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: 2.19). 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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    • "to detect clinically important changes (Lexell and Downham 2005). Reliability estimates for test retest measures of muscle thickness in healthy people have demonstrated that ultrasound measures of muscle size have high reliability (Bemben 2002; Birtles et al. 2003; Gondin et al. 2005; Miyatani et al. 2004; Oguri et al. 2004; Rankin and Stokes 1998; Thoirs and English 2009). However, the results of these trials should be considered with some caution, due to shortfalls relating to measurer blinding, sample size and statistical analyses. "
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    ABSTRACT: This prospective, blinded study investigates the test retest reliability of measures of muscle thickness made by one sonographer across two cohort groups (n = 29) of people hospitalised with acute stroke. Reliability was assessed in cohort one (n = 14) for measurements made bilaterally at the anterior and posterior upper arms, the anterior and posterior thighs (total of eight measurements) and in cohort two (n = 15), for measurements made bilaterally at the lateral forearms, the anterior abdominal wall and the anterior and lower legs (total of eight measurements). Reliability estimates varied between measurement sites; intraclass correlation coefficients (ICCs) ranged from -0.26 (lateral forearm, paretic side) to 0.95 (anterior thigh, nonparetic side), percent mean differences ranged from 0.42% (posterior upper arm, nonparetic side) to 14.68% (anterior lower limb, nonparetic side) and method error ranged from 1.08 (abdomen, nonparetic side) to 9.69 mm (posterior lower limb, nonparetic side). Only four measurement sites (anterior upper arm, posterior upper arm, abdomen and anterior thigh) were within the acceptable ranges (ICC 0.60 to 1.00, mean percent difference range 0%-5% and method error range 0-5 mm) and considered reliable to use for measures of muscle thickness in people hospitalised with acute stroke.
    Ultrasound in medicine & biology 03/2012; 38(3):368-76. DOI:10.1016/j.ultrasmedbio.2011.12.012 · 2.21 Impact Factor
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    • "The response of muscle tissue to eccentric exercise particularly involves the cytoskeletal proteins desmin and actin (Yu and Thornell 2002; Yu et al. 2002; Lieber et al. 2002), as well as causing sarcomere disruption (Morgan and Proske 2004; Friden and Lieber 1998) with resulting sarcomerogenesis/myoWbrillar remodelling (Yu and Thornell 2002; ButterWeld and Herzog 2006). It is speculated that DOMS may be an event occurring in various tissues including epimysium/fascia rather than muscle tissue proper (Malm et al. 2004; Birtles et al. 2003). This is in line with facilitated Xexor-withdrawal response to electrical stimulation found speciWcally at the level of the fascia in rabbit gastrocnemius muscle 48 h post-eccentric exercise (Itoh and Kawakita 2002). "
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    ABSTRACT: Mechanisms and structures which are involved in eccentric exercise-induced delayed onset muscle soreness (DOMS) are not yet clarified. Tissue and site specificity may be important considerations in afferent sensitisation following eccentric exercise. This study investigated the nociceptive response to hypertonic sodium solution applied to fascial/epimysium tissue and mechanically sensitised sites in muscle by assessing (1) afferent recordings in animals and (2) psychophysical assessment in humans. Seventeen male rats underwent eccentric contraction of extensor digitorum longus muscle, while 11 rats served as an unexercised naïve group. Two days post-exercise, group IV afferent fibre activity was recorded in response to superfusion of hypertonic Krebs solution on the mechanically sensitised muscle/epimysium site. Mechanical sensitisation was confirmed with significant increases in afferent response and decreases in threshold to mechanical stimulation in the eccentrically exercised rats compared to naïve rats. There was no difference in afferent response magnitude to hypertonic Krebs solution between exercise and naïve groups. In the human study, 13 volunteers participated. After bilateral assessment of pressure pain thresholds (PPT) along the tibialis anterior muscles, eccentric exercise was performed to induce DOMS in m. tibialis anterior of one leg. Site of maximal mechanical sensitivity was identified 24 h later and injected with hypertonic saline at fascial and deep muscle levels. The corresponding site on the opposite unexercised leg served as a control. Fascial injection of the exercised muscle caused significantly higher pain intensity compared to all other injections. Response to deep muscle stimulation was not different between sides. This suggests that fascia rather than muscle tissue is important in DOMS associated sensitisation.
    Experimental Brain Research 02/2009; 194(2):299-308. DOI:10.1007/s00221-008-1699-8 · 2.04 Impact Factor
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    • "Of note, radiographic findings typically are normal in cases of chronic CECS (Blackman et al., 2000). Repeated episodes of CECS may lead to compartment fascia thickening and concomitant fibrosis, which increasingly affects the ability to return to its normal state of yield (Birtles et al., 2002; Bong et al., 2005). "
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    ABSTRACT: The aim of the study was to assess pre, during, and postexercise compartment pressures in the anterior tibial compartment in asymptomatic long distance runners (5000 m) and recreational athletes. Forty-eight participants (n = 48, 24 females and 24 males) underwent the experimental procedures. The participants were assigned into 4 groups of 12 volunteers. Intracompartmental pressures measurements were recorded 1 minute before, at the 1st minute after the onset of exercise, and finally 5 minutes after the completion of the exercise on treadmill. The wick catheter technique was the method of choice for measuring intracompartmental pressure values. Post hoc analysis of the groups by measures interaction indicated that all pairwise comparisons among pre-test (1 minute before exercise), during-test (1st minute during exercise), and post-test measures (5 minutes after exercise) were statistically significant for male controls (p < .001), male athletes (p < .001), female controls (p < .001) and female athletes (p < .001). The results confirm the correlation between long distance runners and the increased risk of chronic exertional compartment syndrome (CECS) development.
    Journal of sports science & medicine 03/2008; 7(1):96-100. · 1.03 Impact Factor
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