Nerve glide

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Nerve glide, also known as nerve flossing or nerve stretching, is an exercise that stretches nerves. It facilitates the smooth and regular movement of peripheral nerves in the body. It allows the nerve to glide freely along with the movement of the joint and relax the nerve from compression. Nerve gliding cannot proceed with injuries or inflammations as the nerve is trapped by the tissue surrounding the nerve near the joint. Thus, nerve gliding exercise is widely used in rehabilitation programs and during the post-surgical period. In addition to rehabilitating purposes, nerve gliding exercise is also used alongside other treatments to relieve the symptoms and faster recovery. [1]

Contents

Radial, median, sciatica, and ulnar nerves require nerve gliding exercise during the rehabilitation period. The most common conditions that require nerve gliding exercise are carpal tunnel syndrome, cubital tunnel syndrome, radial neuropathy, and so on. Therapists prescribe different nerve gliding exercises in order to maximize the effects by correctly diagnosing the symptoms. Patients feel less pain when there is stretch in nerves, and there should be no aggressive exercise. Without correctly diagnosing symptoms and treatments, it worsens the conditions and nerves. Nerve gliding exercises should be done several times daily, depending on the issue. As patients continuously do nerve gliding exercises, they start to feel less pain after a few weeks.

Research on Therapeutic Effects of Nerve Glide

The Effect of Nerve Glides on Carpal Tunnel Syndrome

Carpal Tunnel Syndrome, symptoms of carpal tunnel syndrome and anatomical location of the affected region. Carpal Tunnel Syndrome.png
Carpal Tunnel Syndrome, symptoms of carpal tunnel syndrome and anatomical location of the affected region.

Carpal tunnel syndrome (CTS) is a condition that induces pain when the median nerve passes through the carpal tunnel in the wrist. It occurs when median nerves get irritated, compress, and strengthen. CTS evokes symptoms, including pain, paresthesia, and muscle atrophy. [2] This further leads to chronic pain and economic difficulties for patients as it requires work absence and surgical treatment.

Nerve gliding exercise becomes one of the optimal CTS treatments by assisting nerve mobilization. Restoring nerve mobilization would relieve edema and restore adhesion in the carpal tunnel. [3] According to the research, nerve gliding exercise has reduced the pain, decreased sensitive distal latency, and improved the functions that require force to grab. However, inappropriate nerve gliding exercises would worsen the conditions. Neural mobilization via nerve gliding should avoid excessive median nerve stretching when extending fingers in wrist extensions or when otherwise not advised. [4]

Nerve gliding exercise is not an optimal method for every patient. There is limited evidence on the effectiveness of neural gliding. However, the addition of nerve gliding exercise in conservative care accelerates the rehabilitation process and avoids surgical treatment. Further research is required to study the effectiveness of nerve glide physiotherapy and to determine groups that tend to respond better. [5]

Emerging of low back pain due to the compression of the sciatic nerve. 3D still showing Sciatica nerve.jpg
Emerging of low back pain due to the compression of the sciatic nerve.

The Effect of Nerve Glides on Acute Sciatica and Hip Range of Motion

Sciatica is low back pain that can extend to the feet. [6] This nerve pain is caused by nerve root irritation or constriction. Sciatica is known as an extremely painful symptom. Nerve glides are a common option for sciatica due to their cost-effectiveness. After performing nerve glides, the Numeric Pain Rating Score (NPRS) rated by patients improved, indicating a reduction in the pain. The nerve glide reduces acute sciatica and improves the range of motion of the hip. When nerve glides were performed along with other therapies, it resulted in a greater reduction in pain. [7] However, the research indicates that there is no statistically significant difference in the results among patients who were treated with nerve glides and other conventional treatments. [8]

The Effect of Nerve Glides on Neck and arm pain

Neural gliding is used for the rehabilitation of nerve-related neck and arm pain. The pain initiates from the neck, expanding to the arm. Nerve gliding physical therapy is beneficial in reducing pain intensity, bringing short-term improvements. [9] This treatment was found to manage neural tissue through specific postures and movements of the parts in pain. The stretch reduces nerve mechanosensitive that relieves discomforts, eventually leading to the normal function of the body. However, the long-term effects of nerve gliding exercises still remain unclear. [10]

The Effect of Nerve Glides on Cubital Tunnel Syndrome

Anatomical location of ulnar nerve, the affected area of the cubital tunnel syndrome. Ulnar Nerve.png
Anatomical location of ulnar nerve, the affected area of the cubital tunnel syndrome.

