Neural Flossing or Gliding: Dr Blake's Video

Nerve pain in the foot goes right to the brain on a super highway called peripheral nerves and gives up the most significant pain a podiatrist will treat. Any time a patient says that they have level 6 pain or higher, I will always look for a nerve component to their pain. It is common for a podiatrist to treat nerve entrapments, Morton's or Joplin's neuromas, tarsal tunnel syndrome, but there are alot of chronic problems that develop a hypersensitivity from nerve overload that needs to be treated. Neural flossing is a wonderful part of any nerve treatment. Here my wife Pat demonstrates neural flossing, aka neural gliding, with several provocations. You are trying to get the nerve to break its pain cycle but gently stimulating it in some way. Warmth and painfree massage, acupuncture, transcutaneous nerve stimulation, Calmare, etc, and other ways to keep reset the nerves to generate less and hopefully no pain. 

https://youtu.be/g94F8g_jzGg

Neural Flossing the Peroneal or Tibial Nerves: Advanced Video with some Caution

I have always taught a very simple sciatic nerve flossing for nerve symptoms. These exercises (by Drs Abelson and Mylanos) are much more stressful to the nerves, but may be able to produce better results. Do any exercise once or twice, and initially avoid the head tilts. Also, initially sit with good support behind your back. Do once a day for several days, then gradually up the exercises to 3 times a day if you see results. Nerves are funny. Positives results mean that numbness gets less, but pain also gets less. Pretty much the nerve is coming back to normal sensation. Because the cause of the nerve symptoms can be a bulging disc in the back, any back symptoms which increase means you need to stop doing the exercise until you are evaluated. Some modification may be more appropriate. These exercise the peroneal nerve. The tibial nerve is done with the foot pointed and flexed back and forth, with the same knee and hip motions or positions. You just take out the foot inversion you see that stretch the peroneal nerve. When patients come in with nerve symptoms, I like gentle neural flossing, topical Neuro-Eze, warmth (not ice), and discovering what positions really make it act up (sitting, sleeping, lifting, etc.) Hope this helps. Rich

https://youtu.be/vk9YElLm57Y

Toenail Pain: Where does it come from??

Dear Dr Blake...I have excruciating pain in my toe nails (left foot 3rd and 4th toes) when I walk...it feels like someone is pulling my toenails off upwards (not fwds)....or maybe like having your barefoot toes rolled over by an office chair....there is no toe trauma at all...in fact when I reach down and massage the toes the pain is strangely gone and even unlocatable...so I am almost sure it is a nerve damage situation....I thought I had Morton's Neuroma because the 4th toe is slightly curved in...however, there is no pain when I do the metatarsal squeeze test...also the pain is exclusively in the toe nails, not the ball of the foot. Additionally, a week ago I had an injection into my foot but that did no good whatsoever. Can you give me your thoughts ??? Thx !!

Dr Blake's comment: You are most likely correct that is it nerve pain. The 3rd and 4th toes are in the L5 nerve root distribution. You can have a Morton's neuroma developing between the 3rd and 4th metatarsals, you can just have a bulging disc at L4/5 or L5/S1, or both called "double crush". To evaluate you have to go up the leg from the foot and look for hot spots or "triggers" which would produce neural tension. See a podiatrist or neurologist/physiatrist to evaluate as your starting point. Try Neuro-Eze OTC nerve med (online) and start doing neural flossing (but it could aggravate things also---at least a clue to what is going on). 

http://www.drblakeshealingsole.com/2014/04/mortons-neuroma-video-playlist.html

http://www.drblakeshealingsole.com/2010/08/mortons-neuroma-treatment-options.html

Calf Pain with other symptoms: Email Advice and Response to Neural Flossing

Dear Dr. Blake,

     I have been studying your blog for a few weeks now and enjoying your expertise and caring manner.  I wish you could be my Dr,  I am looking for advice on how to direct my podiatrist appointment in 9 days.  I will try to make this to the point.  10 yrs ago I stepped down on a rock while saving my son from an active dog and got a stress fracture on my sesamoid. 

    Wore a boot and orthotics made by podiatrist. In the last 6 months I began having knee/calf pain and my sesamoid toe - the big one - was acting up.  Podiatrist took xray and didn't see fracture and added a dancer pad to my orthotics.  The sesamoid started feeling better, but I still had the mild calf/knee pain and the ball and heel of my foot hurt when I walked barefoot.  The pain was bothering me enough to take ibuprofen. 

