Flossing is something the dentist usually nags you about — so why has your physiotherapist prescribed it as part of your management plan? If this is the case, you have likely presented with signs and symptoms of neural entrapment or neural tension that, alongside other management strategies, respond well to neural mobilisation exercises — also known as nerve flossing or neural gliding techniques.
At BeFit Training Physiotherapy, our team uses nerve flossing as part of a broader physiotherapy rehabilitation approach for patients presenting with nerve-related symptoms at both our Edgecliff and Coogee clinics.
How Nerves Work and Why They Become Irritated
Your nerves run from the spine, through the limbs, and into the hands and feet. For proper function, they need to be able to freely slide and move amongst surrounding anatomical structures — including muscles, bones, and joints — and tolerate a degree of tension through various positions. When this movement is restricted or the nerve becomes sensitised, it can produce sharp pain, pins and needles, and symptoms that travel down the arm or leg. These presentations are referred to as neural entrapment or neural tension — slightly different pathologies that may co-exist and present with similar symptoms.
It is worth noting that distinguishing between neural entrapment and neural tension is a clinical decision requiring thorough assessment — patients should not attempt to self-diagnose which category their symptoms fall into, as management differs depending on the specific drivers identified.
Neural Entrapment
Neural entrapment occurs when a nerve becomes irritated or compressed as it passes through a particular anatomical region. The nerve’s ability to move freely is reduced, and it becomes irritated and sensitive to movement and certain positions. Contributing factors include local inflammation or swelling, muscle tightness restricting the nerve’s pathway, joint stiffness altering the mechanical environment around the nerve, altered movement mechanics placing repetitive load on the nerve, and sustained postures that compress or tension the nerve over time.
Neural Tension
Neural tension refers to increased sensitivity of a nerve along its length, where there is not necessarily an obvious single point of compression. The nerve may be physically intact but becomes less tolerant to stretching or movement. Contributing factors include reduced nerve mobility, prolonged postures that load the nerve over time, and previous injuries or surgery that have altered the mechanical environment along the nerve’s path.
Signs and Symptoms
Signs and symptoms of neural entrapment or neural tension can include sharp, burning, or shooting pain along the nerve’s path, pins and needles, tingling, or numbness, symptoms that travel along the arm or leg, pain with certain movements or positions, reduced tolerance to using or stretching the surrounding muscles — which is frequently mistaken for simple muscle tightness — and symptoms that worsen with prolonged postures or repetitive tasks.
How Physiotherapy Manages Neural Entrapment and Tension
Following a thorough assessment to identify the cause or causes of your symptoms, physiotherapy management for neural entrapment and neural tension focuses on offloading and settling the irritated nerve, decompressing surrounding structures, facilitating free nerve movement, and gradually re-exposing the nerve to tension in a controlled and progressive way.
Education and load management are foundational — this involves understanding which positions and activities are currently aggravating the nerve, modifying daily tasks accordingly, and allowing the irritation to settle before progressive loading begins. Manual therapy, including joint mobilisations and soft tissue techniques, reduces mechanical compression and stress on the nerve from surrounding structures. Strength and movement retraining gradually restores normal movement patterns, strength, and load tolerance in the tissues surrounding the affected nerve.
Non-steroidal anti-inflammatory medication can play a role in settling nerve irritation in some presentations — your GP or treating medical professional can advise on whether this is appropriate for your specific situation. This is outside physiotherapy scope but is a relevant part of the overall management picture that your physiotherapist will discuss with you in the context of your broader care.
Nerve flossing — also known as neural gliding or neural mobilisation — is a specific exercise that promotes free movement of the nerve and gradually builds tolerance to stretching without aggravating symptoms. It is prescribed as part of a broader programme rather than as a standalone treatment, and the specific technique used depends on which nerve is affected and the stage of your recovery.
What to Expect Next
The next instalment of this blog will demonstrate specific nerve flossing techniques for the nerves most commonly involved in entrapment or tension — including the median, ulnar, and radial nerves of the upper limb, and the sciatic nerve of the lower limb.
Common Questions About Nerve Flossing
Is nerve flossing safe to do at home?
Nerve flossing prescribed by a physiotherapist is generally safe to perform at home when the technique has been taught correctly and the appropriate level has been selected for your stage of recovery. Performing nerve flossing incorrectly or too aggressively can irritate the nerve further rather than settling it. Always follow your physiotherapist’s specific instructions rather than using generic techniques found online.
How do I know if my symptoms are nerve-related?
Nerve-related symptoms often have a distinct quality — burning, shooting, or electric in nature, travelling along the path of a nerve rather than staying localised to one spot. Tingling, numbness, and pins and needles are also common. However, a thorough physiotherapy assessment is the appropriate way to determine whether your symptoms are nerve-related and what is driving them — self-diagnosis based on symptom description alone can be misleading.
How long does nerve irritation take to settle?
This depends on the severity of the irritation, how long it has been present, and how well the contributing factors can be managed. Mild neural irritation often responds within a few weeks of targeted management. More persistent or severe presentations can take longer. Your physiotherapist will give you a realistic expectation after your initial assessment.
Do I need a referral to see a physiotherapist at BeFit?
No referral is required. You can book directly at either our Edgecliff or Coogee clinic.
How BeFit Can Help
At BeFit Training Physiotherapy, our team assesses and manages neural entrapment and tension presentations at both our Edgecliff and Coogee clinics. If you are experiencing nerve-related symptoms — whether in the arm, leg, neck, or lower back — a physiotherapy assessment is the appropriate starting point for identifying what is driving them and what the right management approach is. No referral is required.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805
References
Butler DS. Mobilisation of the Nervous System. Churchill Livingstone. 1991.
Nee RJ, Butler D. Management of peripheral neuropathic pain: integrating neurobiology, neurodynamics, and clinical evidence. Phys Ther Sport. 2006;7(1):36-49.
Coppieters MW, Butler DS. Do sliders slide and tensioners tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008;13(3):213-221.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
