What is neurogenic pain and what are the symptoms?
Typical scenario: A runner comes into the clinic with ankle pain with an insidious onset, meaning they have no idea when or why the pain started to occur. There was no injury but the pain has just gotten gradually worse. It hurts when they run and maybe a little while afterward. It may not hurt during any other activities. More chronic scenario: The injury started like the runner above, but now it hurts during less and less activity and at a lower threshold. It may be a dull ache and/or present with pins and needles.
Nerve pain is far more common than we realize, as both athletes and medical professionals. A good physical therapist typically sees foot or ankle pain as something coming from further up the musculoskeletal chain, up into the knee or hip. A great physical therapist will assess not only the musculoskeletal causes of pain, but any neural or vascular cause of pain as well.
Here are some signs and symptoms of nerve pain:
- Diagnostic imaging fails to identify the cause of pain. Radiographs (X-Rays) mainly look at bone and will miss any issues in the soft tissue. They oftentimes miss stress fractures as well. A bone scan is more likely to catch a stress fracture. An MRI will show tears in muscle, tendons, and nerves. It may show “slight edema” around a nerve, but overall the image is “unremarkable”.
- The pain fails to respond to conservative treatment. This may look like a period of rest or non-weightbearing, a walking boot, therapeutic exercises.
- Under normal conditions, a nerve is asymptomatic when exposed to mild to moderate pressure and/or stretch. Once a nerve becomes irritated, on the other hand, it can be very sensitive to any compression, stretch, or chemical changes. This often results in neurogenic pain.
- The pain is extremely variable. One day a game of basketball may be fine, and the next it sets you back 2 weeks. Normal soft tissue injury has a very recognizable pattern.