3 Simple Nerve Flossing Exercises to Help Resolve Arm Pain

When we first published this blog in 2021, a growing body of research was demonstrating the value of neurodynamic exercises for a variety of upper-extremity musculoskeletal complaints. Early studies showed meaningful improvements in pain, function, strength, and neural mechanosensitivity. (1–4)

Since that time, the research has continued to mount. Recent systematic reviews, meta-analyses, and randomized trials have further strengthened the evidence for incorporating neurodynamic treatment into the management of nerve-related neck and arm complaints:

• A 2024 Pain systematic review of 27 RCTs found that neural mobilization significantly improved nerve-related neck and arm pain. Adding neurodynamics to standard therapy produced an additional 1.44-point improvement in pain and an 11-point improvement in disability. (5)

• A 2024 systematic review found that neurodynamic treatment, particularly radial nerve mobilization, showed promising benefits for lateral epicondylalgia, including reductions in pain and improvements in nerve mechanosensitivity. (6)

• A 2025 JOSPT network meta-analysis of 50 trial reports found that adding articular and neural mobilization to usual care produced a 1.52-point greater reduction in cervical radicular pain than standard care alone. (7)

• A 2025 randomized placebo-controlled trial of patients with mild-to-moderate cubital tunnel syndrome found that ulnar nerve neurodynamic treatment produced significantly greater improvements than sham treatment across subjective symptoms and objective measures, including nerve conduction and sensory function. (8)

• A 2023 Journal of Clinical Medicine systematic review and meta-analysis found that neurodynamic techniques significantly improved symptoms, function, pain, and nerve conduction in patients with mild-to-moderate carpal tunnel syndrome. (9)

• A 2025 Clinical Rehabilitation meta-analysis of 20 randomized trials involving 953 patients found that median nerve neural mobilization reduced nerve-related neck and arm pain by 3.07 points versus no treatment. (10)

In response to requests for additional neurodynamic tutorials, this week’s blog is an updated review of the three most useful upper extremity neurodynamic assessment and management techniques.

Nerves are dynamic structures that need the ability to glide and stretch. (11) Edema and fibrosis can impair this normal nerve movement and often translate into neurogenic complaints. “Nerve flossing” aims to restore normal neurodynamics and may help to resolve the associated symptoms. Check out the following video demonstration of three simple nerve flossing exercises to help you manage upper extremity complaints.

The Presentation 

“According to the double-crush syndrome hypothesis, the peripheral nerves arising from irritated nerve roots are more sensitive to pressure.”(12) This cumulative nerve irritation is well recognized in neuropathies like carpal tunnel syndrome but is also thought to contribute to other musculoskeletal complaints like tennis elbow or shoulder impingement – as evidenced by the (remarkably reliable) arm squeeze test. (13)

The Diagnosis

How do we confirm that a nerve is irritated? In the lower extremity, it is relatively uncomplicated - straight leg raise for the sciatic nerve and Yeoman (aka Femoral nerve stretch test) for the femoral nerve. However, the upper extremity has more potential candidates, and the associated nerve tension tests are not generally as familiar. For a refresher, check out this ChiroUp tutorial video of three simple nerve tension tests to help you differentiate upper extremity neurogenic complaints.

The Solution

Nerve tension tests place a nerve under maximum stretch in order to elicit irritation; however, these maneuvers should not be confused with nerve flossing treatments. Flossing involves tensing one end of the nerve while simultaneously relaxing the other. This repetitive motion glides the nerve back and forth through its path and aims to release adhesions that have developed along the way. Nerve flossing can be performed in the office by the clinician or as part of a home-based program.

FAQs

• What is nerve flossing, and how does it help with arm pain?

  Nerve flossing (also called nerve gliding or neurodynamic exercises) is a gentle movement technique designed to help nerves move more freely through surrounding tissues. When used appropriately, it may reduce nerve irritation, improve mobility, and help relieve symptoms such as arm pain, numbness, tingling, or burning sensations.

• When should a chiropractor recommend nerve flossing exercises?

  Nerve flossing may be appropriate for patients with conditions involving nerve irritation, including cervical radiculopathy, carpal tunnel syndrome, cubital tunnel syndrome, or other upper extremity neurodynamic dysfunctions. A thorough examination should always determine whether nerve gliding is appropriate for the individual patient.

• What's the difference between a nerve tension test and a nerve flossing exercise?

