The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome

Abstract

Background:Previous studies have reported on the promising effects of changing running style in patients with chronic exertional compartment syndrome (CECS) using a 6-week training program aimed at adopting a forefoot strike technique. This study expands that work by comparing a 6-week in-house, center-based run training program with a less extensive, supervised, home-based run training program (50% home training).Hypothesis:An alteration in running technique will lead to improvements in CECS complaints and running performance, with the less supervised program producing less dramatic results.Study Design:Cohort study; Level of evidence, 3.Methods:Nineteen patients with CECS were prospectively enrolled. Postrunning intracompartmental pressure (ICP), run performance, and self-reported questionnaires were taken for all patients at baseline and after 6 weeks of running intervention. Questionnaires were also taken from 14 patients (7 center-based, 6 home-based) 4 months posttreatment.Results:Significant improvement between preintervention and postintervention rates was found for running distance (43%), ICP values (36%), and scores on the questionnaires Single Assessment Numeric Evaluation (SANE; 36%), Lower Leg Outcome Survey (LLOS; 18%), and Patient Specific Complaints (PSC; 60%). The mean posttreatment score on the Global Rating of Change (GROC) was between +4 and +5 (“somewhat better” to “moderately better”). In 14 participants (74%), no elevation of pain was reported posttreatment, compared with 3 participants (16%) at baseline; in all these cases, the running test was aborted because of a lack of cardiorespiratory fitness. Self-reported scores continued to improve 4 months after the end of the intervention program, with mean improvement rates of 48% (SANE), 26% (LLOS), and 81% (PSC). The mean GROC score improved to +6 points (“a great deal better”).Conclusion:In 19 patients diagnosed with CECS, a 6-week forefoot running intervention performed in both a center-based and home-based training setting led to decreased postrunning lower leg ICP values, improved running performances, and self-assessed leg condition. The influence of training group was not statistically significant. Overall, this is a promising finding, taking into consideration the significantly reduced investments in time and resources needed for the home-based program.

Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces

“…Their study population was homogeneous young, fit, officers in training, with CECS of the anterior compartment only. Recently several studies have confirmed the positive effects of gait retraining on the symptoms of CECS of soldiers 86 101 124. In addition, shoe type also plays an important role in the amount of force placed on the legs in running.…”

Biomechanical differences between cases with chronic exertional compartment syndrome and asymptomatic controls during walking and marching gait

“…As this was the first study to examine the biomechanics of CECS patients we also explored the angular and moment data of joints further up the kinetic chain. These more proximal joints have also been the subject of recent biomechanical interventions for CECS [21][22][23]. Measurements of leg length, height and body mass were performed using a tape measure, stadiometer (SECA, UK) and medical grade scales (SECA, UK) respectively.…”

Biomechanical differences between cases with suspected chronic exertional compartment syndrome and asymptomatic controls during running

“…Modifications to running style that have been used in an attempt to reduce the anterior compartment muscle activity of CECS patients have typically encouraged greater forward lean; along with changing from a heel strike to a forefoot strike, increasing cadence and reducing step length [18]. Clinical observations have also suggested that patients have abnormally high levels of ankle dorsiflexion throughout the gait cycle and 'reduced heel lift during swing phase' [15].…”

“…Conservative treatment through gait modification has recently been promoted as a viable option for CECS [15,17,18]. Forefoot running was first described as a possible treatment in a case report by Cunningham [19] that may reduce the anterior compartment muscle activity [20] and therefore pain.…”