Peroneal strain?

[Sports_Rx]

Update: patient didn't hit the ceiling when I tested for stress # with ultrasound. Last treatment I did some more myofascial release and worked on the trigger points. TPs since gone.

She said it was getting better (no running), has done cycling and swimming to maintain CV. Can walk upstairs on her toes and now do single leg calf raise pain-free. Single leg hopping is still painful and still feels 'weak' compared to other leg.

This bit's interesting: she used a foam roller on the outer shank and experienced severe 'electric shock' pain in the peroneal area. Afterwards leg was sore again as though healing was put back.

Could this have irritated the peroneal nerve? She reports soreness when sitting with legs folded underneath her (compressing the tissues), and can only stand light pressure on massaging the area.

Any feedback / comments welcome

[Physio Dace]

Hi Sport-Rx,

Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

What were the accessory movement of the superior tib-fib joint like?

[Sports_Rx]

Hi Sport-Rx,

Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

What were the accessory movement of the superior tib-fib joint like?

Hi, thanks for your reply. Yes SLR with PF & Inv was more painful on the affected leg, pain in the area of her complaint. I checked sup tib fib - NS accessory mvt on posterior anterior pressure. Are there any other tests for this joint I should consider?

Also both fib heads are tender on palpation (peroneal nerve again).

Patient has improved, resting from running's helped obviously. There is very slight discomfort on repeated single leg hopping so I've advised no running yet.

[Physio Dace]

Hi,

Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?

[Sports_Rx]

Hi,

Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?

No I haven't... like a slump but sensitised for the peroneal nerve?

Thanks for your input, much appreciated.

[bob78h]

Hi Sports_Rx, I am experiencing many of the same symptoms you described in your patient. Could you tell me what the final diagnosis was and what worked in rehab and return to activity? Thanks.