Disclosures: Ankur A. Patel, DO: Nothing to disclose

Case Description: The patient was referred to the clinic due to persistent right leg pain, numbness on the plantar surface of his right foot, and inability to plantar-flex his toes in his right foot for several weeks. Initial symptoms began with acute onset right back and leg pain during a high intensity interval training session at his gym. Magnetic resonance imaging (MRI) of the lumbar spine was unremarkable; therefore, the patient was recommended physical therapy and started on a neuromodulating agent. Despite multiple sessions of physical therapy and pharmacologic treatment, the patient had no symptomatic relief.

Setting: Outpatient academic rehabilitation clinic.

Patient: A 63-year-old male with acute onset tibial nerve dysfunction.

Assessment/Results: Electromyography (EMG) studies demonstrated abnormal spontaneous insertional activity, fibrillation, positive sharp waves, and a reduced recruitment pattern for the following muscles: right abductor hallucis, right flexor hallucis longus, and right flexor digitorum longus. Additionally, nerve conduction studies showed evidence of low amplitude right tibial nerve conduction. These results are suggestive of right tibial nerve injury between the insertions of flexor digitorum longus and flexor hallucis longus in the right calf and the insertion of tibialis posterior in the right calf.

Discussion : This is the first reported case, to our knowledge, of high-intensity interval training (HIIT) causing tibial nerve dysfunction. HIIT utilizes repeated sessions of short-duration, high-intensity “all out,” exercises separated by periods of rest or low-intensity exercises to optimally stimulate the excess post-exercise oxygen consumption (EPOC) effect. HIIT has been rising in popularity amongst active patients and athletes due to its time-efficient workouts and documented health benefits.

Conclusion: HIIT is an important consideration as a source of nerve injury among active patients and even more so in patients who may be increasingly prone to injury including older and unconditioned patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/high-intensity-interval-training-leading-to-tibial-nerve-dysfunction-a-case-report/