  A nerve tension test is a diagnostic procedure used to identify nerve sensitivity or irritation by placing controlled stress on a nerve. Nerve flossing, on the other hand, is a treatment technique that alternates tension and slack to encourage the nerve to glide through surrounding tissues without sustained stretching.

Neurodynamic techniques are a valuable addition to a chiropractor’s clinical toolkit, helping providers assess and address nerve-related complaints with evidence-based strategies. From evaluation and diagnosis to treatment recommendations and patient education, having the right resources at your fingertips can make it easier to deliver consistent, high-quality care.

ChiroUp helps chiropractors confidently manage conditions such as upper-extremity nerve pain with evidence-based clinical resources, customizable patient education, and practical treatment guidance, all in one platform.

Explore the latest research, streamline your clinical workflow, and give your patients the education they need to stay active and recover faster with ChiroUp.

• References

  1. Akhtar M, Karimi H, Gilani SA, Ahmad A, Raza A. The effectiveness of routine physiotherapy with and without neuromobilization on pain and functional disability in patients with shoulder impingement syndrome; a randomized control clinical trial. BMC Musculoskeletal Disorders. 2020 Dec;21(1):1-9. Link

  2. Hamzeh H, Madi M, Alghwiri AA, Hawamdeh Z. The long-term effect of neurodynamics vs exercise therapy on pain and function in people with carpal tunnel syndrome: A randomized parallel-group clinical trial. Journal of Hand Therapy. 2020 Jul 30. Link

  3. Fernández-de-Las-Peñas C, Arias-Buría JL, Cleland JA, Pareja JA, Plaza-Manzano G, Ortega-Santiago R. Manual Therapy Versus Surgery for Carpal Tunnel Syndrome: 4-Year Follow-Up From a Randomized Controlled Trial. Physical Therapy. 2020 Nov;100(11):1987-96. Link

  4. Basson A, Olivier B, Ellis R, Coppieters M, Stewart A, Mudzi W. The effectiveness of neural mobilization for neuromusculoskeletal conditions: a systematic review and meta-analysis. Journal of orthopaedic & sports physical therapy. 2017 Sep;47(9):593-615. Link

  5. Lascurain-Aguirrebeña I, Dominguez L, Villanueva-Ruiz I, Ballesteros J, Rueda-Etxeberria M, Rueda JR, Casado-Zumeta X, Araolaza-Arrieta M, Arbillaga-Etxarri A, Tampin B. Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis. Pain. 2024;165(3):537-549. Link 

  6. Tedeschi R, Platano D, Melotto G, Donati D. Effectiveness of neurodynamic treatment in managing lateral epicondylitis: a systematic review. Manuelle Medizin. 2024;62:276-283. doi:10.1007/s00337-024-01063-z. Link

  7. García-Juez S, Navarro-Santana MJ, Valera-Calero JA, Albert-Lucena D, Varas-de-la-Fuente AB, Plaza-Manzano G. Effectiveness of articular and neural mobilization for managing cervical radicular pain: a systematic review with network meta-analysis. J Orthop Sports Phys Ther. 2025;55(7):1-14. doi:10.2519/jospt.2025.12757. Link

  8. Wolny T, Wieczorek M. Real versus sham-based neurodynamic techniques in the treatment of cubital tunnel syndrome: a randomized placebo-controlled trial. J Clin Med. 2025;14(6):2096. doi:10.3390/jcm14062096. Link

  9. Zaheer SA, Ahmed Z. Neurodynamic techniques in the treatment of mild-to-moderate carpal tunnel syndrome: a systematic review and meta-analysis. J Clin Med. 2023;12(15):4888. doi:10.3390/jcm12154888. Link

  10. Gillot T, Lefebvre D, Michalak A, Miossec L, Combret Y, Prum G. Effect of median nerve neural mobilisation and cervical lateral glide on pain, disability and function in patients with nerve-related neck and arm pain: a systematic review and meta-analysis. Clin Rehabil. 2025;39(11):1405-1424. doi:10.1177/02692155251370881. Link

  11. Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin. Nov 1986;2(4):761-6. Link

  12. Okmen BM. et al. Investigation of the Effect of Cervical Radiculopathy on Peripheral Nerves of the Upper Extremity With High-Resolution Ultrasonography. SPINE. 43(14):E798–E803, JUL 2018 Link

  13. Gumina S, Carbone S, Albino P et al. Arm squeeze test: a new clinical test to distinguish neck from shoulder pain. European Spine Journal 2013; 22: 1558-63. Link

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