    5 weeks ago I reached up in a standing position and I couldn't bear weight on my foot due to extreme calf pain.  I was unable to stand on my tippy toes.  Podiatrist sent me home with 1500mg nabumetone and said to come back in 2 weeks diagnosing me with tarsal tunnel after pushing on foot with his hand to find pain points.  I began physical therapy 2x a week.  

    Eventually I was able to walk but not without pain.  The med prescribed made me tired and my belly hurt so I took ibuprofen instead.  At my 2 week appt with podiatrist he offered me cortisone telling me it was more diagnostic to find out where to operate or a cam walking boot.  I chose the boot - that was 3 weeks ago.  Last week I took off 5 days off my part time custodian job, took the med prescribed and layed low icing and resting.  Felt much improvement, but still unable to walk barefoot due to heel/pad/calf pain. 

    Back to my 2nd day of work wearing my boot and the calf pain is getting worse.  I did get a 2nd opinion last week by an orthopedist and he acted as if I wasn't telling the truth about my pain.  I am looking for help with my next podiatrist appt.  I understand that sesamoid can cause other issues - I also pinched a sciatic nerve on same side of body after recent sesamoid pain.  I know that cortisone will be my next option and it scares me. I am not confident about the diagnosis of tarsal tunnel.  The Dr. said he could do other tests but they wouldn't tell him much. 

    Am I correct that if I get injected in the wrong spot that I could have other problems?  I am somewhat mobile now and have no interest in making the problem worse.  I understand that cortisone is a band aid to the issue and the shot itself truly freaks me out.  Would you recommend an mri or any other tests to make my diagnosis more concrete?  If I truly have tarsal tunnel I believe the Dr. wants to do surgery and resources online say I have a 50/50 chance of being better.  The recovery of surgery seems miserable and I really don't want to be immobile.  I have already given up the gym I went to 4x a week.  When I spoke with orthopedist about the sesamoid/sciatice nerve issue playing a part in my current issues I got a blank look.  I want to go to podiatrist armed with information to help me make the best decision for myself.  Can you help me?

Regards,
Toni (name changed)

Toni,

      I am out of the office until 9/29 and will try to get back to you that week. Rich

Hi Dr. Blake,

     I got a 3rd opinion yesterday and he thinks baxters neuritis and planters fascitis.  He listened to my ideas of right side issues and I am having an emg.  I believe this podiatrist will help me get to the issue of my pain.  Writing to you and reading your blog has helped  get my brain in order to advocate for a correct diagnosis.  Thank you for being there to help me get this into words.  I will follow up with you once I get emg results.  

Enjoy your time out of the office

Hi Dr. Blake,

    Thank you so much for your blog.  It has empowered me to find a doctor who takes my pain seriously.  I had an emg done and there are no nerve issues.  I've been diagnosed with plantar fascitis and peroneus longus tendonitis. After reading your information on these issues it makes sense.  I believe I have found the right diagnosis.  I am off work for 2 weeks and now have a night splint along with the cam walker.  Dr. also prescribed me a cream compound with lots of meds to help with pain and blood flow.  I am also going to continue with physical therapy.  Unless you feel the need to respond I'm ok with studying your blog on these issues and taking your advice.  I appreciate your information so much and hopefully I will be pain free soon.  Take care.

Dr Blake's response finally: 

