Six Signs That Your Running Injury Is Nerve Pain

Stay the CourseOne challenge I come across as a practicing physiotherapist is the vast number of possible sources of pain and dysfunction. A foot may be a foot, but often–because the foot is connected to the lower leg, knee, and hip–a foot problem may arise from a hip issue. Moreover, because the nerve that supplies the foot runs the entire length of the body, literally from head to toe, foot pain may come from the spine! Indeed, a full 10 to 20% of runners with foot pain have an issue stemming from a nerve.

Nerve pain is far more common than we, as runners or medical professionals, realize. While it’s more common to overuse or strain a muscle or tendon, or if we fall, possibly break a bone, irritating a nerve is not only possible but perhaps even commonplace amongst trail and ultramarathon runners. This may be because of the extreme demands we place on our bodies and also because of our propensity for falling. Falling might bruise a muscle or bone, but it can also irritate a nerve.

This article outlines the signs and symptoms of nerve pain: how and why it happens, and how we can go about properly treating it.

What is Nerve Pain?

Nerve pain, or neurogenic (of nerve origin) pain, can arise any time a nerve is sensitized. Under normal circumstances, a nerve is quite robust and asymptomatic when exposed to mild to moderate pressure and/or stretch. However, once a nerve is irritated, it can be very sensitive to any compression, stretch, or chemical changes (even our own, internal stress hormones). This often results in neurogenic pain.

There are generally two types of nerve sensitization, mechanical and chemical sensitization:

Mechanical Sensitization 

This occurs any time the normal motion and position of the nerve is restricted. While this could be a severe pinch (say, from a vertebral disc), the vast majority of mechanical restrictions are far more subtle and related to stiffness of surrounding muscles, tendons, joints, and fascial (connective) tissues.

Moreover, mechanical stress may involve overstretching a nerve. In general, nerves are very sensitive and resistant to stretching (and under normal circumstances, have enough length so they, themselves, don’t need to actually stretch). Thus, any force (whether accidental or intentional) that overstretches a muscle, tendon, or joint might also overstretch–or even strain–a nerve!

Chemical Sensitization 

This occurs from some sort of inflammatory chemicals that come in contact with a nerve, possibly from an injury adjacent to a nerve (like a strained muscle or broken bone).

Where and Why Nerve Pain Occurs

There are two other important things to note about neurogenic pain.

First, the nerve can create pain anywhere along its length. It may surprise even the educated runner to know that a sensory nerve unit in the foot has but three parts: the peripheral nerve (which in a tall male could be four feet long), a tiny interneuron in the spinal cord, and the upper nerve (which runs the length of the spinal column and into the brain). As such, any sensitivity anywhere along that sensory (or motor) unit can cause pain anywhere above or below that nerve! It may be mind blowing to consider that a stiff neck could be causing your foot pain, but it is both possible and far more common than anyone (including the sports-medicine professional) may realize.

Second, nerve sensitivity is cumulative. Because a nerve runs the length of the body, there are countless areas where the nerve might come under irritation. A good analogy for this is a garden hose: a single small crimp in the hose may result in no perceptible difference in flow. But two or three crimps anywhere along the length of the hose often results in major interruption. The nerve functions in the same way: sensitivities anywhere along its length–at the neck, mid-back, low back, or pelvis–can cause a mild compression at the foot and ankle to result in severe pain.

Signs That Your Running Injury is Nerve Pain

Here are six signs that your running injury is actually nerve pain:

1. Your Pain Fails to Respond to Conventional Treatment.

If conventional sports medicine treats injuries to muscles, ligaments and tendons, and bone, then conventional treatment often includes RICE: Rest, Ice, Compression, Elevation. This is the standard treatment for acute injuries; however, it (at least the RI) is often used for chronic injury as well. Resting and icing chronic plantar-foot and Achilles pain continues to be prudent and useful for prolonged, subacute issues.

Sports physical-therapy treatment for orthopedic injuries also includes stretching and strengthening. For healing soft tissues, this stress-and-rest cycle, when patiently and progressively applied, nearly always results in progressive improvements–if the injury in quest is muscle, tendon, or bone!

However, if your pain is neurogenic, then conventional treatment rarely, if ever, is effective, for two reasons:

  1. There is no soft-tissue injury (to rest, ice, stretch, and strengthen).
  2. The sensitive nerve needs very specific (and often very gentle) treatment.

Not only that, but conventional orthopedic treatment–namely aggressive stretching, massage, icing, and compression–could make nerve pain worse by overstretching, compressing, or otherwise irritating an already sensitive nerve.  

Lastly, rest alone seldom improves nerve pain. The reason is simple: if there is a mechanical restriction of the nerve (either in the painful area or anywhere along its length), passive rest will not free the restriction and restore motion. Pain may subside with rest, but nearly always returns with the resumption of running or other activity.

2. Your Pain Includes a Dull Ache, Pins and Needles, Tingling, or Numbness.

Orthopedic pain is nearly always tied to activity, and symptoms will be experienced during activity (such as running, hiking, walking, or standing), and the symptoms are fairly consistent, ranging from tightness and stiffness, to a dull ache or sharp, stabbing pain.

Conversely, nerve pain–which can replicate those aches and stabs–often includes other abnormal symptoms. Pins and needles, tingling, and numbness are classic neurogenic symptoms, and seldom (if ever) arise from an orthopedic injury. That said, nerves can also replicate dull-ache, tight, or stabbing symptoms. What differentiates a painful nerve from the muscle and tendon is outlined below.

3. Your Pain is Extremely Variable and Disproportionate to Activity Level.

Another sign of neurogenic pain is inconsistency in pain behavior. Soft tissue pain–both acute and chronic–has a predictable pattern:

  • Stiff and sore with initial activity (first thing in the morning, after prolonged rest)
  • Generally warms up with small amounts of activity
  • At some point, will worsen with too much activity 

This is the classic pattern for muscle and tendon pain, such as Achilles or plantar-fascial irritation.

However, nerve pain can be maddeningly variable and difficult to predict: a 30-minute jog may feel fine one day, then another day, the same jog (route, pace) may result in a major flareup. Or, aggressive (but variable activity) such as a technical trail run (or a multi-directional running sport, such as ultimate frisbee) may feel okay, but a half-hour flat walk could be quite painful.

Additionally, another hallmark of nerve pain is variable location. Whereas something like plantar fasciitis has extremely focal symptoms (often at the base of the heel, near the anterior/medial aspect), nerve pain can wildly vary in location, often hopping around from one end or side of a bone or joint to the other. This is likely due to the nerve referring symptoms to the various locations of its innervation.

