Gait re-training to alleviate the symptoms of anterior exertional lower leg pain: a case series

Background/purpose: Exercise induced lower leg pain (EILP) is a commonly diagnosed overuse injury in recreational runners and in the military with an incidence of 27-33% of all lower leg pain presentations. This condition has proven difficult to treat conservatively and patients commonly undergo surgical decompression of the compartment by fasciotomy. This case series investigates the clinical outcome of patients referred with exertional lower leg pain symptoms of the anterior compartment of the lower leg following a gait re-training intervention program.

Case description: 10 patients with exercise related running pain in the anterior compartment of the lower leg underwent a gait re-training intervention over a six-week period. Coaching cues were utilized to increase hip flexion, increase cadence, to maintaining an upright torso, and to achieve a midfoot strike pattern. At initial consult and six-week follow up, two-dimensional video analysis was used to measure kinematic data. Patients self reported level of function and painfree running were recorded throughout and at one-year post intervention.

Outcomes: Running distance, subjective lower limb function scores and patient's pain improved significantly. The largest mean improvements in function were observed in 'running for 30 minutes or longer' and reported 'sports participation ability' with increases of 57.5% and 50%, respectively. 70% of patients were running painfree at follow-up. Kinematic changes affected at consultation were maintained at follow-up including angle of dorsiflexion, angle of tibia at initial contact, hip flexion angle, and stride length. A mean improvement of the EILP Questionnaire score of 40.3% and 49.2%, at six-week and one-year follow up, respectively.

Discussion: This case series describes a conservative treatment intervention for patients with biomechanical overload syndrome/exertional compartment syndrome of the anterior lower leg. Three of the four coaching cues affected lasting changes in gait kinematics. Significant improvements were shown in painfree running times and function.

Level of evidence: 4.