I have a client who has been complaining of a burning sensation in his feet. He only get this when he is working out on the elliptical machines. He has not changed his shoes nor does he have any foot problems. This happens once a week, and it is painful enough for him to stop. Any ideas as to what this could be?
Without a comprehensive assessment, it would be nearly impossible to give you an exact protocol. However, let's discuss some possibilities that will help you in your thought process. Based on what you have stated, your client may be experiencing the “burning” due to eccentric overload to the musculofascial structures that decelerate pronation of the lower extremity. When the posterior tibialis, flexor hallucis longus and flexor digitorum longus become over loaded (controllers of pronation), they can create nerve, vascular and articular problems in the lower leg/foot region. The question now becomes why the overload? It is common to observe movement difficulty through deceleration of hip flexion, internal rotation and adduction (components of pronation) due to tightness in the hip flexor complex, which in turn decreases the neural drive to its functional antagonists - GLUTE MAXIMUS.
Now, a look at the elliptical: A great tool for many beginners due to the reduction in ground reaction forces that could be potentially dangerous. However, it is very difficult to maximally fire the glutes (which could already be inhibited due to hip flexor tightness) when the ankle is dorsiflexed as your client is moving through hip extension (prime motion for the glutes). Why is this a concern? Normal gait patterns involve triple extension of the lower extremity (hip extension, knee extension and plantar flexion). So, the machine is placing your client in more hip flexion without allowing max hip extension, which decreases the glutes ability to “fire.” Remember, the glute is a major controller of pronation or deceleration of the lower extremity. As you can see, it is easy to overload lower leg structures if the body is not able to work interdependently. Note: This does not make the elliptical machine a bad one. "It’s not what you do, it's how you do it!”
- Foam roll your clients IT Band, piriformis and adductors (see Self-Myofascial Release Techniques article by Alan Russell)
- Static stretch your clients hip flexors – in all three planes of motion (see A Simple Guide to Stretching)
- Dynamically stretch by using the elliptical or treadmill while having the client cognitively “fire" their glutes or use a dynamic functional warm-up (i.e., prisioner squats, single leg squat touchdown, single leg romanian deadlift, multi-planar lunge, running in place, butt kicks, side shuffle, carioca)
- Now perform the workout