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      • Examination Templates
Picture

Common Peroneal Nerve Tension

4/23/2015

2 Comments

 
Picture
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. 
5. Education

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?

Jim 


Like this post? Check out others from TSPT or our INSIDER ACCESS PAGE! 
THE SLUMP TEST
Picture
Repeated Motions: Why You Should be Using It
Picture
2 Comments
Steve Goldrick link
4/29/2015 12:53:36 pm

Jim, really good treatment program. Something that I have been embracing and using lately with good results is the whole pain science approach. No matter what tissue is being snagged, irritated, stretching, etc causing nociceptive bombardment of the thalamus, the brain has the ultimate job as the "motherboard of the nervous system" as I call it to determine if something is threatening enough to cause pain. After using analogies to explain how pain is really equated to this "sensitive alarm system" I explain that exercise, neuro dynamics, manips, soft tissue, Etc all help to reduce the sensitivity but pain science education and its effects to empower the patient is the foundation of it all. Did you go into that a great deal with this guy? Do you discuss the current pain science literature with most of your patients. I didn't use to.. I'm a recovering biomechanist as they say, but I have seen ridiculous results and significant pain reduction just by sitting down and brewing someone a cup of coffee on visit 2 and hammering out pain education than any other thing I used to do in the past.. I didn't see a prescriptive neuro dynamics exercise given.. Did you give him one? Which one do you like? Slump position like your concordant sign and use distal joint movements to do the neuro dynamic or more a unloaded SLR type position?
Good overall plan and case though Jim

Reply
Jim
5/10/2015 09:20:27 am

Steve,

Thank you for the comment. Sorry for not replying to this sooner. You bring up some excellent points in your comments. With this specific case, I did not have enough time to give appropriate neuroscience education. Fortunately the patient was not presenting with chronic symptoms so I felt 'ok' with that choice. I agree with you that any time spent discussing pain science is time well spent. Sometimes the patient requires that knowledge prior to any hands on therapy. As for neuro mobilization exercise prescription, I had him perform 10 repetitions slowly 2-3x/day in the SLUMP position. I chose this position because I felt it would be easiest for him to perform and reassessing concordant sign is easier as well. I chose 10 repetitions because I did not want to flare him up & I saw a noticeable change after 10 reps in the clinic.

Thanks again for your comment.

Jim Heafner

Reply



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    • Cervical Spine >
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      • Bakody's Sign
      • Cervical Distraction Test
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      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test
    • HEP >
      • Neck and Shoulder >
        • Supine Chin Tuck
        • Supine DNF with Towel Assist
        • Supine DNF
        • Standing Chin Tuck Against Wall
        • Standing Chin Tuck Against Wall with Scaption
        • Seated Cervical Retraction Repeated
        • Seated Cervical Retraction with Extension Repeated
        • Seated Cervical Retraction with Sidebend Repeated
        • Seated Cervical Retraction with Rotation Repeated
        • Standing Wall Shrugs at 90 Degrees Flex
        • Seated Thoracic Whips
        • Standing Ballistic Shoulder Extensions
        • Standing Repeated Shoulder Extension with Squat
        • Standing Repetead Shoulder Horiz. Abd. with Ext. CKC
        • Seated with Arms on Pillows Cervical AROM (Flex/Ext/Rot/SB)
        • Seated with Arms on Pillows Shrugs
        • Seated with Arms on Pillows Shrug with Scapular Retraction
        • Supine Shoulder IR with GH Centralization
        • Supine Shoulder ER with GH Centralization
        • Holding Dumbbell at 180 Degrees Flexion for Time
        • Cat Camel
        • Prone T's
        • Prone Y's
        • Quad Chin Tuck w/ Shoulder Flexion
      • Low Back >
        • Supine TA Isometric
        • Standing TA Isometric Agains Wall with Squat
        • Supine BKFO
        • Quad Rock Back
        • Standing Hip Hinge
        • Sit to Stand with Hip Hinge
        • Repeated Lumbar Sideglides
        • Repeated Standing Lumbar Extension
        • Repeated Standing Lumbar Flexion
        • Repeated Prone Press-Ups
        • Repeated Supine DKC
        • Slump Sciatic Nerve Glides
        • Birddog Progression
      • Hip and Knee >
        • Clamshells with Progressions
        • Fire Hydrants with Progressions
        • Donkey Kicks
        • Bridge Variations
        • Repeated Hip Flexion
        • Squats
        • Seated Repeated Knee Extensions
        • CKC Seated Repeated Knee Extensions
        • Heel Slides
        • CKC DF with Tibial IR
      • Foot and Ankle >
        • Calf Raises
        • Calf Raises with Soccer Ball Between Medial Malleoli
        • Towel Scrunches with Foot in PF
        • Toe Flexion Using T-Band with Foot in PF
        • PF with Toes Flexed Using T-Band
        • DF with Toes Flexed Using T-Band
        • Forefoot Adduction
        • Gastroc Stretch
        • Repeated PF
      • Examination Templates