Issue link: https://www.massageandbodyworkdigital.com/i/1496639
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 83 "Let's try something," I said. Using a paper clip, I pulled it lightly across the skin on the dorsal side of his foot. He experienced hypersensitivity to touch in the area of the superficial fibular nerve relative to other areas. "That's weird," he said. "Why would that be?" "Let's think about the greater context of your injury," I said. "You must have really stretched your toe when you hit the ground, with enough force to make you wonder if you broke something. You didn't, but other tissues in that area were massively affected. Clearly, the ligaments around the joint and the large muscle that extends your great toe were overstretched. On top of that, there is a superficial nerve in this area that was also taken far beyond its normal length. The ligament, muscle, and nerve overstretching could easily account for the pain you have now." "Wouldn't any of that show up on an X-ray?" he asked. "Nope, none of it," I said. "What happens with bones during a trauma is only one part of the picture. Sadly, the rest is often overlooked because you can't see it on a diagnostic image." "Wouldn't it just get better on its own?" he asked. "Would you ask that if it was an injury to the bone?" I asked. "When any one of these aspects of injury are affected, there are ways to accelerate and facilitate the healing process. Hands-on treatments can play a big role in that process." Having made the case for the work, I began by addressing soft-tissue inf luences for branches of the fibular nerve that might explain his symptoms. Finding some fascial restrictions near the superior aspect of the fibularis brevis, I gently followed the nerve all the way to the toe, being careful not to recreate symptoms and further irritate the nerve. Switching gears, I focused on muscular inf luences, especially the extensor hallucis longus. It was quite sensitive, especially the superior aspect of the muscle. This restriction was about the same height of the neural issue, just more medial. "I'm surprised how far up my leg this goes," he said. TAKEAWAY: What happens with bones during a trauma is only one part of the picture. Sadly, the rest is often overlooked because you can't see it on a diagnostic image. "The muscles and nerves over the joint originate much higher on the leg," I said. "Let's see if we are making some difference." Putting pressure on the metatarsophalangeal joint itself, it was far less tender than initially. Dragging the paper clip across the skin, the nerve was also much less sensitive. "Looks like progress," I said. "Feels like progress," he agreed. "You didn't spend as much time with the toe joint as I expected. Yet it is clearly better." "If the effects of overstretching the joint go to distant areas, it also means we can use that to our advantage. You don't have to touch something to affect it," I said. I was feeling good about all this until his last question, which was gut-wrenching. "Is this kind of a dying art?" he asked. I certainly hope not. It is up to all of us to make sure we can make a difference for generations to come. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 20-therapist clinic BodyWork Associates in Champaign, Illinois, and past president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit pnmt.org or email him at doug@pnmt.org.