4. It is Difficult (or not Possible) to ‘Feel’ Your Pain.

Another hallmark of most orthopedic injuries is the ability to palpate (touch, massage, or otherwise locate) the precise area of sensitive tissue. Again, with classic Achilles and plantar-foot pain, there is nearly always a precise area of sensitivity: the location of strained, sensitive, and healing tissue that, when touched, often results in significant pain replication, sensitivity, or, when hotly acute, might send you jumping!

Nerve pain is often elusive. Regardless of how sharp, stabbing, or severe its intensity, many runners may be unable to find the precise area of injury or irritation. They themselves may poke or massage the area, or even get soft-tissue mobilization from a physio or massage therapist, but no one is able to actually pinpoint the sensitive area. This is likely because the pain in question is being referred to the area, from a sensitive area farther away. For nerve pain, this could be anywhere along the length of that nerve: farther up the leg, or in the hip, pelvis, back, or even in the neck.

5. You Have Pain at Rest.

If there is one hallmark sign of neurogenic pain, it is pain at rest. Unless extremely acute, orthopedic injury will not be painful at rest: namely sitting or lying down. Indeed, only if a runner has incurred a severe hamstring strain (resulting in swelling and bruising–which is rare) will they experience pain with sitting.

Conversely, a sensitive nerve often refers pain at rest. Why this occurs is variable (and not completely known); suffice to say that when a nerve is sensitized, several factors can create pain at rest, including:

  • Compression stress (in sitting, on the sciatic or obturator nerves)
  • Postural stress (usually sitting, but any position, due to nerve stress related to spinal position)
  • Restorative healing (as nerves will often try to heal themselves at times of rest)

Symptoms at rest is major red flag for nerve pain and should be considered a strong sign that your running pain is not a simple orthopedic injury.

6. Diagnostic Imaging Fails to Find Any Pathology.

When an injury fails to improve, most runners (and their sports-medicine professionals) will seek out diagnostic imaging in order to help identify the source of the injury and (ideally) why it fails to improve. So it can be a crushing blow to both runner and doctor when that imaging–often an MRI–fails to find any pathology at all. Especially in the case of severe, unremitting pain, how can that be?

Nerve sensitivity very often fails to show anything on diagnostic imaging because:

  • A sensitized nerve will not demonstrate any visual abnormality. Sometimes, mild swelling may occur around the sensitive nerve, but so long as the nerve is intact (not severed), no abnormality will be seen and the painful area often looks perfectly normal.
  • Pain may be referred from far away, out of the view of the imaging. An impinged nerve in the low back may not even appear in a lumbar scan, and certainly won’t appear in imaging studies of a foot and ankle, yet the low back is a common location of nerve sensitivity for the foot nerves.

So unless there is a blatant source of nerve impingement (where a tendon or other tissue may be seen, compressing a nerve), diagnostic imaging will fail to find the source.

More scary, therefore, is the prevalence of ‘false positives.’ These occur when a runner is experiencing neurogenic pain (either locally or peripherally from a sensitized nerve), but the imagining shows “mild arthritis,” “degenerative changes,” or other rather mild tissue wear and tear, which is falsely interpreted as the source of the pain. This often leads runners and doctors alike to rush into surgery to repair or clean up the area. Unfortunately, not only do these procedures fail to improve the symptoms, but they can often worsen them by creating additional scar tissue, mobility loss, or general post-operative sensitivity.

Common Running Pains and Possible Nerve Sources

Here is a short (but hardly exhaustive) list of common running-injury areas and the possible origin of neurogenic pain:

Injury/AreaPossible Nerve Involvement
Posterior pelvis, hip (butt)Cluneal, sciatic, obturator nerves
Anterior and lateral hip and thighCluneal, sciatic, lateral femoral cutaneous nerves
Medial thigh and kneeFemoral, obturator nerve
Lateral shinSuperficial fibular nerve
Medial shinTibial nerve
Lateral ankleSural nerve
Medial ankleTibial nerve
Plantar footMedial and lateral plantar nerves
Dorsal (top of the) foot and toesSuperficial, deep fibular nerves

How to Treat a Nerve-Pain Issue

This can be complicated–and is best left to highly trained professionals–but it is possible to treat a sensitive nerve. And when done carefully and skillfully, neurogenic pain can often improve rapidly. Some recommendations:

Think Like a Plumber (or Electrician).

While this somehow is baffling to an orthopedic professional, it is common sense a plumber: you must address the full length of the ‘cord’ (or pipe). Normal, healthy ‘flow’ requires the entire length of the nerve be free and clear from restriction or stress. This may include treatment of the spine (or even cranium) to get full resolution of pain.

Be Patient.

Sensitive nerves even when freed may still be sensitive. Once a nerve is even mildly irritated, it can take a very long time for that irritation to heal. Some texts believe that it could take a week per centimeter of nerve length for a severe nerve injury to heal (which is often why severe nerve compression from neck and back injuries can take a year to fully heal).

For severe nerve pain, be very patient in return to activity. The goal should not necessarily be a full abolishment of pain, rather a progressive decrease in frequency, intensity, and duration of symptoms.

Be Progressive.

Sensitive nerves heal best with gentle, frequent mobility and lots of blood flow. It is said that the nervous system is only 20% of the body’s mass, yet it ‘consumes’ 80% of its blood flow. Thus, gentle, frequent activity will not only help gently move the nerve, but also supply vital restorative blood flow–both factors that will result in the fastest possible healing.

In conclusion, just because you’re a runner doesn’t mean your injuries will only occur with muscles, tendons, and bones! Be aware of the importance of healthy and mobile nerves, know the possible causes and symptoms of nerve sensitivity, and, if you think you could have nerve pain, seek out comprehensive treatment from a ‘systems professional’–preferably one who thinks like a plumber or electrician!

Call for Comments (from Meghan)

Have you been diagnosed with a nerve injury? If so, what was the diagnosis? And where did you actually feel pain?

Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 69 comments

  1. Henry Bickerstaff

    You state above “Thus, gentle, frequent activity will not only help gently move the nerve, but also supply vital restorative blood flow–both factors that will result in the fastest possible healing.” Does this correlate or not correlate with doing Pilates or Yoga in preventing nerve pain or injury from occurring?

