Great Article on Nerve Pain and Making the Diagnosis in Athletes

I have just starting treating a patient with 2 years of pain unable to get anywhere in treatment. She sent me this article this morning that I read from a physical therapist on nerve pain. I would have to say I agree with so much of this article, and although I am not sure yet if it applies totally to my patient, is a good discussion of the 3rd source of pain in my patient. The 3 sources of pain, each demanding separate treatments at times, are: mechanical sources (like your foot pronates too much or your hip muscles are not strong enough), inflammatory (where swelling in the tissues causes pain from injury or systemic causes), and finally nerve pain (which can be local like Morton's neuroma, referred pain from the spine, or combination of local and up-the-chain problems). 

The one aspect not discussed, and also may apply to my patient, is nerve overload with chronic symptoms. This basically means that there was a mechanical injury, that even with complete heeling, can leave you with nerve hypersensitivity, which now months later is the reason that you do not feel any better. This nerve hypersensivity can also need nerve treatments over mechanical ones. 

So, as I try to sort this all out for my patient, the body will continue giving us clues which can help if we listen. Rich 

https://www.irunfar.com/2017/08/six-signs-that-your-running-injury-is-nerve-pain.html/amp

Achilles Pain: Possibly from the Low Back

Hello Dr. Blake.

 I attempted to post this as a comment in your blog, but I was unsuccessful. I hope that this email finds you well. I have been dealing with achilles pain since March. I believe it started because I was putting all of my weight on my heels when doing the elliptical, to avoid stressing an injury I have on my forefoot. I have tried PT and it did not work, the therapist kept telling me that all the exercises that make patients better were working the opposite on me-making me worse. The exercises included the type on your blog, the eccentric calf exercises. No negative heel drops. I am wondering if I have no relief because I have an over stretched tendon. The calf stretches and exercises replicate my pain, I have no relief from them. The pain that I get is exactly the pain created when I bring my entire foot upward toward my body (picture a negative heel stretch but without weight bearing). I had an MRI which showed a normal tendon, with some non specific swelling at the heel. The pain started bilaterally, but now, the right side is much worse and the left has improved. I have completely rested from all activity for months. Still nothing. Heel lifts work a little. I can't even sleep on my back because my own body weight is enough to cause pain on my heel. Could you please share some thoughts on treatment of an over stretched tendon? Thank you so much! You are an amazing resource.

Dr Blake's comment:

    You could have an overstretched tendon that the PTs should be able to measure, but it sounds like radiculopathy which is localized nerve pain below the low back. Stretching of the hamstrings and calf make radiculopathy worse. Sometimes, MRI of the back can help. I would see a chiro or physiatrist to help the PT develop a plan. When you held your heels back, you probably also could have hyperextended your knee causing the problem. Any postures, movements that effect the sciatic nerve can effect this problem. Try ice packs 2 times daily to the low back and neural flossing 3 times a day (seen on my blog), but avoid calf and hamstring stretches for the next 6 weeks. Keep me in the loop. Rich