Nerve Flossing the Pain Away

Many times, patients come into therapy with symptoms of tightness in one limb or another, and the individual is usually blaming a tight muscle. Well, muscles aren’t always the culprit for pain or tightness. What if I told you that nerves are just as mobile as joints or muscles? What if I said that nerves can be injured like a joint or muscle can be injured? If you haven’t figured it out yet, spoiler alert…they can!

​Nerve flossing, or neurodynamics, is a treatment approach and concept used to improve pain, motion, and flexibility of a symptomatic extremity. A nerve must be able to slide or stretch along its pathway and adapt to load and compression. Mobilization of nerves has been shown to improve chemical communication across the nerve, as well as improve blood flow to the nerve.

Sometimes neural tension, or “tightness,” is a result of inflexibility, irritation to the nerve, or secondary to an injury. Some of the more common conditions in which a patient may benefit from nerve flossing are sciatica, carpal tunnel syndrome, “pinched” nerves, or even surgeries such as a lumbar microdiscectomy (removal and cleaning up around a disc herniation). These are conditions where nerves are irritated and specific movement helps heal or reduce irritation to allow an individual to move better and get back to functioning normally.

The treatment approach can be simplified into nerve sliding and nerve tensioning. The first is facilitating movement of the nerve by sliding it back and forth along its pathway with minimal tension or stretch through it. Nerve tensioning is applying a stretch to the neural tissue. When performing nerve glides, one may feel pain or tingling during the movement, but those symptoms should resolve within seconds to minutes. If symptoms last longer than this, too much tension has been placed on the nerve.

Overstretching can occur and may lead to nerve irritation. In this case, it is best to stop or back off from the movement until symptoms return to their previous baseline. As a general rule for whether to choose between slider or tensioner, there is a saying of “acute and hot” or “old and cold.” An acute condition is likely more irritable and painful and will not tolerate greater amounts of tension through the neural structure. This condition would likely benefit from a nerve slider. On the other hand, a more chronic and typically less painful and irritable condition can handle more stretch like with a nerve tensioner.

When in doubt, it is best to consult with your therapist about whether nerve flossing is a beneficial treatment approach for your condition. If so, they will be able to guide you through the process to hopefully improve your symptoms and get you back to your normal self.

Derrick White, PT, DPT​, OCS

---