Nerve Glides in Physical Therapy

Nerve gliding, also called nerve flossing or neural gliding, is an exercise technique used in physical therapy to improve the way your nerves move and reduce pain.

Nerve gliding exercises, such as ulnar nerve glides, may be used as part of the recovery process for certain conditions that involve any nerve tightness or tension. This could include muscle strains or sciatica from a pinched nerve. Depending on your specific needs, nerve flossing exercises may focus on upper and/or lower extremity nerve gliding techniques.

This article discusses in what circumstances nerve gliding may be used and examples of flossing exercises. It also covers general guidelines, as well as how long it may take to work.

Why Nerve Gliding Is Prescribed

Your physical therapist (PT) may prescribe nerve flossing exercises if nerve tension and tightness are contributing to your pain or limited motion.

To determine your specific condition, your PT may assess your:

• Strength
• Flexibility
• Range of motion
• Balance and proprioception, which describes the body's sense of movement and location
• Nerve tension

Conditions

Common diagnoses that may require nerve flossing exercises may include:

• Sciatica, which describes pain that travels the path of the sciatic nerve, from the lower back through the hips and down each leg
• Herniated disc, or a problem with one of the discs that sits between the spinal bones
• Cervical radiculopathy, or a pinched nerve in the neck
• Carpal tunnel syndrome, or a pinched nerve in the wrist
• Plantar fasciitis, or inflammation of the band of tissue that runs along the bottom of the foot
• Cubital tunnel syndrome, or inflammation of the ulnar nerve which causes pain on the inside of the elbow
• Tarsal tunnel syndrome, or ankle pain caused by a squeezed nerve
• Muscle strains
• After surgery or a period of immobilization

Upper Extremity Nerve Glides

If you are having a problem with your arm or arms and your physical therapist determines that you may benefit from upper extremity nerve gliding, then they may prescribe a flossing exercise, such as the:

• Median nerve glide
• Ulnar nerve glide
• Radial nerve glide

Median Nerve Glide

To floss the median nerve, a major nerve in the upper extremity:

1. Stand up straight.
2. Place your 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 outstretched arm. Be sure to maintain good posture and alignment of your shoulders as you bend your wrist and neck.
5. Hold the position for 2 seconds, and then return to the starting position with your wrist and head.
6. Repeat 10 to 15 times.

Ulnar Nerve Glide

To floss the ulnar nerve, a main nerve in the arm:

1. Stand with your arm stretched out to the side, palm facing the floor.
2. Slowly bend your elbow and wrist up so your the palm of your hand moves towards the side of your face. You should feel a gently tug in your wrist, pinky, or elbow.
3. Hold the position for 2 seconds, and then release.
4. Repeat 10 to 15 times.

Radial Nerve Glide

To floss the radial nerve, a major nerve in the upper extremity:

1. Stand with your arm down at your side near your hip, palm facing back.
2. Flex your wrist and then slowly pull your shoulder back into extension.
3. While holding this position, bend your neck away from your arm.
4. Hold the position for 2 seconds, and then slowly release.
5. Repeat 10 to 15 times.
   

Lower Extremity Nerve Glides

If your physical therapist assesses your lower extremity pain and thinks that nerve flossing may be helpful, lower extremity nerve glides may be prescribed. Most often, the sciatic nerve flossing exercise progression is done, including the:

• Supine sciatic nerve glide
• Sitting sciatic nerve glide
• Standing sciatic nerve glide

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 up and grab behind it with both hands. Then, straighten your knee. Once your knee is straight, flex your ankle up a down a few times. You should feel a slight stretch behind your knee and calf.
3. Slowly lower your leg back down to the bent knee position.
4. Repeat 10 to 15 times.

Sitting Sciatic Nerve Glide

To perform the sitting sciatic nerve glide:

1. Sit upright in a chair.
2. Slump your back and slump your head.
3. Point and flex your feet.
4. Bend your head forward. Hold this position for a few seconds, and then return to the start position.
5. Repeat 10 to 15 times.

Standing Sciatic Nerve Glide

The standing sciatic nerve glide, or the step standing flexion stretch, is a McKenzie Method exercise that can be used to aggressively stretch the sciatic nerve. To do it:

1. Place one foot on a chair or elevated surface, with your leg in a bent or lunge position.
2. Slowly bend forward until a stretch is felt in your stance leg.
3. Hold this position for a few seconds, and then return to the standing position.
4. Repeat 10 to 15 times per each leg.
   

Nerve Gliding General Guidelines

Before trying any nerve gliding exercises, it's important to check in with your healthcare provider and/or physical therapist. They can offer you the most effective gliding exercise suggestions based on your specific diagnosis. Your recovery may also involve additional treatment methods.

What Should You Feel During Nerve Gliding?

Nerve flossing may cause slight pain or tingling, but this should subside within a few minutes after the exercise is done.

If you feel lasting pain or tingling after the nerve flossing exercise, you may be doing the motions a bit too aggressively. If that happens, speak with your physical therapist to figure out how to proceed.

Can You Floss Too Much?

If you stretch too aggressively or pull too hard on your delicate nerves, you may irritate them. While this may intensify your symptoms, this will most likely not cause permanent damage.

If this happens, rest for a few days and check in with your physician or physical therapist before beginning the exercises again.

How Long Does It Take for Nerve Gliding to Work?

Usually, nerve tightness subsides slowly over the course of six to eight weeks. You should notice less pain or tingling a few weeks after starting, and you will likely have to stretch your nerves further and further as you progress.

After six to eight weeks of consistent and daily nerve glides, you can expect to feel no tightness or pain. At that time, your PT may have you discontinue the exercises.

A Word From Verywell

If you have suffered a pinched nerve or an injury that limits your movement, you may have increased neural tension. In that case, nerve flossing or gliding exercises may be prescribed. These exercises can be useful in helping you return to full mobility. That way, you can quickly and safely get back to your previous level of function and activity.