Nerve Treatment: Complete Guide

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

What is nerve treatment in physical therapy?

Nerve treatment in physical therapy, also known as neural mobilization or neurodynamics, is a set of techniques that aim to restore normal movement and function to 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 extremities of the limbs. To function properly, they must be able to slide freely in their anatomical tunnels and adapt to the body's movements. When this sliding motion is impeded, neurological symptoms^appear.

Nerve treatment involves several complementary approaches:

• Neural mobilization: Manual techniques and exercises that restore normal nerve gliding
• Nerve gliding/flossing: Specific movements that slide the nerve through its tunnel.
• Neural tensioning: Techniques that gently stretch the nerve to restore its extensibility
• Treatment of interfaces: Work on the structures surrounding the nerve (muscles, fascia, bone tunnels)

How do nerve treatment techniques work?

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

Functional anatomy of the nerve

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

• Endoneurium: Surrounds each individual nerve fiber
• Perineur: Surrounds each fiber bundle
• Epineurium: Surrounds the entire nerve

These connective tissues allow the nerve to slide over surrounding structures and adapt to body movements. When bending the elbow, for example, the ulnar nerve must lengthen by approximately 5 mm to accommodate the^movement.

Mechanisms of nerve dysfunction

Several mechanisms can disrupt the normal function of the nerve:

A nerve can be compressed in an anatomical tunnel (carpal tunnel syndrome, cubital tunnel syndrome) or by a herniated disc. This compression reduces blood flow 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 slide freely, and every 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 place, it becomes more vulnerable to compression elsewhere along its path. For example, irritation of the median nerve in the cervical region can cause^{symptoms in} the carpal tunnel.

How neural mobilization works

Neural mobilization techniques work on several fronts:

• Sliding restoration: Neural sliding movements gently break up adhesions and restore the nerve's ability to slide.
• Improved circulation: Movement pumps fluid inside the nerve and improves blood supply.
• Reduction in sensitization: Gradual exposure to movement normalizes nervous system responses.
• Drainage of intraneural edema: Movement helps to drain 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. The most commonly treated conditions are:

Canal syndromes

Tunnel syndromes occur when a nerve is compressed in an anatomical tunnel:

• Carpal tunnel syndrome: Compression of the median nerve in the wrist, causing numbness and weakness in the hand
• Cubital tunnel syndrome: Compression of the ulnar nerve at the elbow, affecting the little finger and ring finger
• Thoracic outlet syndrome: Nerve compression at the exit of the thorax, causing symptoms in the arm
• Piriformis syndrome: Irritation of the sciatic nerve by the piriformis muscle
• Meralgia paresthetica: Compression of the lateral cutaneous nerve of the thigh

Radiculopathies

Radiculopathies are irritations of the nerve roots as they exit the spine:

• Cervical radiculopathy: Pain, weakness, or numbness radiating down the arm. See our guide to neuralgia for more details.
• Lumbar radiculopathy (sciatica): Pain radiating from the buttock to the leg and 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: After traumatic injury or surgery

Neural pain

Some musculoskeletal pain has a significant neural component:

• Epicondylitis (tennis elbow) with irritation of the radial nerve
• Low back pain with 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 accurately assess 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 particular path?
• Nature: Numbness, tingling, burning, throbbing pain?
• Triggers: What movements or positions make your symptoms worse?
• Progression: Are the symptoms constant or intermittent?

The physical therapist then performs specific neurodynamic tests. These tests apply tension to the nerve in a specific 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 length.

Similar position but with the wrist and fingers flexed and pronated to target the radial nerve.

The leg is raised straight or the patient sits with the trunk flexed to assess the sciatic nerve and its branches.

A test is considered positive if it reproduces your usual symptoms and if these symptoms change when the position of a distant part of the body is altered (structural differentiation)^.

Treatment techniques

Depending on the results of the assessment, the physical therapist uses different techniques:

These techniques slide the nerve into its tunnel without increasing tension. For example, for the median nerve: bending the elbow while extending the wrist slides the nerve upward, then extending the elbow while bending the wrist slides it downward.

These techniques gently stretch the nerve to restore its extensibility. They are used later in rehabilitation, once the nerve tolerates movement well.

The physical therapist treats the structures surrounding the nerve:

• Relaxation of tense muscles that compress the nerve
• Joint mobilization limiting sliding
• Fascial release techniques on anatomical tunnels

You will receive neural gliding exercises to do at home. These exercises are progressed gradually to avoid irritating the nerve.

Treatment progression

The treatment of nerves follows a logical progression:

• Initial phase: Gentle techniques, low-amplitude movements, treatment of interfaces
• Intermediate phase: Increase in the amplitude of the shifts, introduction of light tensioning
• Advanced phase: Full tensioning, integration into functional movements

The speed of progress depends on your nerve's response. A highly irritable nerve requires 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 impairment: 8–12+ weeks

Long-standing problems generally take longer to resolve. Carpal tunnel syndrome that has been present for 6 months will respond more slowly than a condition that has been present for 6 weeks.

If the cause of nerve compression can be eliminated (e.g., changing your work posture), recovery will be faster. If the cause persists (e.g., cervical osteoarthritis), treatment will focus on managing the symptoms.

Frequency of treatments

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 essential to the success of treatment. Most patients need to do their neural gliding exercises 2-3 times a day for optimal results.

Signs of progress

Encouraging signs include:

• Decrease in symptom intensity
• Regression of symptoms toward the spine (centralization)
• Increased range of motion without pain
• Decrease in the frequency of symptomatic episodes
• Improvement of neurodynamic testing

FAQs about nerve treatment

Is nerve treatment painful?

Nerve treatment techniques should not cause intense pain. You may feel a stretching sensation or a slight recurrence of your usual symptoms, but this should not be unbearable. If the techniques are too intense, the physical therapist will modify them immediately. The principle is to work "with" the nervous system, not "against" it.

What is the difference between neural mobilization and nerve stretching?

Neural mobilization uses movements that slide the nerve within its tunnel, generally without increasing its overall tension. Nerve stretching (tensioning) increases 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 neural gliding exercises myself at home?

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

Can nerve treatment avoid surgery?

In many cases, yes. Research shows that physical therapy, including neural mobilization, can be as effective as surgery for mild to moderate canal syndromes such as^carpal tunnel syndrome. However, some severe cases (significant muscle weakness, atrophy) require surgery. An early evaluation will help determine the best approach for your situation.

How can I tell if my pain is coming from a nerve?

Some clues suggest a nervous origin:

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

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

Can massage help with nervous system problems?

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

When should I seek urgent medical attention for nervous symptoms?

Consult immediately if you experience:

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

These symptoms may indicate a medical emergency requiring immediate evaluation.

Nerve treatment at Physioactif

At Physioactif, our physical therapists 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 suffer from carpal tunnel syndrome, sciatica, or unexplained numbness, our team can help you regain optimal nerve function. Make an appointment at one of our five clinics in the Greater Montreal area for a complete neurodynamic assessment.

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• 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/