Manual therapy and neurodynamic mobilization in a patient with peroneal nerve paralysis: a case report

Abstract

Objective: The purpose of this case report is to describe a therapeutic intervention for peroneal nerve paralysis involving the sciatic nerve.

Clinical features: A 24-year-old man presented with peroneal nerve paralysis with decreased sensation, severe pain in the popliteal fossa, and steppage gait, which occurred 3 days prior to the consultation. Magnetic resonance imaging and electromyography confirmed lumbar disk herniation with sciatic common peroneal nerve entrapment in the popliteal fossa.

Intervention and outcome: A combined treatment protocol of spinal and fibular head manipulation and neurodynamic mobilization including soft tissue work of the psoas and hamstring muscles was performed. Outcome measures were assessed at pretreatment, 1 week posttreatment, and 3-month follow-up and included numeric pain rating scale, range of motion, pressure pain threshold, and manual muscle testing. Treatment interventions were applied for 3 sessions over a period of 1 week. Results showed reduction of the patient's subjective pain and considerable improvement in range of motion, strength, and sensation in his left foot, which was restored to full function.

Conclusion: A combined program of spinal and fibular head manipulation and neurodynamic mobilization reduced pain, increased range of motion and strength, and restored full function to the left leg in this patient who had severe functional impairment related to a compressed left common peroneal nerve.

Keywords: Manual therapy; Peroneal neuropathies; Sciatic nerve.

Figures

Fig 1

Schematic illustration of the high-velocity, low-amplitude spinal manipulation technique.

Fig 2

Fibular head manipulation.

Fig 3

A, Proximal slider, a straight leg raise and application of plantar-flexion without producing symptoms. B, Distal slider; during the phase in which the leg is flexed, the foot is dorsiflexed.