  2. Lee Chamberlain

    Great article. I’m from the UK I’m 38 and male. I used to regularly take part in sport from running, cycling, triathlons, boxing, etc in my youth, army life and after leaving. I then started ultra running.
    I completed two attempts of the 7 day treadmill record once in 2007 and again in 2009 where I was successful in a GWR. I was ultra running on the road also during this time.
    In 2010 I attempted a 800 mile road run speed attempt and it ended in bad hypothermia and a few days in hospital at the end. My wife remembers possible spinal fluid infection.
    In 2011 I noticed a winged scapula(dropped shoulder). I was advised I had a damaged long thoracic nerve, no associated pain and that it would reduce generate. Gentle physio etc overtime.
    In 2015 I noted the winging further and associated constant pain began. Hard to describe but like having a grown man sat on my right shoulder constantly and a constant migraine in my neck.
    Mri shows mild damage to my C5, C6 and C7. But no sign of nerve issues at the spine or damaged enough to fuse etc. These vertebrae are the exact starting point for the long thoracic nerve.
    More nerve testing shows my long thoracic nerve still damaged and after 6 years probally permanently damaged.
    The issues u describe as constant discomfort are spot on for anyone reading. Every day tasks causing issues and pain is correct. Some days are good others are bad for no reason. t’s horrible. On the outside I look healthy apart from mild winging.
    Injections work for a bit but I’m at the stage medically they are saying it’s just a case of pain management. When older they may consider other options.
    Have you come across this before with ur research and work? Everything u describe and discuss is great for anyone reading this article

    1. MikeD

      No input here, Lee but I thought I’d chime in as I am going on month 7 with my winged scapula (right side).
      It started the same time I had a severe pain and numbness in my right forearm. To this day, I still have the numbness but the pain is no longer present. The winged scapula doesn’t hurt at all, just makes push-ups and any lifting overhead difficult, even just raising my arm above my head.

      I attempted some physical therapy that included a few easy light weight exercises, ultrasound, KT taping and nerve flossing. I think some helped the nerve pain but not the winged scapula. Whilst running, I sometimes feel fatigued in my right shoulder and arm.
      Just trying to get this thing figured out…

    2. Joe Uhan

      Lee and MikeD, thanks for sharing, and sorry to hear about your injuries.

      With something like this, you do have to “think like a plumber/electrician” — is the issue with the formed nerve (in this case, Long Thoracic) or possibly at the nerve root (C6-T1), or even higher (at the upper cervical). A thorough assessment and treatment is the only way of knowing. Worst case scenario is some degree of nerve damage has occurred. Those nerves can heal, but it can take a very long time (>a year or longer).

      Good luck.

      1. MikeD

        Thanks Joe.
        Yes, The PT I saw described it much like you: he mentioned a hose connected to a water source. You can turn the water on and water will come out the sprinkler but if you kink the hose anywhere along its length, the water will not flow. Finding where that impingement lies is the mystery…

        Thanks for the articles.

  3. T. Anderson

    I wish you had published this article years ago! I have spent a small fortune on doctors, MRIs, nerve tests, acupuncturists, physical therapists, chiropractors, gizmos, potions, lotions….all to no avail. It has only been recently that I found an ART/LMT soft tissue specialist who has found the source of my pain. I have finally been having small optimistic improvements just when I was about to give up all hope. It has been six long years of frustration.

    Thanks to you all for getting the good info out there to us as we toil away in this goofy sport.

  4. Tomek

    Thank you for this article—”glad” to read nerve related setbacks are more common that I thought; I had that impression that I’m all alone out there. I’ve had sciatic nerve causing around calf muscles cramps—I could tell it was not a calf muscle because the pain would be not directly there. Luckily I’ve had a luck with PT where they identify and were knowledgeable about the problem right away. One of the things not mentioned in the article was dry needling (to stimulate nerve as it was described to me), which has been working for me very well. Good luck to everyone fighting all kinds of body pains and niggles! Thanks again for this great info!

  5. Patrick E

    Interesting article. I think I may be dealing with nerve pain in my feet. It’s been 2 1/2 months. It’s mostly burning pain on top of both feet and around both ankles with some off and on aching/soreness in the outer side of the foot in front of the heel. Sometimes the burning pain reaches my toes.

    I’d been a runner for just 18 months or so when it started. I tried some over the counter insoles from a running store because as my long training runs topped 20 miles, a sore big toe was nagging at me, and it was suggested that a thicker insole might help. I figured it couldn’t hurt to try them out, and I did a pair of five mile runs with the insoles. The night after the second one, the tops of both feet ached and burned. I’d never felt anything like that before, even after my longest training runs. After a little research, I thought I might have irritated the extensor tendons. I got rid of the insoles and figured the problem would clear up, but also went to a physical therapist to see if I was okay to run my first marathon two weeks later. He concluded that if it was my tendons, it was very mild (no touch or pressure sensitivity on examination) and gave me the go ahead to run, which I did. And actually the marathon went okay. The problem wasn’t aggravated much, if at all, by the long run, and I’ve found that while I’m running, it’s usually not that bothersome.

    It’s when I’m at rest that it’s worse. It’s when I’m sitting still or lying down that it bothers me the most. Sometimes I have trouble sleeping because of it. I immediately took six days off when it first started. Time off didn’t help, though I was still walking regularly. Recently, I resolved to take more time off with no running and much reduced walks and see if the rest helped. I made it 11 days. In that time all it did was get worse. So since it seems like rest makes it worse, I’m running again, though only about 15 miles a week.

    I’ve tried stretches and it seems like that didn’t help and maybe made it worse, so I didn’t try for long. I’ve tried different shoes, so far to no avail. I’m halfway through a 16 day course of prednisone from my family doctor. That’s not helping at all.

    I’m very frustrated and baffled at this point. Pain after some short runs with the wrong insoles seems like something that should respond to rest, ice, etc., not get worse with rest, and should be long since healed up anyway. After 2 1/2 months I’m getting scared that it’s more permanent pain. I have a referral to a podiatrist now, but frankly I don’t see how that will help.

    1. Cindy

      I have similar symptoms but I like to walk for exercise. I do feel the burning when I walk but not as bad as when I am at rest. I was told by a podiatrist to try tieing my sneakers by skipping holes in the sneaker near where the burning occurs which is the top of my foot. I do get referred pain in my arche though too. Well, that helped a bit but I still had the same pain just not as bad. It has been a year since this started so I did visit a foot/ ankle orthopedic Dr. He called what I have as Joggers foot. He did a cortisone injection in the nerve but did the injection a bit above where I was having problems…he used ultrasound to find the nerve. He said this will calm the nerve down and may take up to 2 weeks to feel better that it may get worse before better. Well, it has been almost a week …It was a bit sore from the injection for 2days then I got some weird pins and needles which was expected but now 5 days in I am feeling relief. No more pain at rest, I have however not been out walking for exercise ….just trying to give it the best chance to heal. I am optimistic this may help but I did ask if this was a cure and he said unfortunately it may return.

  6. Wil

    Very well written, I’m glad to see this article here

    Do you have any opinion regarding Dr. John Sarno’s concepts about nerve pain? I found his work to be very helpful

  7. Susan

    Hello, loved the detailed comments. I struggled more than 3 years with Pudendal Nerve pain and sciatic nerve pain. The cost dealing with this is around 50,000. Check out meditation. I do 3 short ones during the day. They are 5 minutes but totally relax the muscles which lay off the nerves. At bedtime, I play a healing meditation and fall asleep. So far, this has been the best therapy while I am working with a physical therapist. The pain Science by Mosley is the best. I worked on notebooks for my chronic pain by greglehman. I bought a book “Unlearn Your Pain”. Once we have the memory of pain it is tough to change the brain. You don’t need to join a meditation class look on utube they are free. Good luck!