Cubital tunnel syndrome is a condition that induces pains when ulnar nerves are stretched, pressed, and irritated. This syndrome is also known as “ulnar nerve entrapment”. Similar to carpal tunnel syndrome, cubital tunnel syndrome evokes symptoms, including pain, numbness, tingling, and weakness in the hand. [11] Patients with cubital tunnel syndrome start to lose the power of their hands, which becomes hard to grip. The irritation occurs near the elbow, where the cubital tunnel is located. The ulnar nerve on the cubital tunnel is susceptible as the cubital tunnel is made up of soft tissue. Therefore, strong pressure leads to numbness. [12]

Ulnar nerve gliding is recommended to reduce symptoms of cubital tunnel syndrome. Patients with ulnar nerve gliding should stay away from the holding position. Rather, patients must repeat nerve gliding with the range of movement. There are various ulnar nerve gliding methods, which include elbow flexion, wrist extension, head tilt, and arm flexion. [13]

Comparison of nerve glide and other treatments

Comparison of nerve gliding exercises with static stretching and dynamic stretching

Nerve gliding can reduce and strengthen connective tissues resulting in increased hamstring extensibility and passive stiffness. Passive stiffness refers to the resistance elongation that occurs in the joint, tendon, and connective tissue. The acute increase in hamstring extensibility can be seen right after nerve gliding intervention at the maximum range of motion. Nerve glide intervention is found to be slightly more effective than static stretching. The absolute static nerve extensibility was five times greater than the static stretching. While nerve gliding enhances the ability of the hamstring to stretch, the static stretch is more effective in terms of stress relaxation. Unlike static stretching, dynamic stretching shows similar outcomes to nerve gliding exercise. For hamstring flexibility, dynamic stretching targets low extremity muscles, while nerve gliding exercise targets posterior low extremity muscles and neural structures. Although both nerve gliding exercises and dynamic stretching do not lead to huge changes in exercise performance, both stretching methods are essential for pre-exercise stretches to avoid injuries. [14]

Comparison with laser treatment

An alternative treatment option for carpal tunnel syndrome is low-level laser therapy (LLLT). The research shows that there is a statistically significant improvement in both LLLT and nerve gliding exercises. However, the difference in the effectiveness of LLLT and nerve gliding is not considered to replace nerve gliding physiotherapy. Considering the feasibility of those two treatments in terms of machine availability and cost-effectiveness, nerve gliding exercise remains to be prescribed widely. [15]

Precaution

The injured or entrapped nerves are sensitive to external stimuli. Thus, nerve gliding, or nerve flossing, must be stopped, or range of motion (ROM) must be reduced once the patient feels pain. Patients’ pain must be checked to avoid further irritation and injuries. Continuous nerve gliding enhances the movement of the joints and faster rehabilitation. If there is no further progress in rehabilitation, patients must see doctors or therapists for correct diagnosis. Nerve gliding exercise is not recommended for acute symptoms and severe damage. These cause pulling of nerve roots, which worsens the symptoms and nerve irritations. When the nerve glide is exercised by injured athletes, it has been shown to have no side effects on their sports performance. The measurements of sports performance include bilateral hamstring flexibility, vertical jump height, shuttle run, and dash sprint. This physiotherapy is safe when performed with caution (not going through the pains). Sports athletes can incorporate nerve glides in warm-up sessions. [16]

Related Research Articles

<span class="mw-page-title-main">Carpal tunnel syndrome</span> Medical condition

Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunnel (IMNCT). Idiopathic means that there is no other disease process contributing to pressure on the nerve. As with most structural issues, it occurs in both hands, and the strongest risk factor is genetics.

