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Biomechanical overload syndrome: Defining a new diagnosis

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... The increase in IMP associated with CECS may be due to changes in compartment compliance, compartment volume, or muscle activity. [5][6][7][8][9] It has been suggested that abnormally increased IMP in CECS directly correlates with fascia thickness and structural stiffness, which results in reduced compartment compliance. 8,9 Measurement of IMP is the currently accepted gold standard to confirm the diagnosis of CECS, and the 1-min post-exercise IMP is suggested as the best measure. ...
... 12 There have been questions over the value of IMP testing in the diagnosis of CECS. 6,13,14 Non-invasive methods for the diagnosis of CECS have been suggested, including magnetic resonance imaging (MRI) and near-infrared spectroscopy (NIRS). However, MRI may only be used as a screening test for CECS in the anterior compartment, and further, there is a need for an in-scanner exercise-based MRI, 15 which presently is not available. ...
... The value of IMP measurements has been questioned in earlier studies, 6,13,14 and there is no consensus as to how best to perform or evaluate the IMP measurements in suspected CECS patients. 31,32 Although non-invasive methods for the diagnosis of CECS, including MRI and NIRS, have been suggested, they may be applied as a screening test for CECS but have low sensitivity. ...
Article
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This study aimed to compare intramuscular pressure (IMP) in all four compartments of the lower leg between men and women in patients with suspected chronic exertional compartment syndrome (CECS), and to assess possible effects of gender in relation to covariation factors. A consecutive series of patients with exertional leg pain (n = 962, median age 27 years, 56.2% women) underwent IMP measurements between 2009 and 2019. The CECS diagnosis was confirmed (n = 491, 48% women) or ruled out (n = 471, 65% women) based on the patient’s history, clinical examination, and IMP measurements. IMP values of the compartments were compared between genders. A multiple linear regression analysis was performed for IMP in the anterior and lateral compartments, where the number of patients was large enough to investigate the possible impact of other factors such as height, age, and duration of pain. Among those with a confirmed CECS diagnosis, one‐minute post‐exercise IMP was significantly lower in women than in men for all four muscle compartments: anterior (median [range] mmHg 44 [24–120] vs. 50 [24–130]), lateral (35 [20–89] vs. 40 [26–106]), deep posterior (31 [25–36] vs. 34 [24–53]), and superficial posterior (32 [27–39] vs. 37 [22–54]). In the multiple regression analysis, gender differences remained significant in the anterior compartment but not the lateral compartment, where only height remained a significant predictor of IMP. Gender should be considered when using cut‐off values for IMP in diagnosing CECS, especially for the anterior compartment.
... [14][15][16][17] It is therefore reasonable to postulate that the spectrum of pathoanatomical diagnoses resulting in pain in the region of the shin could all respond to loadmodifying interventions. 16,18 Considering conditions with similar presentations and mechanisms, that are likely to benefit from similar functional interventions, with a region classification has precedence in musculoskeletal research and clinical practice, for example, anterior knee pain, 19 non-specific low back pain [20][21][22] and rotator cuff related pain. 23,24 These multifactorial regional classifications do not signify a specific pathoanatomical tissue damage or specific pathology. ...
... Tibial loading pain is characterised by activity-related pain in the anterior-anteromedial lower limb (shin) region with symptoms easing with periods of relative rest, 3 and is understood to result from a mismatch between external load and capacity for the regional tissue to withstand or recover from that load. 18 However, contemporary understanding of the neurobiology of pain within a biopsychosocial model of health suggests we should broaden our perspective on management even further to incorporate the complexities of pain presentations. High-value management of musculoskeletal pain entails patientcentred communication 57 and the clinical application of a wholeperson approach. ...
