The purpose of this study was to find out the effect of Nerve Flossing in reducing pain and improving Nerve Conduction Velocity in Diabetic Neuropathy populations. It was found that Nerve Flossing was effective to improvement in nerve conduction velocity and pain in Diabetic Neuropathy patients.

          The current study comprised 25 participants who had been diagnosed with diabetic peripheral neuropathy for more than ten years, including 14 males and 11 females. When comparing pre-test and post-test data, the research found significant improvements in all parameters. These findings demonstrate that Sural nerve flossing techniques improve nerve function in nerve pathways. The sensory nerve conduction investigation found a greater improvement in nerve conduction velocity.

         The reason for the greater pain relief, improvement in sensory symptoms, and improvement in spinal mobility may be related to the nerve flossing technique, which is large amplitude movements performed actively in an attempt to take the nerve throughout its available range of motion, potentially affecting the nerve both mechanically and physiologically sufficient to disperse oedema and alleviate hypoxia and its associated symptoms. Furthermore, NFT induces the lumbar nerve roots to slide proximally with neck and knee flexion and distally with neck and knee extension. It also increases the sciatic nerve’s actual excursion.¹⁴

         With a dynamic variation in pressure (by stretching at one end and relaxing at the other end by neck and knee flexion, and vice versa), evacuation of intraneural oedema can be facilitated, as well as a decrease in adhesions and symptoms by allowing the nerve to move freely with minimal increase in tension. This approach may also aid in oxygenating the nerve, so alleviating ischemia discomfort. NFT lowers pressure generated by intraneural and extraneural fibrosis, hence increasing blood circulation and axonal transport, both of which are required for a neuron’s structural and functional integrity. It’s also possible that movement helps manage pain at the central nervous system level. The gate control theory states that stimulating mechanoreceptors in the joint capsule and surrounding tissues inhibits pain in the spinal cord. It might be directly related to the immobilization decrease in neurogenic inflammation.⁴³

          Furthermore, it is theorized that moving the nerve in pain-free variants can aid in minimizing nerve compression, tension, and friction, hence diminishing its mechanosensitivity. McCracking conducted a study on LBP with radiculopathy and suggested that neurodynamic treatment techniques have some long-term effects in treating patients with non-specific low back pain and lower extremity pain with neural tension dysfunction. Similar results were found in favor of neural mobilization.^{44 45}

          Pirart J et al. reported an overall 12% prevalence rate of diabetic neuropathy in patients with newly diagnosed diabetes. The incidence of neuropathy increased with the duration of diabetes, and after 25 years of diabetes, over 50% of patients had DN.⁴⁶ The study was a prospective investigation involving over 4400 diabetic outpatients. According to data from another study, the prevalence of neuropathy rose with age, peaking at 44.2% in patients between the ages of 70 and 79. It was found to be 5% in the group of people aged 20 to 29.

          Muscle strength can also be enhanced by increasing the flexibility of shortened nerves and tissues near the joints. In such cases, improving sciatic nerve flexibility primarily tries to promote nerve tissue compliance by reducing the nervous system’s mechanosensitivity.⁴⁷ This is accomplished by static and dynamic stretching therapies that move the afflicted nerve through its entire range of motion.

          The nerve flossing technique involves moving the nerve as far proximally and distally as possible through the tissues, covering every joint and body component that the nerve passes. This approach is akin to extending a cord from one end while leaving the other slack and then reversing direction. When the sciatic nerve becomes trapped, scar tissue forms along the nerve fibre, causing it to grind against muscles and bones.⁴⁸ Patients may simply practice neural mobilization exercises at home, which require no special equipment and take little time to complete as part of a daily maintenance routine.⁴⁹

          When the Nerve Flossing Technique is performed dynamically, the pumping impact promotes venous return, oedema distribution, and pressure reduction inside the perineurium. It diminishes sensitivity while restoring function, lowering the threat value of an injury. This would diminish the possibility of ion channel upgradation in the dorsal root ganglia and central nervous system, as well as the potential for dorsal and brain alterations. ³⁵

          After examining the statistical data, this study found that nerve flossing activities are a useful therapy for diabetic peripheral neuropathy. These exercises not only increase nerve conduction velocity and sensory function but also help to relieve pain.