Nerve flossing or neural mobilization is a technique used in physiotherapy to treat and evaluate alterations or disorders of the peripheral nervous system. For this, the Flossing of the nerves along their path is necessary.
In this article, you will learn all techniques about nerve flossing and how can you mobilize your nerve with yourself to relieve pain
Nerves run in the body through tunnels between muscles, fasciae, bone, etc. until reaching the tissues that they must innervate. When those areas through which they pass suffer some pathology such as contracture, inflammation, stiffness or entrapment, it can cause irritation in the neuronal tissue causing pain.
Along the course of the nerves there are areas called “conflict zones” that are special places due to the anatomical conditions of the structures that surround the nerve and whose movement through them can be difficult, sometimes being trapped or compressed between them.
Nerve flossing or neural mobilization is a technique used in physiotherapy to treat and evaluate alterations or disorders of the peripheral nervous system. For this, the Flossing of the nerves along their path is necessary.
In this way it is possible to identify the cause that triggers said pathology and to be able to treat it to recover the functionality of the peripheral nervous system.
Two techniques of neurodynamic exercises
Neurodynamic exercises are the appropriate treatment to treat this pathology. It consists of a passive mobilization, if it is performed by the physiotherapist, or active, if it is the affected person who performs it. It is based on two techniques:
- Stretching: it is more aggressive for the nerve and usually causes discomfort and even some pain that should be avoided whenever possible.
- Flossing of the nerves along their entire path: exercises are performed without creating tension, they are softer and more pleasant, so they are better tolerated and cause almost immediate improvement. They are usually used in the initial phases of injuries.
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When are nerve flossing exercises recommended?
When a neuromusculoskeletal pathology is suspected, a correct assessment must be carried out to be sure that these exercises are the appropriate treatment to apply. In addition, the patient must be given the possibility of continuing to perform the exercises at home, always under the indication and monitoring of the physiotherapist.
The flossing of the nervous system through neurodynamic exercises is responsible for reducing and, in many cases, making neurological pain disappear. These are easy exercises to perform and to do them safely.
This treatment is used in pathologies such as:
- Carpal tunnel syndrome, in which the nerve has been trapped at the level of the wrist
- Adhesions and scars
- sciatica
- Cervical or lumbar pain of radicular origin
- Thoracic outlet syndrome
- Fibrosis
- Paresthesia
- pyramidal syndrome
- Alterations in sensitivity
- Nonspecific pain in the arms and legs
What benefits does nerve mobilization provide?
Neurodynamic exercises provide a series of benefits such as muscle relaxation, which helps to release accumulated tension, decrease in spasticity, reduction and even disappearance of pain associated with neuropathy or increase in the range of motion of the affected joints. In short, it produces an effect of general well-being for the patient and, therefore, a better quality of life.
Watch this video for neural flossing
What kind of nerve flossing exercises can be performed?
Depending on the location of the injury, different types of exercises are performed, sharing all the same symptoms such as pain, electrical sensation, burning or needle itching. The exercises will be repeated for 1 minute.
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Upper limb, where three types of neurodynamic mobilizations are differentiated:
– Median nerve flossing:
It is performed when there is pain due to entrapment or irritation of the median nerve. And it is very useful when pain appears along the inner face of the arm and forearm and that can occur with carpal tunnel syndrome.
It consists of placing the hand facing upwards with the palm up and attached to the shoulder, the head is tilted to the opposite side. When the arm is stretched, the wrist is stretched and the head turns towards the outstretched arm.
– Radial nerve flossing:
Applied when pain appears on the outer face of the forearm. It is done the same as the previous one, but with a closed fist.
– Ulnar nerve flossing:
They are recommended when pain appears on the side of the arm. It is done by bending the elbow and resting the hand on the chin with the index fingers and thumb forming a circle and the head tilted to that side. Then the arm is stretched out and the head is turned the other way.
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Lower limb, among which we highlight:
– Sciatic nerve flossing:
This mobilization is useful for sciatica or lumbar pain that causes radiation to the back of the leg. It is done sitting on a table with your legs dangling while dropping the weight of your head and body. Next, the back and head are stretched at the same time as the leg with the tip of the foot towards us.
Another exercise would be lying on your side in a fetal position on the healthy part and stretching and flexing the affected leg. The ball of the foot will go up when the leg is bent and down when the leg is straightened.
– Femoral nerve flossing:
Aphysiotherapy technique used when we have pain due to entrapment or irritation of the femoral nerve, which may cause an electrical, burning, spike or needle sensation. This mobilization is useful, for example, in low back pain that radiates to the groin and to the front of the leg.
– Tibial nerve flossing:
When plantar fasciitis appears. It is performed lying on your back with your legs bent, one leg is placed on the opposite knee, bending and taking the foot out, when the leg is bent, the foot will go in.
– Sural Nerve Flossing:
Used when we have pain due to entrapment or irritation of the sural nerve, we may have an electrical, burning, itching or needle sensation. This mobilization is useful, for example, in persistent pain after an ankle sprain on the inner side in which the nerve has suffered some damage.
– Peroneal Nerve Flossing:
Used when we have pain due to entrapment or irritation of the peroneal nerve, we may have an electrical, burning, itching or needle sensation. This mobilization is useful, for example, in persistent pain after an ankle sprain on the external side in which the nerve has suffered some damage.
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Back:
– Lumbar pain: recommended for lumbar pain and to stretch the lumbar spine.
It is done sitting on the floor with your legs stretched out, leaning your body forward, bending your back until you find tension. At that time, the balls of the feet are raised and then relaxed. This exercise improves flexibility and removes stiffness from the nervous system from head to toe.
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Sciatic Nerve Flossing
Most physiotherapists describe how nerves are free to move within their canal. If there are bottlenecks or irritation of the nerves, the gliding ability is limited.
However, nerves have the ingenious property of being able to free up the bottlenecks through gliding exercises.
And this is how the Nerve flossing works:
- Sit on the edge of a chair or table so your legs can hang freely.
- Now straighten the leg on the affected side and lift it up. At the same time, tilt your head back.
- Hold the position for a moment. Then you reverse the movement.
- Bend the knee again and tuck your chin on your chest. Repeat the movement 10 times.
Caution: Nerve flossing exercises can be wonderful for treating sciatic pain. However, some are very sensitive to it.
Be sure to pay attention to how your body responds to this exercise. If the symptoms are worse after the exercise or the next day, this exercise is not suitable for you. If it works for you, you’ve found something to treat sciatica pain.
Median Nerve Flossing
With the patient standing, there are alternating distal or proximal flossing of the nerve in its interface. Forearm and head tilt in the same direction, like two wiper blades, during the two times of the maneuver.
And this is how the nerve flossing works:
Distal glide of the median nerve is permitted by extension of the elbow and wrist and ipsilateral lateral tilt of the neck, proximal glide is permitted by contralateral lateral tilt of the neck and flexion of the elbow and fingers. These techniques produce major excursions of the nerve in its interface with minimal constraints.
The patient is asked to perform them with the arm abducted at 90° without head rotation. In the presence of pain during the realization, it is advised to him:
- To begin in contralateral rotation of the head, elbow and wrist flexed (proximal sliding) and end in ipsilateral rotation of the head, elbow and wrist in extension (distal sliding) and/or
- To perform glides with the arm in abduction less than 90°.