Article
Objective Conceptualisation of a clinically-relevant group of conditions as a region-based, load-related musculoskeletal pain condition (‘tibial loading pain’) to enable identification of evidence of treatment effect from load-modifying interventions. Design Systematic review and evidence synthesis based on a developed and justified theoretical position. Methods Musculoskeletal pain localised to the tibial (shin) region and consistent with clinical presentations of an exercise/activity-related onset mechanism, was conceptualised as a group of conditions (‘tibial loading pain’) that could be reasoned to respond to load modifying interventions. Five databases were searched for randomised controlled studies investigating any load-modifying intervention for pain in the anterior-anteromedial lower leg (shin). Study quality was evaluated (ROB-2) and level of certainty for the findings determined using the GRADE method. Results Six individual studies reporting seven comparisons were included. Interventions included braces, anti-pronation taping, compression stocking and a stretch + strengthening program. All included studies were assessed as having unclear or high risk of bias. The review found no evidence of beneficial effect of any of the load-modifying interventions on self-reported symptoms or function, physical performance or biomechanical measures, apart from a possible benefit of anti-pronation ‘kinesio’ taping. There was very low certainty evidence that kinesio taping improves pain and pain-free hopping distance after one week. The braces were associated with minor adverse effects and problems with acceptability. Conclusions None of the treatments investigated by the included studies can be recommended. Conceptualization of the problem as regional, primarily loading-related pain rather than as multiple distinct pathoanatomically-based conditions, and clearer load-modifying hypotheses for interventions are recommended.
... Since the tibialis anterior is the primary dorsiflexor of the ankle joint, changes in dorsiflexion moments can be reasonably assumed to affect tibialis anterior force requirements. Peak dorsiflexion moment reductions of up to 18% suggest that tibialis anterior force demands can be substantially overestimated when using CSM, which can have implications for investigations of running-related injuries that are associated with tibialis anterior fatigue and overuse, such as chronic exertional compartment syndrome (Franklyn-Miller et al., 2014). However, the muscle inertia effects demonstrated in this simple example are likely to be further magnified in other scenarios, especially those including high-velocity movements, joints crossed by biarticular muscles, and/or large muscle masses. ...
Conference Paper
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Skeletal muscles have substantial inertia that cause inertial forces working around joints. These inertial forces are not typically considered in musculoskeletal models used for sport biomechanics research, which can lead to considerable errors in estimated joint kinetics. How large these errors are in common sports movements is yet unclear. We therefore examined the role of shank muscle inertia on ankle joint moments during the swing phase of running at different speeds. Ankle moments were considerably affected when muscles were modelled as separate masses, with a general shift towards reduced dorsiflexion and higher plantarflexion moments. These results show that ignoring inertial muscle forces in musculoskeletal simulations can lead to under-or overestimations of structure-specific loads and possibly erroneous conclusions. We therefore encourage sport biomechanics researchers to consider the impact of muscle inertia on inverse dynamics calculations.
... 2 In 2014, the term "biomechanical overload syndrome" was introduced and later used for a syndrome that clinically mimics ant-CECS without pathologically elevated ICPs values. 2,3 ERLP has a manifest effect on young active duty service members in the armed forces. 4 In the Netherlands, ERLP is consistently in the top 3 of overuse injuries and constitutes a significant portion of the 25% attrition rate from musculoskeletal injuries during both basic and elite military training. ...
Article
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Objective: To explore the relationship between a single the intracompartmental pressure value in the anterior compartment of the leg one 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. Interventions: All patients completed a comprehensive conservative treatment program, consisting of four to six 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 Measure(s): The primary treatment outcome was return to active duty. The duration of treatment, occurrence of acute on chronic compartment syndrome, and patient reported outcome measure 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=0.64). A lower SANE-score at intake was negatively associated with the potential to successfully return to active duty (odd ratio 0.95, p=0.01). No acute on chronic compartment syndromes were reported. Conclusions: A single postexercise intracompartmental pressure 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.
... It is known that high recurrent loading of the ACL can lead to graft creeping and eventually failure [20]. Furthermore, issues such as patellofemoral pain syndrome are typically the cumulation of chronic overload [13] and common after ACLR. It is recommended to monitor the cumulative loading of respective tasks, which can be done through documenting the exercise sets, reps and weight lifted/foot contacts alongside the task intensity. ...
Article
Nach einer Rekonstruktion des vorderen Kreuzbands wollen verletzte Sportler so schnell wie möglich wieder zurück auf den Platz. Die Autoren erklären, welche Rolle das Sprungtraining dabei spielt und was man beachten muss.
