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Muscle spasm is the brain's way of applying the brakes to slow us down. Grade 2 inversion ankle sprain. 1 2 92 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 8 technique MYOSKELETAL ALIGNMENT TECHNIQUES Tightness is one way the brain applies the parking brake when the body's natural braking systems fail—and pain is another. When working properly, the brain's motor control system is finely tuned to process peripheral input and deliver appropriate output. However, when the body's healing mechanism has been compromised, the nervous system has the ability to fully engage the parking brake to slow us down and keep us out of trouble (Image 1). When we palpate tissue tightness from an old injury, for example, we often notice a significant amount of resting tone in neighboring muscles. This hypertonicity is the nervous system's way of protecting a weak link. Although the client may believe the injury has healed, the surrounding muscles never got the memo. To most of us, excessive muscle tone indicates lack of mobility, but we need to look further to see if it has a specific cause or if it's simply a habit that got stuck on the client's hard drive and needs to be cleaned. Image 2 shows photos of a client we'll call "Bud" who suffered a fairly serious (Grade 2) inversion ankle sprain when thrown from a horse eight months earlier. A physical therapist friend referred him to me, letting me know his orthopedist had released him and that the ligamentous damage had completely healed, but Bud still complained of persistent leg and hip cramping. During gait evaluation, I noticed him limping. He said his doctor told him the limp had become a habit and would soon go away—but I've found that's not always the case. Granted, a limp was functional for Bud after his painful ankle injury because it offloaded stress, allowing him some degree of locomotion. However, it became dysfunctional once the injury had healed and there was no longer a reason to offload stress. Bud's lingering limp presented a red flag, telling me we may be dealing with a nervous-system processing problem, sending down faulty commands to continue limping. ASSESSING LOCALLY, THINKING GLOBALLY To identify and correct Bud's hip and leg cramping symptoms, I first wanted to determine if the ankle injury was driving the protective muscle guarding I was palpating and if biomechanical compensations from months of limping might be triggering compensatory hip and leg spasm. Initial hands-on assessment of Bud's lower limb revealed limited ankle mobility and peroneus longus and brevis compartmental rigidity. Since these fibularis muscles evert and plantar flex the foot, it's likely they were either strained during the fall or recruited by the brain to splint and stabilize the inversion sprain. To address the peroneal spasm, I applied a mild sling and resist technique (Image 3). This maneuver seemed to work nicely for creating mobility at the talocalcaneal joint, but when I went to the other side of the therapy table to perform the same technique from a different angle, an unexpected thing happened. As my webbed fingers compressed Release the Parking Brake See What's Driving the Muscle Spasm By Erik Dalton, PhD the tissue overlying the superficial peroneal nerve at the anterolateral aspect of the ankle (Image 4), Bud recoiled in pain. Damage to this peroneal branch of the sciatic nerve during an inversion injury is not uncommon and is often mis-assessed. To confirm a peroneal traction injury, I performed a supine straight leg sciatic test with Bud's foot dorsiflexed and inverted (Image 5). He tested positive and also reported mild