A few months back I wrote a differential diagnosis POST discussing the intermediate dorsal cutaneous nerve vs. ATFL sprain. Last week I was working with a gentleman 4 weeks post inversion ankle sprain. The patient's subjective report: "My strength and ROM have significantly improved. I have minimal pain except a burning sensation on the top of my outer three toes." The burning sensation was increased with palpation and single leg weight bearing.
A common peroneal nerve stress test (SLUMP test while biasing the foot and ankle in PF/IN) revealed reproduction of the patient's symptoms. The symptoms met the 3 criteria for positive neural tension: 1. side to side difference 2. reproduction of the patient's symptoms 3. changes with a distant component.
How do you treat peripheral nerve tension?
The keys to treating nerve tension are:
1. Mobilization/manipulation of the joints which the nerve passes
2. Nerve gliding/sliding exercises
3. Soft tissue mobilization
4. Light endurance exercises.
My daily treatment to give you an idea how to treat common peroneal nerve tension:
First, I manipulated the mid-thoracic spine to mobilize the sympathetic nervous system.
Then I reassessed the asterisk sign. Symptoms improved (SLUMP test with PF/IN bias), but were not abolished.
Next, I manipulated L4-L5 to further mobilize the common peroneal nerve.
Reassessing the asterisk sign completely relieved the patient's symptoms.
Third, I addressed talocrural joint mobility since the joint was hypomobilie and affecting the ability to heel to toe strike
Fourth, I performed endurance and corrective exercises, I had the patient perform 15 minutes on the stationary bike, followed by two ankle mobility exercises, calf raises, and gait training on the treadmill promoting heel to toe progression and toe off.
Would you have done anything differently?
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|The Student Physical Therapist||
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