... Decreased gluteus maximus strength is theorized to lead to increased reliance on the secondary hip extensor muscles, such as the hamstrings and hip adductors to produce hip extension torque (Macadam & Feser, 2019;Wagner et al., 2010). Dependency on secondary hip extensors may lend to greater tissue stress in the hamstring and hip adductor musculature, thus resulting in a higher risk of soft tissue injury (Franklyn-Miller et al., 2014;Kisner et al., 2017;Renström & Johnson, 1985) as well as decreased performance. ...
... Due to ethical reasons, we performed no simultaneous intracompartmental pressure measurements, which is frequently described as standard for confirming CECS [28]. Strong evidence from recent research, however, questions the value of intra-compartmental pressure measurements to effectively diagnose CECS [2,6,10,11,29,30]. Previous studies demonstrated that the indication for operative compartment release could be based on history and clinical findings alone [8,30]. ...
Article
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Background Diagnosing chronic exertional compartment syndrome (CECS) is still a challenge. An increase in intramuscular pressure during and following exercise is accepted as the diagnostic standard. However, neither the methods used nor the interpretation of the obtained results are sufficiently standardized. Methods In the present pilot study, the metabolic state of CECS patients was investigated using microdialysis. We hypothesized that there was no difference in intramuscular concentrations of glucose, lactate, glutamate, and glycerol before and after exercise (H10) or between patients suffering from CECS and healthy control subjects (H20). This study was designed as an explorative case-control study (level of evidence III). Twelve patients suffering from CECS of the lower leg and six matched asymptomatic control subjects underwent microdialysis in the anterior (n = 7) or deep posterior compartment (n = 11) of the leg. Following ultrasound-guided insertion of the microdialysis catheters, 10-minute fractions of the dialysates were collected first during rest and then following fatigue- or pain-induced discontinuation of exercise. Dialysates were analysed for lactate, glucose, glutamate, and glycerol concentrations 6 × 10 min before and 6 × 10 min after exercise. Results Exercise-induced increases in lactate, glutamate, and glycerol concentrations were detected in both CECS patients and control subjects (all p < 0.001). No differences between CECS patients and control subjects were found by comparing the intramuscular glucose, lactate, glutamate, and glycerol concentrations at rest and following exercise (all p > 0.05). Conclusions We found exercise-induced increases in the lactate, glutamate, and glycerol levels in skeletal muscle. However, the metabolic changes did not differentiate CECS patients from healthy subjects. Trial registration The registration trial number is DRKS00021589 on DRKS. ‘Retrospectively registered’. Date of registration: April 4, 2020.
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This paper presents a four-stage plyometric program to be undertaken as part of criterion-based rehabilitation for athletes with anterior cruciate ligament reconstruction (ACLR). After ACLR, the patient experiences alterations of joint mobility, gait and movement patterns, neuromuscular function and general physical fitness. Plyometric training is an important component for neuromuscular and movement re-conditioning after ACLR. Effective use of plyometrics can support enhancements in explosive sporting performance, movement quality and lower risk of injury. Plyometric training, as a component of the ACL functional recovery process, can aid in restoring function and supporting timely return to sport. However, few patients undertake or complete a plyometric program prior to return-to-sport. To truly impact individual patients, a stronger focus on research implementation is needed from researchers to translate efficacious interventions into practice. In designing a plyometric program, it is important to match the specific plyometric tasks to the functional recovery status of the ACLR patient. To do this, it is important to understand the relative intensity of plyometrics tasks, align these tasks to the ACL functional recovery process and monitor the athlete as part of criterion based rehabilitation. Plyometric intensity is based on the intensity of efforts, the vertical and/or horizontal momentum prior to ground contact, the ground contact time and the surface or environment on which they are performed on/in. Furthermore, how the person technically performs the task will influence joint loading. There should be a gradual increase in task intensity and specificity throughout the program, with all tasks used for both neuromuscular and motor control re-conditioning. The aim of this paper is to provide recommendations to clinicians on how to design and implement plyometric training programs for the ACLR patient, as part of the functional recovery process. Level of evidence: 5.
