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A 21-year-old rugby football player presents to an outpatient physical therapy clinic with a 4-month history of intermittent deep aching pain in his right anterolateral lower leg and paresthesia in the first web space. The pain starts after 15 minutes of running. He can continue to run for about 30 minutes when he has to stop due to the pain intensity (9 on the 0-10 visual analog scale). He reports that this pain started after intense pre-season rugby training for 3 weeks. This training consisted of 5 sessions per week, each with an aerobic component and 3 with resistance training (gym program) incorporated. The running during this training was at faster speeds and for longer distances than he had previously done. He decided to seek professional treatment because a similar ache has been developing in his left leg over the past few weeks. The pain is less severe and he has no paresthesia in the left leg. Except for self-administered ice and occasional oral anti-inflammatories (which he reported provided no pain relief), he has received no previous treatment. The physical therapy referral is for evaluation and treatment of his shin pain. No diagnostic imaging has been requested yet.

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Describe a physical therapy plan of care for this patient.

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What is his rehabilitation prognosis?

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Based on his suspected diagnosis, what do you anticipate may be the contributing factors to the condition?

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Based on the patient's symptoms and history, what are the most appropriate tests and measures to help determine the etiology of his shin pain?

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  • FASCIA: “Band” (derived from the Latin); superficial and deep connective tissue surrounding individual muscles, groups of muscles, blood vessels, and nerves; fascia binds some structures together while allowing others to glide smoothly over each other
  • PERIOSTITIS: Inflammation of the periosteum, the connective tissue layer surrounding bone
  • STRESS FRACTURE: Microfracture in bone caused by repetitive physical loading below the single cycle failure threshold due to redistribution of impact forces resulting in stress at focal points in the bone or the action of muscle pull across the bone1

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  1. Describe chronic exertional compartment syndrome (CECS) and the potential risk factors for this condition.

  2. Describe three main causes of lower leg or shin pain.

  3. List the different compartments in the lower leg and the muscles, blood vessels, and nerves that each compartment contains.

  4. Identify key questions to confirm a suspected diagnosis of CECS.

  5. Describe the common impairments found with CECS and discuss the rationale of physical therapy.

  6. Determine when a surgical consultation is appropriate for an individual with CECS.

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PT considerations during management of the individual with suspected chronic exertional compartment syndrome:

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  • General physical therapy plan of care/goals: Improve neurologic symptoms; relieve leg pain during running; identify and treat musculoskeletal impairments and additional risk factors to prevent ...

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