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Exercise Induced lower leg pain is a common condition with a number
of differential diagnoses which commonly overlap, one of which is chronic
exertional compartment syndrome (CECS). Traditionally, CECS is thought to
be caused by elevated pressures in a muscular compartment and is commonly
diagnosed by measuring elevated intramuscular pressures.
However, as discussed by Hislop and Batt (2011), there continues to...
However, as discussed by Hislop and Batt (2011), there continues to
remain uncertainties with regards to methodological issues, risks involved
and the necessity of resting and bilateral pressure measurements and
debate on the types of compartments measured. Roberts & Franklyn-
Millar (published online, 2011) found in their systematic review that the
pressures used to diagnose CECS overlap with normal healthy subjects
Surely the question we need to ask is that, are we diagnosing,
investigating and treating these patients effectively? As clinicians, we
need to be sure that the intervention administered is necessary and
beneficial. Given uncertainties, it would be prudent to understand the
pathophysiology of the condition and the presenting symptoms.
Poor biomechanics can predispose to overload of muscular or tendon
structures resulting in overuse and pain. Correcting the biomechanical
element that is causing these symptoms can be a method to treat patients
who present with symptoms akin to CECS.
A study done in patients with patello-femoral syndrome found that
gait retraining resulted in significant improvement in hip mechanics that
was associated with a reduction in pain and improvements in function
(Noehran et.al, 2011). It is thought that the reduction in vertical load
rates may be protective for the knee and reduce the risk for other running
related injuries. It may be that this rationale can be extrapolated in
exercise induced lower leg pain and is a way forward to treating these
patients prior to subjecting them to invasive tests.
Hislop & Batt (2011) Chronic Exertional Compartment Syndrome. Br
J Sports Med; Vol 45 (12): 954-955
Noehren, Scholz & Davis (2011) The effect of real-time gait
retraining on hip kinematics, pain and function in subjects with
patellofemoral pain syndrome. Br J Sports Med; Vol 45 (9): 691-696
Roberts & Franklyn-Millar (2011) The Validity of the diagnostic
criteria used in Chronic Exertional Compartment Syndrome: A systematic
review. Scand J Med Sci Sports. First published online: 13 Sep 2011