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The diagnosis and management of chronic exertional compartment syndrome in the UK military population.

Roscoe, David (2016) The diagnosis and management of chronic exertional compartment syndrome in the UK military population. Doctoral thesis, University of Surrey.

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Abstract

Background Chronic Exertional Compartment Syndrome (CECS) presents as exertional pain in the lower limb presumed to be a result of elevated intramuscular compartment pressure (IMCP) although this has never been proven. Doubt exists regarding the validity of the diagnostic criteria for CECS, the role of IMCP and the outcomes from surgical management. An alternative biomechanical condition, Anterior Biomechanical Overload Syndrome (ABOS), was proposed to account for the symptoms of CECS and a programme of gait re-education (GRE) was introduced although no primary research has been carried out to investigate the predisposing biomechanical and anthropometric factors for CECS. Methods Case-control studies investigated the anthropometric, biomechanical and IMCP differences between CECS cases and asymptomatic controls. A post-surgical study evaluated the role of IMCP and a longitudinal study investigated the effectiveness of GRE and the nature of resultant biomechanical changes. Results Cases were significantly shorter than controls with increased plantarflexion at toe off and an increased rate of plantarflexion after heel strike. IMCP levels were significantly higher in cases than controls allowing for the extraction of diagnostic criteria for CECS. Surgical responders had similar IMCP to controls but significantly lower IMCP than non-responders. The biomechanical symptoms of ABOS were not replicated. GRE made changes to gait but these did not correspond to those identified in the CECS case-control study. Conclusions The intrinsic role of IMCP in CECS has been confirmed allowing for improved diagnostic criteria. Use of these criteria should allow for improved patient selection for surgery and improved outcomes for CECS. Novel insights to the biomechanical and anthropometric differences are provided allowing for the proposal of a new pathophysiological model whereby extrinsic training conditions impact upon intrinsic risk factors leading to CECS. These studies do not support the existence of ABOS or the use of GRE in the management of CECS.

Item Type: Thesis (Doctoral)
Subjects : Sports and Exercise Medicine
Divisions : Theses
Authors :
AuthorsEmailORCID
Roscoe, Daviddr26@doctors.net.ukUNSPECIFIED
Date : 23 March 2016
Funders : Defence Postgraduate Medical Deanery
Copyright Disclaimer : This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognize that its copyright rests with its author and the UK Ministry of Defence and that no quotation from the thesis and no information derived from it may be published without the author’s prior consent.
Contributors :
ContributionNameEmailORCID
Thesis supervisorHughes, Michael P.m.hughes@surrey.ac.ukUNSPECIFIED
Thesis supervisorShaheen, Aliayaha.shaheen@surrey.ac.ukUNSPECIFIED
Uncontrolled Keywords : Sports and Exercise Medicine Exercise Induced Leg Pain Chronic Exertional Compartment Syndrome Intramuscular Pressure Measurement 3-dimensional kinematics Barefoot Plantar Pressure Leg Pain Fasciotomy Gait Re-education Military Running Marching
Depositing User : David Roscoe
Date Deposited : 11 Apr 2016 09:19
Last Modified : 11 Apr 2016 09:19
URI: http://epubs.surrey.ac.uk/id/eprint/810140

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