Diabetic neuropathy is various types of nerve damage associated with diabetes mellitus. Symptoms depend on the site of nerve damage and can include motor changes such as weakness; sensory symptoms such as numbness, tingling, or pain; or autonomic changes such as urinary symptoms. These changes are thought to result from a microvascular injury involving small blood vessels that supply nerves. Relatively common conditions which may be associated with diabetic neuropathy include distal symmetric polyneuropathy; third, fourth, or sixth cranial nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; and autonomic neuropathy.

<span class="mw-page-title-main">Piriformis syndrome</span> Medical condition

Piriformis syndrome is a condition which is believed to result from compression of the sciatic nerve by the piriformis muscle. The largest and most bulky nerve in the human body is the sciatic nerve. Starting at its origin it is 2 cm wide and 0.5 cm thick. The sciatic nerve forms the roots of L4-S3 segments of the lumbosacral plexus. The nerve will pass inferiorly to the piriformis muscle, in the direction of the lower limb where it divides into common tibial and fibular nerves. Symptoms may include pain and numbness in the buttocks and down the leg. Often symptoms are worsened with sitting or running.

<span class="mw-page-title-main">Tarsal tunnel syndrome</span> Medical condition

Tarsal tunnel syndrome (TTS) is a nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

<span class="mw-page-title-main">Nerve conduction velocity</span> Speed at which an electrochemical impulse propagates down a neural pathway

In neuroscience, nerve conduction velocity (CV) is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, which include age, sex, and various medical conditions. Studies allow for better diagnoses of various neuropathies, especially demyelinating diseases as these conditions result in reduced or non-existent conduction velocities. CV is an important aspect of nerve conduction studies.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Ulnar tunnel syndrome</span> Medical condition

Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring and little fingers before progressing to a loss of sensation and/or impaired motor function of the intrinsic muscles of the hand which are innervated by the ulnar nerve. Ulnar tunnel syndrome is commonly seen in regular cyclists due to prolonged pressure of the Guyon's canal against bicycle handlebars. Another very common cause of sensory loss in the ring and pink finger is due to ulnar nerve entrapment at the cubital tunnel near the elbow, which is known as cubital tunnel syndrome.

<span class="mw-page-title-main">Ulnar nerve entrapment</span> Medical condition

Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from the spine at cervical vertebra C7 to the wrist; the most common point of entrapment is in the elbow. Prevention is mostly through correct posture and avoiding repetitive or constant strain. Treatment is usually conservative, including medication, activity modification, and exercise, but may sometimes include surgery. Prognosis is generally good, with mild to moderate symptoms often resolving spontaneously.

<span class="mw-page-title-main">Ulnar neuropathy</span> Medical condition

Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or and paralysis of the muscles supplied by the nerve.

<span class="mw-page-title-main">Magnetic resonance neurography</span>

Magnetic resonance neurography (MRN) is the direct imaging of nerves in the body by optimizing selectivity for unique MRI water properties of nerves. It is a modification of magnetic resonance imaging. This technique yields a detailed image of a nerve from the resonance signal that arises from in the nerve itself rather than from surrounding tissues or from fat in the nerve lining. Because of the intraneural source of the image signal, the image provides a medically useful set of information about the internal state of the nerve such as the presence of irritation, nerve swelling (edema), compression, pinch or injury. Standard magnetic resonance images can show the outline of some nerves in portions of their courses but do not show the intrinsic signal from nerve water. Magnetic resonance neurography is used to evaluate major nerve compressions such as those affecting the sciatic nerve (e.g. piriformis syndrome), the brachial plexus nerves (e.g. thoracic outlet syndrome), the pudendal nerve, or virtually any named nerve in the body. A related technique for imaging neural tracts in the brain and spinal cord is called magnetic resonance tractography or diffusion tensor imaging.

Anterior interosseous syndrome is a medical condition in which damage to the anterior interosseous nerve (AIN), a distal motor and sensory branch of the median nerve, classically with severe weakness of the pincer movement of the thumb and index finger, and can cause transient pain in the wrist.

