Treatment guideline for ERLP in the Dutch Armed Forces10
| Week | Treatment action | Professional | Treatment phase | Component | References |
|---|---|---|---|---|---|
| 0 | Significant reduction of running, marching, etc | Doctor | Visit 1 | 1 | 31 |
| 0 | Examine ROM of ankle, knee, hip | Doctor | Visit 1 | 2 | |
| 0 | Reduce BMI if too much | Doctor | Visit 1 | 3 | |
| 0 | Stop creatine supplements | Doctor | Visit 1 | 3 | 87,88 |
| 0 | Stop smoking | Doctor | Visit 1 | 3 | 23 |
| 0 | Vitamin D in blood (goal >78 nmol/L) | Doctor | Visit 1 | 3 | 26,27 |
| 0–2 | NSAID | Doctor | Visit 1 | 2 | 57 |
| 0–2 | Ice | Doctor | Visit 1 | 2 | 57,89 |
| 2 | Send patient to physical therapist on base | Doctor | Visit 2 | 1 | |
| 2 | Place in on-base part-time rehab programme | Doctor | Visit 2 | 1 | |
| 2 | Place in off-base full-time rehab programme | Doctor | Visit 2 | 1 | 6,7 |
| 3 | Judge running shoes and boots | PT | PT phase 1 | 3 | 90 |
| 3 | Examine/issue orthopaedic inlays | PT | PT phase 1 | 3 | 31 |
| 3 | Judge walking biomechanics | PT | PT phase 1 | 3 | |
| 3 | Judge running biomechanics | PT | PT phase 1 | 3 | 31,80 |
| 3 | Compression sleeves (not for CECS) | PT | PT phase 1 | 4 | 5,91 |
| 3–8 | Massage | PT | PT phase 1 | 2 | 92,93 |
| 3–8 | Taping (kinesio) | PT | PT phase 1 | 2 | 94,95 |
| 3–8 | Dry needling, (neural) prolotherapy | PT, doctor | PT phase 1 | 2 | 96 |
| 3–8 | Improve range of motion (stretching) | PT | PT phase 1 | 3 | |
| 3–12 | Improve relevant strength | PT | PT phase 1 and 2 | 3 | 97–99 |
| 3–12 | Maintain/improve cardiovascular fitness | PT | PT phase 1 and 2 | 3 | 31 |
| 6–12 | Gradual transfer from low impact to impact | PT | PT phase 1 and 2 | 4 | 12,100 |
| 6–12 | Gait retraining marching (boots) | PT | PT phase 1 and 2 | 3 | PJ 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. |
| 6–12 | Gait retraining running (running shoes) | PT | PT phase 1 and 2 | 3 | 101–104 |
| 8–12 | Extracorporeal shockwave therapy (ESWT) | Sports medicine | PT phase 1 | 2 | 105,106 |
| 12–20 | Gradual increase marching km | Military instructor | Sports- and specific | 4 | |
| 12–20 | Gradual increase running km | Military instructor | Sports- and specific | 4 | 31 |
| 12–20 | Judge fitness for intended job | Doctor | Evaluation | 5 | 7 |
| 8–20 | Send to regional military hospital | Doctor | Stagnation | 5 |
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.