If you’ve ever heard me talk about nerves, I like to describe them as telephone wires. I visualize how these wires have a decent amount of slack on them as they traverse from pole to pole, transmitting countless conversations along the way. I will see birds come to perch and wonder if there’s a breaking point where the slack needed to transmit the electrical impulse is no longer available due to the weight of the birds along the way. The nerves in our bodies can be visualized in much the same way. They need freedom to move and glide, with enough just slack to allow the neural impulses to travel from the brain to the body and back. It’s not uncommon to have areas of impingement along these nerves, which can cause a whole host of issues including sensory changes, weakness, and pain. I imagine those areas of impingement as birds sitting on that wire, taking up the slack and causing tension. These “birds” can be anything from disc bulges, bone spurs, tight muscles, and poor posture, to restricted soft tissues, etc. It’s my job as a physical therapist to remove as many of these birds from the wire, especially if they’re causing pain.
A common place people will experience nerve impingement symptoms is in the neck and arms. We have a bundle of nerves coming from our neck into our upper extremities called the brachial plexus, which exits the neck and splits into five nerve branches in the arm: the axillary, musculocutaneous, median, radial, and ulnar nerves. For the purposes of this PT Corner, we are just going to discuss the median, radial, and ulnar nerves, as these are the nerves we most commonly treat when it comes to nerve impingement syndromes.
The median nerve runs down the inside of the arm and through the center of the forearm and wrist. It is probably the most well-known of the three, as when it is impinged, people may develop something called carpal tunnel syndrome. The median nerve provides sensation to the palm of the hand, palm side of the thumb, index, middle, and half of the ring finger, and ends of the back side of the thumb, index, middle, and half of the ring finger. It innervates the muscles that pronate the forearm, flexes the wrist and fingers, and abduct the hand.
The radial nerve runs more along the back of the arm before wrapping around the thumb side of the forearm to the thumb side of the hand. It provides sensation to the posterolateral upper arm, the posterolateral forearm, the lateral side of the base of the thumb, and thumb-side half of the back of the hand, and the back side of the thumb, index, and half of the middle finger. It innervates the muscles that flex and extend the elbow, supinate the forearm, extend the wrist and fingers, and move the thumb.
Finally, the ulnar nerve runs along the inside of the arm, inside of the elbow, and down the pinky side of the forearm to the pinky side of the hand. It’s the nerve you feel when you hit your “funny bone”. The ulnar nerve provides sensation to the pinky side of the hand, front and back, including the entire pinky and half of the ring finger. It innervates the muscles that flex the wrist and fingers, move the pinky, and adduct the thumb.
Nerve gliding or mobilizing is one way to take “a bird off the wire”, by restoring homeostasis in and around a nerve. It is believed to decrease pain caused by the entrapment of a nerve by encouraging movement between nerves and their surrounding structures. These nerve glides can be manual techniques performed by a healthcare professional on a patient or by the patient themselves. Studies have shown that mobilizing a nerve can decrease edema (swelling) improve fluid dispersion within a nervous structure, reduce pain, and reverse the increased immune responses following a nerve injury. When mobilizing a nerve, you do not want to irritate or stretch the nerve. Just imagine that you are flossing the nerve along the path it follows from the head to the arm, freeing up any areas of entrapment. Here are some simple beginner nerve glide exercises for the upper extremities, which can be done on your own:
- Median nerve glide – begin with your arm at your side, palm facing forward; you can place the opposite hand on the space between your neck and shoulder as an anchor; slowly flex and extend your wrist. Repeat 10-20 times.
- Radial nerve glide – begin with your arm at your side, palm facing back; you can place the opposite hand on the space between your neck and shoulder as an anchor; extend the arm slightly behind you; slowly flex and extend your wrist. Repeat 10-20 times.
- Ulnar nerve glide – extend your arm out to the side with the elbow bent to 90 degrees and your palm facing your face; you can place the opposite hand on the space between your neck and shoulder as an anchor; slowly flex and extend your wrist. Repeat 10-20 times.
You can find a demonstration of these glides and some more advanced versions on our YouTube channel by clicking the link below! As always, seek the help of a physical therapist or other healthcare professional if symptoms progress or do not improve. Let’s keep those nerves moving and grooving so I can keep seeing you on the mat!
