Case Studies – Nerves

The human body is incredibly complicated. I’ve been through various anatomy, physiology, and biomechanics classes that have given me an appreciation of the body, but being able to study on cadavers was life changing. It was amazing to hold a human heart in my hands knowing that it belonged to a living, breathing person who had hopes, dreams, aspirations, a family, children…a life. To hold that person’s heart, one of the most important organs yet a symbol of vitality and love, was something I’ll never forget.

More to the point, the musculoskeletal system was fascinating. Instead of looking at bones or models of bones and muscles, I could see them right in front of me. The rectus femoris attaches on the anterior inferior iliac spine and travels down to integrate with the other three parts of the quadriceps to a common tendon that attach to the patella, which shifts into a ligament that attaches on the tibial tuberosity on the anterior side of the proximal tibia. God damn it, isn’t it beautiful? Seeing it gave me an immense appreciation for the complexity of life and how it evolved to be that way.

I love and appreciate this kind of shit, and I love and appreciate teaching people to optimally train their bodies to perform and be as healthy as possible. There’s a lot going on when we train, eat, sleep, or experience life. It takes effort to keep things on track, yet there’s a lot that can easily go wrong. I’m often surprised that some people have made it as far as they have; the crack addict still breathes years after being addicted and the ignorant guy who deadlifts with a horribly flexed lumbar still hasn’t blown out a disc. Humans are a hardy species.

I have two friends that have had nerve issues to the point that it has effected their training. Shawn has made his way through law school and still manages to train about four times a week. “Mace” is a soldier who has been blown up and shot. They have very different backgrounds and different nerve related issues that they have either fixed or improved.

I want to point out that I’m not a medical doctor. I’ve had several medical doctors comment that I know anatomy better than they do, but I think they were just being nice. Anything I say should not be taken for medical advice; when in doubt, go see a doctor. But let’s face it, some times we — people who train regularly — do not have the resources to see a doctor. Does this mean you should try adjusting your vertebral segments on your own? Absolutely not. But there are ways that you can work on your body to improve your ailments (it’s the premise behind MobilityWOD). Most of us can handle the minor repairs in our house; it’s only when there is a major issue (a flooded basement, the hot water heater craps out, etc.) that we’ll get ‘professional help’. Our bodies should be no different. Let’s look at how we addressed some nerve related issues.


Earlier this year Shawn started noticing that his left hand was feeling numb. Specifically it was his pinky finger and half of his ring finger. When he pressed, he noticed that his wrist felt extremely unstable, especially at the top half of the range of motion. He felt as if he had no sensory feedback, kind of like when your foot falls asleep. Shawn can deadlift close to 405, but when he was doing 315 one day it felt hard, and the bar just fell out of his hand halfway up. He realized something was wrong and had it looked at. He was told he had carpal tunnel.

To me, that’s a bullshit over simplification. The pinky and ring finger are precisely where the ulnar nerve travels to. That tells me there is something occluding or impinging his ulnar nerve, but the question is where? After being told he had carpal tunnel, Shawn was conscious of his wrist position when typing (he was working at a law firm while finishing his degree), yet the issue never went away. That told me it didn’t have much to do with the wrist.

I started thinking about three other places: the elbow, shoulder and neck. If someone is particularly tight in their internal rotators of the shoulder, I could see that pinching down on the brachial plexus and causing issues, but I’d sort of expect there to be some shoulder or inner biceps pain. There wasn’t really any of that, but file that info away. I started asking Shawn about what his elbow was doing when he is sitting. He primarily sits in class, at work, in his truck commuting, or at his desk at home. It turns out that his medial elbow was often mashed down on the arm rest of his chairs or the door of his truck (you know, the “I’m a big guy and my elbow is sticking out my window” style of driving a truck).

I collected all of this data and created a non-invasive prescription for Shawn.

1. Stop sitting with the medial elbow in contact with surfaces.

2. Complete nerve flossing 4x/day (more on this below).

3. Stretch the internal rotators of the shoulder and tie in the neck 2x/day.

By not impinging the nerve, we should free up that medial elbow and allow the nerve signal to pass through the area. By stretching the shoulder and neck, we could account for any possible tightness in the area that could impinge on cervical or brachial nerves. Lastly, the nerve flossing seems to be significant in treating the issue. To perform it, a person would reach their arm out laterally from their side so that their whole arm is horizontal. The palm is up, which supinates the forearm and slightly externally rotates the shoulder. They then look forward with good spinal posture and gently laterally flex their neck away from the outstretched arm. They would hold for a count, and then return their head to neutral position.

