Bilateral ankle pain and sympathetic tone

[Tim]

As a PT in a VA hospital, I have been perplexed with multiple outpatients over a long period of time who have developed "overuse" syndromes of their ankles and lower legs, fail boot camp, and then make the rounds for years, trying to find something to reduce their chronic pain. Typically it is the ankle pain that is the most problematic. With the use of myofascial release, I would get better results than the therapists preceeding me, however, relief of pain would always come back within a week. After taking Barrett's seminar, I would get even better results, but still not lasting. With the current patient I am working with (25 yo female), I feel like I am making some gradual progress, especially now that I am emphasizing work on improved diaphragmatic breathing and general relaxation. In fact, it is amazing to me to see how much more improvement there is in her bilateral ankle pain simply with focus on reducing sympathetic tone. I would be interested in how some of you address sympathetic tone in these types of cases, what techniques you use, and any other advice? Thanks.:teeth:

[emad]

Hi Tim ;

What is the abbreviation VA you have mentioned !

Regarding the Ankle pain ,could you clarify more that pain ,i mean Does it appear with ankle motions or what ?

As for Sympathetic tone ,do you mean by it tension ?

Regards
Emad

[Diane]

How about teaching these people good old-fashioned foot and ankle exercises?
Lots of people, all ages, all occupations, get canky ankles.. lots of big nerves, narrow tunnels, bad shoes, tender soles, restricted range. Higher up, lots of lower leg structures that cross the back of the knees, which are usually in a bent sitting position much of the day. No one seems to ever explore the full movement available in the feet and ankles/knees.

Suggestion: Patient supine. Abdominal breathing first. Add quads contraction, full concentric/static. Add foot plantar OR dorsiflexion. Hold for three complete inhale/exhales. Let go and rest. Repeat, this time with the feet going whatever way they did not go the first time.

It's progressive.. by the third breath they can take up increased slack in the range with the increased eccentric lengthening they've gained.
It feels good, so they are more likely to continue to do it.
Hint: It helps to show people a picture of the nerves behind/on top of the ankle/leg so they know what they are trying to affect.

[Barrett Dorko]

Tim,

How often do you handle the head?

[Tim]

Thank you, Diane, for your suggestions.

Emad, VA is Veterans Administration, so I see a lot of ankle injuries from intense running and jumping. Many develop musculoskeletal problems in boot camp that never recover, and they get a medical discharge. The lady patient in question here, originally injured her ankles falling off of a climbing wall and landing on her feet. She was then forced to continue running, and did so for days. Her pain is constant, whether static or in motion. She has gradually improved most, I think, with a combination of simple contact and ankle mobilization (traction with anteroposterior grade IV mobs of the talus), followed with the gradual progression of closed chain exercise.

Emad, Barrett would give a better explanation of sympathetic tone. I think of it as a hypersensitization of the sympathetic nervous system, similar to what occurs in regional sympathetic reflex dystrophy.

We have graduated her exercise program, and she is a hard lady to keep from over-exercising, however, we are finally to a point where she is doing aerobic exercise most days (running and eliptical machine) without any aggravation of the bilateral ankle pain; this only since working on diaphragmatic breathing and simple contact as Diane and Barrett have explained in other soma simple threads.

Barrett, I have done some simple contact on the head a couple of treatments. Do I need to do more?

[emad]

Hi Tim ;

I liked your comments regarding keeping the patient from over moving ;

she is a hard lady to keep from over-exercising

I face the same problem with most of my patients .

Best wshes
Emad