Posterior Thigh Pain Part 3 - Management of Nerve Pain

Unless you recognise the source of your posterior thigh pain, your recovery can be drawn out and suboptimal.
Ashleigh Flanagan
February 1, 2022

One of the most common presentations I see is posterior thigh pain. However, depending on the source of symptoms, the management of posterior thigh pain, especially in the early stages, can be very different. While there are just a handful of common reasons for pain in this area, they can occur concurrently, or the mechanism behind the symptoms can change over time, making management tricky.

Rehabilitation is required to resolve most posterior thigh pain and extended rest is never best, but unless you (and your health professional) recognise the source of your symptoms, recovery can be drawn out. It's not uncommon for me to meet clients that have posterior thigh pain that limits their training for YEARS. It honestly shouldn't be this way. In general, posterior thigh pain is very 'treatable'.

The first post in this series briefly outlined the most common reasons for posterior thigh pain. Read the blog here.

This last post discussed the management of muscular posterior thigh pain. Read the blog here.

Posterior thigh pain Part 2 - Management of Nerve Pain

How do I know if it's Nerve pain?

You should suspect a nerve is the source of your pain if:

Other common features include:

When a nerve is the source of posterior thigh pain, common mechanical triggers are stretching or compression of the sciatic nerve. The mechanism is most commonly ischemic (reduced blood supply). Usually, nerve compression occurs at the spine, but other common points of irritation are at the glute and sacroiliac joint (SIJ). 

Anyone who has experienced nerve pain knows how awful it can be. Fortunately, nerve pain doesn't necessarily mean that you have injured or damaged your nerve. Unless you are experiencing weakness, it's unlikely that you have damaged nerve tissue. Instead, the distinct quality of nerve pain is due to the role the nervous system plays in the protection and defence of the body. 

What is making you vulnerable?

In general, pain sensitivity is influenced by many factors, including your beliefs about pain, your general health, lifestyle factors, coping strategies, the context and your past experiences. Nerve pain is particularly susceptible to influence from the immune system. Immune cells are part of the makeup of nerve tissue. This is why you can experience widespread pain when you are sick. It's helpful to be more sensitive to pain when your body is more vulnerable. This response drives protective action and encourages you to rest and recover. 

When you experience increased nerve pain, it's helpful to ask yourself what is currently making you more vulnerable? 

It's important to actively and consistently increase your sense of resilience and safety when managing nerve pain. 

Nerve Pain First Aid

When you feel an increase in nerve pain, it's important not to worry. While unpleasant, a flare-up of nerve pain is more likely to indicate aggravation rather than damage or injury. 

  1. If you feel the pain increasing down your leg, stop what you are doing and change positions.
  2. Move, ideally in ways that settle your pain or cause the pain to retreat up your leg towards your back.
  3. Add heat.

It can be helpful to keep a note of what you are doing when the pain seems to get worse. However, nerve pain often has a latent period. For example, it's common for people to sit all day but experience worsening symptoms only when they lay down to sleep at night. 

When to seek professional help

It's always appropriate to seek professional guidance because it can be tricky to manage nerve pain. 

Initially, rehab will focus on settling symptoms, identifying aggravating factors, developing coping strategies and fostering helpful behaviours (e.g. sleep and stress management). It's essential to find meaningful ways to move that don't excessively aggravate your symptoms. Often this requires minor modification to your training, such as working to a pain level or avoiding intense long hold split stretches. Remember, movement is critical for the management of nerve pain. In most cases, imaging (e.g. MRI, CT) is not recommended in the absence of other symptoms (eg weakness or bladder/bowel dysfunction), and usually only when symptoms have not improved for a couple of months.

When the pain is more predictable, your rehab professional will support you through the process of increasing the tolerance of the nerve to loading through graded exposure. By loading the nerve in controlled yet provocative ways, your body learns that loading doesn't represent a threat and becomes less sensitive. You may start with general movement, progress to nerve sliding ('flossing') and finally, nerve tensioning/provocation. Throughout this process, it's essential to focus on the basics and prioritise activities that promote safety, belonging and resilience.

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