The Role of Neural Tension in Low Back Pain

Low back pain is the most common diagnoses that physical therapists see in clinics, and is one of the leading causes of disability in the country. One of the most common symptoms of low back pain is commonly known as “sciatica,” or symptoms that run down the back of the leg. Sciatica is a very broad term, and the pain that can be in the back of your leg may just be an irritated or inflamed nerve, rather than “sciatica.” This term is referred to as neural tension.

Neural tension is a symptom of a nerve that is inflamed or irritated, and reproduces symptoms of “sciatica” when it is actively stretched, or passively stretched over a long period of time. You may notice that certain positions bring on the pain in the back of the leg, including sitting with your feet up, driving, reading in bed, walking, etc. This is because the nerves running from your low back to your foot are being stretched either repeatedly or for a prolonged period of time. So the next question is, how do we improve this?

A lot of research shows that “nerve flossing,” “nerve gliding,” or stretching must be done to “allow the nerve to move better,” but the research does not describe the dose of how much to stretch, how often, and even states that doing too much or too little can cause an adverse reaction in symptoms. Nerve flossing is only applicable for an “adhesion” of the nerve, which is in fact pretty rare. Instead, think of your nervous system like a rope. It is one length, and one length only. If tugging on the rope repeatedly or for a prolonged period of time increases the pain, slacken the rope and the symptoms will reduce. Another analogy I like to use is a finger trap. If your fingers are on both ends of the finger trap, and you pull, it stretches and compresses your fingers, not allowing you to escape. The same thing applies to the nervous system. If you relax both ends, you are able to escape the finger trap, and in real life, escape the back of the leg pain. So the best thing to do to reduce the back of your leg pain is to identify the positions or activities that bring it on, and modify or change as appropriate, rather than different stretches at first.

If this sounds familiar to you, you have lower back pain, or have any questions about potential symptoms you may have, come over to see us for an evaluation to see how we can help you!

Dr. CJ Artus, PT, DPT,  FAAOMPT, KEOMPT, CSCS

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