peroneal nerve injury?

[bullseye]

If anyone can help me manage this problem it would be greatly apprecaited. I started off with isolated pain in my fibula head that was very manageable at first. I found that when I massaged my biceps femoris that it would help take the pain away. However, I didn't manage it closely enough and the pain in the fibula head got quite severe that it caused me to stop running. I had a deep massage into the bicps femoris and instantly after the massage I had no pain in my fibula head but on my next run I started getting a vague pain down my peroneals and tib ant. I thought I was just overcompensating with these muscles when I was running so thought nothing of it. I had a massage into the peroneals and immediaelty after the massage I had a lot of swelling in the muscle. The pain in the peroneals+tib ant went away but then I started getting some vague weakness, uncoordintion into my ankle especially when walking down hill. Saw specialist who thought deep peroneal nerve injury and said to begin running again when I felt like all my strength had come back. Symptoms stayed fairly constant. It was never so bad that I had complete loss of strength or anything like that. I had normal strength on resisted eversion+resisted dorsiflexion but when it came to walking or running it just did not feel right. I did some light soft tissue massage into my biceps femoris as it felt like a rock in there and either as a coincidence or because of the massage my nerve symptoms settled. I started back into light running and had no nerve symptoms but a vague tightness up higher into hamstring. I did some trigger point work on that and that relieved it. I started back running and had no hamstring or nerve symptoms but pain on impact into my tibial tubersosity. I thought this was just a return to running type pain although on palpation I had no pain at all. I attempted a harder run and got through it ok but by the next day all my pain had gone from the tibial tubersosity and my vague weakness/nerve pain has returned to the front of my ankle again.
My gut feel is that it is coming from the biceps fem because it feels like a rock in there but if I do resisted knee flexion with lateral rotation of tibia I have no pain. If I do resisted knee flexion with internal rotation that brings on my symptoms strongly. There is no positive response with peroneal nerve or sciatic nerve tension testing.
I am at a loss as to what is going on. I am meant to be starting my track and field season now and it has been 7 weeks since I have run and things don't seem to be getting better. Any advice would be greatly appreciated.

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[msk101]

Hi Bullseye,

I'm curious, have you seen a physio about this?? what is your ITB like (tight/short), and your glut muscles (esp glut med) as far as strength and endurance - do yout fatigue around the hips when jogging or walking. Do you over pronate or supinate when you walk and does the foot position change with your running shoes on.. or do you wear orthotics?
I have found that in some people excessive ITB tension can cause a burning pain localised around the head of the fibula (the ITB inserts onto the lateral condyle of the tibia but can cause local pain at this point - google iliotibial band syndrome) and inflammation in the area could potentially irritate the peroneal nerve branch (which wraps around the neck of the fibula) which might cause the distal symptoms you get when the condition is really irritated.

i would suggest getting a good lower body biomechanics assessment to see if structures are tight and or weak (eg tight ITB, weak glutes, overactive hip flexors etc etc) and addressing that rather than just the local site of symptoms which doesn't seem to have worked long term so far.

Let us know how you go.

Cheers
msk101

[bullseye]

I'd say I have fairly tight ITBs but I have no pain with obers testing. I have seen a physio about the issue and they are a little baffled as to what is causing the problem. My gut feeling is that it is coming from the short head of biceps femoris but the sports physician said it was unlikely the nerve would get entrapped here. I have had some massage to the hamstring but it is just so difficult for anyone to get into. The restriction feels very deep. I am having an ultrasound of the nerve on monday. Hopefully something will come of that.

[emad]

How about numbness or tingling along anterolateral aspect of the leg ! How about muscle power of toes abduction and adduction ? Yes , the nerve can be trapped near the head of the fibula , I saw some drivers with this complaint from just resting their left leg over the car door long times espicially big cars . The point is more stress and pressure over the nerve could detriorate it , the nerve just needs chance to recover ( regenerate or rewiring if there is real problem ) , give it chance of rest for one week by :
-Stop sleeping over it
-Stop pressing it by your thumb and hand
-Stop over excerising it , because more muscle contraction means more stress
-Stop flaring -up pain and referred symptoms
-Calm down , practise some breathing
-imagrey ex. could help
-Neural Mobilization gentle of great value
-after the week you can begin some gentle bicycling
-just simple active motions are appropriate


Testing if there is weakness or not can be through testing if you can walk on toes , and if you can walk on heels ?!

That is much ideas
Best luck for you
Emad