You've tried everything—rest, ice, massage, stretching. Nothing works. The pain keeps returning, or worse, it's getting worse.

Here's what most healthcare providers miss: your pain might not be coming from your elbow, shoulder, or neck at all. It's coming from your median nerve.

The median nerve runs from your neck, through your shoulder, down your arm, across your elbow, and into your fingers. When this nerve gets compressed, stretched, or irritated anywhere along its path, you experience symptoms that can masquerade as joint problems, muscle strains, or tendinopathies.

At Grapplers Performance, we see this constantly in athletes with "mystery" elbow and arm pain that traditional treatment hasn't resolved. The median nerve test takes 60 seconds and can immediately clarify whether nerve tension is your real problem.

What Is the Median Nerve?

The median nerve is one of three major nerves running from your neck to your hand. Understanding its anatomy explains why seemingly unrelated symptoms can all stem from the same source.

Path of the median nerve:

1. Origin: Nerve roots from C6, C7, C8, T1 vertebrae in your neck

2. Shoulder: Passes through the armpit and along the inner arm

3. Elbow: Travels along the front of your elbow, through muscle tissue

4. Forearm: Runs between flexor muscles in your forearm

5. Wrist: Passes through the carpal tunnel

6. Hand: Innervates thumb, index, middle, and half of ring finger

What it controls:

• Sensation: Palm side of thumb, index, middle, and part of ring finger

• Motor function: Wrist flexion, thumb opposition, finger flexion

• Proprioception: Position sense in hand and forearm

Common compression sites:

• Neck (nerve root impingement)

• Anterior shoulder (between pec minor and coracoid process)

• Elbow (pronator teres syndrome)

• Forearm (between flexor muscles)

• Wrist (carpal tunnel syndrome)

Why BJJ Athletes Get Median Nerve Problems

Grappling creates unique mechanical stresses on the median nerve that most sports don't:

1. Sustained nerve tension during defensive positions When defending armbars, kimuras, or other submissions, your arm gets forced into positions that stretch the median nerve to its mechanical limits. Repeated exposure creates cumulative irritation.

2. Compression from collar grips Deep collar grips compress the nerve at the shoulder and elbow. High-level gi competitors spend hours in these positions weekly.

3. Neck position during guard work Looking up at your opponent from bottom positions creates cervical extension with rotation—a common site of nerve root compression.

4. Poor posture from desk work + training Many grapplers work desk jobs creating forward head posture, then train 3-5 nights per week. The cumulative stress on nerve tissue is significant.

5. Previous injuries creating adhesions Old shoulder, elbow, or wrist injuries can create scar tissue that traps the nerve, even years after the original injury healed.

Symptoms of Median Nerve Tension

Unlike a muscle strain or joint injury with localized pain, nerve problems create distinctive patterns:

Classic symptoms:

• Diffuse, hard-to-locate pain (can't point to one specific spot)

• Burning or "hot water" sensation running down arm

• Pins and needles in hand (especially thumb, index, middle fingers)

• Numbness that comes and goes

• Weakness in grip or thumb opposition

• Symptoms that change with arm position (worse with certain movements)

• Pain that doesn't match typical injury patterns

Red flag symptoms (serious compression):

• Constant numbness that doesn't resolve

• Significant weakness in hand

• Muscle wasting in thumb or forearm

• Symptoms in BOTH arms simultaneously

• Pain accompanied by fever or systemic illness

If you have red flag symptoms, see a healthcare provider immediately. These suggest more serious nerve compression requiring urgent evaluation.

The Median Nerve Tension Test

This test stretches the median nerve along its entire path. If the nerve is irritated, compressed, or adhered anywhere, you'll feel it.

How to Perform the Test:

Starting position: Stand or sit upright with good posture.

Step 1: Shoulder position

• Extend your arm straight out to the side at shoulder height

• Keep elbow completely straight

• Palm facing forward (supinated position)

Step 2: Add wrist extension

• Bend your wrist back (extend it) as far as comfortable

• Fingers should point toward the ceiling

• Hold this position

Step 3: Add lateral neck flexion

• Tilt your head AWAY from the test arm

• For example, if testing right arm, tilt head to the left

• This increases tension on the nerve

What you're feeling for:

• Negative test: Mild stretch in forearm/arm, no significant discomfort

• Positive test: Sharp pulling, burning, tingling, or pins-and-needles sensation that reproduces your typical symptoms

Critical distinction: You should feel a nerve sensation (burning, tingling, electric), NOT a muscle stretch. If you only feel muscle stretching, the test is negative.