  8. Tracy Boyer

    I foolishly overtrained or maybe undertrained for a half marathon. I’ve been running for 7 years 4-6 days/ week.
    This late spring I wasnt getting much running in due to our late winter. I was running 15 miles wk. and next thing you know my half was here. So the week before my half I ran over 40 miles. The following week I continued to run when I should’ve rested.
    I started having upper hamstring pain but only when I ran. I was going to PT but didn’t have a diagnois. Did some stretches, and soon pain started in the buttock. Doctors gave me a steroid injection for what they thought was ischeal bursitis. Felt okay backed off on working out but I did continue to walk a few miles at night. 10 days later..i felt pretty good. I increased my walking to 4-5 miles daily and doing elliptical. And I flared something awful. It’s been over a month and the inflammation and deep buttock pain have unleashed. It’s a cloud of constant ache deep in my left buttock. Sometimes it feels it’s in one specific spot, sometimes in my groin, sometimes numbness in front thigh, sometimes down the side of my leg. But there is always a constant ache in the low Glute..
    Mri pelvis showed a bunch of little things but nothing to indicate
    The pain is like a never ending tooth ache. I’m Scheduled to have another mri of lumbar spine. Not sure if I should proceed. I’m afraid they’ll find something really serious (this just is not normal), Or another fear they will find nothing at all and maybe I’m just going crazy. I haven’t ran in 2 mos. I’ve completely been resting from all activity for about 3 weeks and no improvement.
    This article explains so much. I am afraid I won’t be able to find a physician to treat this. So frustrating.

    1. Joe Uhan

      Tracy-

      Thanks for the comments, and sorry to hear about your pelvis issue.

      There are a great deal of structures in the posterior pelvic area. One structure you might consider in your case is the obturator nerve. It can cause “sit bone” pain, radiation of glute/butt pain, as well as medial thigh/groin. It often gets irritated in conjunction with a hip stability issue, but also can get “tensed” by issues in the low back (and even the neck!).

      Referrals: My general recommendation is anyone listed below:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me. They’ll know about al the possible goings-on in that area.

  9. Susie

    Thank you for posting this article. I have become so incredibly jaded by the healthcare realm at this point and preaching this “plumber’s approach” is the most accurate advice I’ve read in a long time. I used to run about 15 miles a week and did yoga. I developed peroneal tendonitis and was put in a boot… took care of it… and I was okay. About 7 months after the initial injury I overdid it again by running 6 miles on the first nice day of spring. …went back in the boot. However this time, I never fully recovered. I was still doing yoga, but running was painful on the outside lateral side of my boot. I was about to do a hiking trip and so my ortho gave me a cortisone shot. Had an MRI, no tears just some mild inflammation. After the hiking trip I was determined to make a full recovery so went back into the boot for 7 weeks. Instead of healing my calf shrank to half its normal size, and it still wasn’t back to normal. Had a second MRI… nothing but very mild inflammation right under my fifth metatarsal. 3 months after my first cortisone shot I had a second. Worst mistake. I had a reaction to the cortisone and it completely wiped out the muscles and fat on the bottom of my foot and under my ankle.

    No one has been able to help me and instead they’ve just made things worse. At this point I’ve stopped seeking ortho/podiatrist medical help because they try to get me into surgery without any proof that something is damaged… and with very high risk and long recovery times. I have been trying acupuncture and a chiropractor which has had some minor improvements. I’m convinced it’s nerve related because I’m starting to feel it in the other foot even though I haven’t ran in over a year. The bottoms/outsides of my foot feel strained or tingly… especially when they’re resting. I am (and have always been) a healthy athlete- now a 27 female at 130lbs… but I can’t wear heels or walk. The only shoes I can wear have to have very padded soles.

    Do you know any type of nerve specialist I should seek out, or any advice? Have you heard anything like this? I’m desperate for my old life back! I can hike… but would love to wear normal shoes or play tennis again!

  10. Jason

    What are your views on returning to sport? I’m suffering hamstring neuralgia from compulsive massaging but am slowly recovering and leaving my hands off of it, so it’s not a problem of a pinched nerve. In this case, would it be okay to continue training hard? Should I see improvement in the nerves regardless of how hard I’m working the muscle as long as there’s no interference with its circuit? (pinching)

    Thank you!

  11. Jason

    Thank you for this article, Joe. I’m curious about this point you made: “Pins and needles, tingling, and numbness are classic neurogenic symptoms, and seldom (if ever) arise from an orthopedic injury.”

    I have numbness in my left foot and a bit in the back of my left thigh associated with sciatic pain throughout my left leg and buttock. Orthopedist says it’s caused by a herniated disc and that I may have already done permanent nerve damage, and the damage could get worse unless I can address it with steroid shots or surgery. I have a lot of distrust of traditional Western medicine, especially after reading Dr. Sarno’s work, and so I wonder about your point above. It’s encouraging.

    Do you mean to say that the numbness is most likely not the result of the herniated disc? What are other possible causes of the numbness? I know what Dr. Sarno would say but what do you think? I’m encouraged by this line of thinking but would love to hear more. Thank you!

  12. Amy

    Has anyone experienced damage to their sural nerve? After 3 years of copious amounts of testing, multiple doctors visits, PT, massage, you name it…I finally found a doctor who specializes in the nerves of the feet and diagnosed sural nerve damage. Checking to see if anyone has had a sural neurectomy and if it was successful at relieving pain and the numbness from the neuectomy was tolerable?

  13. Joe Uhan

    Amy-

    I’ve had multiple clients I’ve treated with sural neuralgia. None have had to do surgery, but when a nerve is involved, you have “treat the whole length”: making sure it is free/unrestricted from head to lateral foot (where it ends).

  14. Charlie

    I have lateral knee pain / just below the knee, in and around the tib fib joint but hard to pinpoint. It only comes on after running for about a mile, I have been trying to sort this for a few years now with physios and chiropractors. I had an MRI but all they saw was minor fat pad inflammation and a cortisone injection was no help.vI get a numbness / tingling in my lower leg at the same time – do you think this could be nerve related? If so how should I got about finding the source?

  15. Joe Uhan

    It could ***definitely*** be neurogenic.

    The scatic nerve splits to two, just above the knee, in the back of the leg. From there, you have a branch go medial (inner shin = tibia nerve) and lateral (outer shin = fibular nerve).

