Neural Pain: Causes, Diagnosis, and Management

“It’s probably something neural” is a phrase that often gets thrown about in sport, and perhaps you’re an athlete and you’ve been told that before, with limited detail around what that means and what you should do… Neural pain, or nerve pain, is a complex condition characterised by discomfort resulting from nerve damage or irritation. It can significantly impact daily activities, mobility, and overall quality of life. For athletes, it can also be incredibly frustrating and have you in and out of the squad for weeks due to the random nature of your flare ups. This guide aims to unravel the complexities of neural pain, offering insights into its causes, diagnostic methods, and management techniques.

Causes of Neural Pain

The origins of neural pain are multifaceted. It often occurs when nerves are prevented from sliding and are instead, stretched. This can be due to:

Joint Compression

Nerves running through joints may get pinched which limits “gliding”, especially in conditions like arthritis or due to injuries.

Muscle Injury

Injury to muscle can sometimes put stress on localised areas leading to increased scar tissue.

Bone Changes

Alterations in bone structure, such as those caused by osteoporosis or trauma, can impinge on nerve pathways.

Diagnostic Tests for Neural Pain

Diagnosing neural pain requires specific tests to identify the affected nerves and the severity of the condition. Typically these should be completed by a professional, but if you don’t have access to one, they are relatively safe and straightforward to administer yourself at home. Two common tests include:

Bowstring Test

This involves a passive straight leg raise until sensations are observed, followed by a 20 degree knee bend and applying pressure on the popliteal fossa (see below). If symptoms are reproduced, you can assume positive neural pain, often being sciatica.

Bowstring Test at KPI

Slump Test

This test involves sitting on a box in a neutral position. From this position, fully round your back and pull your chin to your chest with hands on the back of your neck. Extend one knee and dorsiflex (pull your toes to your shin) fully. Then try the other side and if there are any cramps, tightness, shooting pains or localised feelings it can indicate a positive neural symptom. An example of this is below.

Slump Test at KPI

Management and Treatment of Neural Pain

After identifying the presence of neural pain, there are certain activities that should be (a) avoided, at least initially and (b) completed, to ensure your return to sport is a smooth one. See below for an overview of how the process typically looks. This may slightly change case by case and depending on your baseline physical profile and the severity of your neural pain.

Early stage

  • Isometric exercise
  • Slow eccentric exercise
  • Mobility exercise of muscles around the affected area
  • Light mobility exercise of the affected muscle
  • Movement control exercise to enhance joint stability and biomechanics

*Light sport-specific exercise participation

Mid stage

  • Dynamic exercise including concentric exercise
  • Moderate intensity explosive movements

*Moderate sport-specific exercise participation

End stage

  • High intensity explosive movements
  • Reactive and high-stability demand movements

*Non-restricted sport-specific exercise participation

Neural pain, with its multifaceted nature, requires a comprehensive approach for effective management. Understanding its causes, recognising symptoms, and adopting a holistic treatment strategy are essential steps towards alleviating discomfort.

Feel free to drop us a line via our contact page here or on social media here if you think that you are struggling with neural pain and require any further assistance!


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