Comparing Clinical and Biomechanical Metrics for Treatment of Chronic Exertional Compartment Syndrome: A Regression Approach- APTA CSM 2026
t velasco, n reilly, c hulsopple, k roberts, r boeth, d hoellen, c dickison, d goss, j leggit
Abstract accepted for poster presentation at the 2026 American Physical Therapy Association Combined Sections Meeting
Chronic exertional compartment syndrome (CECS) presents a significant challenge for active-duty service members (ADSMs), with exercise-induced lower-limb pain, weakness, and in extreme cases, disability impacting military readiness. While various treatments have been described, from surgery to structured exercise programs, no consensus on an optimal treatment approach currently exists for CECS2-6. This randomized, placebo-controlled trial’s objective was to determine how different components of a multifaceted, non-surgical treatment program—specifically botulinum toxin A (BoTN-A) injections and structured gait retraining—were associated with improvements in distinct clinical and biomechanical outcomes.
36 ADSMs diagnosed with CECS via Pedowitz’s criteria were randomized to receive BoTN-A (n=20) or saline injections (n=16) into the anterior and lateral lower leg compartments. All participants received structured gait retraining with corrective exercises and running form instruction.
A multiple regression model was developed to analyze the relationship between the interventions and various biomechanical and clinical metrics over the course of rehabilitation. Biomechanical metrics were collected during treadmill running using instrumented shoe insoles (Loadsol, Novel USA, St. Paul, MN)7 to measure cadence, average vertical loading rate (AVLR), and peak ground reaction forces (GRF). Clinical metrics included self-reported current and worst pain, as well as functional scores during running and day-to-day activities via the University of Wisconsin Running Index (UWRI), and Single Assessment Numerical Evaluation (SANE), respectively. All metrics were collected at baseline, 8 weeks, and 3 months.
The analysis revealed that participation in the structured gait retraining program was significantly associated with reduction in self-reported current pain (Est: -1.52, p=0.03) and worst pain (Est: -2.86, p<0.01) at the 3-month follow-up. BoTN-A use was significantly associated with reduced AVLR during running at 3 months (Est: -10.74, p<0.01). While the overall model was significantly associated with improved UWRI scores (p=0.03), no single intervention independently reached significance for this outcome.
A combined, non-surgical approach is beneficial for treating CECS in ADSMs. The components of the multimodal intervention target different aspects of the condition—structured gait retraining was most associated with pain reduction (clinical outcome), while BoTN-A was most associated with improved loading mechanics (a biomechanical outcome).