Is your pain coming from a nerve or muscle?

Whether you're an athlete, clinician, or just someone trying to figure out why your leg hurts after a run, knowing the difference between a muscle strain and a nerve injury is essential. While they can feel similar at times, these two types of injuries require very different treatment approaches. Here's a breakdown of how to spot the difference, along with practical advice for both self-testing and treatment.

Understanding Muscle Strains

Muscle strains are classified into three grades:

Grade 1 (Mild):

• Minor muscle fiber damage

• Mild soreness and tightness

• No visible bruising or swelling

• Full strength and function remain intact

• Usually heals within a few days to two weeks

Grade 2 (Moderate):

• Partial muscle fiber tearing

• Noticeable swelling, bruising, and weakness

• Some loss of strength or range of motion

• May require imaging (like an MRI)

Grade 3 (Severe):

• Complete muscle rupture or avulsion (where muscle detaches from bone)

• Severe pain, swelling, and bruising

• Significant loss of strength and function

• Often includes a visible “recoil” or bulge in the muscle

• Likely requires surgery or extended rehab

Understanding Nerve Injuries

Nerve injuries fall into three main categories:

Neuropraxia (Mild):

• Temporary blockage of nerve signals due to pressure or traction

• No structural damage to the nerve

• Common with awkward positions or minor trauma

• Recovery usually takes days to weeks

Axonotmesis (Moderate):

• Damage to nerve fibers (axons) with the surrounding sheath intact

• Caused by more severe or repetitive traction or compression

• Symptoms include pain, numbness, and tingling

• Recovery occurs via nerve regeneration: about 1 mm/day or 1 inch/month

Neurotmesis (Severe):

• Complete disruption of the nerve structure

• Often results from crush injuries or severe trauma

• Recovery is minimal even with surgical intervention

Real-World Example: The Baseball Player

Imagine a baseball player rounding first base, suddenly feeling a pop in his hamstring. No visible bruising, just pain and reduced motion. Is it a mild muscle strain—or something more?

In this case, further testing revealed signs of a Grade 1 strain of the biceps femoris, along with a nerve sensitivity issue likely caused by traction on the sciatic nerve. Treatment focused on calming down the nerve irritation and gradually reintroducing movement.

Self-Testing at Home

Here are a few tests to help differentiate between muscle and nerve issues:

1. Toe Touch Test

• Used to assess hamstring or posterior chain discomfort

• Pain from either muscle strain or nerve irritation may show up here

2. Slump Test

• Sit, round your back and neck without moving your legs

• If symptoms appear in your leg during this, it points more toward nerve irritation

3. Extension-Based Movements

• Repeated back extensions (like cobra stretches)

• If symptoms improve, this may indicate a spinal or nerve component rather than a pure muscle issue

How to Treat Each Injury Type

For Muscle Strains:

• Avoid complete rest — gentle movement is key

• Progressive loading helps tissue heal better and faster

• Stretching and strengthening must be balanced to avoid reinjury

For Nerve Injuries:

• Use nerve glides or flossing techniques to improve nerve mobility

• Focus on reducing surrounding tissue tension

• Movement provides blood flow and nutrients essential for healing

Key Takeaways

1. Muscle strains show more visible signs (swelling, bruising) and respond well to progressive loading.

2. Nerve injuries involve neurological symptoms (numbness, tingling) and often require different movement strategies.

3. Simple home tests like the slump test can give you insight into the source of your pain.

4. Accurate diagnosis matters — it affects treatment and recovery timeline.

5. Early movement is critical for both types, but must be done with care and intention.

   
   

By understanding the core differences between muscle and nerve injuries, you can make smarter decisions about your recovery and avoid setbacks. And if you're ever unsure, seek guidance from a trained clinician who understands both sides of the equation.

Stay active. Stay informed. And when in doubt — test, don't guess.