Variations for Specific Problem Areas:

Variation 1: Elbow emphasis

• Add elbow extension with forearm supination (palm up)

• This increases tension specifically at the elbow

• Useful for suspected pronator teres syndrome

Variation 2: Shoulder emphasis

• Add shoulder depression (actively push shoulder down)

• Increases tension at shoulder and upper arm

• Useful for suspected shoulder compression

Variation 3: Wrist emphasis

• Maximize wrist extension

• Add finger extension (straighten all fingers)

• Increases tension at wrist/carpal tunnel

• Useful for suspected carpal tunnel syndrome

Interpreting Your Results:

Clearly positive test: Reproduces your exact symptoms—burning, tingling, or sharp pain along the nerve path. This strongly suggests median nerve involvement.

Equivocal test: Some discomfort but doesn't fully reproduce symptoms. May indicate mild nerve irritation or could be normal tissue tension.

Negative test: No significant symptoms, only normal muscle stretch feeling. Unlikely that median nerve is the primary problem.

Asymmetrical test: One arm clearly more symptomatic than the other. Strongly suggests mechanical nerve compression on the affected side.

How to Fix Median Nerve Tension: Nerve Flossing

If your test was positive, nerve flossing (also called nerve gliding) can provide immediate relief and long-term resolution.

What is nerve flossing? Controlled movement that gently mobilizes the nerve through its tissue sheath, reducing adhesions and improving nerve mobility.

Basic Median Nerve Floss:

Equipment: None needed

Starting position: Stand or sit upright

The movement:

1. Position 1 (nerve relaxed):

   • Arm at side, elbow bent

   • Wrist flexed (bent forward)

   • Neck tilted TOWARD the arm

   • Hold 2 seconds

2. Position 2 (nerve tensioned):

   • Straighten elbow

   • Extend wrist (bend backward)

   • Tilt neck AWAY from arm

   • Hold 2 seconds

3. Alternate smoothly between positions 1 and 2

4. Perform 25 repetitions (full cycle = 1 rep)

5. 1-3 sets per session

Dosage:

• Acute irritation: 1-2 times daily

• Chronic issues: 3-4 times daily initially, then reduce as symptoms improve

• Maintenance: Once daily or as part of warmup

What you should feel:

• Gentle stretch/pull along nerve path during Position 2

• Symptoms may increase slightly during the movement (3-4/10 intensity)

• Relief after completing the set

• Improved range of motion over days/weeks

Critical rules:

• Never force into severe pain (stop if >5/10 intensity)

• Movement should be smooth and controlled, not jerky

• If symptoms significantly worsen, reduce range or stop

• Can perform during symptom flare-ups for relief

Advanced Flossing Technique:

Once basic flossing is comfortable, add these progressions:

Progression 1: Slump floss

• Sit and round your upper back (slight slump)

• This adds more nerve tension through the spinal column

• Same arm movements as basic floss

• More aggressive—only use if basic floss is pain-free

Progression 2: Standing full-body floss

• Stand with arm extended to side

• Alternate between:

  • Looking away from arm + wrist extension (tension)

  • Looking toward arm + wrist flexion (slack)

• Incorporates more nerve mobility through neck and shoulder

Progression 3: Resistance flossing

• Add light resistance band to wrist during flossing

• Increases neural loading and promotes tissue adaptation

• Only appropriate after 2-3 weeks of pain-free basic flossing

Treating the Root Cause: Common Compression Sites

Nerve flossing manages symptoms, but you must identify and address WHERE the nerve is getting compressed.

Compression Site 1: Anterior Shoulder (Most Common in Grapplers)

Anatomy: Median nerve passes between pectoralis minor and coracoid process. Tight pec minor compresses the nerve.

Test: Arm across body while maintaining good posture. Pain or tingling = positive.

Treatment:

• Pec minor stretching (doorway stretch with arm at 90 degrees)

• Soft tissue release (lacrosse ball on upper chest)

• Shoulder external rotation strengthening

• Posture correction

Dosage: Daily pec work, 2-3 minutes per side

Compression Site 2: Elbow (Pronator Teres Syndrome)

Anatomy: Nerve passes between two heads of pronator teres muscle in forearm. Muscle tightness or hypertrophy compresses nerve.

Test: Resisted pronation (palm down motion) reproduces symptoms.

Treatment:

• Pronator teres soft tissue release

• Forearm flexor stretching

• Avoid excessive pronation during training

• Grip position modification

Dosage: Pre-training release work, 1-2 minutes

Compression Site 3: Neck (Cervical Nerve Root)

Anatomy: Nerve roots exit cervical spine and can get compressed by disc issues, bone spurs, or muscle tension.

Test: Spurling's test (extend and rotate neck toward affected side while applying compression). Symptoms down arm = positive.

Treatment:

• Cervical traction

• Neck mobility work

• Deep neck flexor strengthening

• Posture correction

• May require professional intervention

When to seek help: If neck is primary source, professional assessment recommended to rule out serious pathology.