Kinda like this, but keep the wrist straight and laterally flex the head away from the arm. Click picture for source.

Within a week or so, Shawn noticed improvement in his numb fingers. His wrist felt more stable when training, and his grip strength returned. His fingers became sensitive to regular temperatures of water; they would feel like extreme hot or cold on the pinky and half of ring finger while the rest of the hand felt a moderate temperature. My guess is that because his fingers had lost innervation for several weeks, his body adapted to not feeling anything. When the neural innervation returned, his sensitivity was heightened to the temperatures. Now, several months later Shawn doesn’t have any issues with his fingers or wrist.


This guy is a crazy asshole in the Army who has made a really solid effort on getting killed in or out of combat. When his humvee was blown up by an IED, it started a series of issues that eventually resulted in two herniated discs in his back that cause localized and sciatic pain. When he was trying to jump off of a building to avoid an RPG, the explosion took his feet out from under him and he dislocated his left shoulder and tore his labrum. At least the grazing AK round on his leg didn’t leave any lingering damage.

Mace’s issue is in his right shoulder. He noticed that his right deltoid was just not being innervated, and this resulted in a lop-sided press. “Brute force and ignorance” didn’t seem to help, so we started collecting info on his situation. Unlike Shawn, who had no history of cervical injury, Mace probably has some kind of cervical issue that could be causing this. He could have a brachial plexus issue. Who knows? He’d have to wait to wait a bit to see a military doc, so I figured we might as well try:

1. Nerve flossing, same thing as what Shawn did.

2. Working on shoulder mobility, especially internal rotation stuff.

Before trying this treatment, Mace’s deltoid simply wouldn’t innervate properly (he sent me a video, it’s weird). He found that if he did the neural flossing at home, it would help innervate his deltoid and he’d get a decent press workout. He found that if he did it as part of his warm-up at the gym that he would still favor his right shoulder. Regardless, he still does it at the end of his training session. Despite our efforts that improved the issue slightly, his “shit is still fucked up”. He will see a neurologist soon and hopefully they can shed some light on where his issue originates and whether or not he can do basic treatments to keep him operational.


Nerve issues are not incredibly common in the training world. Hopefully this post gives you two perspectives. In Shawn’s case, we were able to identify what caused his issue, created an effective rehab program, and completely eradicated the problem. In Mace’s case, he has some more serious stuff going on that is going to require actual medical attention. We can discern the difference through collecting data on our “patients”. I was quickly able to identify what was probably causing Shawn’s problem by critically thinking with anatomical knowledge. I knew Mace’s issue was going to require “proper medical attention” since there wasn’t really one cause we could point to, but I still thought we could improve it to some degree (we did).

In either case, the assessment and “prescription” were derived from a knowledge of anatomy and physiology. I’ve explained in the past why anatomy is important for people who coach or train, but took it to a different level here. Coaches, trainers, or “fitness professionals” owe it to their clients to continuously learn about the human body. That doesn’t mean they should have to take bullshit continuing education credits on stupid pieces of equipment, coaching, or nutrition, but should focus on the hard sciences applied to relevant scenarios. I didn’t do anything special here; PT’s or chiros may have better solutions. Yet I was able to eliminate or improve serious problems that hampered two friends’ training.

And it all starts with anatomy and physiology.


25 thoughts on “Case Studies – Nerves

  1. Good post. I had some sort of ulnar nerve impingement/damage from doing circus dumbbell last year – took me a while to figure out what was going on and how to fix it. Same thing happened with the pinky/half-ring finger and the loss of grip strength. The nerve flossing thing would have been helpful to know – I just did a lot of massaging, stretching, and grip stuff to try to rehab. Took about a month and a half to be normal again.

    • How did it occur? Did you experience some ulnar deviation when trying to handle the dumbbell (your wrist crunched down on the pinky side)?

      • I’m pretty sure it was caused by the pressure of the oversized bell on my forearm while in the “clean” position prior to or after pressing. Took a weird grip and ended up driving with an ulnar assist or caught it back at my shoulder in this way – can’t completely recall.

  2. Nerve flossing is good stuff. I got some numbness in my fingers last year thanks to a crappy front squat rack position, but I tried nerve flossing and it helped resolve the issue.

  3. Excellent troubleshooting, Justin! It’s funny how elementary it sounds when one has an in depth anatomical knowledge and takes the time to analyze the signs and symptoms. The more I am exposed to issues in mobilty, the more I realize that looking up and downstream of an affected area is just as important as the area its self.

