Reversing muscle contracture

[dibblego]

Hello gcoe,
Thank you for the response. My problem was an trapped superficial peroneal nerve a few centimetres above the lateral malleolus. I have done all the diagnosing with respect to this injury, which is unfortunate. I cannot consult a specialist for a diagnosis because they have all (and I mean all) concluded that I am psychiatrically unstable and that I am "wasting others' time". This is despite the fact that I diagnosed it correctly and travelled interstate to have it successfully surgically treated. Even in light of the facts, they refuse to acknowledge the extent of their mistake (it extends well beyond just this one). I have visited a neurosurgeon who specialises in pain management, who told me that I am inventing the pathology because he had never heard of it in 40 years of practice. I have many stories like this and I am resigned to overwhelming medical incompetence in my state.

So all I have is the words of the treating surgeon who tells me it was a very nasty entrapment, and will take about 12 months to know the full outcome and it was precisely where I said it was (My essay pre-surgery in an effort to convince these fools was titled: The Case for Entrapment Neuropathy of the Superficial Peroneal Nerve 10cm Proximal to the Lateral Malleolus). My surgeon is also encouraged by my progress since surgery. Consider; I could barely walk on the day of surgery, and last week, I climbed a grade 4/5 mountain. I used to be a professional athlete before this injury.

My associated foot drop does not seem to align with what I have read in my orthopaedics text books (I own 23 of them now, yay!) and there is not much literature published on foot drop associated with SPN pathology, so I am tempted to suggest I have a partial foot drop. Immediately after surgery I was able to evert slightly (not at all before surgery).

My contracture symptoms have resulted in weakness in my gluteus and lower back muscles, all on the right-hand side. This causes difficulty breathing and restricts my muscle flexibility. My pelvis has turned on an angle as if tipping forward and my back muscles are extremely tight. These symptoms started at the time of the injury.

I read your leaflet and I don't think this sounds like me. I am not hyper-sensitive to pain, but my muscle problems do make me very uncomfortable. I really have the urge to put my foot into dorsiflexion in an effort to stretch muscles, but I simply can't and haven't been able to for a very long time (over two years). My intuition tells me that if I could just stretch these muscles I would have some relief, so I spend a lot of time trying, even though I know it is to no avail.

I have tried heel raises and various other efforts to get more strength into my foot muscles (MRI and NCS have determined denervation at EDB and EHB) for eversion, but I always feel like I am back to the same place.

I wish I could get a diagnosis, but I am certainly resigned to the fact that if I ever get one, it will be from my own investigations. The state of medical aptitude, at least in my area, is lamentable.

Thank you for your response.

[gcoe]

Hi dibblego

You certainly are knowledgeable about your problem and what you say on the whole makes sense to me. Thanks for filling me in on the details. I certainly don't own that many orthopaedic texts! - I'll know to consult with you on such matters in the future! :-)

It is unfortunate when the medical profession resorts to the relegating people to the "too hard basket" labelling them as psychiatric. This a wholly unhelpful cop-out thing to do but as you say is quite common.

From a functional/activity point of view you are doing very well getting back into mountaineering - sounds great!

However I am still a bit perplexed by this:

My contracture symptoms have resulted in weakness in my gluteus and lower back muscles, all on the right-hand side. This causes difficulty breathing and restricts my muscle flexibility. My pelvis has turned on an angle as if tipping forward and my back muscles are extremely tight. These symptoms started at the time of the injury.

People can have quite extreme reactions to the paralysis - maybe because you were walking around with such a poor gait after the injury you developed some compensatory motor control problems around the pelvic, spinal and thoracic segments. This doesn't sound like a chronic pain situation as such. rather a case of adaptive motor control that has got you into trouble. It surprises me these symptoms developed straight after the injury as often they develop more over time. However that doesn't rule out it being an adaptive problem.

Two suggestions:

1. you could seek an opinion from a PT that is skilled and experienced in movement impairment syndromes - this is an approach that looks at how poor habitual movement causes pathology. This approach can be affective in the overuse or chronic misuse kind of problem. Ask if your PT has skill in Dr Shirley Sahrmann's approach to movement impairment syndromes. Basically this is a balancing up the muscles approach - lengthening that which is tight, strengthening that which has developed length related weakness and avoiding bad motor patterns.

2. Another approach is a bit more out there on the borderlands of science. The Feldenkrais method and the Alexander method both are systems of movement education that may offer success with these sorts of problems, at least with some people. However the hard evidence is not always there. Of the two I would opt for the Feldenkrais method and visit a PT who is trained as a Feldenkrais practitioner as opposed to a Feldenkrais practitioner who isn't dually qualified. A Feldenkrais practitioner teaches in groups or individual lessons. The latter might be the best way. The experience is generally very gentle and involves by touch and movement making you aware of how you are using your pelvis, spine and ribs. A practitioner might be able to help you to work out what you are actually doing at a motor control level and give you options on how to move better. A sort of reprogramming the brain to work better. I trained in this method many years ago and although I don't use it a lot in my area of practice, I find it useful to fall back on when other things fail. Anecdotally I have had a lot of success with such adaptive problems when others have given up. As you seem quite aware of your body and the effect this is having on your functioning you may find this approach worth trying.

If you want some more info on either of these options let me know