehab our clients. I believe that fascial tensioning is the future of proprioceptive training!



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