Three weeks ago I wrote a post about a 50 year old male status post peroneal tendon debridement and repair. The patient had spent 6 weeks in a cast and was seeing me 1-week after cast removal. At initial evaluation, he presented with early CRPS signs and symptoms- skin trophic changes, swelling, pain, hypersensitivity to light touch, nail bed changes, coolness of the lower limb and difficulty initiating movement.
Below are pictures taken 3 weeks ago on the initial evaluation
In the past three weeks, my treatment has focused on both local foot and ankle biomechanics and more importantly addressing the patient's central sensitization. To address the CRPS-type symptoms, each session I manipulated the thoracic and lumbar spine to facilitate autonomic nervous system and nerve root mobility. Additionally, I focused on a graded exercise approach. Each session I have had the patient ride the stationary bicycle or walk on the treadmill while providing neuroscience education. These treatments have shown within session changes in hypersensitivity and neural tension. Finally, I have been addressing foot strength, ROM, and joint mobility to treat local impairments.
Below are pictures taken after 7 PT visits (Disregard the camera angle. Focus on skin tissue quality, color, and appearance)
I cannot definitively conclude that the addition of neuroscience education and mobilizing the spinal cord/ANS has provided a quicker recovery, but the patient's subjective reports and objective improvements allows me to believe each treatment has been effective. A quick measure of success is using your asterisk sign within session to ensure you are providing appropriate care.
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