Nerve Flossing in Physical Therapy

Nerve Glides as Part of Your PT Exercises

Photo of a woman stretching her median nerve.
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Nerve flossing is an exercise technique often used in physical therapy to improve the way your nerves move. Nerve flossing is also known as nerve gliding or neural glides. Occasionally after injury or illness, muscles, joints, and tendons can become tight. Guess what? Nerves can also become tight after an injury, and your physical therapist may determine that nerve flossing is necessary to help improve neurodynamics (nerve motion) and help you move better and feel better. Your therapist may prescribe nerve glides to help you fully recover. But what is nerve flossing, and how is it done?

Neurodynamics in Physical Therapy

Your nervous system is grossly divided into two parts: The central nervous system, consisting of the brain and spinal cord, and the peripheral nervous system. The peripheral nervous system are the nerves that exit your spinal cord and travel through your body to your arms, trunk, and legs. These nerves communicate information from your body to your brain to tell it what is going on. They sense things like temperature, pain, pressure, and position. The peripheral nerves also communicate information from your brain to your muscles, telling them to move or relax.

After an injury, these peripheral nerves may become tight. Consider the sciatic nerve in your leg. It is the largest nerve in your body. (You have two of them; one on each side.) If this nerve becomes pinched by a facet joint or herniated disc, slight damage to the membrane of the nerve may occur. This damage may result in a bit of scar tissue developing around the nerve, leading to tightness, pain, or tingling in that area where the nerve courses. The nerve travels all the way down your leg, and the tightness in the nerve may limit your ability to fully move the joints of your hips, knees, or ankles.

A tight nerve is also sometimes referred to as an adhered or adherent nerve root.

Nerve pinching and injury may also occur in the arms, leading to tightness there. This may occur after a pinched nerve in your cervical spine, or may happen after repetitive strain or an injury to your arm or arms. A common upper extremity nerve injury is called carpal tunnel syndrome. This often leads to pain, tingling, and weakness in your hand and thumb muscles.

Why Nerve Flossing Is Prescribed

After an injury or illness, you may benefit from physical therapy (PT) to help you fully recover. Your therapist will assess you for various impairments. These may include measures of:

If your physical therapist determines that nerve tension and tightness may be a component in your pain or limited motion, they may prescribe nerve flossing exercises to improve mobility of the nerve or nerves.

Common diagnoses that may require nerve flossing exercises may include:

The goal of nerve flossing is to decrease pain, improve range of motion and flexibility, and improve function and motion.

What Should You Feel During Nerve Flossing?

It is important to understand what your nerve gliding exercises should feel like while doing them. Nerve flossing typically causes specific feelings and symptoms. The symptom you usually feel is production of pain or tingling, but no worse, as a result. When stretching, you should feel your symptom turn on, but once the flossing exercise is done, you should be back to normal within a few minutes.

Most often, you should feel very little or no pain when there is no stress or stretch on the nerve that is injured or tight; symptoms are only felt when the nerve is stretched.

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.

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. These may include:

Median Nerve Glide

To floss the median nerve:

  1. Stand up straight.
  2. Place the arm to be stretched out to 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 repetitions.

Ulnar Nerve Glide

To floss the ulnar nerve:

  1. Stand with your arm to be 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 repetitions.

Radial Nerve Glide

To floss the radial nerve:

  1. Stand with your arm down at your side near your hip, palm facing back.
  2. Bend your wrist up, 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 repetitions.

Each exercise should be done slowly and rhythmically for 10 to 15 repetitions. Be sure to stop if you feel any lasting or increasing pain.

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. Types of sciatic nerve flossing can be the following examples.

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

  1. Sit upright in a chair.
  2. Allow your body to slouch down, and then slowly straighten your knee all the way.
  3. Flex your ankle up until a stretch is felt in your leg or calf.
  4. Bend your head forward. Hold this position for a few seconds, and then return to the start position.
  5. Repeat 10 to 15 repetitions.

Standing Sciatic Nerve Glide

This is known as the flexion in step standing stretch. The step standing flexion stretch is a McKenzie Method exercise that can be used to aggressively stretch the sciatic nerve. To do it:

  1. Stand with one foot on a chair. The leg to be stretched is standing with your foot on the floor.
  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.

Be sure to check in with your physical therapist before starting any nerve flossing exercise. Keep in mind that the symptomatic response should be "pain produced at the end of the stretch that is no worse as a result."

Can You Floss Too Much?

What happens if you do too much nerve flossing? Can you overstretch things? The short answer is yes. If you stretch too aggressively or pull too hard on your delicate nerves, you may overstretch things and cause worsening pain in your arm or leg. You most likely will not do permanent damage, but you will irritate your nerve a bit and suffer a slight worsening of your symptoms. If this happens, rest for a few days and start the nerve flossing again. Check in with your physician or physical therapist as well.

The best way to prevent overstretching your neural tissue is to be gentle. Say to yourself, "Pressure on, pressure off" as you stretch. Your symptomatic response to nerve flossing should be the production of pain or tingling at the end of the stretch, but no worse as a result. You'll know you have overdone it if your pain lasts longer than 30 minutes after stretching.

How Long Does It Take To Get Better?

If you have tightness or pain due to an adhered nerve, it should slowly get better as you progress with your nerve flossing exercises. 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. Nerve flossing may cause a temporary increase in your pain, but symptoms should abate quickly. 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.

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Article Sources
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