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Venous Obstruction in Healthy Limbs: A Model for Chronic Compartment Syndrome?


Medicine & Science in Sports & Exercise: October 2003 - Volume 35 - Issue 10 - p 1638-1644
doi: 10.1249/01.MSS.0000089347.55980.9D
CLINICAL SCIENCES: Clinical Investigations

BIRTLES, D. B., M. P. RAYSON, A. CASEY, D. A. JONES, and D. J. NEWHAM. Venous Obstruction in Healthy Limbs: A Model for Chronic Compartment Syndrome? Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1638–1644, 2003.

Purpose Chronic exertional compartment syndrome (CECS) in the anterior tibial (AT) compartment is generally believed to be the result of reduced venous blood flow caused by restrictive compartments and increased intramuscular pressures. If this is so, then restricting venous flow in the muscles of healthy subjects during exercise should mimic CECS.

Methods This hypothesis was tested in 10 control subjects (aged 19–41 yr, five males) with and without external venous occlusion induced by a sphygmomanometer cuff fitted just below the knee and inflated to 80 mm Hg. Twenty CECS patients (20-39 yr, 16 males) were studied without external occlusion. Subjects performed intermittent, isometric maximal voluntary contractions (MVC) of the AT for 20 min (1.6-s contractions, 0.5 duty cycle). MVC, tetanic force (2 s at 50 Hz), muscle thickness (ultrasound imaging), and pain were measured during exercise and 10 min of recovery.

Results Venous occlusion in the controls induced greater pain, fatigue, and increase in muscle thickness (P < 0.01). Initially the patients fatigued more slowly than the occluded controls, but at the end of exercise, the fatigue and pain were similar in these two groups. The controls showed a greater increase in muscle size (P = 0.01). Recovery was similar in all three groups, although the size of the patients’ muscles recovered rather more slowly.

Conclusion External venous occlusion of the AT muscles in control subjects induces changes very similar to those of CECS patients, although the different time courses indicate that different processes are involved. The AT compartment of CECS patients is capable of distension.

1Applied Biomedical Research Centre, GKT School of Biomedical Sciences, King’s College London, UNITED KINGDOM;

2Optimal Performance Ltd., Farnham, Surrey, UNITED KINGDOM;

3QinetiQ Centre for Human Sciences, Farnborough, Hampshire, UNITED KINGDOM; and

4School of Sport and Exercise Science, University of Birmingham, Birmingham, UNITED KINGDOM

Address for correspondence: Prof. D. J. Newham, Applied Biomedical Research Centre, GKT School of Biomedical Sciences, King’s College, London, Shepherd’s House, Guy’s Campus, London SE1 1UL, United Kingdom; E-mail:

Submitted for publication November 2002.

Accepted for publication June 2003.

©2003The American College of Sports Medicine