    The fibular nerve, in particular, wraps around the fibular head, a little notch of a bone just below the lateral knee. It then immediately splits in two, again, forming the superficial and deep fibular nerves. The former (I think) actually wraps around the fibular head.

    So yes:

    * numb/tingle is a dead-on nerve sign
    * the question then is, what’s causing the nerve irritation?

    Your manual therapist needs to look at how the fibular head moves: this is called the proximal tib-fib joint (and is considered a third “knee joint”). Poor movement here could compress/strain that nerve.

    Good luck!

  16. Max Williams

    I am a runner and have pain in the joints of my great toes. I had hallux rigidus surgery in 1991. This relieved the pain, but I did not get full mobility in the joints. I was OK until about six years ago when again had pain in my toes. Several prolotherapy and osteopathic adjustments took care of the issue. I am again having pain. A prolotherapy injection and a PRP injection in January, and an ozone injection in February, have not helped. I haven’t run in several weeks, but the pain was sometimes less when running than when walking. The pain generally isn’t in the large joint but is sometimes in the first joint or along the outside of the toe. The pain is mostly in my left toe. I did break the metatarsal bone of the little toe of the left foot in 2015. It healed OK with only a cast and boot (no surgery). I am researching stem cell injections. Any thoughts on other treatment options or if this might be nerve pain?

  17. Tyler

    Hi Joe,

    Thank you for the content that you provide. I find that your articles are very detailed, well thought out, and informative.

    I have been having pain in my anterior thighs (vastus lateralis/tfl on both of my legs) for almost a year now (ever since running the Boston Marathon). The pain is a deep dull ache that intensifies slightly with exercise and then is particularly noticeable at rest during hours/days after exercise. I have remained active for most of the year despite the pain (not running so much, but mountain biking a fair amount, and swimming), however, I finally got scared that I had femoral stress fractures and have been resting for the past 6 weeks. I got an MRI and it turns out that I don’t have stress fractures (I do have a labral tear though – but I think I’ve had this for a while with no pain), so I am surprised that this time off hasn’t healed this injury. Does it seem like it could possibly be a lateral femoral cutaneous nerve entrapment?

    I have tried:
    PT
    Massage
    Strengthening: core, glutes, hamstrings
    ROLFing
    Acupuncture
    Chiropractic
    constant foam rolling
    EMS/TENS stimulation
    Postural restoration (which is amazing for anyone with hip impingements) (http://chadwaterbury.com/align-your-pelvis-to-reduce-pain/)

  18. Sam Shah

    Dear Joe
    I got severe nerve compression after a gym deadlift injury which caused a herniated disc. This was confirmrd by MRI. I had back pain and stiffness and spasms for 2 weeks and now i am totally pain free. Spine surgeon said no surgery needed and i am taking pregabalin tablets twice daily. Its now 3 months since my injury but i get pins n needles and slight numbness in both feet after i walk for more than 12 minutes. Is this normal? Will this numbness n pins n needles ever go away? My surgeon has said only to walk and swim for exercise. No lifting weights or jogging allowed. Do reply- Sam

    1. Joe Uhan

      Hi, Sam-

      Very sorry to hear about your injury, but thank you for sharing.

      My take: just becase the disc is healed (and you don’t need surgery) means that the tissues (muscles, joints, ligaments, etc) in the low back area are efficiently alilgned and moving correctly. I strongly suggest you see a skilled manual PT to be assessed. Without proper assessment – and treatment if things aren’t aligned/moving correctly – it’s likely that you will continue to have symptoms. Here are among the best manual PTs in the country:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      Good luck, -Joe

  19. Jacqueline

    I have been experiencing a burning/pressure type sensation on the sole of my foot, at about the level of the metatarsal-baby toe joint. Sometimes the pain extends vaguely into my baby toe as well. It starts after about 2 hours of running, and I’ve had it for almost a year, despite switching to Altras. It can become quite painful, especially on uneven surfaces but it will disappear for brief periods. As soon as I’m off my feet there is no trace of it. It feels very superficial, but deeper than the skin (not blisters). Could this be nerve pain? I would love to solve this mystery!

    1. Joe Uhan

      Jaqueline-

      This sounds a lot like a Morton’s Neuroma:

      https://www.mayoclinic.org/diseases-conditions/mortons-neuroma/symptoms-causes/syc-20351935

      This is nerve pain, which often arises from two stride issues:

      1. Over-striding
      2. Narrow/lateral striding (thus loading the forefoot in an abnormal, stressful way)

      Check out this and be sure you’re not landing too narrow!

      https://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html

      1. Jacqueline

        Thanks so much Joe! I had a tib post injury on the same foot not long before I first started experiencing this. Your article makes me think I may have altered my stride to compensate. I plan on trying the drills and hope I can widen my stride, or at least strike wider with my right foot since I run a lot of narrow trails.

  20. D. Murphy

    Competitive swimmer – flip turns; similar nerve injury – as you’ve described – that has progressed over the past 8 years.

    After a couple years of middle-age neighborhood running, transitioned back to sport of preference, competitive swimming. Early nerve discomfort at base of toes has deteriorated. Initially saw GP, who recommended nerve-conduction testing, did that twice and referred to orthopaedic surgeon who had no clue, saw podiatrist who recommended PT who could not locate source of pain, then to chiropractor who likewise offered no relief, 2 x acupuncturists, a second orthopaedic surgeon tried steroidal injection and back again to the podiatrist who wanted CT scan. Tried OTC vitamins B12, alpha lipoic acid, curcumin – no relief while chasing these pariahs. All x-rays negative (3 – 4 times over the years); not diabetic.

    So headed to muscular neurologist next as pain continues to progress.

    Joe, your description of the condition tracks precisely symptoms experienced from pool swimming 4,000 yards (160 laps) 3-4 x week for the past 8 years. 160 laps converts to about 125-150 flip turns and very strong pushing off the wall.

    Grateful that you have a provided a check list that suggests a possible, if not probable, diagnosis of the mechanical issue causing the pain. I know that your description is not a diagnosis of my condition, but it is more logical than the stone silence I’ve gotten from 2 orthopaedic surgeons, a nerve conduction specialist, 2 GPs, a podiatrist, a chiropractor, and 2 acupuncturists.

    Now, I just need to find a neurologist or PT who is willing to work with me on dealing with healing the extant nerve damage.

    Much appreciated.

  21. Liliana Tincher

    Wow, you hit it right on the nail! Wish I would have found your site sooner. Finally went to the doctor because three months of extra stretching was not working, and it turns out I have a compressed fracture on the lower lumbar which is possibly pinching a nerve/s that shoot pain down one leg all the way to my toes, causing tingling, numbness and pain that won’ let me sleep at night, after 3-5 miles of walking, can’t even run for a minute anymore.

