Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-up

Wes O Zimmermann, Mark Robert Hutchinson, Ruud Van den Berg, Rigo Hoencamp, Frank J G Backx, Eric W P Bakker

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: To assess the outcome of conservative treatment for chronic exertional compartment syndrome (CECS) as it relates to the reduction in surgical fasciotomy and return to active duty in a military population.

Methods: Historic cohort. From 2015 to 2018, 75 surgically eligible patients with pressure-positive anterior CECS (Group 1), or with positive pressures and associated medial tibial stress syndrome (Group 2), underwent a conservative treatment programme emphasising gait retraining of running and marching. Treatment success was defined as return to duty, without surgery. Fifty patients from 2015 to 2017 were surveyed to assess mid-term outcomes.

Results: The average duration of conservative treatment was 144.9 (±59.6) days. Initially, 65% (49/75) were able to return to duty; 28% (21/75) were referred for surgery and 7% (5/75) left the armed forces. There was no difference in outcomes between Group 1 and Group 2. Survey response rate, on average after 742 days (SD 267, range 381-1256), was 84% (42/50); 57% (24/42) had continued duty, without surgery; of them, 43% were at the same military specialty, 57% in a physically less demanding job.

Conclusion: A conservative treatment programme for anterior CECS was able to return 65 % of patients to active duty, without surgery. At 2 years, the success rate decreased slightly, but remained positive at 57%. In this high-risk group, initiating a conservative treatment protocol with an emphasis on gait retraining can significantly reduce the need for surgical fasciotomy. For those that fail conservative treatment, surgical release may still be indicated.

Original languageEnglish
Article numbere000532
JournalBMJ open sport & exercise medicine
Issue number1
Publication statusPublished - 1 Mar 2019


  • exercise related leg pain
  • fasciotomy
  • gait retraining
  • occupational
  • prognosis


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