Neural Fibrolipoma is an overgrowth of fibro-fatty tissue along a nerve trunk that often leads to nerve compression. These only occur in the extremities, and often affect the median nerve. They are rare, very slow-growing, and their origin is unknown. It is believed that they may begin growth in response to trauma. They are not encapsulated by any sort of covering or sheath around the growth itself, as opposed to other cysts beneath the skin that often are. This means there are loosely defined margins of this lipoma. Despite this, they are known to be benign. Neural fibrolipomas are often more firm and tough to the touch than other lipomas. They are slightly mobile under the skin, and compress with pressure.

<span class="mw-page-title-main">Nerve compression syndrome</span> Human disease

Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by direct pressure on a nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. Nerve conduction studies help to confirm the diagnosis. In some cases, surgery may help to relieve the pressure on the nerve but this does not always relieve all the symptoms. Nerve injury by a single episode of physical trauma is in one sense a compression neuropathy but is not usually included under this heading.

<span class="mw-page-title-main">Wrist pain</span>

Wrist pain or open wrist is a type of syndrome that prevents the patient using their hand due to a painful wrist. The pain may be sharp, sometimes steadily increasing after trying to apply force. Typically pain is caused after exerting too strong a demand on the wrist, as is the case with weight lifters, athletes in general, or with any weight-bearing activity to the wrist.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

This article is about physical therapy in carpal tunnel syndrome.

<span class="mw-page-title-main">Carpal tunnel surgery</span>

Carpal tunnel surgery, also called carpal tunnel release (CTR) and carpal tunnel decompression surgery, is a surgery in which the transverse carpal ligament is divided. It is a surgical treatment for carpal tunnel syndrome (CTS) and recommended when there is constant (not just intermittent) numbness, muscle weakness, or atrophy, and when night-splinting no longer controls intermittent symptoms of pain in the carpal tunnel. In general, milder cases can be controlled for months to years, but severe cases are unrelenting symptomatically and are likely to result in surgical treatment.Long-term outcomes of carpal tunnel release: a critical review of the literature Approximately 500,000 surgical procedures are performed each year, and the economic impact of this condition is estimated to exceed $2 billion annually.

<span class="mw-page-title-main">Osborne's ligament</span> Connective tissue in the body

Osborne's ligament, also Osborne's band, Osborne's fascia, Osborne's arcade, arcuate ligament of Osborne, or the cubital tunnel retinaculum, refers to either the connective tissue which spans the humeral and ulnar heads of the flexor carpi ulnaris (FCU) or another distinct tissue located between the olecranon process of the ulna and the medial epicondyle of the humerus. It is named after Geoffrey Vaughan Osborne, a British orthopedic surgeon, who described the eponymous tissue in 1957.