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La sobrecarga es una de las etapas del continuo de carga vocal. Actualmente, se considera que su investigación permite una mejor comprensión de la patología y sintomatología funcional de la voz. El objetivo de este trabajo fue analizar las consecuencias laringoscópicas, electroglotográficas, acústicas y sintomatológicas producidas por la sobrecarga vocal en mujeres con voces sanas y no entrenadas. Se examinó el comportamiento acústico, laringoscópico, electroglotográfico y sintomatológico de 30 mujeres que se sometieron a una tarea de sobrecarga vocal caracterizada por la lectura ininterrumpida de un texto durante 60 minutos, cuya intensidad fluctuó entre los 75 y 85 dB. A nivel laringoscópico, se observó mayor vascularización, aumento de la compresión supraglótica y cambios en la amplitud, simetría y onda mucosa. Acústicamente, se evidenció incremento significativo en la frecuencia fundamental e intensidad vocal. En la electroglotografía, el cociente de cierre y la fase abierta y cerrada disminuyeron significativamente, mientras que a nivel sintomatológico, la totalidad de la muestra expresó al menos un síntoma de fatiga vocal. En conclusión, los hallazgos observados son expresiones de la fatiga del mecanismo tiroaritenoideo y de la inflamación aguda de la cubierta cordal.
Article
Clinical history and physical examination are usually not sufficient to diagnose leg chronic exertional compartment syndrome (CECS). Two predictive clinical models have been proposed. The first model by De Bruijn et al. is displayed as a nomogram that predicts the probability of CECS according to a risk score. The second model by Fouasson-Chailloux et al. combines two signs (post-effort muscle hardness on palpation or hernia). To evaluate those models, we performed a prospective study on patients who were referred for possible CECS. 201 patients underwent intra-compartmental pressure at 1-min post-exercise (CECS if ≥ 30 mmHg) – 115 had CECS. For the De Bruijn et al. model, the risk score was 7.5±2.2 in the CECS group and 4.6±1.7 in the non-CECS group (p<0.001) with an area under the ROC curve of 0.85. The model accuracy was 80% with a sensitivity of 82% and a specificity of 78%. Concerning Fouasson-Chailloux et al. model, the accuracy was 86%; the sensitivity and the specificity were 75 and 98%, respectively. The De Bruijn et al. model was a good collective model but less efficient in individual application. In patients having both muscle hardness and hernia, we could clinically make the diagnosis of CECS.
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Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners. For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition. Case series; Level of evidence, 4. Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention. After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery. In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients.
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Chronic exertional compartment syndrome (CECS) is occasionally observed in the forearm flexor muscles of motocross racers. Long-term results of fasciectomy and fasciotomy for this syndrome are scarce. To study the long-term effects of 2 surgical techniques for forearm flexor CECS. Case series; Level of evidence, 4. A database of patients with forearm CECS who underwent surgery was analyzed. Long-term pain reduction (visual analog scale [VAS], 0-100) and efficacy were evaluated using a questionnaire. Data of 24 motocross racers were available for analysis. Intracompartmental pressures during rest, during provocation, and after 1 and 5 minutes of provocation were 15 ± 4, 78 ± 24, 29 ± 10, and 25 ± 7 mm Hg, respectively. Painful sensations in the forearm were reduced from 53 to 7 (median VAS; P < .001). Both fasciectomy (n = 14) and fasciotomy (n = 10) were equally effective. More than 95% (23/24) of the patients were satisfied with the postoperative result after 5 ± 2 years' follow-up. Surgical fasciotomy and fasciectomy of the forearm flexor compartment are equally successful in motocross racers suffering from forearm CECS.
