title: The Effectiveness of a 6-Week Intervention Program Aimed at Modifying Running Style in Patients With Chronic Exertional Compartment Syndrome: Results From a Series of Case Studies.
abstract: BACKGROUND
  Previous studies have reported on the promising effects of changing running style in patients with chronic exertional compartment syndrome (CECS) using a 6-week training program aimed at adopting a forefoot strike technique. This study expands that work by comparing a 6-week in-house, center-based run training program with a less extensive, supervised, home-based run training program (50% home training).
  
  
  OBJECTIVE
  An alteration in running technique will lead to improvements in CECS complaints and running performance, with the less supervised program producing less dramatic results.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  Nineteen patients with CECS were prospectively enrolled. Postrunning intracompartmental pressure (ICP), run performance, and self-reported questionnaires were taken for all patients at baseline and after 6 weeks of running intervention. Questionnaires were also taken from 14 patients (7 center-based, 6 home-based) 4 months posttreatment.
  
  
  RESULTS
  Significant improvement between preintervention and postintervention rates was found for running distance (43%), ICP values (36%), and scores on the questionnaires Single Assessment Numeric Evaluation (SANE; 36%), Lower Leg Outcome Survey (LLOS; 18%), and Patient Specific Complaints (PSC; 60%). The mean posttreatment score on the Global Rating of Change (GROC) was between +4 and +5 ("somewhat better" to "moderately better"). In 14 participants (74%), no elevation of pain was reported posttreatment, compared with 3 participants (16%) at baseline; in all these cases, the running test was aborted because of a lack of cardiorespiratory fitness. Self-reported scores continued to improve 4 months after the end of the intervention program, with mean improvement rates of 48% (SANE), 26% (LLOS), and 81% (PSC). The mean GROC score improved to +6 points ("a great deal better").
  
  
  CONCLUSIONS
  In 19 patients diagnosed with CECS, a 6-week forefoot running intervention performed in both a center-based and home-based training setting led to decreased postrunning lower leg ICP values, improved running performances, and self-assessed leg condition. The influence of training group was not statistically significant. Overall, this is a promising finding, taking into consideration the significantly reduced investments in time and resources needed for the home-based program.
authors.affiliation: Department of Training Medicine and Training Physiology/Military Sports Medical Center, Personnel Command, Royal Netherlands Army, Utrecht, the Netherlands.
authors.forename: Pieter H
authors.initials: PH
authors.lastname: Helmhout
authors.affiliation: Physical Therapist Assistant Program, Fort Sam Houston, San Antonio, Texas, USA.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Diebal
authors.affiliation: Human Movement Sciences, Free University, Amsterdam, the Netherlands.
authors.forename: Lisanne
authors.initials: L
authors.lastname: van der Kaaden
authors.affiliation: Department of Training Medicine and Training Physiology/Military Sports Medical Center, Personnel Command, Royal Netherlands Army, Utrecht, the Netherlands.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Harts
authors.affiliation: Department of Family Medicine, Uniformed Services University, Bethesda, Maryland, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Beutler
authors.affiliation: Department of Training Medicine and Training Physiology/Military Sports Medical Center, Personnel Command, Royal Netherlands Army, Utrecht, the Netherlands.
authors.forename: Wes O
authors.initials: WO
authors.lastname: Zimmermann
keywords: chronic exertional compartment syndrome; conservative treatment; forefoot running; lower leg pain