peroneal spasticity (Full Version)

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sabby731 -> peroneal spasticity (August 21, 2006 11:12:00 AM)

I work in outpatient orthopaedics and don't have much experience with kids, but I have a preteen patient with unilateral peroneal spasticity. She had surgery 3 months ago - "medial facet capsulectomy and medial and lateral subtalar mobilization". Before that, she was casted. For 3 months, we have treated her with manual stretching, joint mobs, soft tissue work to peroneals and extensor digitorum, manual resistance to strengthen inversion, proprioceptive activities,strengthening, cryotherapy to reduce spasticity, ultrasound to peroneals, etc. She has had a botox injection. She continues to have severe spasticity that stops her from using her ankle normally and affects her gait. She has been seen by 2 doctors, one doesn't know what else to do, the other thinks she will eventually grow out of it. What else can we try? Anyone else with this experience?



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 24, 2006 4:09:00 PM)

I'd suggest a neurodynamic assessment to see if symptoms can be differentially evoked upon level 3c neurodynamic bias testing. Assuming that overt abnormal finding can be found (relative to sural or tibial nerve bias upon supine SLR testing), I'd suggest a two-ended glider, NOT A TENSIONER (the latter of which is often, in error, called a "nerve flossing" by "experienced" PT's who have never taken a neurodynamic course).

Anyway, I WOULD NOT suggest trying the testing, nor treatment, techniques unless you've either read Mike Shacklok's book, or taken David Butler's course (or any of the NOI neurodynamic courses) --- because you CAN cause LONG-TERM injury/damage if you don't know what you're doing.

The good news is that the book is relatively inexpensive and Mike Shacklock regularly posts on another website (that we're censored from mentioning), and while David Butler's and Barrett Dorko used to have a thread that they moderated here Mr. Butler's neurodynamic course can be taken online, for about $149 through NorthEast seminars, which is a supporter and sponsor of this very site.

Drew



emad/emad -> Re: peroneal spasticity (August 27, 2006 8:49:00 AM)

Hello Drew;

Correct neurodynamics are of benefical for both neurological and orethopedic cases .

However , i like to know if this kid has upper motor neuron lesion ? Spasticity means neurological !!

Cheers
Emad



avalon -> Re: peroneal spasticity (August 27, 2006 9:20:00 AM)

Hi,

The censored name (without any reason) is [URL=http://www.soma-simple.com/forums]www.soma-simple.com/forums[/URL] (just remove the hyphen beetwen soma and simple in the link).



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 27, 2006 3:58:00 PM)

Emad,

Good point, but I'm of the NDT thinking that, in general, neurologic tone is posturally dependent, and that the UMN lesion's direct effect is that of HYPOTONIA of core musculature, with everything else (e.g. UE and/or LE hypertonia) being an indirect effect.

Under that framework, there is a sequential pattern of increasing tone as we observe distally -- and peroneal "spasticity" usually isn't in the pattern (that's not to say it can't be . . . just unusual). Also, under that framework, "specific muscle spasticity" is now used to describe local muscular abnormalities not associated with an UMN lesion, such as congenital torticollis.

Cross-reference with the fact that the surgery was local to the foot, peroneal area in particular, and we'd want to think horses before zebras. An UMN lesion that was anesthesia related would be MUCH more likely to impact much more than just peroneal musculature (physical findings alone would be much more likely to produce gastroc hypertonicity, clonus, and babinski . . . none of which was described).

I think that, as an outpatient orthopedic PT, Sabby actually used the term correctly to describe specific peroneal muscle spasticity, absent of UML lesion. At least that's how I read it.

Drew



nari -> Re: peroneal spasticity (August 27, 2006 8:05:00 PM)

Drew

Definitely the way to go.

Your warnings are appropriate; neurodynamics are very effective but not in the wrong hands. I suspect this is why some PTs do not use them - it takes a while to 'feel' one's way around neural structures and respect the nerves' ability to make or break a situation.

Nari



emad/emad -> Re: peroneal spasticity (August 28, 2006 6:12:00 AM)

Drew;

The issue is complex with little research !!

Even in case of pain and CNS sensitivity the overactivity of muscles is atype of hypertonicity without any lesion of UMNL .

Could you give me another example of spasticity in distal /perpherial lesions .

