REMEMBER THE DTM FLOW…
1. Identify provocative movement
2. Consider involved neurology for potential neuropathic component
3. Assess for neural sensitivity
4. Apply treatment to improve mechanical interface of the involved neuro
5. Re-test provocative movement
6. Apply homecare and perform regularly until sensitivity to movement normalizes
Common Diagnosis
- Achilles tendinitis/tendonopathy
- Tarsal tunnel syndrome
- Calcaneal neuritis
- Plantar faciitis
- Metatarsalgia
- Chronic ankle sprain
Target Neurology
- Sural nerve
- Superficial peroneal (fibular) nerve
- Posterior tibial nerve
- Saphenous nerve
A reminder…most of these nerves are “mixed nerves” carrying both motor and sensory function. As such, an evaluation of motor function to rule out nerve root involvement in a radicular process is warranted. Not uncommonly, we will see such radicular processes and “sciatica” manifest as part of a foot or leg pain condition referred to our office and the primary driver for their pain is upstream nerve root compression. DTM may temporarily help with some of the symptoms, but the potential for a nerve root issue must be evaluated! Consider McKenzie evaluation as part of your work up and home care.
Athlete’s in general, and especially runners, will often respond well to DTM in these areas. Be particularly suspicious of “chronic plantar fasciitis” or metatarsalgia as well as Achilles tendinitis that is difficult to resolve.