    It was so difficult to describe the pain to the doctor because it shifts and is totally deep and dull!
    Awaiting patiently for MRI in a fee days. Unfortunately a surgery consult will follow.
    And to think I only thought it was my piriformis compressing my sciatic nerve. Wish I would have gone to the doctor sooner.

  22. martina mcintyre

    At the start of a race on Jan 1st I got a stabbing pain in my glute – excruciating pain. I had 3 mri scans first one in Feb showed swelling at isheal tuberosity and second scan on lower back and glute and hamstring 3 days ago showed everything normal – no reason for me to be in pain. I came accross this article last night and I think my pain is nerve damage. I’ve had complete rest from training (am an ironman athlete) for months and pain did get alot better – yesterday I decided to do 30 mins on turbo easy cycling and my leg was burning/throbbing after it – mainly middle to lower hamstring and on isheal tuberosity. I’ve seen doctors, specialists, physios, chiropractors, osteopaths, therapists have spent a fortune and am no wiser today as to the problem than I was on Jan 1st. Who is best to treat this type of injury? its a great article thank you

    1. Joe Uhan

      Martina-

      Sorry to hear about your pain. A couple notes:

      1. Unremitting pain doesn’t mean “damage”; rather, there’s aspects of this system (motion, stability) that are clearly dysfunctional.

      2. MRIs are like family pictures: everyone sitting, motionless, neatly arranged. Unless there’s a knife in “brother”‘s head, they often fail to show “family dynamics” — or how things function with motion, in daily life.

      Thus, you need a highly-skilled, hands-on, functional orthopedic assessment: not just a five-minute talk, or another scan (or drugs or surgery).

      These folks are best suited for the job:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

  23. Crystal M.

    This article has helped me. I have been a runner for 10 years and never had anything like this. I am wondering if this stemmed from different running shoes I had been wearing. I have been having numbness, tingling, and some pain for a month. Had MRI and all came back good for my neck, spine, and lower back. My problem starts from the knee down and travels to the foot. I dont know what to do for this other than rest it as much as I can. I see a neurologist but have to wait 3 weeks . This has been awful as it makes it difficult to sleep or enjoy much. We have vacation plans that involve walking and sightseeing and this will definitely interrupt my enjoyment. I pray this will subside soon. Good luck to all.

    1. Joe Uhan

      Hi, Crystal-

      Sorry to hear about your issue, but thanks for sharing.

      Numb/tingle is classic nerve signs; “knee down to foot” can be either tibial (medial) or fibular (lateral) nerve symptoms.

      Scans will only show severe pathology (see snarky reply above); impaired motion of the nerve (/fascia) can cause the symptoms you describe, absent of any actual damage.

      To treat, one needs to “think like a plumber or electrician” and treat the entire length of the nerve. These folks are best suited for the job:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

      Good luck!

  24. Kelsey

    Hi!

    I’m an elite marathon runner who is trying to avoid surgery for plantar nerve impingement (entrapment ). I’ve taken over 16 weeks off, done PT, and have gotten all kinds of therapies and still have pain on my medial side of heel. Was wondering if you have seen such a case and had recommendations.

    1. Joe

      Kelsey-

      Thanks for sharing, but sorry to hear about your foot.

      How was the entrapment diagnosed? Was it actually “seen” clearly on imaging?

      If so (hate to say it): a surgical excision could be a simple way to treat it (with way less than 16 weeks of downtime). However, if this entrapment diagnosis is MD conjecture, having skilled manual treatment, to the heel (as well as potentially all the way up the chain) is necessary.

      These folks are best suited for the job:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

      Good luck!

  25. Adam

    Dear Joe,

    For three months I have been experiencing a weird, consistent discomfort in my crotch area. At first the sensation started as a tight feeling in both groins (precisely in the spot where the groin “joins the pubic bone”), however over time it became more of a stabbing, stining sensation that has spread all over the whole crotch area including scrotum, provoked even by walking. I can´t really pin down a specific moment the pain started, it sort of developed gradually, without any obvious trigger moment, after training 4x times a week on a pretty hard artificial surface (I play as a goalkeeper and am thus pretty often getting into a almost split position). The pain is not anyhow cripling, I´m still able to carry on playing football, running, stretching, etc., but it has become really annoying and uncomfortable. Even when I press my skin near the groin, I can feel the stinging sensation, as if the skin itself was anyhow more sensitive. I also sometimes feel a pressure right under the scrotum, close to buttocks while sitting after a longer walk.
    I would like to ask you whether you think that this sensation might be caused by a nerve irritation or something similar, as I have found some of the symptoms somehow related.
    Thank you very much in advance.

    1. Joe Uhan

      Hi, Adam-

      Thanks for the comment – and sorry for the delay.

      This symptoms certianly could be neurogenic (and I would wager a guess it’s “pudendal nerve” – look it up). As “inconvenient” as it may be, we have a lot of mechanical (and “electrical”) structures in our “pelvic floor” area and if they’re stiff/dysfunctional, can cause a lot of issues.

      Looking at your coccyx would be a good start for any skilled manual PT:

      https://www.irunfar.com/2019/08/pain-in-the-butt-considering-the-coccyx.html

      But I would also consider seeing a PT who specializes in pelvic floor treatment. As always, My general recommendation for great manual therapy PTs is anyone listed below:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

      Good luck,
      -Joe

  26. Simon Bucknell

    I am a former competitive middle distance runner (4:04 mile/1:51 800m) and track/running was a huge part of my life. But since 2014 I havent been able to run due to what I believe now to be nerve pain. My symptoms are: A light cramping sensation begins in the calf area which continues to build as I try and run, when I get to approximately 5mins of total running the cramping gets to a point where I get a sharp spasm/grabbing sensation and have to stop running straight away. This pain feels like a calf tear (which is what I initially thought) but numerous MRIs confirmed this is not the case. Once I get to this stage it takes about 2 weeks to subside whereby I wont be feeling virtually any discomfort/pain while walking (maybe 1 out of 10 for pain while working). I do get the pain in both legs but it varies, and some days I first get pain in the right leg and other days I get it in the left leg. You name it I have tried it – Physical therapy, Deep Tissue Massage, Osteopathy, Yoga, Pain therapy, dry needling/acupuncture, MRIs on legs and spine, local corticosteroid in the calf area, corticosteroid in the epidural region of my spine, vascular ultrasound testing, podiatry, medication with Gabapentin and Amitriptyline, Nerve Flossing…I have probably missed something. I think I am close to giving up trying to find relief to be able to run again which really breaks my heart. Any other advice would be hugely appreciated.

    1. Joe Uhan

      Simon-

      Thanks for the message, and sorry for the delayed response.

