Nerve Treatment: Complete Guide

Numbness, tingling, burning sensations, or pain radiating along a limb: these symptoms can indicate nerve irritation or compression. The good news? Physiotherapy offers specialized techniques to treat these nerve problems. At Physioactif, our physiotherapists use neural mobilization and nerve treatment approaches to restore nerve function and relieve your symptoms.

What is nerve treatment in physiotherapy?

Nerve treatment in physiotherapy, also known as neural or neurodynamic mobilization, is a set of techniques aimed at restoring normal movement and function of peripheral nerves. These techniques help reduce pain, numbness, and abnormal sensations caused by nerve irritation or compression.

Peripheral nerves run throughout the body, from the spine to the ends of the limbs. To function properly, they must be able to slide freely within their anatomical tunnels and adapt to body movements. When this sliding is hindered, neurological symptoms appear¹.

Nerve treatment includes several complementary approaches:

• Neural Mobilization: Manual techniques and exercises that restore normal nerve gliding
• Nerve Gliding (nerve gliding/flossing): Specific movements that help the nerve slide within its tunnel
• Neural Tensioning: Techniques that gently stretch the nerve to restore its flexibility
• Interface Treatment: Work on the structures surrounding the nerve (muscles, fascia, bony tunnels)

How do nerve treatment techniques work?

Peripheral nerves are not just passive electrical wires. They are living structures that require adequate blood supply, space to move, and the ability to stretch and glide during body movements.

Functional Anatomy of the Nerve

A peripheral nerve is composed of thousands of nerve fibers (axons) grouped into bundles. Each level of the nerve's anatomy has its own connective tissue sheath:

• Endoneurium: Surrounds each individual nerve fiber
• Perineurium: Surrounds each bundle of fibers
• Epineurium: Surrounds the entire nerve

These connective tissues allow the nerve to glide over surrounding structures and adapt to body movements. For example, when bending the elbow, the ulnar nerve must lengthen by about 5 mm to accommodate the movement².

Mechanisms of nerve dysfunction

Several mechanisms can disrupt normal nerve function:

A nerve can be compressed within an anatomical tunnel (carpal tunnel syndrome, cubital tunnel syndrome) or by a herniated disc. This compression reduces blood supply to the nerve and disrupts signal transmission.

After an injury, surgery, or inflammation, adhesions can form between the nerve and surrounding tissues. The nerve can no longer glide freely, and each movement creates excessive tension.

The nerve itself can become inflamed and hypersensitive, reacting excessively to normal stimuli. This sensitization explains why sometimes simple movements trigger intense pain.

When a nerve is slightly compressed in one area, it becomes more vulnerable to compression elsewhere along its path. For example, irritation of the median nerve in the neck can make carpal tunnel syndrome symptomatic³.

How neural mobilization works

Neural mobilization techniques work on several fronts:

• Restoring Glide: Neural gliding movements gently break down adhesions and restore the nerve's ability to slide
• Improving Circulation: Movement pumps fluid within the nerve and improves blood supply
• Reducing Sensitization: Gradual exposure to movement normalizes the nervous system's responses
• Draining Intraneural Edema: Movement helps to clear swelling that can accumulate around and within the nerve

Which conditions benefit from nerve treatment?

Nerve treatment is indicated for any condition involving peripheral nerve irritation or compression. Here are the most commonly treated conditions:

Entrapment Syndromes

Entrapment syndromes occur when a nerve is compressed within an anatomical tunnel:

• Carpal Tunnel Syndrome: Compression of the median nerve at the wrist, causing numbness and weakness in the hand
• Cubital Tunnel Syndrome: Compression of the ulnar nerve at the elbow, affecting the little and ring fingers
• Thoracic Outlet Syndrome: Nerve compression at the outlet of the chest, causing symptoms in the arm
• Piriformis Syndrome: Irritation of the sciatic nerve by the piriformis muscle
• Meralgia Paresthetica: Compression of the lateral femoral cutaneous nerve in the thigh

Radiculopathies

Radiculopathies are irritations of the nerve roots as they exit the spinal column:

• Cervical Radiculopathy: Pain, weakness, or numbness radiating into the arm. Consult our guide on neural pain for more details.
• Lumbar Radiculopathy (Sciatica): Pain radiating from the buttock down the leg and into the foot.
• Herniated Disc: When the disc compresses or irritates a nerve root.

