Nerve flossing has emerged as a game-changer for chiropractors looking to address common conditions like sciatica, cervical radiculopathy, shoulder pain, and carpal tunnel syndrome. Recent research shows impressive results for nerve mobilization, and these simple yet powerful techniques can drastically improve patient outcomes.

But here's the catch: if you're not incorporating these techniques and associated home exercises into your practice, you’re missing out on a critical tool that can set you apart. Read on to discover the top 3 nerve mobilization treatments every chiropractor needs to master—right now.

What is Nerve Flossing?

Nerve flossing, or neural mobilization, is a technique designed to restore the normal glide and movement of nerves through the surrounding tissues. When irritation, edema, or fibrosis develops anywhere along a nerve’s path, it can impair the normal function of the entire nerve, causing pain, paraesthesia, or numbness. Studies show that nerve flossing can reduce these symptoms by improving nerve mobility and reducing adhesion and edema.

Quick Tutorial: Neurodynamics 101: What You Need to Know in 90 Seconds

Chiropractors know all too well the impact of poor neurodynamics on musculoskeletal health. With evidence supporting its role in reducing symptoms for a wide range of conditions—lower back pain, neck pain, sciatica, carpal tunnel, and shoulder impingement, to name a few—nerve flossing is a must-know for every practitioner.

This blog will detail our top three nerve flossing techniques, helping you secure your position as the undeniable best choice for MSK presentations.

1. Sciatic Nerve Flossing: The Go-To for Low Back Pain and Sciatica

Low back pain and sciatica are among the most common complaints in chiropractic offices. Sciatic nerve flossing is one of the most effective tools for alleviating nerve irritation and restoring proper function.

Studies have shown significant improvements in pain, disability, and range of motion for patients who incorporate nerve flossing for sciatica into their treatment plan. (1-4, 15-17) One systematic review of 40 studies on chronic low back pain revealed that nerve mobilization led to an average improvement of 9.3 points in the Oswestry Disability Index and a 1.8-point reduction in Visual Analog Scale pain scores. (2)

How to perform a Sciatic Nerve Floss

Sciatic nerve flossing involves tensioning the nerve at one end (hip flexion) while releasing tension at the other (neck extension), promoting the smooth glide of the sciatic nerve through the tissues. Check out this video tutorial on sciatic nerve flossing:

The patient starts supine with their affected leg extended. The clinician flexes the patient's hip (SLR) while the patient holds their neck in extension until symptoms begin to be reproduced in the leg. Next, the patient is instructed to flex their neck as the clinician lowers the patient's leg. Flossing motions should not create or intensify any radicular complaints. The flossing pattern should be repeated ten times, from the starting position to the end position.

Deeper Dive: Check out our prior blog and tutorial video on 4 Nerve Flossing Exercises for Back & Leg Pain Relief.

2. Median Nerve Flossing: Essential for Cervical Radiculopathy and Carpal Tunnel

The C4/5/6 nerve roots and the median nerve are frequently implicated in upper extremity conditions, ranging from cervical radiculopathy to rotator cuff syndrome and carpal tunnel. Median nerve flossing is a critical tool to help restore proper nerve function and reduce the associated pain, tingling, or numbness.

Multiple studies have shown that upper extremity nerve flossing is beneficial for a variety of complaints, including neck pain, cervical radiculopathy, shoulder impingement, and carpal tunnel syndrome. (2,5-11,18,19)

A randomized trial of cervical radiculopathy patients found that adding nerve mobilization to their care plan had “significant effects in improving quality of life.” (19)
A randomized trial of 80 shoulder impingement patients evaluated the effectiveness of adding nerve mobilization to standard therapy. The study found that nerve mobilization patients had a nearly two-point greater VAS improvement (lower mean pain score 2.15 vs. 4.90). (5)
A study of 120 CTS patients found that: “desensitization maneuvers of the central nervous system resulted in similar outcomes to surgery.” (7)

How to perform Median Nerve Flossing

Check out this tutorial video on median nerve flossing:

Median nerve flossing is performed on a supine patient with their shoulder elevated and elbow flexed. The patient is asked to slowly depress the shoulder and externally rotate the arm with fingers and wrist in extension. Lastly, the arm is abducted. Flossing motions should not create or intensify any radicular complaints. The flossing pattern should be repeated ten times, from the starting position to the end position.

Deeper Dive: Check out our most popular chiropractic blog post EVER: 3 Simple Nerve Flossing Exercises to Help Resolve Arm Pain

3. Radial Nerve Flossing: A Must for Lateral Elbow Pain and Radial Tunnel Syndrome

Radial nerve flossing is an invaluable tool for addressing lateral elbow pain, cervical radiculopathy, and radial tunnel syndrome (12,13). Whether caused by cervical spine irritation or peripheral nerve entrapment, dysfunction of the radial nerve can lead to debilitating pain and weakness in the arm and hand.

