Association Between Intracompartmental Pressures in the Anterior Compartment of the Leg and Conservative Treatment Outcome for Exercise-Related Leg Pain in Military Service Members

Sanne Vogels; Eric W P Bakker; Francis G O'Connor; Rigo Hoencamp; Wes O Zimmermann

doi:10.1016/j.arrct.2021.100171

Association Between Intracompartmental Pressures in the Anterior Compartment of the Leg and Conservative Treatment Outcome for Exercise-Related Leg Pain in Military Service Members

Arch Rehabil Res Clin Transl. 2021 Dec 4;4(1):100171. doi: 10.1016/j.arrct.2021.100171. eCollection 2022 Mar.

Authors

Sanne Vogels^{1

2}, Eric W P Bakker³, Francis G O'Connor⁴, Rigo Hoencamp^{1

2

5

6}, Wes O Zimmermann^{4

7}

Affiliations

¹ Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
² Trauma Research Unit, Department of Trauma Surgery, Erasmus MC, Rotterdam, The Netherlands.
³ Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
⁴ Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
⁵ Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.
⁶ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Royal Netherlands Army, Department of Sports Medicine, Utrecht, The Netherlands.

Abstract

Objective: To explore the relationship between a single the intracompartmental pressure (ICP) value in the anterior compartment of the leg 1 minute after provocative exercise and the outcome of a conservative treatment program in a cohort of military service members with chronic exercise-related leg pain.

Design: Retrospective cohort study.

Setting: Department of military sports medicine at a secondary care facility.

Participants: In the years 2015 through 2019, the conservative treatment program was completed by 231 service members with chronic exercise-related leg pain, of whom 108 patients with 200 affected legs met all inclusion criteria (N=108).

Interventions: All patients completed a comprehensive conservative treatment program, consisting of 4-6 individual gait retraining sessions during a period of 6-12 weeks. In addition, patients received uniform homework assignments, emphasizing acquisition of the new running technique.

Main outcome measures: The primary treatment outcome was return to active duty. The duration of treatment, occurrence of acute on chronic compartment syndrome, and patient-reported outcome measures were considered secondary treatment outcomes. Potential risk factors for the primary treatment outcome were identified with a generalized logistic mixed model.

Results: Return to active duty was possible for 74 (69%) patients, whereas 34 (31%) needed further treatment. The multivariable analysis showed that the absolute values of ICP in the anterior compartment were not associated with the treatment outcome (odds ratio, 1.01; P=.64). A lower Single Assessment Numeric Evaluation score at intake was negatively associated with the potential to successfully return to active duty (odds ratio, 0.95; P=.01). No acute on chronic compartment syndromes were reported.

Conclusions: A single postexercise ICP value in the anterior compartments of the lower leg of military service members with chronic exercise-related leg pain was not associated with the outcome of a secondary care conservative treatment program and can be safely postponed.

Keywords: CECS, chronic exertional compartment syndrome; Chronic exertional compartment syndrome; Conservative treatment; ERLP, exercise-related leg pain; GPE, Global Perceived Effect; ICP, intracompartmental pressure; Medial tibial stress syndrome; Military personnel; Rehabilitation; SANE, Single Assessment Numeric Evaluation; ant-CECS, anterior chronic exertional compartment syndrome.