Monday, 23 July 2012

A Case Study

Clinical Perspectives on Nerve Pain in Runners

Today I saw a 16 year old male elite runner who sustained a calf injury 8 days ago. He complained of pain and tightness about his left lateral posterior calf that had stopped him running for a few days.  For the most part it felt ‘tight’ but seemed to warm up.

The difference between a nerve based injury and a small tear (strain) may not always be obvious. Some of the consequences of soft tissue injury have been dealt with in a previous post Consequences of soft tissue injury. The following, details the assessment and treatment approach that should allow him to resume full load training within 1-2 weeks, depending on how well he responds to treatment.

On assessment the following was found (we’ll keep it simple);

Dysfunction of the SIJ on the left,
Increased tone in the left TFL (usually as a result of decreased glute medius stability),
Increased tone on the left gluteus maximus (again trying to take over the role of glute medius),
Tight through left Psoas (hip flexors),
Pain reproduction on a nerve tension test assessing the common peroneal nerve,
Further palpation revealed pain directly of the common peroneal nerve to the fibula head.

A thorough musculoskeletal assessment was able to define nerve pain from a calf strain despite similar presentations.  For this runner, the causative factor lay in his tight SIJ/pelvic mechanics on the left side.  Why this happened would need a look at his biomechanics when running.

Nerve pain generally warms up reasonably well (unless it’s really irritated) where as calf strains do not and simply get worse. Nerve based pain in the calf usually doesn’t evoke pain on active or passive contraction and stretch where as a tear can certainly present this way

The treatment addressed his pelvic mechanics whilst dealing with the symptoms (nerve related pain). Treating the site of pain would simply not address the problem. Home-based treatment relies on daily nerve mobilisation, decreasing the overactivity of gluteus maximus and TFL through self massage techniques. Addressing these factors is able to keep the SIJ mobile.

                                      You can see the common peroneal nerve wrapping around the head of the fibula

I’d like to hear your opinion or questions

For now,

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