Understanding Neural Tension and Its Impact on Lower Extremity Pain in Runners

When leg pain appears, many runners focus on muscle strains or joint issues, but neural tension can often be a hidden cause or contributor to discomfort. Recognizing neural tension and addressing it properly can make a significant difference in recovery and performance.

What Is Neural Tension?

Neural tension refers to the abnormal tightness or irritation of nerves as they move through the body. Nerves are not just passive wires, they glide and stretch with movement. When nerves become restricted or compressed, they can cause pain, tingling, or numbness along their path.

In runners, neural tension often affects the sciatic nerve or the nerves in the lower leg. This tension can result from:

• Muscle tightness compressing or restricting the nerve

• Scar tissue around the nerve from previous injuries (i.e. a hamstring injury that results in scar tissue on the sciatic nerve)

• Poor running mechanics causing excessive tension on the nervous system

• Impaired mobility or restrictions anywhere along the spine including the neck, mid back, and low back

• Primary spinal diagnoses including herniated discs, facet arthropathy, and stenosis

How Neural Tension Presents in Runners

Runners with neural tension often describe symptoms that may seem like muscular pain, but is slightly different. Some common description of nerve type pain is:

• A feeling of tightness or deep achyness that does not improve with rest or typical stretching

• Sharp or shooting pain that radiates down the leg

• Tingling or numbness in the foot or calf

• Deep tightness in the hamstring, calf, and/or arch of the foot that doesn't improve with stretching

• Pain that worsens with certain movements like bending forward or extending the leg

• Symptoms that are aggravated by certain positions (that place the nerve on stretch) more than muscle activation

  
  

For example, a runner might feel deep tightness along the back of the thigh during or after a run. They may try to stretch it in a forward fold and notice that this makes the pain worse and travel further down the leg into the calf. This pattern suggests neural involvement rather than just muscle strain.

Diagnosing Neural Tension

Physical therapists use specific tests to identify neural tension. One common method is the Slump Test, where the athlete sits slumped forward and the leg is extended. If the symptoms are reproduced with leg extension and relieved with lifting just the head, this suggests that the symptoms are driven by neural tension more so than muscular restrictions.

Other assessments include:

• Straight leg raise test, in which the leg is passively raised with ankle flexed while lying down

• Palpation along nerve pathways to find tender spots

• Checking for muscle weakness or reflex changes

  
  

Accurate diagnosis is essential because treating neural tension differs from treating muscle or joint injuries.

Treating Neural Tension

At Precision Performance and Physical Therapy, we understand how to treat all facets of an injury, including nerve related pain. The key is to reduce nerve irritation and improve normal nerve movement. Treatment often includes some combination of the following:

• Nerve Gliding Exercises: These exercises gently move the nerve through its pathway to reduce tightness and improve mobility. Instead of putting a nerve on full stretch, which irritates it, it uses tension on one end of the nerve combined with slack on the other end. This is done by coordinating movements at different joints, such as the neck and lower leg to improve mobility without increasing symptoms.

• Soft Tissue Mobilization: Manual techniques can be used to release tight muscles or scar tissue pressing on nerves. This can include dry needling and cupping in addition to hands on soft tissue mobilization. Restrictions may be addressed locally around the area of nerve pain or up and down the chain, including around the spine. Athletes can also perform self myofascial release with a foam roller or similar tool to help with tissue mobility at home.

  
  

• Spinal Mobility: Manual treatment and exercises to restore normal spinal movement are imperative to reducing symptoms of neural tension

  
  

• Posture and Running Mechanics: Improving posture and running form can reduce unnecessary nerve stretch. At Precision, we look at your posture throughout running, how far the leg is extending in front of the body, and how much your back is working at push off, to determine if running form is contributing to your symptoms.

  
  

• Therapeutic Exercises: Targeted stretches for muscles can help relieve pressure on nerves. Strengthening weak muscles supports better alignment and reduces nerve irritation.

If you've been working through a muscle strain that just isn't getting better, especially if your symptoms sound like some of the above listed, your pain may have a neural tension component. Properly diagnosing and treating all aspects of an injury, including neural aspects, is imperative to full recovery and return to sport. If you are in the Atlanta area and think you may be experiencing neural tension symptoms, call today (404.343.3314) or email (admin@precisionpt.org) to schedule an appointment!

Thanks for reading!

Dr. Elizabeth Karr PT, DPT, OCS