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

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

• Chronic exertional compartment syndrome
• Conservative treatment
• Medial tibial stress syndrome
• Military personnel
• Rehabilitation