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The available data on the innervation of the thoracolumbar fascia (TLF) are inconsistent and partly contradictory. Therefore, the role of the fascia as a potential source of pain in the low back is difficult to assess. In the present study, a quantitative evaluation of calcitonin gene-related peptide (CGRP) and substance P (SP)-containing free nerve endings was performed in the rat TLF. A preliminary non-quantitative evaluation was also performed in specimens of the human TLF. The data show that the TLF is a densely innervated tissue with marked differences in the distribution of the nerve endings over the fascial layers. In the rat, we distinguished three layers: (1) Outer layer (transversely oriented collagen fibers adjacent to the subcutaneous tissue), (2) middle layer (massive collagen fiber bundles oriented obliquely to the animal's long axis), and (3) inner layer (loose connective tissue covering the paraspinal muscles). The subcutaneous tissue and the outer layer showed a particularly dense innervation with sensory fibers. SP-positive free nerve endings-which are assumed to be nociceptive-were exclusively found in these layers. Because of its dense sensory innervation, including presumably nociceptive fibers, the TLF may play an important role in low back pain.
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In this paper the authors present a case history along with results of case series and a literature review to demonstrate the complexity of this condition. The main aim is to increase the awareness among clinicians and the scientist to research in the area of chronic exertional compartment syndrome (CECS). CECS usually refers to myoneural ischaemia due to a reversible increase in tissue pressure within a myofascial compartment. CECS of the leg is well documented in the literature since it was first described by Mavor in 1956. CECS of the foot remains underdiagnosed and has been reported in the literature only on an anecdotal basis. Wood Jones proposed that there were four compartments in the foot but Manoli and Weber suggest that there are nine separate muscle compartments. Clinical signs and symptoms of CECS of the foot remain diverse and lack the consistency of its counter part in the leg. The range of signs and symptoms include swelling, tension, cramps, tightness, paraesthesia, numbness, cyanosis and soft tissue indurations. As a result number of diagnosis is first considered and includes plantar fasciitis, tibialis posterior tendonitis, tarsal tunnel syndrome and medial Lisfranc injury. CECS of the foot remains a diagnosis of exclusion. The most effective treatment is a superficial fasciotomy.
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Striding bipedalism is a key derived behaviour of hominids that possibly originated soon after the divergence of the chimpanzee and human lineages. Although bipedal gaits include walking and running, running is generally considered to have played no major role in human evolution because humans, like apes, are poor sprinters compared to most quadrupeds. Here we assess how well humans perform at sustained long-distance running, and review the physiological and anatomical bases of endurance running capabilities in humans and other mammals. Judged by several criteria, humans perform remarkably well at endurance running, thanks to a diverse array of features, many of which leave traces in the skeleton. The fossil evidence of these features suggests that endurance running is a derived capability of the genus Homo, originating about 2 million years ago, and may have been instrumental in the evolution of the human body form.
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Using a survey questionnaire design, we investigated the incidence, site, and nature of jogging injuries among all participants of a popular 16 km race. The response rate was 83.6%. Of 4,358 male joggers, 45.8% had sustained jogging injuries during the 1 year study period, 14.2% had required medical care, and 2.3% had missed work because of jogging injuries. Occur rence of jogging injuries was independently associated with higher weekly mileage (P < 0.001), history of previous running injuries (P < 0.001), and competitive training motivation (P = 0.03). Higher mileage was also associated with more frequent medical consultations due entirely to jogging-related injuries. In 33 to 44 year olds (N = 1,757), the number of years of running was inversely related to incidence of injuries (P = 0.02). Injuries were not significantly related to race running speed, training surface, characteristics of running shoes, or relative weight. Achillodynia and calf muscle symptoms were the two most common overuse injuries and occurred significantly more often among older run ners with increased weekly mileage. We conclude that jogging injuries are frequent, that the number of firmly established etiologic factors is low, and that, in recom mending jogging, moderation should be the watchword.
