A Neuromuscular Intervention for Exercise-Related Medial Leg Pain

in Journal of Sport Rehabilitation
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Context:

Exercise-related medial leg pain (ERMLP) is a common complaint among athletes, and efforts toward rehabilitation are often unsuccessful.

Objective:

To evaluate the efficacy of a therapeutic intervention in ERMLP localized to soft tissue.

Design:

A quasi-experimental, nonequivalent control-group study.

Setting:

Athletic training facility.

Patients:

20 volunteer male and female athletes (18–22 y old) with ERMLP. Complete data were available for 13 participants.

Intervention:

Treatment group (TRE, n = 7) received therapeutic intervention focused on relieving muscle hypertonicity in the deep compartment of the lower leg and restoring balance of the toe flexors and extensors. Control group (CON, n = 6) received no intervention.

Main Outcome Measures:

Self-reported pain intensity, pain threshold, and extensor hallucis longus to extensor digitorum brevis (EHL:EDB) electromyography ratio.

Results:

There were no significant differences in age, duration of symptoms, or pain measures between the 2 groups at baseline. CON demonstrated no significant changes in any of the outcome measures in posttreatment testing, but significant between-groups differences were identified for pain during activity (CON mean = 6.5, 95% CI 5.05, 7.95; TRE mean = 3.5, 95% CI 1.67, 5.33; P = .01), change scores for pain during activity (CON mean = 0.33, 95% CI −1.25, 1.91; TRE mean = −3.43, 95% CI:−4.6, −2.25; P < .001), change scores in pressure threshold (CON mean = −0.25, 95% CI −0.74, 0.23; TRE mean = 0.72, 95% CI 0.22, 1.37; P = .006), and change in EHL:EDB ratios (CON mean = 0.05, 95% CI −0.22, 0.33; TRE mean = 1.07, 95% CI 0.75, 2.07; P < .046).

Conclusion:

Therapeutic interventions focused on restoring muscle balance appear to be effective in resolving ERMLP.

Newsham is with the Dept of Physical Therapy and Athletic Training, Saint Louis University, St Louis, MO. Beekley is with the Dept of Kinesiology, and Lauber, the Athletic Training Dept, University of Indianapolis, Indianapolis, IN.