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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):

  1. Stand up straight.

  2. Place your right arm by your side with your palm facing up.

  3. Slowly bend your wrist down, stretching the front of your wrist and palm.

  4. Then, bend your head away from your arm.

  5. Hold the position for two seconds, and then return to the starting position

  6. Repeat five to 15 times.


Median Nerve Glide #2

Ulnar Nerve Glide #1

Ulnar Nerve Glide #2

Radial Nerve Glide #1

Radial Nerve Glide #2


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:

  1. Lie on your back with your legs out straight.

  2. Bend one knee and grab behind it with both hands.

  3. Straighten your knee.

  4. Flex your ankle up a down a few times. You should feel a slight stretch behind your knee and calf.

  5. Slowly lower your leg back down to the bent knee position.

  6. Repeat five to 15 times.

Sitting Sciatic Nerve Glide

Standing Sciatic Nerve Glide

Mobilizing Nerve Glide

Hamstring Nerve Glide

Piriformis Stretch


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:

  1. Stand up straight with your arms at your sides.

  2. Reach back and lace your fingers together.

  3. Pulling your hands down, draw your elbows and shoulder blades together.

  4. Shrug your shoulders up, holding for a few seconds.

  5. Relax and repeat five to 15 times.

Brachial Plexus Nerve Glide #2


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:

  1. Start slowly with five or so repetitions, gradually increasing to 10 to 15.

  2. Don't tense up. Keep your body relaxed even as certain muscles are stretched or flexed.

  3. Be conscious of inhaling and exhaling as you go through the movements.

  4. 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

  1. 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

  2. American Academy of Orthopaedic Surgeons. Therapeutic exercise program for carpal tunnel syndrome.

  3. 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).



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