Nerve "Flossing" May Help With Symptoms of Peripheral Neuropathy
Key insights: 60-second read
- Neurodynamic techniques significantly improved neuropathy severity - Patients receiving nerve mobilisation techniques had a meaningfully large improvement in their Michigan Diabetic Neuropathy Score .
- Quality of life improved substantially - The improvement in neuropathy-specific quality of life was also clinically meaningful.
- Nerve conduction studies didn't change - Despite clinical improvements, nerve conduction velocity and other electrical parameters remained unchanged, suggesting the benefits come through mechanical rather than electrical changes.
- Hamstring flexibility improved - Participants experienced meaningful improvements in straight leg raise range of motion.
If you or someone you know has diabetes, you may have heard about diabetic peripheral neuropathy - a common complication that affects up to 50% of people with diabetes. It can cause tingling, numbness, pain, and weakness in the feet and legs, and it is a major risk factor for foot ulcers and even amputations. And above all else, it can be frustrating and debilitating both mentally and physically.
Current treatments focus mainly on controlling blood sugar and managing pain, but they don't directly target the nerves themselves. This may leave many people still struggling with symptoms that affect their quality of life.
A recent randomised controlled trial published in BMC Complementary Medicine and Therapies set out to test whether something called "neurodynamic techniques" - essentially, gentle nerve mobilisation exercises - could help people with diabetic peripheral neuropathy feel better and function better.
About the research: This was a randomised-controlled trial involving 40 adults with diabetic peripheral neuropathy. Participants were randomly assigned to receive either real tibial nerve mobilisation techniques or sham (fake) techniques, in addition to their standard care. The study was conducted over eight sessions (twice weekly for one month) at a hospital in Tehran, Iran.
"While neurodynamic techniques did not enhance nerve conduction parameters, they significantly reduced neuropathy severity and improved quality of life in individuals with diabetic peripheral neuropathy."
On this page
1. What Are Neurodynamic Techniques?
Neurodynamic techniques - also called nerve mobilisations, nerve glides, or my favourite - nerve "flossing" techniques - are gentle exercises that "floss" nerves through their surrounding tissues. Think of it exactly like flossing your teeth, but gently gliding the nerve through all of the soft-tissue channels that it passes through.
The idea is that our nervous system is a fixed length, and while the nerves themselves don't stretch, there should be enough slack in the entire system for all of our nerves to move freely as our body does. When neural tissue become restricted, they can often become irritated, leading to pain, tingling, and reduced function.
In this study, the researchers applied specific mobilisation techniques to the scaitic nerve, which runs down the back of your leg from your lower back to your foot. The techniques involved moving the ankle, toes, and neck in coordinated ways to gently slide the nerve back and forth within its surrounding tissues.
Key concept: Neurodynamic techniques don't try to "stretch" the nerve. Instead, they aim to improve the nerve's ability to glide and slide as our body moves, reducing tension and irritation.
2. Key Findings
So, did the nerve mobilisation techniques actually help? The answer is yes - in some very important ways.
Neuropathy Severity Improved Significantly
The researchers used the Michigan Diabetic Neuropathy Score to measure the severity of participants' neuropathy. This score looks at sensation, strength, and reflexes. After one month of treatment, the nerve flossing group showed a large and clinically meaningful improvement in their scores compared to the sham group. The improvement was big enough that if two people received the treatment, one would benefit in a way that really mattered to them.
Quality of Life Improved
The study also measured quality of life using a questionnaire designed specifically for people with neuropathy. The nerve flossing group showed a medium and clinically meaningful improvement in their quality of life. This included improvements in pain, sensation, balance, daily activities, and emotional wellbeing.
Hamstring Flexibility Improved
Participants also experienced small to medium improvements in hamstring flexibility, as measured by straight leg raise range of motion. This improvement was clinically meaningful for the left leg but not quite for the right leg - which sounds a little strange. For me clinically, the wording here is interesting. The straight leg raise is a great test for sciatic neural tension NOT hamstring tightness. I would argue their hamstring flexibility may be better, but they'd need a more hamstring-specific test to figure this out.
Nerve Conduction Studies Didn't Change
Interestingly, despite the clinical improvements, nerve conduction studies did not change. The speed at which electrical signals travelled along the tibial nerve remained the same. This is actually a common finding in neuropathy research - clinical improvements can happen even when nerve conduction studies don't change.
"The lack of significant results in the nerve conduction parameters might be attributed to the absence of the tibial tensioner NDTs in this study, which could lead to neurophysiological impacts."
3. Why Did It Work?
The researchers suggest several possible mechanisms for why neurodynamic techniques might help with diabetic peripheral neuropathy:
- Improved blood flow: Mobilising the nerve can improve blood circulation in and around the nerve, which may help reduce hypoxia (lack of oxygen) and promote healing.
- Reduced swelling: These techniques can help disperse fluid and reduce pressure within the nerve.
- Anti-inflammatory effects: Animal studies suggest that nerve mobilisation can reduce inflammatory chemicals like TNF-α and IL-1β, which are involved in nerve damage.
- Pain modulation: Flossing may influence pain pathways in the brain and spinal cord by affecting opioid receptors.
- Mechanical effects: These techniques help the nerve move more freely within its surrounding tissues, reducing tension and irritation.
