Nerve Glides in Physical Therapy
Flossing Exercises That Mobilize the Nerves
Nerve gliding, also called nerve flossing or stretching, is an exercise technique used in physical therapy that stretches nerves to improve nerve movement and reduce pain. Nerve gliding exercises can help you recover from conditions that cause nerve tightness or compression in the upper or lower extremities as well as the lower back and chest areas.
Examples include ulnar nerve glides that help ease pain caused by injury to the ulnar nerve (which services the forearm and hand). Sciatic nerve glides can help relieve pain associated with a common condition known as sciatica affecting the lower back and legs.
This article explains when nerve gliding is used and provides step-by-step instructions for exercises you can do at home. It also describes how long it can take to achieve results and how to perform the exercises safely.
Why Nerve Gliding Is Prescribed
Your physical therapist (PT) may prescribe nerve flossing exercises if nerve tension or tightness is contributing to pain and/or the loss of range of motion of a joint.
Nerve gliding exercises are used to enable smooth movement of peripheral nerves. These are the nerves that extend from the brain and spinal cord to the rest of the body. The exercises help peripheral nerves move freely without impediment as a joint or muscle is extended or flexed.
Conditions for which nerve gliding exercises may be recommended include:
Muscle strain (an injury caused by the overstretching of a muscle or a tendon)
Sciatica (nerve pain in the lower back and legs caused by injury to the sciatic nerve)
Herniated disc (the bulging of the cushioning disc between spinal bones)
Cervical radiculopathy (the pinching of a nerve exiting the spinal bones of the neck)
Carpal tunnel syndrome (the pinching of the median nerve as it passes through a narrow tunnel in the wrist)
Cubital tunnel syndrome (the pinching of the ulnar nerve as it passes through a narrow tunnel in the elbow)
Tarsal tunnel syndrome (the pinching of the tibial nerve as it passes through a narrow tunnel in the ankle)
Plantar fasciitis (inflammation of the band of tissue that runs along the bottom of the foot)
Piriformis syndrome (spasms of the piriformis muscle of the buttock that compress the sciatic nerve)
Thoracic outlet syndrome (the compression of nerves, arteries, and veins in the lower neck and upper chest areas)
Post-surgical or post-immobilization rehabilitation
Upper Extremity Nerve Glides
If you are having nerve pain in your arm or hands, your PT may recommend the following upper extremity nerve gliding exercises:
Median Nerve Glide #1
To floss the median nerve (which helps you bend the wrist and fingers):
Stand up straight.
Place your right arm by your side with your palm facing up.
Slowly bend your wrist down, stretching the front of your wrist and palm.
Then, bend your head away from your arm.
Hold the position for two seconds, and then return to the starting position
Repeat five to 15 times.
Median Nerve Glide #2
This more advanced exercise is performed as follows:
Stand up straight.
Extend your arm out to the side with your elbow straight.
Bend your wrist upward as you tilt your head away from your outstretched arm.
Hold for two seconds.
Then, bend your wrist downward as you tilt your head toward your outstretched arm.
Hold for two seconds, and then return to the starting position.
Repeat five to 15 times.
Median nerve glides are especially useful if you have carpal tunnel syndrome
Ulnar Nerve Glide #1
To floss the ulnar nerve (which also helps bend your wrist and move your fingers from side to side):
Stand with your arm stretched out to the side, palm facing the floor.
Slowly bend your elbow and wrist up so that the palm moves towards the side of your face.
Hold the position for two seconds, and then release.
Repeat five to 15 times.
Ulnar Nerve Glide #2
This more advanced exercise is performed as follows:
Stand up straight.
Extend your arm out to the side.
Bend your elbow at a 90-degree angle with your palm turned away from your body.
Bend your wrist toward you as you bend your head towards the outstretched arm.
Hold for two seconds.
Then, bend your wrist away from you as you bend your head away from your outstretched arm.
Hold for two seconds, and then return to the starting position.
Repeat five to 15 times.
Radial Nerve Glide #1
To floss the radial nerve (which helps you straighten the elbow, wrist, thumb, and fingers):
Stand with your arm down at your side near your hip, palm facing back.
Flex your wrist and then slowly pull your shoulder back into extension.
While holding this position, bend your neck away from your arm.
Hold the position for two seconds, and then slowly release.
Repeat five to 15 times.
Radial Nerve Glide #2
This more advanced exercise is performed as follows:
Stand up straight with your hanging down at your side.
Keeping your elbow straight, turn your palm so that it is facing backward.
Bend your elbow at a 90-degree angle with your palm turned away from your body.
Bend your wrist back as you bend your head towards the arm.
Hold for two seconds.
Then, bend your wrist forward as you bend your head away from the arm.
Hold for two seconds, and then return to the starting position.
Repeat five to 15 times.
Sciatic Nerve Glides
Nerve glides for the lower extremities are focused on improving the movement of the sciatic nerve. There are several that can help in different ways:
Supine Sciatic Nerve Glide
To perform the supine sciatic nerve glide:
Lie on your back with your legs out straight.
Bend one knee and grab behind it with both hands.
Straighten your knee.
Flex your ankle up a down a few times. You should feel a slight stretch behind your knee and calf.
Slowly lower your leg back down to the bent knee position.
Repeat five to 15 times.
Sitting Sciatic Nerve Glide
To perform the sitting sciatic nerve glide:
Sit upright in a chair with your feet flat on the floor.