References

  1. ↑ "Nerve Flossing: How it Works for Sciatica and Other Conditions". Healthline. 23 April 2018. Retrieved 20 March 2022.
  2. ↑ "Carpal tunnel syndrome". nhs.uk. 24 October 2017. Retrieved 1 April 2022.
  3. ↑ Waldhelm, Andy; Gacek, Marissa; Davis, Hannah; Saia, Christy; Kirby, Brock (July 2019). "Acute Effects of Neural Gliding on Athletic Performance". International Journal of Sports Physical Therapy. 14 (4): 603–612. doi:10.26603/ijspt20190603. ISSN   2159-2896. PMC   6670065 . PMID   31440411.
  4. ↑ Martin-Vera, Daniel; Fernández-Carnero, Josué; Rodríguez-Sanz, David; Calvo-Lobo, Cesar; López-de-Uralde-Villanueva, Ibai; Arribas-Romano, Alberto; Martínez-Lozano, Pedro; Pecos-Martín, Daniel (5 November 2021). "Median Nerve Neural Mobilization Adds No Additional Benefit When Combined with Cervical Lateral Glide in the Treatment of Neck Pain: A Randomized Clinical Trial". Journal of Clinical Medicine. 10 (21): 5178. doi: 10.3390/jcm10215178 . ISSN   2077-0383. PMC   8584397 . PMID   34768696.
  5. ↑ Ballestero-Pérez, Ruth; Plaza-Manzano, Gustavo; Urraca-Gesto, Alicia; Romo-Romo, Flor; Atín-Arratibel, María de los Ángeles; Pecos-Martín, Daniel; Gallego-Izquierdo, Tomás; Romero-Franco, Natalia (1 January 2017). "Effectiveness of Nerve Gliding Exercises on Carpal Tunnel Syndrome: A Systematic Review". Journal of Manipulative and Physiological Therapeutics. 40 (1): 50–59. doi: 10.1016/j.jmpt.2016.10.004 . PMID   27842937. S2CID   3870724 . Retrieved 17 March 2022.
  6. ↑ "Sciatica - Symptoms and causes". Mayo Clinic. Retrieved 2022-04-19.
  7. ↑ Pinar, Lamia; Enhos, Aysel; Ada, Sait; Güngör, Nevin (2005-09-01). "Can we use nerve gliding exercises in women with carpal tunnel syndrome?". Advances in Therapy. 22 (5): 467–475. doi:10.1007/BF02849867. ISSN   1865-8652. PMID   16418156. S2CID   19839017.
  8. ↑ Anikwe, E. E.; Tella, B. A.; Aiyegbusi, A. I.; Chukwu, S. C. (2015). "Influence of Nerve Flossing Technique on acute sciatica and hip range of motion". International Journal of Medicine and Biomedical Research. 4 (2): 91–99. ISSN   2315-5019.
  9. ↑ Basson, Cato Annalie; Stewart, Aimee; Mudzi, Witness; Musenge, Eustasius (1 November 2020). "Effect of Neural Mobilization on Nerve-Related Neck and Arm Pain: A Randomized Controlled Trial". Physiotherapy Canada. 72 (4): 408–419. doi:10.3138/ptc-2018-0056. ISSN   0300-0508. PMC   8781504 . PMID   35110815.
  10. ↑ Nee, Robert J.; Vicenzino, Bill; Jull, Gwendolen A.; Cleland, Joshua A.; Coppieters, Michel W. (2012). "Neural tissue management provides immediate clinically relevant benefits without harmful effects for patients with nerve-related neck and arm pain: a randomised trial". Journal of Physiotherapy. 58 (1): 23–31. doi: 10.1016/S1836-9553(12)70069-3 . ISSN   1836-9553. PMID   22341379.
  11. ↑ "Cubital Tunnel Syndrome". www.hopkinsmedicine.org. 8 August 2021.
  12. ↑ "Cubital tunnel syndrome: Exercises, symptoms, and home treatment". www.medicalnewstoday.com. 15 February 2022. Retrieved 21 March 2022.
  13. ↑ "Cubital Tunnel Syndrome Exercises: For Pain Relief". Healthline. 29 January 2016. Retrieved 19 March 2022.
  14. ↑ Satkunskiene, Danguole; Khair, Ra’ad M.; Muanjai, Pornpimol; Mickevicius, Mantas; Kamandulis, Sigitas (2020-07-29). "Immediate effects of neurodynamic nerve gliding versus static stretching on hamstring neuromechanical properties". European Journal of Applied Physiology. 120 (9): 2127–2135. doi:10.1007/s00421-020-04422-5. ISSN   1439-6319. PMID   32728819. S2CID   220843342.
  15. ↑ Vaidya, Shlesha Maulik; Nariya, Darshana (2020). "Effect of Neural Mobilisation Versus Nerve and Tendon Gliding Exercises in Carpal Tunnel Syndrome: A Randomised Clinical Trial". Journal of Clinical and Diagnostic Research. doi: 10.7860/jcdr/2020/43320.13779 . ISSN   2249-782X. S2CID   226682064.
  16. ↑ Waldhelm, Andy; Gacek, Marissa; Davis, Hannah; Saia, Christy; Kirby, Brock (July 2019). "Acute Effects of Neural Gliding on Athletic Performance". International Journal of Sports Physical Therapy. 14 (4): 603–612. doi:10.26603/ijspt20190603. ISSN   2159-2896. PMC   6670065 . PMID   31440411.
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