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Nerve Work - The Forgotten Exercise


A brain sending out a nerve that connects to a briefcase to pull it along. The title: "Nerve Work", "The Forgotten Exercise"

We know that exercise is good for us to keep our bodies functioning well. Most of us initially learn to exercise informally through play as children. Some forms of exercise like running and walking come naturally. Other forms of exercise are learned in a more formal setting like a physical education class or sports team practice. By the time we reach adulthood, most of us have some concept of what cardiovascular exercise, strength training, and stretching are.

Sadly however, we often overlook one of the major body systems until there is a problem. The nervous system doesn't get much attention in the exercise world. Perhaps, because it is one of the systems we understand the least about. It is also however, the system most responsible for processing pain and other information in the body. In a world where one in five people experience some type of chronic pain (1), a closer look at how to exercise your nerves is long overdue.

Our nervous system is a series of flexible wires that communicate with tiny electrical impulses. While our understanding of how this works is in its infancy, we do have some ideas about how nerves work. (See How Nerves Work: Simplifying Complex Neuroscience)

When it comes to exercising our nerves, there are a few different approaches we can take. Similar to other kinds of exercise, we can stretch them, we can move them, we can try to get them better blood flow, and we can use them to send messages. Let's take a look at some of the different kinds of nerve exercise


Nerve Stretching

Stretching your nerves is often called "tensioning". This type of exercise should be used cautiously. Some nerves, especially ones that are already painful, may not like being pulled on. Some people who perform nerve tensioning exercises will say that it "hurts good" while other people will feel like it is painful in a harmful way that doesn't make them feel good afterwards. Unfortunately, there aren't good, standardized tests at this point to help us know in advance who will respond well, and who will find the tension to be unpleasantly painful. To some extent, this is determined by trial and error.

When tensioning a nerve, we intentionally pull on both ends. This requires some knowledge of anatomy and is best done under the care of a licensed physical therapist. Most of us, however, have had the unpleasant experience of tensioning a nerve without even realizing what we are doing.

Many children in physical education classes do something called the presidential fitness test. If you grew up thinking that you had tight hamstrings based on the presidential fitness test, you may want to reconsider. The hamstring attaches to the pelvis (ischial tuberosity), and the bones just below the knee (the tibia, and fibula). To stretch the hamstring, a person has to straighten/extend their knee, and tip the pelvis (usually accomplished by leaning forward). The presidential fitness test however, requires that a person flexes their feet, and reaches forward towards their toes with the head down. This places added tension on the sciatic nerve chain down at the ankle, and in the neck. (Coming Soon: Mastering Mobility: The Sciatic Nerve).


Nerve Movements

The goal with these exercises is to move your nerve, without pulling on both ends. Nerve glides, are sometimes called "flossing" because the idea is that you pull on one end of the nerve, while reducing tension on the other, similar to the way you move a piece of floss back and forth between your teeth.

Ideally, during this process your nerve moves comfortably, which helps to teach your brain that movement isn't painful and dangerous. It has also been suggested that if there is any "scar tissue", or fascial tissue adhesions, that moving the nerve can help to break them up.

As an additional benefit, nerve movements help signal your body to generate better blood flow in the area around the nerve. This is because all the tissues need blood and oxygen to supply them energy to actively move.


Nerve Targeted Blood Flow

While gliding the nerves is a great way to try and facilitate blood flow on the whole by moving and using all the muscles around the nerve, there are other strategies we can try.

A physical therapist may suggest targeted stretches for the muscles that the nerve passes through. As you pull on these muscles, you naturally compress all the veins and arteries that flow in and out of the muscles. This can help to squish the blood out and pump it along.

If tissue adhesions, or "scar tissue" is present, stretching can also help to pull on this tissue and make it more flexible. If the tissue is rigid, blood flow can get trapped within it. Stretching the tissues can help to free up the blood flow in this way as well.


Nerve Messaging

Our nerves are busy places. They are like highways for information sending sensory information up to the brain, and then carrying commands from the brain for how to respond to our environment back down. (See: Nervous System Highways)

We can exercise our nerves in a unique way, by various types of stimulation. A physical therapist might prescribe the use of TENS units, hot/cold packs, vibration/percussion, two-point discrimination training, or positional awareness/sensory mapping, to stimulate your nerves and send messages to your brain.

A therapist may also recommend graded motor imagery techniques such as laterality training, mirror therapy, or guided visualization to encourage the brain to send signals back down.

Closing Thoughts

In a world where neurological disorders like Parkinson's, Alzheimer's, neuropathy, migraines, and chronic pain are increasingly common we may be able to prevent or delay the onset of these conditions if we start to re-evaluate how we care for our nervous system. With a little bit of intentionality, we may be able to reduce the severity of pain with some of these conditions. We are just beginning to understand the ways in which nerve exercise effects the body. This is true even for chronic pain conditions that we don't think of as neurological. A 2017 pilot study found that patients with rheumatoid arthritis reported improved pain with addition of nerve glides to their exercise routine (2).

If you aren't sure where to start and nerve exercise feels new to you, you aren't alone. Most people have very little exposure to how to exercise their nerves. Physical therapists are trained to dose exercise in the same way a medical doctor learns to dose medication. The right type, and the right amount is important for the medicine to be effective.

This article is intended for educational purposes as a starting point for a conversation with your healthcare team. It is not intended as a replacement for individual medical advice from a licensed healthcare provider. If you are interested in an evaluation and recommendations for your personal situation, click to Book Online and set up an appointment with one of our physical therapists.


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