      Questions:

      1. Is the pain in the posteiror calf, about midway up (just below the point where the two “bellies” of the calf split off)?

      and/or

      2. Is the pain felt deep, and feel like a building-up pressure?

      For #1: the culprit may be the sural nerve (look it up): it’s a cutaneous nerve that pops superficially at the mid-calf (as described above), then does sensory innervation for the whole lower calf.

      For #2: this typifies Compartment Syndrome (look that up, too) and is due to excessive pressure within the fascial compartments of the calf (where at least one nerve lives).

      Either way, you’ll need someone (else) to take a close, mechanical look at your systemt to see how both your nerves, and overall calf tissues, move.

      My general recommendation for great manual therapy PTs is anyone listed below:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

      Good luck!

  27. Anna

    Hi! I am a college distance runner and I have been dealing with some posterior tibial tendinitis issues since this past spring. Oddly, I also have “nerve” irritation like symptoms in the same leg and even in the other leg at times. It feels like a pins and needles or pinching sensation, always from the knee down into my foot. I have tried a ton of different therapies on it and have been seeing a PT for 12 weeks. It is independent of activity, I feel it pretty much all the time. It is mostly from my inner thigh down into my inner foot. Any suggestions on what to do?

    1. Joe Uhan

      Hi, Anna-

      Thanks for the comment, and sorry to hear about your shin pain.

      What you can do:

      * try this test: https://www.youtube.com/watch?v=HFGfP84uwEo&t=85s

      If this test — especially with ankle/foot “pumping” — replicates (even generally) the area of your symtpoms, it’s likely the issue is largely nerve

      * talk to your PT. Ask about nerve pain, if they can check for it, and how to treat it

      If you fail to get resolution, you might consider a different PT: My general recommendation for great manual therapy PTs is anyone listed below:

      http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      http://www.instituteofphysicalart.com/index.php/ipa/world/view/

      These folks have advanced training, outstanding manual therapy skills, and are educated similar to me.

      Good luck,
      -Joe

  28. Jesse Dunn

    I am a physical therapist in Washington and if you haven’t tried fascial counterstrain for nerve pain,
    you should. It is a newer branch of the strain counterstrain technique that not only looks at the nerves, but also looks at the fascia around the veins and arteries as a source of this neurogenic type pain. Call the Jones institute to see if there is a practitioner in your area.

    1. Joe Uhan

      Thanks for the comment, Jesse. I agree – what’s actually lacking mobility is likely the fascia around the nerve, rather than the nerve itself. IPA-training physios have extensive training in this sort of soft tissue mobs, as well.

  29. Eileen

    I have been running for 20 years. 4-6 times per week, 3-5 miles per run. I slacked off for a few months and began to resume lately. I noticed last weekend a strange feeling in my right foot. Almost like my foot was waking up from being asleep. But as the day went on it felt more like buzzing in the bottom of my foot in the very middle….same buzzing feeling somewhat in the back of my calf. It’s not painful but super annoying. It almost feels more noticeable with my blood circulation,pulsating buzzing. I know that sounds crazy. I’m healthy, no injuries (that I’m aware of), not diabetic. I haven’t been to Dr yet. Any words of advice? I’m a worrier so my mind goes to scary places like, do I have MS?? Just let me know your thoughts. I enjoyed your informative article.

    1. Jacqueline

      Eileen-look up tarsal tunnel syndrome and tibial nerve irritation. I seem to be holding some minor version of this at bay. Would love to hear how this works out for you.

  30. Kevin

    I have 3 pinched nerves in my lower back left side which have been hampering my runs more and more as I age which is frustrating and depressing. The only thing that seems to calm it is dry needling in the area by a PT. Hoping for a miracle it’ll go away one day.

    1. Joe Uhan

      Kevin-

      At some point, I’d like to write a post that’s more detailed in terms of strategy in dealing with nerve pain.

      “Pinching” can happen from a variety of tissues/locations. What needs to be cleared:

      * lumbar joint mobility
      * posterior pelvis (“butt muscle”/piriformis, etc) and posterior thigh (hamstring) tissue mobiltiy
      * general nerve “flossing and gliding” mobility
      * thoracic and cervical mobility

      Think like a plumber/electrican when you have a nerve “pinch”: trace along its entire length to “free the pinch”! It’s quite possible, and can provide relief.

  31. Grace

    Dear Joe,

    I was an active runner until about 2.5 years ago but had to stop due to my on-going pain in my left leg (with a sudden loud stomping and feeling of heaviness). The pain was associated with a strange sensation from by left buttock running down my thigh and travelling down the outer side of my lower leg (shin). My left leg often felt weak and constant uncontrollable stomping.

    When I first felt this pain, I visited two physiotherapists and a chiropractor, and they had mentioned that this was due to a sciatic nerve pinched from my lower back and was given a stretch routine. I felt better at first but a couple of months later, I had attempted to return to run, but the pain continued. The pain (with the sensation) typically started after 5 minutes of run and couldn’t continue. A year later, I went for an MRI but the result showed no signs of sciatic pinched nerve.

    I have visited multiple physiotherapists and chiropractors, completed MRI and X-rays,and visited my family doctor but they don’t seem to have an answer for my condition. Could this be nerve related? Any advice would be great!

    1. Joe Uhan

      Grace-

      Thanks for sharing.

      It sure sounds like nerve pain. The interesting (/frustrating) aspect of nerve pain is that it WILL cause strange, abberent movement issues (“stomping”): increasing tension will make it almost literall throw a monkey wrench into the works of the stride.

      Of note: MRIs seldom will show nerve impingment unless it’s really bad. It doesn’t take much “neuro-fascial” restriction to cause dysfunction, unfortunately.

      My advice: find a high-level PT (see recs above) AND request they look at your whole nervous system (e.g. treating cervical, thorax, lumbar, sacrum, and especially coccyx: https://www.irunfar.com/2019/08/pain-in-the-butt-considering-the-coccyx.html)

      Good luck!
      -J

  32. Guy

    Hi Joe,

    Great article – certainly describes my symptoms which I’ve been dealing with for over a year: persistent low level nerve pain – even at rest, burning/spasm-y pain in glute, tingling/burning in little toes/foot, occasional “zing” next to knee when curling my leg, deep tightness/pain in buttocks when trying to run. No idea where it’s getting pinched. Been trying to work on my lumbar mobility put that hasn’t helped. (nor has shots in L5-S1, piriformis, and SI Joint)

    Do you have nerve mobility exercise that you would recommend? Anything else?

  33. Jason

    Hello everybody,

    I just came to the realization of how to fix my 2-year ongoing battle with this problem…

    Let me preface this by saying that I have seen 3 athletic trainers, 2 chiropractors, 2 MD’s and a massage therapist about this condition, gotten 2 MRI’s, ultrasound, and tried every conservative treatment available to me.