4. Study Limitations
Like all research, this study has some limitations worth considering:
- Small sample size: With only 40 participants, some outcomes may have been underpowered to detect statistically significant differences.
- Short follow-up: The study only measured outcomes immediately after the intervention. We don't know whether the benefits lasted over time.
- Single nerve focus: The study only applied techniques to the tibial nerve. Diabetic peripheral neuropathy affects all peripheral nerves, so applying techniques to other nerves might produce additional/different benefits.
- Sham group limitations: The sham techniques were not completely inactive, as they still involved passive movement of the ankle, which could have some non-specific effects.
Important note: The clinically significant differences observed do not imply that nerve flossing techniques can "cure" diabetic peripheral neuropathy. Rather, they suggest these techniques can be a valuable addition to management strategies to help people feel and function better.
5. What This Means For You
If you or someone you care about has diabetic peripheral neuropathy, this research offers some encouraging news:
Gentle nerve mobilisation techniques may help improve symptoms and quality of life, even if they don't change the underlying nerve conduction. This is consistent with what we see in other nerve conditions - clinical improvement can happen without corresponding changes in nerve conduction studies.
The improvements were meaningful - people in the real NDT group experienced changes that were noticeable and valuable in their daily lives, including improvements in pain, sensation, balance, and overall wellbeing.
It is important to note that these techniques were applied by a trained physiotherapist in a clinical setting. If you are interested in trying nerve flossing techniques for diabetic peripheral neuropathy, it would be best to see a qualified physiotherapist who can assess your specific situation and apply the techniques safely.
Learn how to perform the simple Elephant Walk nerve flossing technique here.
The Bottom Line
This study suggests that adding gentle nerve mobilisation techniques to standard care can significantly improve neuropathy severity and quality of life in people with diabetic peripheral neuropathy. While nerve conduction studies didn't change, the clinical improvements were meaningful and exceeded thresholds that matter to patients.
If you have diabetic neuropathy and are looking for additional ways to manage your symptoms, neurodynamic techniques may be worth discussing with your physiotherapist or healthcare provider.
If you or someone you know is living with diabetic neuropathy and struggling with symptoms that affect your quality of life, it can feel like there aren't many options beyond pain medication. This research offers a promising avenue worth exploring.
As always, it is important to work with a qualified healthcare professional who can assess your specific situation and guide you safely. Neurodynamic techniques are gentle, but they do require proper training to apply effectively and safely.
I genuinely hope this research summary offers some useful perspective. If you have questions or would like to explore whether these techniques might help you, please reach out.
- Grant
One key insight from this research
"Neurodynamic techniques significantly improved neuropathy severity and quality of life in people with diabetic peripheral neuropathy, even though nerve conduction studies didn't change. This suggests the benefits come through mechanical and biological changes, not just electrical ones."
Frequently Asked Questions
What are neurodynamic techniques?
Neurodynamic techniques - also called nerve flossing or nerve gliding - are gentle exercises that move nerves through their surrounding tissues to improve their ability to glide and move freely. They don't try to "stretch" the nerve but rather aim to reduce tension and irritation by improving the nerve's mobility within its natural range.
Can neurodynamic techniques cure diabetic neuropathy?
No. The researchers are very clear that these techniques do not "cure" diabetic peripheral neuropathy. However, they can significantly improve symptoms and quality of life, even though the underlying nerve damage remains. They should be considered as an addition to standard care, not a replacement.
Are neurodynamic techniques safe for people with diabetic neuropathy?
The study used gentle sliding techniques and found them to be safe. However, the researchers did not use tensioner techniques due to safety concerns. If you are interested in trying neurodynamic techniques, it is important to see a qualified physiotherapist who can assess your situation and apply the techniques safely.
Why didn't nerve conduction studies improve if symptoms improved?
This is actually a common finding in neuropathy research. Clinical improvements can happen even when nerve conduction studies don't change. The improvements likely come through mechanical effects (improved nerve mobility, reduced swelling, better blood flow) and biological effects (reduced inflammation, pain modulation) rather than changes in the electrical properties of the nerve.
How do I find someone who can do neurodynamic techniques?
Look for a physiotherapist who has experience or training in neurodynamic techniques. Not all physiotherapists are trained in these techniques, so it is worth asking specifically. If you are in Port Macquarie, I offer telehealth consultations and can help you explore whether these techniques might be appropriate for you.
Reference: Ashoori, M., Hashemi, S.E., Pourahmadi, M., et al. (2025). Adding tibial nerve neurodynamic techniques to a rehabilitative pain management strategy improved neuropathy severity and quality of life in patients with diabetic peripheral neuropathy: a randomized sham-controlled trial. BMC Complementary Medicine and Therapies, 25, 429. View Study
Living With Persistent Pain or Neuropathy?
If your pain has lasted longer than expected, feels disproportionate, or hasn't responded to standard treatment, you may benefit from a broader approach. Learn more about our chronic pain physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via telehealth.
Disclaimer: This information is for educational purposes and does not replace individualised medical advice. Always consult a qualified health professional for your specific situation. This blog post summarises a published randomised controlled trial (Ashoori et al., 2025); the original source should be consulted for full methodological details.
