The McGinley Method: Casper doctor revolutionizes treatment for chronic exertional compartment syndrome

By Kristy Bleizeffer Oct 23, 2013

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Dr. Joe McGinley demonstrates how he uses three-dimensional images of a patient's legs to diagnose chronic exertional compartment syndrome. McGinley developed a non-invasive treatment for the syndrome as an alternative to surgery. Now patients fly to Casper from around the country to get the treatment.

Five years ago, Lauren was a college athlete, sprinting up and down the soccer field. She gradually noticed pain in her calves when she ran. It seemed to be getting worse. The deep burning pain eventually appeared every time she exerted any force on her legs -- flexing her feet, walking up stairs, running or squatting.

Doctors diagnosed her with chronic exertional compartment syndrome, an exercise-induced pain and swelling in leg muscles that will often sideline athletes from favored sports. Lauren underwent three surgeries on each leg. None worked.

“After each one, I never had any relief. Doctors kept convincing me to have another one. This is not my style. I used to be a high-level athlete who never had injuries,” said Lauren, a patient of Dr. Joe McGinley who recently flew to Casper from her home in New Jersey to undergo a new non-surgical treatment for the syndrome. McGinley, who specializes in musculoskeletal radiology and sports medicine, is the only doctor in the country to offer this therapy, but is traveling the country training other doctors to do it safely.

A new procedure

Until very recently, athletes with exertional compartment syndrome had two options: conservatively treat symptoms with rest and pain killers, but these are only successful if they give up the activities they love. The other option was surgery.

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Dr. Joe McGinley, at left, uses a portable ultrasound machine to see inside the legs of Lauren, a college-level soccer player from New Jersey until chronic lower leg pain stopped almost all physical activity.

Lauren didn’t want to give up soccer and she’d found no relief through surgery. During one of her many late night Google searches, she found Dr. McGinley, a Casper doctor who claimed to have a new procedure that used Botox injections to relieve exertional compartment syndrome symptoms.

Dr. McGinley understands athletes. He’s one himself. In July, he ran the Cowboy Tough, a 300-mile adventure race from Cheyenne to Casper. He puts a special emphasis on treating sports injuries without surgery.

He is also a mechanical engineer, with both a bachelor’s and master’s degree in the field. He often applies engineering principals to treating patients. It’s how he developed his new therapy for exertional compartment syndrome.

In 2011, Laura Stamp was a venerable high school athlete for Natrona County High School, competing in cross country, soccer and Nordic skiing. Her calf pain had started in 2008 at the end of her freshman year and gradually worsened. She was diagnosed with exertional compartment syndrome.

About a month before Stamp was to undergo surgery, a friend heard a talk on the syndrome by Dr. McGinley and arranged for the two to meet.

Dr. Joe McGinley inserts guide needles into Lauren's legs at a recent treatment in Casper. The needles mark the pressure points where McGinley will inject Botox into the legs.

Dr. Joe McGinley inserts guide needles into Lauren's legs at a recent treatment in Casper. The needles mark the pressure points where McGinley will inject Botox into the legs.

On a CT scan, McGinley noticed that Stamp’s thigh muscles were compressing her veins during exercise. Her arteries were carrying blood down to her calves, but her veins weren’t carrying it out at the same rate. It caused swelling, pressure and pain in her calves.

“From there, I just put the engineering mechanics together: If she is exercising, she is exerting force and the artery is open, but the vein is now compressed. It’s a pressure mismatch. It’s a flow mismatch, and from an engineering standpoint, there has to be a consequence to that,” McGinley said.

The mechanics of exertion compartment syndrome had never been considered in this way. But, McGinley had to prove his theory. He temporarily blocked the muscle compressing Stamp’s vein and rescanned her legs. Not only had the pain disappeared, the compression had too. All McGinley had to do was figure out how to keep the muscle off the vein long term.

He doesn’t often work with Botox, but knew that it would temporarily block muscle function, perhaps preventing the muscle from compressing the vein. “So I called (Stamp’s) parents, and said don’t hang up on me, but I have a great idea.”

Stamp was McGinley’s first patient in the experimental treatment. She canceled her scheduled surgery and was back to playing soccer within a month. Two months later, she ran a half marathon. She’s now on the Nordic ski team at Williams College in Massachusetts.

“I’ve always been very active and competitive, so when compartment syndrome started to take that away, it was beyond frustrating. To have it fixed and be able to compete at my best has allowed me to live the lifestyle I crave. I fully attribute this to Dr. McGinley’s therapy,” Stamp said.

Promising outcomes

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Dr. Joe McGinley poses in front of the CT scanner at Casper Medical Imaging. McGinley scans the legs of his chronic exertional compartment syndrome patients to determine where muscles are constricting blood flow through veins, creating painful swelling during exercise. He then injects botox into the pressure areas to allow blood to flow freely. He is the only doctor in the country to use this non-evasive treatment, but is training doctors from top hospitals so they may treat patients closer to home.

McGinley has since treated about 50 patients with this Botox therapy. They have flown to Casper from all over the country, often finding the procedure from the Internet or word of mouth. The first injections relieve symptoms an average of about three months. The second round of injections last about six months, and after three injections, many patients don’t need any more. About 75 percent of McGinley’s patients report positive outcomes.

“It makes a huge difference in their lives. Sports they could no longer do, they can now do on a competitive basis. Some thought their sporting careers were over and we were able to get them back out on the field or the court,” McGinley said.

McGinley has a patent pending on the procedure to protect patient safety. It’s highly technical and can pose serious risks if physicians aren’t properly trained. He is working with doctors at New York University, the Cleveland Clinic and a clinic in Colorado who want to start offering the treatment closer to patients who need it – patients like Tyler McIntosh, 19, of Jackson.

McIntosh, a sophomore at Stanford University, quit the triathlon club team and walked slowly across campus because of the pain in his lower legs. Like Stamp, he was scheduled for surgery before finding Dr. McGinley on the internet. He received his first injections in July and returned in August for a touch-up, required in about half of patients. But before coming back to Casper, he hiked 30 miles on a backpacking trip – something he wouldn’t have been able to do before McGinley’s treatment.

Joseph McGinley M.D., Ph.D.

Dr. McGinley specializes in musculoskeletal radiology and sports medicine with an emphasis in non-surgical treatments at Wyoming Medical Center and Casper Medical Imaging. He is an adjunct faculty member at Stanford University in the Department of Radiology. Click here to learn more at about McGinley’s new therapy or  watch this report from CBS New York which traveled to Casper this spring to report on McGinley's treatment. 

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