Extend your right leg, keeping the knee taut and muscles rigid.
Slowly flex your foot, moving your torso to your knee, and hold for several seconds.
Then, slowly point your toe and hold for several seconds.
Release and relax.
Repeat five to 15 times on each leg.
Standing Sciatic Nerve Glide
The standing sciatic nerve glide is a McKenzie Method exercise that can be used to stretch the sciatic nerve more intensely. To do it:
Place one foot on a chair or a step with your leg in a lunge position.
Slowly bend forward until a stretch is felt in your standing leg.
Hold for a few seconds, and then return to the standing position.
Repeat five to 15 times per each leg.
Mobilizing Nerve Glide
This exercise helps release the sciatic nerve by twisting the lower body at the waist away from the torso. To do this:
Lie flat on the floor on your back.
Bend your left leg and hold the knee with your hands.
Gently pull the left leg across the right side of your body, keeping the knee at a 90-degree angle.
Hold for a few seconds and gently release.
Repeat five to 15 times for each leg.
Hamstring Nerve Glide
Unless hamstrings are regularly stretched, they can become tight and lead to piriformis syndrome. The following standing exercise can help remedy this:
Place the heel of your foot on a chair while keeping the leg straight. (To stabilize yourself, you can place the chair next to a wall and hold onto it for balance.)
Tilt your chest forward until you can feel a stretch in your hamstring.
Point your toes upward and hold for several seconds.
Release and bring your torso upright.
Repeat five to 15 times for each leg.
Piriformis Stretch
The exercise directly targets the piriformis muscle where sciatic nerve pain is acutely felt. To do this:
Lie on your back with your legs extended.
Place your left ankle on the knee of your right leg.
Grab the back of your right knee with both hands.
Pull the knee toward your chest until you feel a gentle stretch at the top of your buttocks.
Hold for a few seconds and release.
Repeat five to 15 times for each leg.
Thoracic Nerve Glides
Although much of the focus of nerve glides is placed on sciatica or conditions like carpal tunnel syndrome, they can also be used when you have thoracic outlet syndrome (a condition involving the brachial plexus nerves that originate at the neck).
Brachial Plexus Nerve Glide #1
This exercise focuses on nerve pain that travels from the neck to the armpit. To do this:
Stand up straight with your arms at your sides.
Reach back and lace your fingers together.
Pulling your hands down, draw your elbows and shoulder blades together.
Shrug your shoulders up, holding for a few seconds.
Relax and repeat five to 15 times.
Brachial Plexus Nerve Glide #2
This exercise also helps release the brachial plexus nerves with a series of lateral stretches and rotations. To do this:
Stand up straight with your arms at your sides.
Lift your left arm to your side so that it is extended straight from the shoulder.
Pull your arm back as far as it can go, keeping the arm straight.
Flex your wrist so that your palm is facing outward, holding for several seconds.
Then, bend your wrist as far as you can, holding for several seconds.
Repeat the exercise for five to 15 reps on each arm.
Nerve Gliding Safety Guidelines
Before trying any nerve gliding exercise, it's important to check in with your healthcare provider or PT who can recommend exercises specific to your condition.
To ensure safety, there are four rules to remember when embarking on any nerve gliding exercise:
Start slowly with five or so repetitions, gradually increasing to 10 to 15.
Don't tense up. Keep your body relaxed even as certain muscles are stretched or flexed.
Be conscious of inhaling and exhaling as you go through the movements.
Stop immediately if you feel any new pain.
Nerve flossing may cause slight tingling or aching, but this should subside within a few minutes. If the pain or tingling is extreme or persists, you may be doing the movements too aggressively. Give it a rest for several days, and speak with your PT to see if there are any adjustments you can make.2
Can Nerve Flossing Make Sciatica Worse? In the same way that piriformis muscle spasms trigger sciatic pain, overly aggressive muscle contractions can compress the sciatic nerve and also cause pain. Doing too much too soon can also cause inflammation that directly irritates the sciatic nerve.3 To avoid this, perform the exercises with control and try not to overdo it. With nerve flossing, less is sometimes more.
Subscribe to check out our next post: Sciatica Exercises to Avoid
How Long Does It Take for Nerve Gliding to Work?
If nerve flossing is performed diligently, nerve tightness and pain will usually subside over the course of six to eight weeks. You should notice less pain or tingling within a few weeks, and you will likely need to extend the stretches further and further as you progress.
After six to eight weeks of consistent and daily nerve glides, you should be reassessed by your healthcare provider or PT. In some cases, ongoing exercises may be recommended to prevent the return of symptoms.
Summary
Nerve glides, also known as nerve flossing, are exercises that help stretch or release nerves that are trapped, compressed, or injured. The exercises can be used for conditions like carpal tunnel syndrome, sciatica, or thoracic outlet syndrome. Nerve glides can be taught by a physical therapist and performed at home to help ease certain types of nerve pain, often within six to eight weeks.
References
Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. J Orthop Sports Phys Ther. 2017;47(9):593-615. doi:10.2519/jospt.2017.7117
American Academy of Orthopaedic Surgeons. Therapeutic exercise program for carpal tunnel syndrome.
Anikwe EE, Tella BA, Aiyegbusi AI, Chukwu SC. Influence of nerve flossing technique on acute sciatica and hip range of motion. IJMBR. 2015;4(2).