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Purpose: The purpose of this study is to evaluate the effects of increased compartment pressure on anterior tibial arteriovenous flow patterns and to determine whether mechanical and biochemical properties of fascia are responsible for compartment pressure abnormalities. Methods: Twenty patients with chronic anterior compartment syndrome (CACS) and 20 age-matched control subjects had compartment pressure measurements and analysis of tibial arterial and venous flow before and after fasciectomy. Fascia specimens were evaluated for thickness, stress failure, structural stiffness, and total collagen content and prevalence of collagen cross-linkage. Results: Pressures were significantly elevated in patients with CACS versus control subjects (23.8 mm Hg vs 6 mm Hg). No significant difference in tibial arterial flow could be detected in either group (43 cm/sec mean vs 41.9 cm/sec mean). Venous drainage was severely impaired in patients with CACS but not in control subjects. CACS fascia was thicker and stiffer than control fascia specimens (0.35 mm +/- 0.12 mm, 109 +/- 65 MN/mm; versus 0.22 mm +/- 0.06 mm; 60.3 +/- 22 MN/mm). Fasciectomy normalized postoperative compartment pressures and improved venous drainage. Collagen content per unit mass was similar for both CACS and control fascia specimens, although collagen cross-linking was significantly lower in the CACS fascia than in the controls. Conclusions: Tibial venous drainage is impaired, but arterial flow is not in patients with CACS. Fascia thickness and structural stiffness can account for increased pressure in CACS compartments. Collagen content and cross-linkage are unrelated to fascia stiffness or thickness. Postoperative improvement in vascular hemodynamics and reduction in compartment pressure is caused by increased capacitance in the compartment after fasciectomy.
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This retrospective study tests if runners who habitually forefoot strike have different rates of injury than runners who habitually rearfoot strike. We measured the strike characteristics of middle- and long-distance runners from a collegiate cross-country team and quantified their history of injury, including the incidence and rate of specific injuries, the severity of each injury, and the rate of mild, moderate, and severe injuries per mile run. Of the 52 runners studied, 36 (69%) primarily used a rearfoot strike and 16 (31%) primarily used a forefoot strike. Approximately 74% of runners experienced a moderate or severe injury each year, but those who habitually rearfoot strike had approximately twice the rate of repetitive stress injuries than individuals who habitually forefoot strike. Traumatic injury rates were not significantly different between the two groups. A generalized linear model showed that strike type, sex, race distance, and average miles per week each correlate significantly (P < 0.01) with repetitive injury rates. Competitive cross-country runners on a college team incur high injury rates, but runners who habitually rearfoot strike have significantly higher rates of repetitive stress injury than those who mostly forefoot strike. This study does not test the causal bases for this general difference. One hypothesis, which requires further research, is that the absence of a marked impact peak in the ground reaction force during a forefoot strike compared with a rearfoot strike may contribute to lower rates of injuries in habitual forefoot strikers.
Article
Chronic exertional compartment syndrome (CECS) of the lower limb is part of a group of overuse lower limb injuries with common presenting features. It is commonly diagnosed by the measurement of raised intramuscular pressures in the lower limb. The pathophysiology of the condition is poorly understood, and the criteria used to make the diagnosis are based on small sample sizes of symptomatic patients. We carried out a systematic review to compare intramuscular pressures in the anterior compartment of healthy subjects with commonly used criteria for CECS. Thirty-eight studies were included. With the exception of relaxation pressure, the current criteria for diagnosing CECS, considered to be the gold standard, overlap the range found in normal healthy subjects. Several studies reported mean pressures that would prompt a positive diagnosis for CECS, despite none of the subjects reporting any symptoms. The intramuscular pressure at all time points has also shown to vary in relation to a number of other factors other than the presence of CECS. Taken together, these data have major implications on the ability to use these published criteria for diagnosis and question the underlying pathophysiology. Clinicians are recommended to use protocol-specific upper confidence limits to guide the diagnosis following a failed conservative management.
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To examine the construct and concurrent validity of a new occupational military outcome measure (the Functional Activity Assessment [FAA]). A validation study. British Defence rehabilitation facilities. A total of 141 service personnel who attended a musculoskeletal injury assessment clinic. The association among the Short Form 36 (SF-36), Physical Workload Questionnaire, and the FAA was examined. Agreement and correlation with an actual medical category also was examined. FAA, SF-36 and Physical Workload Questionnaire scores. The FAA was significantly correlated with heavy physical workload and all SF-36 subscale and component scores, in line with predictions. The regression model retained 3 variables that accounted for 49% of the variation in FAA, most of which was accounted for by the role-physical subscale score of the SF-36. The FAA was well correlated with actual medical category. The FAA is a valid measure of physical health in relation to physical workload.