If you’ve ever experienced nerve-related pain, you probably knew instantly that it wasn’t just another sore muscle. The numbness, pins and needles, burning sensations, or even stabbing pain just feels different than, say, the tender, throbbing, stiff feeling of a hamstring strain.
Worse, nerve pain tends to stick around longer than a muscle pull — sometimes lasting six months or longer — and it’s trickier to treat. Depending on the severity of the injury, treatment can involve a blend of medications (NSAIDS, antidepressants, anticonvulsants), procedures (transcutaneous electrical nerve stimulation — or TENS — plasma exchange), and physical therapy. All of this is to say, if you find yourself in a standoff with nerve pain, you could be facing a frustrating hurdle in your ability to train or race.
Enter “nerve flossing,” an emerging physical therapy technique that’s gaining a fan base of PTs and athletes alike. The name sounds gnarly, but in fact, nerve flossing is beautifully natural and simple, and when performed properly, it can offer relatively fast and significant relief from nerve pain. Done wrong, however, and you risk making things worse. Here’s what you need to know to get the benefits.
What Is Nerve Flossing, Anyway?
For starters, it’s not exactly a new thing. Nerve flossing was pioneered by Australian physiotherapist and researcher David Butler back in the early 90s, but the practice has become trendy in the U.S. only in the past few years. It actually goes by a few different names, including neural gliding and neural mobilization. Whatever the moniker, it points to the same concept: The nerve is moved smoothly back and forth and through something.
“Imagine the nerve like a piece of dental floss,” says Tiffany Cruikshank, L.AC, MOAM, as well as the founder of Yoga Medicine and author of Optimal Health for a Vibrant Life. “You can tug on both ends, which is a stretch. Or you could tug on one end at a time and move it side to side – that’s flossing.”
Instead of running between teeth and gums, your nerves are sliding through tissues throughout your body.
“Whether that’s connective tissue or muscles or nearby blood vessels, every nerve has to be able to glide through those surrounding tissues as we move,” explains Cruikshank.
To imagine how flossing a nerve works, picture your sciatic nerve — which happens to be the largest and most commonly injured nerve in the body, says Cruikshank. It starts at the lower back and branches over the hips, down the back of each leg, and attaches at the bottom of the foot. One way to floss it: Lay on your back with your right knee bent, and then flex your right foot to move the nerve toward your foot. To move the nerve back toward your spine, extend your right leg up and point your foot.
Remember this: Nerve flossing shouldn’t hurt. If it does, you’re doing it wrong. More on that in a minute.
How Nerve Flossing Helps Ease Pain
When you practice flossing, the nerves don’t move much — just up to a couple of centimeters. Turns out, that’s a significant amount of ground to cover.
“Even just that bit of movement is crucial to the health of the nerve, its capacity to relay communication through the system and regulate immune response, and its ability to help prevent inflammatory and pain responses,” explains Cruikshank.
So it makes sense that if a nerve isn’t moving properly, trouble — as in, pain and loss of mobility — ensues.
Among athletes, a common culprit is overuse of muscles around a nerve that cause it to become compressed or “trapped,” says Aaron Drogoszewski, the cofounder of ReCOVER — a studio in New York City dedicated solely to recovery — and an educator for the National Academy for Sports Medicine. “For instance, if you’re grabbing and pulling up on the monkey bars in an obstacle course race, you can over-recruit the muscles that flex the wrist and forearm, which can then press on nerves in your elbow.”
Keep repeating this movement, and the channel of tissues that the nerve runs through gets inflamed, as does the nerve itself.
“The nerve can become, for lack of a better word, stuck,” says Drogoszewski. “And then it almost becomes like a dragon chasing its tail: It’s stuck because it’s inflamed, and it’s inflamed because it’s stuck.”
How does nerve gliding help mitigate the inflammation and resulting pain? Research points to a number of possible mechanisms. For instance, it may help remove intraneural edema or excess watery fluid that has been associated with compression syndromes like sciatica. It may also stimulate mechanoreceptors in joints and tissues to inhibit pain. And the gentle, pain-free movement of the nerve may help reduce compression and sensitivity.
“Ultimately, nerves are really blood-thirsty structures,” says Cruikshank. “If their blood supply is getting cut off, it affects nerve conduction, inflammation, pain responses — all sorts of things.”
Is Nerve Flossing Right for You?
Flossing can be great if you’re already experiencing nerve pain, and even as a preventative measure. But there are a few important things to know before you start searching for how-to videos on YouTube.
For one, a lot of the “nerve gliding” videos you find online are actually nerve stretching, says Cruikshank. And the wrong kind of stretching can further inflame the nerve and perpetuate the cycle of pain.
Flossing also requires knowing where the troublemaking nerve begins and ends, along with the right moves to manipulate it in a gliding fashion, and most of us don’t have that kind of anatomy knowledge.
“If you think you have something neurological going on, I recommend you tread with caution and work with a licensed physical therapist,” says Drogoszewski.
A pro can help you pinpoint what’s to blame for your pain and address the underlying cause.
“There are so many different reasons that a nerve can become inflamed,” says Drogoszewski. “Whether it’s the way you’re moving, or a muscle is cramping the nerve, or you have a vertebra out of alignment, the inflamed nerve is not the cause. If you keep treating the effect without going for the cause, you might wind up with more discomfort.”
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Nerve flossing isn’t a stand-alone therapy, but instead should be part of a program that incorporates other therapies like foam rolling and static stretching, Drogoszewski points out. In fact, he suggests you do only five reps of flossing before stopping to take stock of your pain. If you experience some relief, do a second set and add a few more reps; if the pain feels worse, stop and move on.
As for prehab, both Drogoszewski and Cruikshank agree that if you have a history of trouble with a particular nerve, practicing flossing one or two times a week — or before you compete — might help prevent future flare-ups.
“We know that healthy movement of the nerves is important for its ability to prevent pain responses,” says Cruikshank. “So if you tend toward sciatica or other nerve issues, why not get a step ahead of it?”
Sounds like another kind of flossing we know.