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Numbness with use of elliptical trainer

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Rickthefootguy, Jan 18, 2012.

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    I have a patient who reports numbness with the use of an eliptical trainer. She has no issues when walking or using a treadmill. She also states no change in footwear. Any ideas??
  2. Craig Payne

    Craig Payne Moderator

    There is no "swing" phase with an elliptical trainer or cross trainer, so they are constantly weighbearing. With a step machine r treadmill, there is a "swing" phase so they not constantly loaded.
  3. Rick:

    This is very common in people doing elliptical trainer workouts and I have experienced it myself. This may also occur in cyclists.

    I call the condition transient forefoot pressure neuropathy, where the individual reports transient forefoot "pins and needles" either during or immediately after they do their elliptical trainer workout. The solution is to have them lean backwards slightly so that more weight is on their heels and less weight is on their forefoot, by giving them a slight heel lift, or by having them adjust the platforms on the elliptical trainers so that the rearfoot portion of the platform is slightly higher than the forefoot portion of the platform. This typically totally eliminates the condition.

    I have been seeing this condition for the past 5-7 years but have, not yet, seen it described within the medical literature. Sounds like a good topic for next month's Precision Intricast Newsletter!
  4. Athol Thomson

    Athol Thomson Active Member

    Like Kevin, I have personally experienced transient forefoot numbness when using elliptical trainers but not had a problem with any other exercise. Patients report similar issues quite regularly.

    I ask patients to do cardio-type circuit by rotating various machines (rowing, stepper, elliptical, bike, treadmill for 10-15 minutes each. Seems to keep the paraesthesia to a minimum or eliminate it completely.
  5. CamWhite

    CamWhite Active Member

    I have an elliptical trainer and have often felt tingling in the balls of my feet and anterior/patellar knee pain. Loved the workout, hated the side effects.

    One day, I noticed my Ryns (heel-to-toe rocker shoe) and decided to see how they would work. I felt absolutely no knee strain or foot tingling, regardless of how much resistance I set on the machine. I theorized that the rocker adapts to the pitch of the pedals and allows the entire knee joint to engage the pedals through its elliptical path of motion. I'm not sure exactly why it felt so good, but I have heard the same results from others that have tried wearing their Ryns on elliptical trainers.

    Did 30 minutes of high-intensity interval training this morning wearing Ryns with absolutely no pain or discomfort. Any thoughts on why this is occuring?
  6. mak

    mak Welcome New Poster

    yep, ive had the same type of transient forefoot pressure neuropathy when on the cross trainer and have found that, as Kevin mentions, by shifting my weight back toward the rearfoot for a minute or so it goes away. havent tried a rocker type shoe but will give it a go. would there be any concern regarding long term nerve damage?
  7. I have had a few patients develop more long lasting pain in the forefoot that persists the next day or so after repetitive and daily use of the elliptical trainer. That is why I think this condition is a transient neuropathy versus just the arterial supply to the plantar metatarsal heads being temporarily shut off due to the constant increased pressure on the plantar metatarsal heads during the elliptical trainer exercise, which, if it is, should be called transient plantar forefoot ischemia. It may be also a combination of a transient plantar forefoot ischemia and a transient forefoot pressure neuropathy that is causing the condition, but for now, I think the term transient forefoot pressure neuropathy makes the most sense clinically.
  8. Athol Thomson

    Athol Thomson Active Member

    Could there be an issue with the increased anterior pelvic tilt and lumbar lordosis when using an elliptical trainer causing compression on neural structures about the lumbar spine? Especially in patients with restricted hip extension (tight hip flexors etc) Although if this were the case you would expect more wide-spread numbness than just the feet perhaps?

    Two studies show decreased plantar pressure with elliptical trainers when compared to running/walking. And found greater peak hip flexion angles on the elliptical when compared to walking, as well as larger peak hip flexor moments.

    Medicine & Science in Sports & Exercise:
    November 2007 - Volume 39 - Issue 11 - pp 2012-2020
    Variations in Plantar Pressure Variables across Five Cardiovascular Exercises


    Purpose: To quantify variations in plantar pressure variables in healthy adults across five cardiovascular exercises.

    Methods: Ten young (19-35 yr old) and 10 middle-aged (45-60 yr old) individuals participated. After equipment familiarization, plantar pressure data were recorded during walking, running, elliptical training, stair climbing, and recumbent biking. Separate one-way analyses of variance with repeated measures identified significant differences in pressure variables across exercises and between age groups under the forefoot, arch, and heel.

