West Palm Beach Chiropractor: West Palm Beach Chiropractor: “Pinched Nerve” from a Pickleball Injury

From Dr. Natalie Meiri’s Clinical Pearl Stories:

West Palm Beach Chiropractor: “Pinched Nerve” from a Pickleball Injury

This was a 68 year old patient who had a chief complaint of aching pain in his right leg and low back. Additionally, on his pain diagram, he indicated radiation of pain up the front of his thigh from his knee and down his right leg from his right knee. To be HIPAA compliant, I will call him Wilbur instead of his real name. He stated it seemed “bearable” during the day.  However, at night, he couldn’t sleep due to the intense pain.  It had started after he twisted and flung forward during a pickleball game a week ago.  He stated, “this is the first time I have ever been to a chiropractor and I think I have a pinched nerve”.  Furthermore, he had never had any back or leg problems previously. 

Wilbur presented to my office with intense pain. He had no history or symptoms of any systemic condition that could cause a neuropathy (i.e. diabetes).  Wilbur was taking over the counter drugs such as acetaminophen (for pain) and a NSAIDS (Non-steroidal anti-inflammatory drug for inflammation).  The meds seemed  to help very little after the injury.

Wilbur’s Examination and X-rays

Upon examination, there were positive tests for his low back, right hip, and right knee. Apparently, he had an entrapment neuropathy in the lower right extremity (leg) of his peroneal nerve.  After that, I sent him out for x-rays for his lumbar spine (low back) and right knee. Findings on his x-rays were mild to moderate degenerative joint disease or osteoarthritis (O.A.).  This is a wear and tear type of arthritis. Wilbur had a moderate amount of O.A. in his low back and right hip. However, his right knee x-ray showed very mild Osteoarthritis. Wilbur’s diagnosis was Pain of his lumbar spine and Peroneal Neuropathy in his right leg.  Neurodiagnostic testing (EMG/NCV) would be ordered if there was no improvement within 12 visits for the peroneal neuropathy.

Is Peroneal Neuropathy a type of pinched nerve?

Firstly, the term “pinched nerve” is a colloquial term.  Wilbur described his condition as a pinched nerve. The pinched nerve term is not a formal, literary or true medical term.  Pinched nerve is used to describe one type of damage or injury to a nerve or set of nerves. Neuropathy, or nerve damage, occurs when peripheral nerves outside the brain and spinal cord are injured.  It may result from compression, constriction, or stretching of the nerve(s). Symptoms can include numbness, “pins and needles”, burning sensations, and pain radiating outward from the injured area.

Secondly, the common peroneal nerve, also known as the common fibular nerve, is a branch of the sciatic nerve and supplies the leg. Injury to the common peroneal nerve results in a foot drop described as slapping or tripping. Pain and parethesia (pins and needles) may occur at the site of compression as well as distally (further down) into the lateral leg. At times there may be a radiation of pain into the thigh. Numbness and tingling can occur along the lateral leg and dorsum (upper surface) of the foot. Peroneal neuropathies occurring at the fibular (outer of two bones of the lower leg) neck (upper part of fibula) affect the DPN (deep peroneal nerve).  The SPN (superficial peroneal nerve) entrapment occurs in the lower leg at the ankle frequently due to a twisting of the ankle.

Thirdly, so Wilbur had the peroneal neuropathy or “Pinched nerve” at the fibular head of his right knee.

Wilbur’s Chiropractic Treatment for Lumbar Spine Pain and Peroneal Neuropathy

Wilbur’s treatment consisted of chiropractic adjustments of the low back, right hip and right knee. The areas were misaligned (subluxations or intersegmental dysfunctions) due to the injury he had. Additionally, soft tissue therapy (myofascial release, pressure point and various post isometric relaxation procedures) to the soft tissues/muscles were provided. For example, the muscles involved were the peroneus longus/brevis, tibialis anterior, and extensor digitorum longus. And modalities (cold/heat therapy and electric muscle stimulation) were administered as needed. Finally, he was given therapeutic exercises for stretching and strengthening. And recommendations for ergonomics/activities of daily living (i.e. proper gait/posture) were provided.