Peripheral Neuropathies

• Diabetic Neuropathy: Nerve damage related to diabetes.
• Postherpetic Neuralgia: Persistent pain after shingles.
• Stretch Neuropathy: Occurs after a traumatic injury or surgery.

Neural-Origin Pain

Some musculoskeletal pains have a significant neural component:

• Epicondylitis (Tennis Elbow) with radial nerve irritation.
• Low Back Pain with a central sensitization component.
• Cervicogenic Headaches involving the occipital nerves.

What happens during a nerve treatment session?

A nerve treatment session at Physioactif is structured to precisely evaluate your condition and apply the most appropriate techniques.

Neurodynamic Assessment

The assessment begins with a detailed questionnaire about your symptoms:

• Location: Where do you feel the symptoms? Do they follow a specific path?
• Nature: Numbness, tingling, burning, throbbing pain?
• Triggering Factors: What movements or positions worsen your symptoms?
• Evolution: Are the symptoms constant or intermittent?

The physiotherapist then performs specific neurodynamic tests. These tests put the nerve under tension in a precise sequence to identify which nerve is involved and at what level:

The arm is positioned in abduction, the elbow in extension, and the wrist and fingers in extension. This test evaluates the median nerve along its entire path.

A similar position but with the wrist and fingers in flexion and pronation to target the radial nerve.

The leg is raised straight or the patient sits bending their body forward to check the sciatic nerve and its branches.

A test is considered positive if it brings back your usual symptoms and if these symptoms change when a different, distant body part is moved (structural differentiation)⁴.

Treatment Techniques

Based on the assessment results, the physiotherapist uses different techniques:

These techniques help the nerve slide smoothly within its pathway without increasing pressure. For example, for the median nerve: bending your elbow while straightening your wrist makes the nerve slide up, and then straightening your elbow while bending your wrist makes it slide down.

These techniques gently stretch the nerve to help it regain its ability to move freely. They are used later in your recovery, once the nerve can comfortably handle movement.

The physiotherapist treats the structures surrounding the nerve:

• Releasing tight muscles that are compressing the nerve
• Joint mobilization for joints that are limiting the nerve's ability to slide
• Fascial release techniques on the natural pathways where nerves run

You'll be given nerve gliding exercises to do at home. These exercises are gradually increased in intensity to avoid irritating the nerve.

Treatment progression

Nerve treatment follows a logical progression:

• Initial Phase: Gentle techniques, small, gentle nerve glides, and treatment of the surrounding tissues
• Intermediate Phase: Increasing the range of nerve glides, introducing light stretching of the nerve
• Advanced Phase: Full nerve stretching, incorporating movements into daily activities

How quickly you progress depends on how your nerve responds. A very sensitive nerve will need a more gradual approach.

How long does it take to see results?

The duration of treatment varies considerably depending on several factors:

Factors Influencing Recovery

• Mild irritation: 2-4 weeks
• Moderate compression: 4-8 weeks
• Severe or chronic condition: 8-12+ weeks

Problems that have been present for a long time usually take longer to resolve. For example, carpal tunnel syndrome that has lasted 6 months will improve more slowly than one that has only been present for 6 weeks.

If the cause of nerve compression can be removed (for example, by changing a work posture), recovery is quicker. If the cause remains (for example, cervical arthritis), treatment will focus more on managing your symptoms.

Treatment Frequency

Typically:

• Acute Phase: 2 sessions per week for 2-3 weeks
• Recovery Phase: 1 session per week for 4-6 weeks
• Maintenance Phase: As needed

Home exercises are crucial for successful treatment. Most patients need to perform their nerve gliding exercises 2-3 times a day for optimal results.

