Table 2

Treatment guideline for ERLP in the Dutch Armed Forces10

WeekTreatment actionProfessionalTreatment phaseComponentReferences
0Significant reduction of running, marching, etcDoctorVisit 1131
0Examine ROM of ankle, knee, hipDoctorVisit 12
0Reduce BMI if too muchDoctorVisit 13
0Stop creatine supplementsDoctorVisit 1387,88
0Stop smokingDoctorVisit 1323
0Vitamin D in blood (goal >78 nmol/L)DoctorVisit 1326,27
0–2NSAIDDoctorVisit 1257
0–2IceDoctorVisit 1257,89
2Send patient to physical therapist on baseDoctorVisit 21
2Place in on-base part-time rehab programmeDoctorVisit 21
2Place in off-base full-time rehab programmeDoctorVisit 216,7
3Judge running shoes and bootsPTPT phase 1390
3Examine/issue orthopaedic inlaysPTPT phase 1331
3Judge walking biomechanicsPTPT phase 13
3Judge running biomechanicsPTPT phase 1331,80
3Compression sleeves (not for CECS)PTPT phase 145,91
3–8MassagePTPT phase 1292,93
3–8Taping (kinesio)PTPT phase 1294,95
3–8Dry needling, (neural) prolotherapyPT, doctorPT phase 1296
3–8Improve range of motion (stretching)PTPT phase 13
3–12Improve relevant strengthPTPT phase 1 and 2397–99
3–12Maintain/improve cardiovascular fitnessPTPT phase 1 and 2331
6–12Gradual transfer from low impact to impactPTPT phase 1 and 2412,100
6–12Gait retraining marching (boots)PTPT phase 1 and 23PJ Helmhout, et al. The effectiveness of a training programme aimed at modifying marching technique in military service members with CECS. A case series with six patients and a 9-month follow-up. In progress.
6–12Gait retraining running (running shoes)PTPT phase 1 and 23101–104
8–12Extracorporeal shockwave therapy (ESWT)Sports medicinePT phase 12105,106
12–20Gradual increase marching kmMilitary instructorSports- and specific4
12–20Gradual increase running kmMilitary instructorSports- and specific431
12–20Judge fitness for intended jobDoctorEvaluation57
8–20Send to regional military hospitalDoctorStagnation5
  • BMI, body mass index; CECS, chronic exertional compartment syndrome; ERLP, exercise related leg pain; ESWT, extracorporeal shockwave therapy; NSAIDs, non-steroidal anti-inflammatory drugs; PT, physical therapist; ROM, range of movement.