Ankle Trauma
Presenting symptoms
A high school student presented with chronic swelling and pain on the inner right ankle due to a direct hit from a baseball. X-rays revealed no structural damage. Over the course of a year he had undergone physical therapy, chiropractic and strength training, and he had worn a brace for balance and used a heel lift to equalize leg lengths. All modalities had been only moderately effective at relieving his pain.
Evaluation, clinical reasoning & treatment strategizing
The single leg stance test showed poor balance and ankle stability on the right side. NMT palpation revealed a significant adhesion between the tibialis posterior muscle and the distal/medial soleus muscle, possibly sourcing the dysfunction in the ankle joint. We also suspected damage to the three deep compartment muscle tendons within their tendon sheaths as they hooked around the medial malleolus.
Treatment
The following lower extremity tissues were treated over the course of six visits: tibialis posterior, flexor digitorum longus, flexor hallucis longus, gastrocnemius, soleus, the Achilles tendon, the three fibulari and the plantar fascia. NMT treatment around the site of the baseball impact/trauma restored normal ankle movement and optimized weight-bearing distribution. Once the extensibility of these muscles was increased, the patient was able to stop using his heel lift (his leg lengths had equalized).
Results and follow-up
Recovery was speedy, since the patient also had been under the care of a chiropractor and physical therapist. Even after one NMT session he had less pain and was able to discontinue the use of the brace. After four NMT treatments, the patient was able to run without pain and resumed baseball training. NMT treatments to the adhesions in the lower extremity were a valuable component in this collaborative recovery program.
