Assessing Adverse Neural Tension in Athletes

Abstract

Sports medicine assessment and treatment techniques are ever developing and becoming more holistic. Traditional musculoskeletal assessment is changing to incorporate neural tissue pathology. Neural tension tests assess the mobility of neural tissue in the extremities and spinal canal. Positive adverse neural tension tests suggest poor mobility of neural tissue. Athletes with adverse neural tension often present with pain and decreased range of motion. These disorders can occur individually or can be associated with sports injuries. Ankle sprains, hamstring strains, tennis elbow, and thoracic outlet syndrome are some conditions that respond well to treatment of adverse neural tension. Reports of improved treatment outcomes following neural tension assessment and treatment suggest that adverse neural tension should be considered as a possible source of pain and dysfunction. This paper outlines concepts necessary to understand adverse neural tension including neuroanatomy, pathology, assessment techniques, and common sports injuries that may have an adverse neural tension component.

Rectus femoris muscle injuries in football: a clinically relevant review of mechanisms of injury, risk factors and preventive strategies

“…Examination reveals that stretching, palpation at the site of injury and resisted knee extension are painful. Differential diagnosis includes assessment of neural tension of the femoral nerve,18 where the athlete may complain of a burning or stinging sensation located in the anterior aspect of the thigh.…”

The Role of Neural Tension in Minor and Recurrent Hamstring Injury, Part 1: Evaluation

“…Because the neural system is contiguous, actions that affect the system can produce symptoms within it. 5 Normal neural tissue is nonpainful both at rest and during motion. Pathologic neural tissue, on the other hand, which has been referred to as neural tension in the literature, might precipitate pain and motion restriction.…”

“…Pathologic neural tissue, on the other hand, which has been referred to as neural tension in the literature, might precipitate pain and motion restriction. 5 NT has been defined as abnormal physiological and mechanical responses in nervous-system structures when the normal range of movement and stretch capabilities are exceeded. 4 Neural tissue has an abundant blood supply to satisfy its high oxygen requirements, but this supply is easily disrupted when nerves are stretched beyond the normal range.…”

“…6 The endoneural tube has no lymphatic vessels to remove edema, resulting in formation of scar tissue and adhesions that can reduce normal mobility of the nerve within its sheath. 5 When this occurs, the nervous tissue no longer moves in synchrony with surrounding soft tissues as body position changes. Lack of normal extensibility might cause sharp pain or a burning sensation when an athlete attempts to stretch the involved limb.…”

Bilateral dorsal foot pain in a young tennis player managed by neurodynamic treatment techniques

“…Exercise-related lower limb pain represents one of the most common presentations in sports medicine practice (McCrory et al, 2002). This is usually caused by musculoskeletal overuse injuries but not uncommonly, a neuropathic cause may be suspected (Gallant, 1998;McCrory et al, 2002). In addition to compressive radiculopathy and nerve entrapment, peripheral neuropathic pain mechanisms may contribute to musculoskeletal syndromes commonly seen in sport such as hamstring strains (Kornberg and Lew, 1989) and ankle inversion sprains (Pahor and Toppenberg, 1996).…”