I think the thin line between UMNL and LMNL is NOT exist as we studied it espicially spasticity marker

Cheers
Emad



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 28, 2006 4:44:00 PM)

I'm not sure I fully understand your question. Could you please rephrase it?

Drew



emad/emad -> Re: peroneal spasticity (August 29, 2006 12:40:00 AM)

Drew;

Sorry

Do you think a kid with peripheral lesion could present in spastic marker(hypertonic) ?

Cheers
Emad



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 24, 2006 4:09:00 PM)

I'd suggest a neurodynamic assessment to see if symptoms can be differentially evoked upon level 3c neurodynamic bias testing. Assuming that overt abnormal finding can be found (relative to sural or tibial nerve bias upon supine SLR testing), I'd suggest a two-ended glider, NOT A TENSIONER (the latter of which is often, in error, called a "nerve flossing" by "experienced" PT's who have never taken a neurodynamic course).

Anyway, I WOULD NOT suggest trying the testing, nor treatment, techniques unless you've either read Mike Shacklok's book, or taken David Butler's course (or any of the NOI neurodynamic courses) --- because you CAN cause LONG-TERM injury/damage if you don't know what you're doing.

The good news is that the book is relatively inexpensive and Mike Shacklock regularly posts on another website (that we're censored from mentioning), and while David Butler's and Barrett Dorko used to have a thread that they moderated here Mr. Butler's neurodynamic course can be taken online, for about $149 through NorthEast seminars, which is a supporter and sponsor of this very site.

Drew



emad/emad -> Re: peroneal spasticity (August 27, 2006 8:49:00 AM)

Hello Drew;

Correct neurodynamics are of benefical for both neurological and orethopedic cases .

However , i like to know if this kid has upper motor neuron lesion ? Spasticity means neurological !!

Cheers
Emad



avalon -> Re: peroneal spasticity (August 27, 2006 9:20:00 AM)

Hi,

The censored name (without any reason) is [URL=http://www.soma-simple.com/forums]www.soma-simple.com/forums[/URL] (just remove the hyphen beetwen soma and simple in the link).



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 27, 2006 3:58:00 PM)

Emad,

Good point, but I'm of the NDT thinking that, in general, neurologic tone is posturally dependent, and that the UMN lesion's direct effect is that of HYPOTONIA of core musculature, with everything else (e.g. UE and/or LE hypertonia) being an indirect effect.

Under that framework, there is a sequential pattern of increasing tone as we observe distally -- and peroneal "spasticity" usually isn't in the pattern (that's not to say it can't be . . . just unusual). Also, under that framework, "specific muscle spasticity" is now used to describe local muscular abnormalities not associated with an UMN lesion, such as congenital torticollis.

Cross-reference with the fact that the surgery was local to the foot, peroneal area in particular, and we'd want to think horses before zebras. An UMN lesion that was anesthesia related would be MUCH more likely to impact much more than just peroneal musculature (physical findings alone would be much more likely to produce gastroc hypertonicity, clonus, and babinski . . . none of which was described).

I think that, as an outpatient orthopedic PT, Sabby actually used the term correctly to describe specific peroneal muscle spasticity, absent of UML lesion. At least that's how I read it.

Drew



nari -> Re: peroneal spasticity (August 27, 2006 8:05:00 PM)

Drew

Definitely the way to go.

Your warnings are appropriate; neurodynamics are very effective but not in the wrong hands. I suspect this is why some PTs do not use them - it takes a while to 'feel' one's way around neural structures and respect the nerves' ability to make or break a situation.

Nari



emad/emad -> Re: peroneal spasticity (August 28, 2006 6:12:00 AM)

Drew;

The issue is complex with little research !!

Even in case of pain and CNS sensitivity the overactivity of muscles is atype of hypertonicity without any lesion of UMNL .

Could you give me another example of spasticity in distal /perpherial lesions .

I think the thin line between UMNL and LMNL is NOT exist as we studied it espicially spasticity marker

Cheers
Emad



Andrew M. Ball PT PhD -> Re: peroneal spasticity (August 28, 2006 4:44:00 PM)

I'm not sure I fully understand your question. Could you please rephrase it?

Drew



emad/emad -> Re: peroneal spasticity (August 29, 2006 12:40:00 AM)

Drew;

Sorry

Do you think a kid with peripheral lesion could present in spastic marker(hypertonic) ?

Cheers
Emad



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