    So what I have been experiencing is biceps femoris pain (lateral hamstring) when performing knee flexion. When I would flex it laying down or standing I would get a deep pain and cramping. That is annoying enough as it is. After runs, I would then get deep gluteal soreness and if I was doing something like 200m intervals, I would even have some back pain. The solution seems obvious then, right? Strengthen the hamstrings… Except, my hamstrings did not tolerate calisthenics or lifting of any kind. The research points to eccentric strengthening of the hamstring, I did countless hours of this rehab, only to experience the same cramping and pain sensations over and over again. I tried to just continue my training regimen and run track (400m/800m) only to put so much strain on my glutes that I had to take 3 months off for IT band syndrome. This was all caused by the hamstring’s neuromuscular deficiencies.

    The solution came just recently when I decided to try to activate my hamstrings consciously during my run. I did 6 miles easy, basically kicking back up to my butt the entire way. The result was astounding. Later that day I experienced normal hamstring soreness for the first time in months. I thought, okay, we’re getting somewhere. Now, about a week into this running with conscious activation, I really feel like I am gaining back the strength that I have not had in the hamstring for years. I also noticed a huge flaw in my biomechanics that I have also developed to compensate for the weak hamstring. My stride rate has gone down and I have started leaning my back forward slightly. If you know anything about running biomechanics, both of these actions increase hip flexion and put more strain on the glutes, rather than using the hamstrings. I have been consciously working on my heel recovery, posture, and stride rate, and I have been absolutely blown away with the results. My thought, my hamstrings needed the lowest level of activation possible to reestablish that neural connection and begin to fire; the workout/lifting sessions were too much for them because these were ISOLATED activities.

    My suggestions, if you have nagging deep gluteal pain after exercise as I did, address the possible piriformis syndrome by strengthening your hips, try to take some time off of what you’re doing and strengthen your glutes as well, make sure your entire hip complex is working in harmony. If you’re still getting that nagging pain, then your glutes are definitely working too hard and it may be neuropathic in nature, originating in the hammys. Even if you’re not a runner, try running the way I described it. It is the lowest level stimulation you can offer your hamstring and I’m sure it will help you if this is your chronic issue as well.

    I really tried to keep this in lay-terms and succinct, but this is a very complex and involved process. I have much more detailed descriptions of the problem and the pathophysiology. If anyone thinks this may apply to them, reach out to me and I’ll do my best to respond.

    – A runner of 9-years, a former biochem student, current nursing student, and lifetime student of the sport of running.

    1. Guy

      Thanks Jason, this really resonated with me as I’ve had similar symptoms. Particularly the deep glute pain when trying to run and the cramping when curling my leg standing up or lying down. As it happens, I also noticed a “better-feeling” gait when trying some butt-kicks and other drills recently. Seems like that’s something I should pursue further. I’ve done a ton of glute strengthening over the last year, but not too much on the hamstrings. Do you have any exercises that you would recommend to re-awaken the hamstring a bit more? Seems to me that starting with the simple leg curls with no weight might be a good start. Thanks!

      1. Jason

        If you are a runner and if it is truly a similar situation to mine, you should start with exactly what I’m doing which is avoiding any activity that isolates the hamstring as this will probably cause pain and subsequent muscle “guarding” and exacerbate your issue. If it is an issue with hamstring activation, try to focus on running form and consciously activate the hamstrings while running by keeping a stride rate of 90/min/leg and staying upright with a relatively straight back. It sounds goofy that these little tweaks could make such a profound change but don’t knock it till you try it. If you find that your glutes are still taking the brunt of the soreness, take the pace down a notch and again, just focus on doing “seat-kickers” while running. I personally have not found a way to remedy this condition with anything but running with these techniques. It seems like the aid that accessory muscles give in running takes the stress off the hamstring and allows you to work it at a consistently low level. The way I knew this was working for me was the normal hamstring breakdown and soreness I felt after these really easy runs. Normally my runs would not cause any soreness (besides slight glute discomfort), but after taking down the pace and focussing on the activation of the entire posterior chain, I am VERY sore. Try it out and don’t get possessed by the idea that you need to work the hamstring harder in order to make a difference, we’re talking about a neuromuscular problem.

        1. Joe Uhan

          Jason-

          Thanks for the comments, insight and experimentation.

          To that end, I have one vitally important rule that governs all running injury treatment:

          “The Efficiency Rule: Anything that *sustainably* relieves pain must also make you faster”.

          (https://www.irunfar.com/2019/01/the-efficiency-rule.html)

          Why?

          First, it’s easy to make pain go away simply by doing something different (for example – no joke – a research paper published findings recommending the best way to decrease landing stress while running is to….quickly walk). Changing something — such as doing concerted efforts to activate muscles while running (e.g hamstring curling) — MIGHT decrease pain, but what collateral issues might result?

          The Efficiency Rule asks: is doing “seat-kickers” while running going to make you more efficient (and thus faster)? Does it improve overall stride efficiency? (Does it pass “the look test”? Does it LOOK better?)

          If not, beware. You’re making a wholesale stride change that, while maybe relieving strain, could, over time, could cause a major derailment of your stride.

          1. Jason

            I’m not suggesting this as a prolonged and consistent treatment strategy, I’m talking about this as a gateway to reestablishing a neural connection with the musculature in question. It’s all about maintaining a balance between the heads of the biceps femoris and semimemb./semitend. This has been my issue at least, which is why I gave my insight.

            1. Joe Uhan

              Is there a balance between heads of hamstring muscles? And do you (/does anyone know) what this is, versus what it isn’t? Seems awfully complicated (and arbitrary). When changing hamstrings, what other thing (or 10, or 25 things) might also change (for the worse)?

              While it’s useful to occasionally zoom in, ultimately zooming out is abslutely crucial in running efficiency — for consistent efficient motor control, peak performance…and not driving onself insane with all the moving parts.

              Two recommended readings on this subject:

              My take: https://www.irunfar.com/2018/03/look-fast-feel-fast-stride-optimization-for-the-long-run.html
              The source material: https://www.amazon.com/Inner-Game-Tennis-Classic-Performance/dp/0679778314

            2. Jason

              Nothing changes for the worse and simply because you find something to be arbitrary does not mean that it does not work for the individual, especially given your “source material”.

  34. Joe Uhan

    As I say about all nerve issues:

    “You gotta think like a plumber or an electrician”

    The nerve flows from the cranium to the toe. As such: it’s possible that any dysfunction along that path can be relevant to your symptoms.

    Thus, if you (your medical team) has done treatment to the lumbar/lower quarter with no improvement, I would suggest addressing cervical and thoracic.

    I hesitate to recommend any nerve mobility exercises (over-doing them can make things worse); however, if you’re curious, a simple google search of nerve mobility (with emphasis on upper- or lower- body) will provide some options.

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