[Editor’s Note: This is the first of a two-part series on nervous system dysfunction and cervical spine integrity.]
While many running injuries result from issues with muscles, tendons, and ligaments, nervous system dysfunction can also cause pain and prevent running injuries from healing. Nervous system dysfunction and neurogenic issues can be difficult to diagnose.
As a physiotherapist specializing in runners, I frequently encounter athletes grappling with persistent aches, pains, and injuries — including chronic hip impingement and hamstring tightness, recurring iliotibial band pain, or persistent calf, shin, Achilles tendon, and plantar foot pain — that resist standard recovery periods and treatments.
When these injuries stubbornly persist despite prolonged rest, exercise, and skilled hands-on treatment, it often suggests we’re missing an underlying factor that is creating and perpetuating the pain, stiffness, weakness, or swelling.
Nervous system irritation in the neck and cervical spine cause and extend running injuries in the lower limbs. Photo: iRunFar/Eszter Horanyi
The hidden culprit is often the nervous system, including the peripheral nerves and their surrounding fascia. The body’s nervous system originates inside the head, passes through the cervical spine, and extends to the arms, torso, and lower extremities.
When this system becomes irritated — through tension, compression, and other factors — it can create both pain and tension anywhere downstream of the irritation, including in the legs and key parts of the running mechanical system.
Nervous System Dysfunction in the Neck
It’s important to understand that nervous system dysfunction doesn’t always manifest as nerve pain.
When nerves become tight or irritable, they can create tension in certain other areas to prevent further strain on highly sensitive nerve structures. This tensioning protects the nervous system but comes at the expense of the orthopedic system. It can tension muscles, tendons, and limit the motion of joints and whole body segments. This protective response can lead to local, regional (affecting neighboring joints and body parts), or systemic (whole-body) stiffness, malalignment, or weakness. These effects can place chronic strain and compromise on a running injury, preventing it from healing fully and perpetuating the cycle of discomfort.
Because of its small size and relative sensitivity, the neck is a prime zone for irritating and tensioning the nervous system, and can cause downstream effects for the rest of the body. Factors such as impact trauma, poor posture, or repetitive strain may lead to neck stiffness and, in turn, a tight and irritated nervous system.
This may manifest as dysfunction lower in the body, including persistent mobility loss, muscle weakness, and even localized redness and swelling.
The cervical spine can result in some of our most severe and stubborn running pains. Photo: iRunFar/Eszter Horanyi
While not necessarily intuitive, all of these symptoms may originate in the head and neck and can arise even in the absence of overt neck pain or other cervical symptoms.
The cervical spine is an often-overlooked culprit in some of our most severe and stubborn running pains.
This column will explore six key indicators to help you determine if your running injury may be caused or perpetuated by neck dysfunction and recognize signs that your neck may require treatment to conquer your lower-body running issues once and for all.
Six Signs of Nervous System Dysfunction
[Author’s Note: The indicators below relate to mild to moderate cervical spine dysfunction and its effects on the lower body. Spinal cord compression in the neck, called cervical myelopathy, has specific signs and symptoms — including impaired walking gait, poor balance, and loss of dexterity and coordination — suggestive of severe nervous system strain. Should you experience any of these symptoms, we strongly encourage you to seek medical care without delay, as this may result in more severe and potentially permanent injury.]
1. Injury Shows Signs and Symptoms of Nerve Pain
It is possible that your running injury is neurogenic, and your pain stems directly from an irritable nerve.
We developed six key signs that a running injury is neurogenic:
- Unresponsive to conventional treatment: Standard treatments like RICE, stretching, or strengthening don’t help and may worsen pain.
- Neurogenic symptoms: Includes pins-and-needles sensation, tingling, or numbness alongside typical pain.
- Variable pain behavior: Pain intensity and location vary unpredictably, unrelated to activity level.
- Elusive pain source: Difficult to pinpoint the exact pain location through touch or massage.
- Pain at rest: Pain persists during rest, unlike typical orthopedic injuries.
- No pathology on imaging: Diagnostic imaging shows no abnormalities despite severe pain.
While it is more common for a nerve to be irritable closer to the symptom area, say, the tibial nerve with plantar foot pain, the root cause of the issue could be the nervous system in the cervical spine.
2. Significant Neck and Upper Back Stiffness
Healthy athletic individuals should have full and pain-free cervical spine mobility. This includes:
- Flexing chin to chest
- Tilting the head backward
- Turning the head 90 degrees
- Sidebending the head to 45 degrees
Significant mobility loss, consisting of 50% or more from these norms, or painful or substantial asymmetrical motion, may be suggestive of relevant cervical pathology.
3. Neck, Upper Back, or Headache Pain
Chronic and persistent headaches or neck and upper back pain could be an indicator of cervical pathology with neuro-fascial tension that could affect the lower body.
Nerve-based injuries can be more difficult to diagnose and longer-lasting than other running injuries. Photo: iRunFar/Eszter Horanyi
4. Neurogenic Symptoms in Your Arms
Symptoms such as persistent tingling, numbness, pins-and-needles or “falling-asleep” sensations in the arms may indicate significant upper extremity nerve tension. This neurofascial tension might also affect or be present in the lower body.
5. Nerve Tension in Your Arms
Similar to nerve symptoms, nerve tension pertains to deficient mobility of the nerve cord in the arm. Various arm movements result in painful tightness or nerve symptoms — including sharp, shooting pain — when the arms are placed in certain positions, particularly when extended outward or overhead, or bent overhead. Significant upper body nerve tension can indicate, or create, similar tension in the lower body.
6. Sensations of Stiffness and Tightness on One Side of the Body
Finally, a less common but relevant sign of cervical spine dysfunction is a sensation of everything being tight on one side of the body: an entire leg, arm, or both. This, again, indicates the nervous system on that side of the body is under significant tension. When an issue affects an entire limb or side of the body, the cervical spine is the common source of the tension.
Conclusion
My hope is that these six key indicators can help you determine if your running injury may be caused or perpetuated by neck dysfunction and to recognize signs that your neck may require treatment to fully resolve your lower body running issues. By understanding these connections, you can take the first step toward breaking the cycle of persistent pain and reclaiming your stride.
In part two, we will outline simple steps to improve cervical spine integrity, which may help prevent neck dysfunction from creating and perpetuating your running injuries and set you on the path to stronger, pain-free running.
Good cervical spine integrity may help with some types of running injuries. Photo: iRunFar/Eszter Horanyi
Call for Comments
- Have you dealt with nerve injuries that affected your running?
