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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:

  1. 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”.
  2. The pain fails to respond to conservative treatment. This may look like a period of rest or non-weightbearing, a walking boot, therapeutic exercises.
  3. 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.
  4. 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.

If this sounds like you, you may benefit from Neural Mobilization or Fascial Counterstrain.

Jesse Dunn DPT CSCS

Jesse Dunn DPT CSCS

Jesse graduated from Eastern Washington University in 2017 with her Doctorate of Physical Therapy. Prior to graduate school, she graduated North Dakota State University with a degree in both Exercise Science and Psychology. Jesse has been a certified personal trainer since 2007 and a Certified Strength and Conditioning Coach with the National Strength and Conditioning Association since 2010. She enjoys working with all types of patients, especially helping athletes of all ages return to optimal performance. She uses a combined approach of manual therapy and exercise to help patients return to the activities they love. When she’s not working, Jesse enjoys biking, gardening, and exploring the outdoors. “I have been an injured athlete, trying to stretch, exercise, and tape myself out of an injury without success. That’s where manual therapy comes into play. I have been practicing fascial counterstrain for over a year now and notice more benefits with this technique than any other. Some things you can’t do yourself, and that’s when coming in for manual therapy can help you.”