  4. Very timely post as I have recently developed numbness in my right index finger, which I understand to be the median nerve. I think this is from low bar back squatting. I will try stretching the internal rotators and doing some nerve flossing. One question though, what is nerve flossing actually doing? Are you attempting to stretch the nerve?

    • Ah, that would have been good info to add. The nerve flossing, to my knowledge, stretches the limbs out so that the nerve tracts are relatively “straight”. When you laterally flex the neck over (or something similar in other positions), I think that the nerves are getting elongated and then returned.

      I don’t fully know what’s going on physiologically, but nerves have similar properties to muscles, so I would guess that they are actually stretching a bit. Then they are returned to their normal shape. My reasoning is that this helps alleviate any impingement/occlusions since it sorta moves the nerve around at a given point.

      • Hey Justin,
        just on that note, i understand how nerve flossing works for the arm, but what would a similar position be for your leg to obtain the same effect?

        As always, great work on expanding our knowledge through your experience.

    • I had a similar issue a few months back — numbness in my thumb and index finger. I figured that it was the median nerve. So I hunted around in my shoulder and found something that caused excruciating pain when I touched it with a lacrosse ball. I parked myself on that ball, put something heavy on my chest, and wept until the pain and numbness dissipated.

  5. Always enjoy these type of posts because it always helps me know myself better if that makes any sense at all. Thanks Justin for your dedication to all of us!

  6. Nice post Justin. I’m a little surprised your friend was told he had carpal tunnel with ulnar nerve symptoms, particularly since the ulnar nerve doesn’t even pass through the carpal tunnel into the wrist. We use nerve flossing manual techniques and exercises frequently with patients in the clinic, and they typically get some great outcomes, so it’s good to hear everything worked out with your prescription. Oh, and sorry for sniping you, but the rectus femoris has its proximal attachment on the anterior inferior iliac spine. See you in Killeen!

    • Egads, you are correct, sir. I’ve honestly been saying that wrong for a while now. Fixed it; I’m embarrassed.

      I always forget I could go to you with questions. Expect some when I get stumped in the near future. You’ll also have to show me some other neural flossing at nationals.

  7. Carpal tunnel syndrome is entrapment of the median nerve (which innervates the thumb, index, middle and inner ring fingers), not the ulnar nerve. I had done the nerve conduction studies to diagnosis this condition with a neurologist I had worked with.

  8. I know all about the frustration of nerve issues too well. I dealt with sciatica from a bulging disc for a year before going under the knife and 3 months after surgery I’m still left with some nerve pain. Surgeon says my Mri is clear and he thinks the nerve pain is from healing and I should rest….I have been resting for too long and I think that’s part of the problem. After making a program for my self with mcgill exercises and light weights I’m starting to feel better. I wish going to the doctor was always the answer but so far 2 different pts, an ortho, and a nuero haven’t offered much. I really wish I could find a good therapist in my area. I’m giving a third pt a try this week.

  9. I’ve been meaning to post this question for a while. As its supposed to be summer here in the UK, I decided to try and lean out a little, the ladies deserve it. I’ve had no issues with strength loss but seem to be more prone to blackouts when going for max efforts (more often that not, it’s with squats). I’ve never experienced them when I’m heavier and carrying more body fat but since I’ve been leaner it happens at least once a fortnight (British words are fun!) any suggestions anyone?

  10. Great post! I don’t know nearly enough about A&P, need to buy Dr. Kilgore’s book.

    Reading your posts on this type of information makes me want to pursue PT, Chiro, or some sort of job where I could help people with mobility, fitness, and quality of life. As a firefighter all of this is very relevant to me as well ensuring I can continue to function in my job.

  11. That nerve flossing mumbo jumbo sounded like horse crap hippie nonsense, but judging from the comments it must be the real deal. I too have pinkie/half ring finger numbness. Time to start flossing!

  12. I wanted to put in my 2 Cents about “flossing.” I know how Kelly says to do it, which is like stretching. I didn’t really get much out of it.

    Their method involves giving slack to one end while tightening the other. For example extending the knee while tilting the head back is one extreme, then tilting the head to chest while flexing the knee is the other extreme. Take Kelly’s words about what “flossing” accomplishes and apply it to this method, it restores the sliding surfaces and breaks up matted down tissue, etc. Do like 10 reps of this and see if you can’t get an improvement.

  13. Pingback: Q&A – 34 |

  14. Man, this article was great. I’ve been having similar problems with my fingers, but usually just during the night, rather than when I’m lifting.
    I’ll be trying out the nerve flossing and see if that helps, and also trying to not bend my arm when I’m sleeping.

  15. Pingback: Numbness and Tingling in Hands « Crossfit South Bend blog

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