Effect of eccentric exercise on patients with chronic exertional compartment syndrome.

Applied Biomedical Research Centre, GKT School of Biomedical Sciences, King's College London, Shepherd's House, Guy's Campus, UK.
Arbeitsphysiologie (Impact Factor: 2.66). 02/2003; 88(6):565-71. DOI: 10.1007/s00421-002-0740-z
Source: PubMed

ABSTRACT There are a number of similarities between chronic exertional compartment syndrome (CECS) and the effects of high force eccentric contractions in healthy controls. We hypothesised that CECS patients would be particularly susceptible to pain, fatigue and swelling after eccentric exercise. Ten CECS patients [aged 30.3 (8.0) years, mean (SD)], 7 males) and 14 healthy controls [aged 32.3 (9.0) years, 7 males] performed 40 maximal eccentric contractions of the anterior tibial muscles at an angular velocity of 90(o) s(-1). Maximal voluntary isometric contractions (MVC), force generated by electrical stimulation at 10 Hz and 50 Hz and muscle thickness (measured by real-time ultrasound scanning) were measured before exercise and for 10 min afterwards. Ratings of pain and tenderness were made before exercise, then 24 h and 48 h later. The two groups were comparable for initial isometric strength and muscle size. MVC force immediately after exercise fell to 90 (2.5)% [mean (SEM)] in patients and 86.5 (2.4)% in controls (P<0.0005 for both groups) and had not recovered after 10 min. Preferential loss of force at the low stimulation frequency occurred in both groups to a similar extent (20%, P<0.0005) and continued to decline over 10 min of recovery. There was no significant change in muscle thickness in either group. Only mild pain and tenderness were reported by the controls. The patients showed great individual variation but their mean pain scores were significantly higher during dorsiflexion and palpation (P<0.05) 24 h after exercise. After 48 h the patients reported more pain during dorsiflexion (P=0.005), plantarflexion (P<0.05) and palpation (P<0.05). These results suggest that some, but not all, CECS patients may be more susceptible to the pain associated with eccentric contractions that is thought to be the cause of damage and inflammation of connective tissue.

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    ABSTRACT: OBJECTIVE:: To test the hypothesis that patients with chronic exertional compartment syndrome (CECS) of the anterior leg compartment have an increased anterior compartment thickness (ACT) compared with control subjects after exertion using ultrasound. DESIGN:: Prospective comparison study. SETTING:: Diagnostic imaging department of a tertiary care hospital. PATIENTS:: Four patients with CECS and 9 control subjects. INTERVENTIONS:: Patients with CECS and control subjects ran on a treadmill for up to 10 minutes. ACT (both groups) and anterior compartment pressure (CECS patients) were measured before exertion and at scheduled intervals after exertion. MAIN OUTCOME MEASURES:: Anterior compartment thickness, percentage change in ACT from rest, and compartment pressure. RESULTS:: Anterior compartment pressures were diagnostic of CECS using the modified Pedowitz criteria in patients with CECS. Mean percentage change in ACT from rest in patients with CECS versus control subjects at 0.5 minutes was 21.3% versus 6.32% [95% confidence interval (CI), 6.92-35.6 and 0.094-12.5, respectively; P = 0.011], at 2.5 minutes, it was 24.6% versus 4.22% (95% CI, 10.7-38.5 and -1.85-10.3, respectively; P = 0.003), and at 4.5 minutes, it was 24.9% versus 5.08% (95% CI, 14.3-35.5 and -0.813-11.0, respectively; P = 0.003). Mean ACT in patients with CECS versus control subjects significantly increased after exertion (P = 0.003) at 0.5 minutes, 2.5 minutes, and 4.5 minutes. CONCLUSIONS:: Ultrasonography reveals a significant increase in ACT in patients with CECS of the anterior leg compartment. Further studies are warranted to validate these findings with the goal of developing anterior leg compartment CECS ultrasound diagnostic criteria and exploring the role of using ultrasound to diagnose CECS in other compartments.
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