One recent Journal of Hand Surgery article highlighted the prevalent connection between tennis elbow and altered neurodynamics: "63.2% of limbs with lateral epicondylitis were noted to have an associated sensory disturbance of the superficial radial nerve." (14)

How to perform Radial Nerve Flossing

Check out this video tutorial on radial nerve flossing:

Radial nerve flossing is performed on a supine patient with their shoulder elevated and elbow flexed to 90 degrees. The patient is asked to slowly depress the shoulder and extend the elbow. The arm is then passively internally rotated with fingers and wrist in flexion. Adding arm abduction may impart additional stretch. Flossing motions should not create or intensify any radicular complaints along the nerve being flossed. The flossing pattern should be repeated ten times, from the starting position to the end position.

Deeper Dive: Check out our prior blog and tutorial video on Differentiating Radial Tunnel Syndrome From Tennis Elbow.

Maximize Your Clinical Outcomes

While performing nerve flossing techniques in the office is effective, providing patients with supplementary flossing exercises for home use can dramatically speed up their recovery. Patients who take an active role in their healing tend to improve faster but need the proper guidance to succeed.

ChiroUp automates this process for subscribers, delivering personalized instructions and exercises to your patients in seconds. Check out this video to learn how.

Not a subscriber yet? Try it free for 14 days and experience the impact firsthand. Join over 3,000 chiropractors who trust ChiroUp to help enhance patient care.

Bottom Line: Don’t Miss Out on These Essential Nerve Flossing Techniques

With such strong evidence supporting the benefits of nerve flossing, it’s time to ensure you’re incorporating these exercises into your treatment protocols. Whether it’s sciatic nerve flossing for sciatica, median nerve flossing for carpal tunnel, or radial nerve flossing for elbow pain, these simple yet effective techniques can make a profound difference in your patients' lives and your practice.

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1. Alshami AM, Alghamdi MA, Abdelsalam MS. Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial. Journal of Chiropractic Medicine. 2021 Jun 1;20(2):59-69. Link
2. 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
3. Almeida RS, Machado E, Yamato TP, Santos De Melo L, Nogueira LA. Pragmatic neural tissue management improves short-term pain and disability in patients with sciatica: a single-arm clinical trial. Journal of Manual & Manipulative Therapy. 2019 Aug 8;27(4):208-14. Link
4. Castellote-Caballero Y, Valenza MC, Puentedura EJ, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Immediate effects of neurodynamic sliding versus muscle stretching on hamstring flexibility in subjects with short hamstring syndrome. Journal of sports medicine. 2014 Apr 15;2014. Link
5. 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
6. 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
7. 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
8. Wilgis EF, Murphy R. The significance of longitudinal excursion in peripheral nerves. Hand Clin. Nov 1986;2(4):761-6. Link
9. 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
10. Wise S, Bettleyon J. Neurodynamics Is an Effective Intervention for Carpal Tunnel Syndrome. Journal of Sport Rehabilitation. 2022 Dec 30;1(aop):1-4. Link
11. Jiménez-del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, Estébanez-de-Miguel E, López-de-Celis C, Bueno-Gracia E, Pérez-Bellmunt A. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. International Orthopaedics. 2021 Dec 3:1-2. Link
12. Latinovic R, Gulliford MC, Hughes RA. Incidence of common compressive neuropathies in primary care. Journal of Neurology, Neurosurgery & Psychiatry. 2006 Feb 1;77(2):263-5. Link
13. Arumugam V, Selvam S, MacDermid JC. Radial nerve mobilization reduces lateral elbow pain and provides short-term relief in computer users. The open orthopaedics journal. 2014;8:368. Link
14. Satake H, Naganuma Y, Honma R, Shibuya J, Maruyama M, Takagi M. The Effect of Elbow and Forearm Position on the Resisted Wrist Extension Test and Incidence of Sensory Disturbance of the Superficial Radial Nerve in Patients with Lateral Epicondylitis. The Journal of Hand Surgery (Asian-Pacific Volume). 2022 Aug 11;27(04):665-71. Link
15. Peacock M, Douglas S, Nair P. Neural mobilization in low back and radicular pain: a systematic review. Journal of Manual & Manipulative Therapy. 2023 Jan 2;31(1):4-12. Link
16. Lin LH, Lin TY, Chang KV, Wu WT, Özçakar L. Neural Mobilization for Reducing Pain and Disability in Patients with Lumbar Radiculopathy: A Systematic Review and Meta-Analysis. Life. 2023 Nov 26;13(12):2255. Link
17. Pradhan A, Muthukumaran J. Effects of Neurodynamics Along With Conventional Exercises on Sciatica Patients: A Single-Blinded Randomized Clinical Trial. Cureus. 2024 May;16(5). Link
18. Zaheer SA, Ahmed Z. Neurodynamic techniques in the treatment of mild-to-moderate carpal tunnel syndrome: a systematic review and meta-analysis. Journal of Clinical Medicine. 2023 Jul 25;12(15):4888. Link
19. Rafiq S, Zafar H, Gillani SA, Waqas MS, Liaqat S, Zia A, Rafiq Y. Effects of Neurodynamic Mobilization on Health‐Related Quality of Life and Cervical Deep Flexors Endurance in Patients of Cervical Radiculopathy: A Randomized Trial. BioMed Research International. 2022;2022(1):9385459. Link

The Top 3 Nerve Flossing Techniques Every Chiropractor Must Know—And Why You Can’t Ignore Them