    Results: Forefoot: Peak pressures were higher during walking (253 kPa), running (251 kPa), and elliptical training (213 kPa) than stair climbing (130 kPa) and recumbent biking (41 kPa; P ≤ 0.001). Biking pressures were lower than all other conditions (P < 0.001). Arch: Pressures were higher during running (144 kPa) compared with all other conditions (P ≤ 0.001). Intermediate-level pressures during walking (119 kPa) and elliptical training (102 kPa) exceeded those during stair climbing (80 kPa; P ≤ 0.002). Pressures were lowest during recumbent biking (33 kPa; P < 0.001). Heel: Pressures were highest during walking (215 kPa) and running (188 kPa), exceeding those recorded during all other activities (P < 0.001). Moderate elliptical training pressures (94 kPa) surpassed stair climbing values (66 kPa; P = 0.014). Pressures were lowest during recumbent biking (25 kPa; P < 0.001). The only significant difference identified between age groups was a larger arch contact area in the young compared with middle-aged, when averaged across exercises (P = 0.011).

    Conclusions: When protection of the forefoot is important (e.g., diabetic foot neuropathies), biking and stair climbing offer optimal pressure reductions. If protecting the heel from high pressures and forces is warranted, recumbent biking, stair climbing, and elliptical training provide greater relief.

    Medicine & Science in Sports & Exercise:
    September 2007 - Volume 39 - Issue 9 - pp 1651-1658
    Joint Loading in the Lower Extremities during Elliptical Exercise


    Purpose: To determine the joint loading during elliptical exercise (EE) by a detailed three-dimensional dynamic analysis, and to compare the results with those during level walking.

    Methods: Fifteen male adults performed level walking and EE while 3D kinematic data, right pedal reaction forces (PRF), and ground reaction forces (GRF) were measured. Pedal rate (cadence) and step length during EE without workload were set according to those measured during level walking for each subject. The motion of the body's center of mass, lower-limb-joint angles and moments were obtained.

    Results: Pedal rates and step lengths were 52.20 rpm (SD = 2.34) and 50.56 cm (SD = 2.14), respectively. During early stance the vertical PRF was smaller than the GRF, and the medial and posterior shear components were greater. PRF also occurred during swing. Loading rates around heelstrike during EE were all smaller than those during walking. During EE, the peak flexion angles of the hip, knee and ankle were greater. Peak hip flexor and knee extensor moments were also greater, whereas peak ankle plantarflexor moments and all abductor moments were smaller.

    Conclusions: Different lower-limb kinematics and kinetics were found between EE and level walking. Smaller vertical PRF and loading rates during EE were achieved at the expense of greater hip flexor and knee extensor moments. Use of the elliptical trainer for athletic and rehabilitative training would have to consider users' joint function and muscle strength, especially at the knee, to avoid injury
  9. Craig Payne

    Craig Payne Moderator

    Or could it be due to a constant strain on the tibial nerve as the foot is constantly in the "stance" phase?
  10. Craig:

    The symptoms are only in the plantar metatarsal heads, no the longitudinal arch of the foot, which seems to indicate that the pathology is localized to the areas of highest plantar pressure at the plantar metatarsal heads, not the tarsal tunnel.

    In addition, I see some patients with large calf muscles and cavus type feet develop nearly the same symptoms as those seen on elliptical trainers that nearly always resolves with gastroc-soleus stretching and foot orthoses/in-shoe padding.

    Best diagnosis: Transient Forefoot Pressure Neuropathy
  11. CamWhite

    CamWhite Active Member

    And that's probably why my little rocker experiment works as well as it does. The shoes I'm wearing on the elliptical trainer offloads pressure on the metatarsal heads. That's great for the tingling in my forefoot, but what really makes me happy is there is no knee pain at all anymore.
  12. Athol Thomson

    Athol Thomson Active Member

    Hi Kevin,

    From the Burnfield study in my earlier post:

    Results: Forefoot Peak pressures were higher during walking (253 kPa), running (251 kPa), and elliptical training (213 kPa)

    Why do we hear from so many patients who only get the issue on the elliptical trainer despite marginally decreased forefoot plantar pressure when compared to walking or running?

  13. Athol:

    Because there is constant high pressure on the forefoot, with no swing/forward recovery phase that would allow periods of no pressure on plantar forefoot? Maybe ischemia? Certainly this is an interesting area for further research.
  14. While researching my February 2012 Precision Intricast Newsletter titled "Transient Forefoot Compression Neuropathy in Elliptical Trainers", I found a nice review article on compression neuropathies in the foot and lower extremity that I thought that many of you might enjoy (McCrory P, Bell S, Bradshaw C: Nerve entrapments of the lower leg, ankle and foot in sport. Sports Med, 32(6):371-391, 2002).

    Hope you like it.:drinks
  15. RobinP

    RobinP Well-Known Member

    Thanks kevin,

    I'm sure someone posted that pdf a couple of years ago . I printed it off then and subsequently lost it so thanks for posting it. I have been looking for it for a while.

    I too experience a transient forefoot neuropathy on an elliptical trainer and I'm pretty certain it is neurological and localised. Backwards motion on the trainer works for me(ie making the same elliptical motion in reverse). The Cop is shifted toward the heel a little more and one can still train with similar resistance. Never thought to raise the heel a little. Simpleton!

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