An update on nerve “Flossing” techniques: How to treat nerve compression

Date: February 21, 2016 Author: James Categories: Latest
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Using nerve flossing techniques has for some time now been advocated by clinicians as a treatment technique for reducing mechanical restriction from scarring or adhesions, improving nutrition at the nerve, removing inflammatory chemicals from around nerves and normalising pressure in injured nerves.

Nerve flossing techniques aim to move the nerve along its distribution by lengthening or shortening that path that the nerve must travel from it’s source at the spinal cord to it’s end-point in the hands or feet. A variety of techniques have been proposed, and generally fall into two camps; sliding techniques and tensioning techniques.

Sliders… . This increases the tension at one one joint while reducing the tension at another joint further up or down the nerve path.

Tensioners… . this increases tension at two or more joints along a nerve path creating a cumulatively strong pull on the nerve.

Studies in the past few years have shown that the amount of actual nerve movement is significantly greater using a sliding technique, while nerve strain actually remains relatively low. By comparison, while tensioner techniques do provide some nerve movement, that movement is significantly smaller than that observed using sliding techniques. At the same time tensioner techniques result in substantially larger strain on the nerve versus sliders.

For this reason, I have adjusted  my clinical practice to include sliding techniques where possible instead of tensioning techniques (as I used to commonly use). It stands to reason that the increased nerve movement coupled with reduced tension in the nerve will deliver more beneficial effects with reduced potential to irritate affected nerve. This is also a neat demonstration of the nature of science informed practice. We work one way until research evidence convinces that a refined approach is warranted. Hopefully this leads to better and better outcomes over time!

In the video attached I demonstrate a sliding technique for both upper and lower extremity (arms and legs) peripheral nerves. If you have a nerve irritation because of adhesion or compression these techniques may be appropriate for you! If you are unsure don’t hesitate to check with your physiotherapist for guidance, and remember that these techniques can easily irritate of performed to excessive vigor. There should never be an increase in discomfort after the exercise so ask if in doubt.



For further reading (If you really want to dig deeper)

Coppieters, M. W., Andersen, L. S., Johansen, R., Giskegjerde, P. K., Høivik, M., Vestre, S., & Nee, R. J. (2015). Excursion of the Sciatic Nerve During Nerve Mobilization Exercises: An In Vivo Cross-sectional Study Using Dynamic Ultrasound Imaging. journal of orthopaedic & sports physical therapy, 45(10), 731-737.

 

Coppieters, M. W., & Butler, D. S. (2008). Do ‘sliders’ slide and ‘tensioners’ tension? An analysis of neurodynamic techniques and considerations regarding their application. Manual therapy, 13(3), 213-221.

 

Coppieters, M. W., Hough, A. D., & Dilley, A. (2009). Different nerve-gliding exercises induce different magnitudes of median nerve longitudinal excursion: an in vivo study using dynamic ultrasound imaging. journal of orthopaedic & sports physical therapy, 39(3), 164-171.