Signs of Progress

Encouraging signs include:

• Decreased symptom intensity
• Symptoms moving back towards the spine (centralization)
• Increased pain-free range of motion
• Reduced frequency of symptomatic episodes
• Improvement in neurodynamic tests

Nerve Treatment FAQ

Is nerve treatment painful?

Nerve treatment techniques should not cause intense pain. You might feel a stretching sensation or a mild reproduction of your usual symptoms, but it should not be unbearable. If the techniques are too intense, your physiotherapist will adjust them immediately. The principle is to work "with" your nervous system, not "against" it.

What is the difference between neural mobilization and nerve stretching?

Neural mobilization uses movements that allow the nerve to glide within its pathway, usually without increasing its overall tension. Nerve stretching (tensioning) increases the tension on the nerve. Both techniques have their place in treatment, but mobilization is generally used first because it is better tolerated by irritated nerves. Stretching is introduced gradually once the nerve tolerates movement better.

Can I do nerve gliding exercises myself at home?

Yes, and it's even essential for successful treatment. Your physiotherapist will teach you specific exercises tailored to your condition. These exercises are generally simple but must be performed correctly. Do them as instructed: usually 10-15 repetitions, 2-3 times a day. Do not increase the intensity without your therapist's approval.

Can nerve treatment help avoid surgery?

In many cases, yes. Research shows that physiotherapy, including neural mobilization, can be as effective as surgery for mild to moderate entrapment syndromes like carpal tunnel syndrome⁵. However, some severe cases (significant muscle weakness, atrophy) require surgical intervention. Early evaluation helps determine the best approach for your situation.

How do I know if my pain is coming from a nerve?

Certain clues suggest a nerve-related origin:

• Pain that follows a specific path (along the arm or leg)
• Numbness or tingling
• Burning or electric shock sensation
• Symptoms that change with neck or back position
• Pain triggered by stretching a limb

The physiotherapist uses neurodynamic tests to confirm nerve involvement and identify which nerve is affected.

Can massage help with nerve problems?

Massage can help relax muscles that are compressing a nerve, but it doesn't directly treat the nerve itself. An approach combining muscle release AND neural mobilization is generally more effective. This is why nerve treatment often includes techniques targeting the "interfaces" (muscles, fascia) in addition to direct work on the nerve.

When should I seek urgent care for nerve symptoms?

Seek immediate medical attention if you experience:

• Loss of bladder or bowel control
• Progressive weakness in both legs
• Numbness in the saddle region (perineum)
• Rapid loss of strength in a limb
• Fever accompanying nerve symptoms

These symptoms may indicate a medical emergency requiring immediate evaluation.

Nerve Treatment at Physioactif

At Physioactif, our physiotherapists are trained in advanced neural mobilization and nerve treatment techniques. We use an evidence-based approach to accurately assess your condition and develop a personalized treatment plan.

Our approach integrates nerve treatment with other complementary techniques: manual therapy, strengthening and stabilization exercises, and strategies to modify activities that irritate the nerve.

Whether you are suffering from carpal tunnel syndrome, sciatica, or unexplained numbness, our team can help you regain optimal nerve function. Book an appointment at one of our five clinics in Greater Montreal for a comprehensive neurodynamic evaluation.

• Shacklock M. Clinical Neurodynamics: A New System of Neuromusculoskeletal Treatment. Elsevier Health Sciences. 2005.

• Millesi H, Zoch G, Reihsner R. Mechanical properties of peripheral nerves. Clin Orthop Relat Res. 1995;(314):76-83. https://pubmed.ncbi.nlm.nih.gov/7634654/

• Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2(7825):359-362. https://pubmed.ncbi.nlm.nih.gov/4124532/

• Butler DS. The Sensitive Nervous System. Noigroup Publications. 2000.

• Fernández-de-Las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, et al. Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial. J Pain. 2015;16(11):1087-1094. https://pubmed.ncbi.nlm.nih.gov/26281946/