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Webinar with Dr. Cobb

Chronic Ankle Sprains? Your Go-To Solution- Episode 400

Video Highlights

- What is behind recurrent ankle sprains
- Nerve flossing for the sural nerve
- Suggestions for stacking nerve work with motor activities

I want to talk today about a very specific nerve that comes up when people are complaining about either recurrent ankle sprains or achilles tendonitis.

One of the nerves, that supplies that area – the lateral side of the foot, back of the Achilles tendon is called the sural nerve. And, in many cases this nerve is overlooked by a lot of professionals because it’s not a, what’s called, motor nerve. In other words, it does not supply muscles, it’s not involved in moving the foot or moving the ankle, or moving the Achilles tendon. It is just a sensory nerve.

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However, what we often find is that when people have recurrent ankle sprains, right? They get a sprained ankle all the time or they have achilles tendonitis, often that is a result of a decrease in sensory awareness. In other words, if your brain doesn’t know where your ankle is, it’s more likely to let it roll out whenever you step on that rock when you’re out for a hike. So we’re going to do is show you a quick little nerve glide, or nerve flossing exercise, for the dural nerve. We’ve found this to be extremely effective for many people.

So, here’s how we do it. We’re going to sit comfortably. You can do it on the floor, but I normally recommend for most people, particularly if you have a problem, that you begin in a chair. I’m going to be at the edge of the chair sitting up, nice and tall. And the key ideas here, we’re going to be setting up kind of like a hamstring stretch but really what’s going to drive this into the sural nerve is what I do with my foot and ankle. So our basic positioning, I’m going to be here. The working leg is going to be straight in front of me. The knee will be locked. I’ll be sitting up nice and tall
and now I’m going to assume this foot position. I’m going to pull my toes up toward my knee and now I’m going to invert my ankle.
In other words, I’m going to take my toes. I’m going to move them to the inside of my leg. So toes to the knee, toes to the inside, dorsiflexion and inversion. Now from here, I’m going to simply begin to hinge forward from the waist. If you are really targeting the sural nerve and you have a problem there, you will likely already be feeling a small amount of tingling and ant-like sensation on the lateral side of the ankle and maybe across the lateral surface of the foot. That means that you’re right on target, all right.

So again, we’re here. Toes up, toes in. We hinge forward. Now, once we’re in this position, we need to do a little bit of flossing work. In other words,
we need to move the nerve through the tissue.
So the way that I normally like to have people do this, in the beginning, is to use the knee. So I get a little tension on the nerve, bend, the knee to take tension off straighten the knee to put tension on. So we’ll do that for five or six reps. And now, I’m going to go to my hip. For my hip,
I’m going to internally rotate and externally rotate my hip. It’s a little hard to maintain your foot position, but that’s what you need to do. And then, last but not least, I’ll come to my lumbar spine. So I’m now going to flex my low back. Extend my low back flex and extend.
Usually five repetitions. So five at the knee, five at the hip, five at the low back. After you’ve done that shake it out a little bit.
And now we will finish this by coming back to the ankle, we’ll set up with a little tension on the nerve again. You should feel it. And now we’re simply going to reverse the foot position, toes to the outside, to take tension off, toes to the inside to put tension on. Out and in. Another five reps. When you do these neuromechanic drills as we call them, keep the tension low – think 3 out of 10, not ten out of ten. I don’t want you to injure yourself. I don’t want you to over-stretch the nerve. So, keep this very, very light and gentle. You should feel again, a small amount of nervy sensation of some type in the distribution of the sural nerve. If you don’t know where that is, look at some of our posts, check out other blogs or look it up on online. You should feel a little bit there. The goal here is to re-educate this nerve. Get it moving so that your brain can understand where your ankle is.

So, after you have done the sural nerve work, I highly recommend you stand up and start doing a little bit of balance work or grab a band and do some motor activity or motor activations for the ankle. The combination of that sensory and motor work is really one of the best things that you can do for that chronic ankle sprain or chronic achilles tendonitis issue.


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