     Toni, thank you. I am back from the Greek Isles (someone had to go) celebrating my wife's big #__ birthday (intentionally left out number). I am so happy you found someone to listen. Tarsal Tunnel diagnosis is so difficult to make that considering injections and surgery for this needs to be very well thought out, with numerous opinions. With your history of sciatica, and the nerve hypersensitivity that can linger, you can have symptoms all along the course of the nerve leading to many mistaken diagnoses---from metatarsal pain, to arch pain, to heel pain, to ankle pain, to calf pain, to pain in back of the knee or thigh or butt. Changes in your gait, especially over supinating (or rolling to the outside of your foot), can trigger sciatica. This nerve hypersensitivity does not mean nerve damage, and that means the nerve testing (conduction or emg studies) can be negative. This severe calf pain that you had is typically only produced by nerve pain or blood clots, so if the calf pain gets bad again have a doppler ultrasound of your calf to rule out DVT (deep vein thrombosis). Your treatment right now makes sense (activity modification, protected weight bearing, and physical therapy). Eliminate all that sets off any pain. Do neural flossing from my blog for several days to see what symptoms it helps or irritates, but hopefully it is very relaxing to the sciatic nerve. When you stretch the calf, and you should 3 times a day, always keep your knee slightly bent to protect the sciatic nerve. As the pain calms down, all of the secondary symptoms should go first, with the pain from the main injury lingering. Daily keep track of what hurts (say at the end of the day) that day. You hopefully will see a pattern. The problem you face, when you have many symptoms, is that the docs and physical therapists can spend a lot of time treating secondary symptoms, and lose track of what is important to treat consistently. I sure hope this helps somewhat and thanks for all your kind words. Rich

Patient Response:
     Dr. Blake,

Thank you so much for taking the time to help me with my issues.  The neural flossing helped tremendously! The first time I did it my hip cracked every time and I knew we were onto something.  After first day the throbbing in my foot/calf stopped and my hip hurt like crazy.  After 4 days I was able to walk more comfortably and I only have pain in my heel when I walk barefoot.  I saw a chiropractor and he found issues with my L5 and other things.  Today I am returning to work!  If I hadn't done the exercise I would have been strongly been considering cortisone in my foot due to being tired of the pain.   I believe you helped me avoid the unneeded shot and I am grateful.  I have an appointment with my podiatrist and I'm not sure I need to go.  I would love to share this information with him, but not sure it's worth the office visit.  

You are a good man for sharing your knowledge with the world.  I will find a way to pay it forward.  Thank you so much!

Sunday's Video of the Week: Piriformis Syndrome Stretches combined with Neural Flossing

Piriformis syndrome is quite common in the athletes our Sports Center treat. I have another few posts on this syndrome. Since the piriformis muscle/tendon is an external rotator of the hip, and since excessive foot pronation can cause excessive internal rotation of the hip, podiatrists are called on to design orthotic devices to correct that. If the hip internally rotates too much, the external hip rotators must overwork to stabilize the hip, and the piriformis may strain, swelling, tighten and irritate the sciatic nerve. Here is a wonderful video on combining piriformis stretching with neural flossing (see my other posts on neural flossing). Do these gently at first to see if they have any negative reaction. Or, review with your physical therapist on some modification that is tailored to you. But, sufferers of piriformis syndrome will be helped with some version of these wonderful exercises. Good luck! As you can tell from another post on neural flossing, I personally prefer spine neutral stretches with the patient laying on the back.






Also check out this incredible video about the San Francisco Fog!!

http://biggeekdad.com/2014/02/san-francisco-fog/#.UvgAty4zOhQ.gmail

Neural Flossing: Initial Lesson for patient with Ankle Nerve Pain

Podiatrists deal with a lot of nerve pain. Neural Flossing or Gliding is a great technique to be tried to gently move the nerve and prevent scar tissue and swelling to collect around the nerve. Here, this wonderful patient, agreed to have me video her initial exposure to Neural Flossing. The motion should be gentle and smooth. The patient should do 10 leg extensions and 10 leg flexions 3 times per day. For nerve pain in the foot and ankle, neutral spine is important. The patient should extend the hip, knee, and ankle with foot pointing, then immediately flex the ankle, knee, and hip. Comparing the two sides is a great way of seeing the differences, the starting point issues,  and the  progress made. This patient has a long way to go, but the lesson really showed us a lot of why she is still having problems with lower extremity stability.






http://www.drblakeshealingsole.com/2012/12/neural-flossing-gentle-stretch-to-break.html

Neural Flossing: A Gentle Stretch to Break Scar Tissue forming around an Injured Nerve

     When treating nerve pain, physical therapists will use variations of movements to glide or floss the nerves as it runs from your head to your toes. Nerve pain can be from neural tension that develops, and the scar tissue that forms around the nerve. If you are suffering from nerve pain, discuss your individual case with your physical therapist or treating physician and see if neural flossing could be beneficial for you. See the video and article below which introduce neural flossing.





http://www.livestrong.com/article/287430-sciatic-nerve-flossing-exercise/