Neurovascular Entrapments
Presenting symptoms
A 19-year-old female college student and soccer player presented with exercise-induced lower leg pain. She had been diagnosed with bilateral popliteal artery entrapment syndrome. Despite five surgeries to correct the artery entrapment and receiving physical therapy for more than three years, this client was still experiencing calf pain and burning on the bottom of her feet.
Evaluation, clinical reasoning & treatment strategizing
Popliteal artery entrapment syndrome is an example of soft tissue pressing on structures to either occlude blood flow (claudication) or interrupt nerve impulses (entrapment), or both. The cause is often due to the mal-position of the artery. While generally uncommon, it can occur in young athletic individuals with well-developed leg muscles. In this case, the deep myofascial scarring resulting from five surgeries could have complicated any benefits from surgeries.
Treatment
NMT was applied to residual scar tissue behind and below the knee. Every muscle with possible trigger point referral into the posterior knee and plantar surface of feet was examined and treated. Sessions were short because of the deep, intense and painful nature of the treatment. Biweekly sessions resulted in myofascial unwinding and reduced muscular adhesions in the calf muscles, distal hamstrings and hips.
Outcomes and follow-up
NMT treatment helped to decrease secondary calf cramping and reduce the burning sensation in the client’s feet. However, due to severity of scar tissue at multiple surgical sites this case is ongoing. NMT will continue to be integrated into her therapy regimen over the course of the next year as she slowly increases athletic activities.