Compression Site 4: Wrist (Carpal Tunnel)

Anatomy: Nerve passes through carpal tunnel at wrist. Repetitive wrist flexion or inflammation can compress nerve.

Test: Phalen's test (hold wrists in full flexion for 60 seconds). Tingling in hand = positive.

Treatment:

• Wrist extensor strengthening

• Carpal bone mobilization

• Nighttime wrist splinting

• Activity modification

• May require surgery if severe

The 3-Phase Nerve Recovery Protocol

Phase 1: Reduce Irritation (Week 1-2)

Goals:

• Decrease inflammation

• Improve nerve mobility

• Reduce symptoms to manageable levels

Interventions:

• Nerve flossing 2-3x daily

• Identify and modify aggravating positions

• Release tight muscles compressing nerve

• NSAIDs if needed (consult provider)

Success marker: 50-70% symptom reduction

Phase 2: Address Root Causes (Week 3-6)

Goals:

• Fix mechanical compressions

• Restore normal tissue mobility

• Build tissue resilience

Interventions:

• Continue nerve flossing 1-2x daily

• Aggressive treatment of primary compression site

• Movement pattern correction

• Strengthen supporting structures

Success marker: 80-90% symptom reduction, only occasional flare-ups

Phase 3: Prevent Recurrence (Week 7+)

Goals:

• Maintain nerve mobility

• Build robust tolerance to training demands

• Self-manage minor irritations

Interventions:

• Nerve flossing as part of warmup

• Ongoing mobility work for common restriction areas

• Periodic assessment and correction

• Early intervention at first sign of symptoms

Success marker: Train without limitations, rare or no symptoms

When Nerve Flossing Isn't Enough

Seek professional evaluation if:

• No improvement after 2-3 weeks of consistent flossing

• Symptoms getting progressively worse

• Significant weakness developing

• Constant numbness (doesn't resolve)

• Symptoms affecting both arms

• Night symptoms disrupting sleep

• Muscle wasting visible in hand/forearm

These signs may indicate more serious compression requiring imaging, electrodiagnostic testing (EMG/NCS), or potentially surgical intervention.

Our I3 Model Assessment helps determine whether your nerve symptoms stem from incomplete mechanics (posture, movement patterns), an incident (specific injury), or structural injury (disc herniation, severe compression).

Integration With BJJ Training

Pre-training protocol:

1. Nerve floss (25 reps per arm) - 3 minutes

2. Release primary compression site - 2 minutes

3. Light movement warmup - 5 minutes

4. Retest nerve tension - should be improved

Post-training protocol:

1. Ice if significant inflammation - 10 minutes

2. Nerve floss (15-20 reps) - 2 minutes

3. Stretch tight areas identified - 3 minutes

During training modifications:

• Avoid extreme nerve tension positions when possible

• Tap earlier to submissions that stretch nerve

• Modify collar grips if they aggravate symptoms

• Use tape or sleeves to remind you of positional awareness

Competition considerations:

• Pre-compete nerve flossing essential

• Pack NSAIDs if needed

• Have ice available between matches

• Accept that symptoms may flare—plan recovery protocol

Common Mistakes That Slow Recovery

Mistake #1: Aggressive flossing too early Nerves are sensitive. Overly aggressive flossing creates more inflammation. Start gently.

Mistake #2: Only treating symptoms Nerve flossing without addressing the compression site means temporary relief followed by recurrence.

Mistake #3: Ignoring posture Forward head posture and rounded shoulders compress nerves at multiple sites. Fix your desk setup and training positions.

Mistake #4: Training through severe symptoms Mild nerve irritation (2-4/10) during training is manageable. Severe symptoms (6+/10) require rest and treatment.

Mistake #5: Not testing the other arm Bilateral symptoms or finding significant asymmetry provides diagnostic information. Always test both sides.

Conclusion

Mysterious arm and elbow pain that doesn't respond to typical treatment often stems from median nerve tension or compression. The median nerve test takes 60 seconds and can immediately clarify if this is your issue.

Your action plan:

1. Perform the median nerve tension test (described above)

2. If positive, start nerve flossing 2-3x daily

3. Identify your primary compression site (shoulder, elbow, neck, wrist)

4. Address that specific area with targeted treatment

5. Integrate into training warmup and recovery

Most athletes see significant improvement within 2-3 weeks. If you don't, professional evaluation is warranted to rule out serious pathology.

The four athletes who contacted me this week with "tennis elbow" that wasn't improving? All had positive median nerve tests. All started appropriate treatment. All avoiding months of ineffective protocols.

Test your nerve. Treat specifically. Train without mysterious pain.

Related Resources:

• BJJ Elbow Injuries Hub

• Tennis Elbow vs Bicep Tendon

• Shoulder Internal Rotation Test

• Free Elbow Injury Guide