Non-Surgical Interventions and Instrumented Running Kinetics Evaluation for Treatment of Lower-Limb Chronic Exertional Compartment Syndrome in an Active-Duty Service Member: A Case Study — MHSRS 2023

Reilly N, Velasco T, Roberts K, Hulsopple C, Wise S, Goss D, Leggit J

Abstracted accepted for a poster session at the 2023 Military Health System Research Symposium

Active-duty service members (ADSMs) regularly run and perform vigorous physical activity per their training and physical fitness requirements. As such, ADSMs are at a higher risk of developing acute and persistent running-related musculoskeletal pathologies. As such, chronic exertional compartment syndrome (CECS) presents a significant clinical problem among the ADSM population. The condition impacts the ability to run as the repetitive mechanical strains incurred during gait result in localized pain, weakness, and/or paresthesia, predominantly in the musculature of the lower legs. Troublingly, the exact pathophysiology of CECS is not thoroughly understood, and surgical interventions to treat the condition (i.e., fasciotomy) have generally seen mixed outcomes regarding clinical success. As a result, alternative, non-surgical approaches have received increased attention. Two such approaches include 1) pharmaceutical interventions via botulinum toxin A (BoNT-A) to reduce lower limb pain and symptoms and perhaps reduce intramuscular compartment pressure, and 2) structured gait retraining to modify running mechanics (i.e., transition to forefoot strike pattern) to decrease skeletal muscle activity and stresses of the lower limbs. Prior research and case series utilizing each modality have reported promising results and clinical outcomes regarding pain and overall function during running. However, the implementation of these non-surgical interventions for patients with CECS has, to date, been limited in scope due to the availability of laboratory-grade equipment and analytical expertise for corresponding biomechanical gait data. The combination of these modalities on specific biomechanical gait parameters associated with injury risk in patients with CECS is mainly unexplored.