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

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. (Photo by Dan Cepeda Photography)

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.

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.

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

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 (Photo by Dan Cepeda Photography)

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.

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. 

Racing the Cowboy Tough

Fresh faced and clean shaven, McGinley Innovations team members pose at the start of the race on Thursday, July 18. They are, from left, captain Dr. Joe McGinley of Casper, navigator Afsheen Mostofi, Adam Knight and Lindsay Chirdiron.
The team got its first look at the race course on Wednesday and spent the rest of the day planning strategy and gathering gear. Their strategy was simple: First, maintain their bodies to prevent malnutrition and injury. “If you get injured or you get severe blisters, you probably aren’t going to finish. If you get sick or dehydrated, you aren’t going to finish,” McGinley said.
Second, besides the mandatory check points, get as many optional checkpoints as possible without sacrificing too much time.

The whitecaps in Seminoe Reservoir were rising 3 feet in the air, crashing against the adventure racers’ canoes. On the bright side, that brutal wind was at their backs, pushing them out of the channel.

Then, Team McGinley Innovations took the final turn onto open water and the wind opened up, blowing water into their faces. The whitecaps, now rising 5 feet high, crested the sides of their canoes. Though they needed to get across that reservoir, the wind pushed them to shore.

In moments like those, Dr. Joe McGinley often asks himself what the heck he’s doing. He was operating on just an hour or two of sleep. He’d already biked, trekked and climbed what seemed like halfway across Wyoming. He didn’t have to be there, crawling along Seminoe’s rocky beach, pulling his canoe on a rope, stopping to dump out the water that kept pouring inside. He was in the middle of a 9-hour slog across a reservoir that deposited him and his three teammates at another rocky beach every time they pushed off shore. And it was dark, nearly 11 p.m. before they made it off the water.

“Why? I ask that several times in a race,” said McGinley, a diagnostic radiologist at Casper Medical Imaging and Wyoming Medical Center and captain of Team McGinley Innovations which competed in the premier class of the Cowboy Tough adventure race July 18-21.

“If you just wanted a race to the finish, you’d do triathlons. You know what you’re going to get. This is adventure racing. Even though that was the hardest part of the race, it was definitely the most exciting part of the race.”

McGinley is back home in Casper now, having biked, hiked, rappelled and paddled more than 300 miles from Cheyenne to Mike Lansing Field in 3 ½ days in the state’s first Cameco and City of Casper Cowboy Tough Expedition Race.

You can follow his progress through the photos below, courtesy of Jacek Bogucki/Video Works who followed the team through the course. (Bogucki will be making a video of the race, and we’ll post parts on The Pulse when they are available.)

Here’s something to remember as you scroll through the photos below: McGinley and his team spent nearly 80 hours racing more than 300 miles across Wyoming, sleeping just 1 to 2 hours per night. They crossed the finish line in Casper around 10 a.m. Sunday.

Tuesday, McGinley was back at work seeing patients. How’s that for Cowboy Tough?

Building Team Wyoming

For next year’s Cowboy Tough race, Joe McGinley would like to build an all-Wyoming team for the elite class. He’ll also be looking for sponsors to support the team through training and the race.

For more information, email him at mcginley@mcginleyinnovations.com.

For tips on training for your own adventure race, scroll down to the last photo.

McGinley’s wife and son – Diane and Charlie, 3 – give McGinley an enthusiastic send off at the start line in Cheyenne. The Cowboy Tough start was unlike any other adventure race McGinley has been a part of. Gov. Matt Mead rode in on a horse, said a few words, and then fired the start gun from the center of the circle. Racers scattered in all different directions.
“That was truly Wyoming,” McGinley said.

McGinley rappels 100 feet down a boulder at Vedauwoo after trekking 5 miles in Curt Gowdy State Park and orienteering on bikes for about 12 miles to collect optional checkpoints.
“Vedauwoo is one of the places I hadn’t seen yet in Wyoming,” McGinley said. “It was just really amazing.”

Team McGinley rides from Happy Jack to Laramie, arriving at about 8 p.m. McGinley, who prefers junk food to protein bars during long races, stopped at McDonald’s, ordering a few cheeseburgers.
Still ahead: The last leg of the first day, a 58-mile bike ride to Medicine Bow — in the rain.

The team arrives at the first transition camp at about 2 a.m. Friday. Each team must make it to the predetermined transition camp before the next leg begins. There, they have access to their travel bins – one per team – which carries all the gear and food they will need for the entire race.

The early morning sun rises on the transition camp at Miracle Mile on Saturday morning, just hours after they battled 5-foot waves on Seminoe Reservoir. The team averaged 1 to 2 hours of sleep each night before waking up, packing their gear and doing it again.
During their late-night walk from Seminoe, Chirdiron started hallucinating, a fairly common danger in adventure racing, McGinley said. Chirdiron claimed to see water bottles buried in the ground. They gave her a Monster energy drink and she woke up enough to get to transition camp.
“You can fall asleep when you’re walking and walk off the trail. You can fall asleep when you’re biking. You have to watch people when they start doing that because if they get a little goofy, along with the hallucinations, they can just run off the trail and can get lost,” McGinley said.

The team hikes around Pathfinder Dam with temperatures nearing 103 degrees. They would trek about 80 to 90 miles during the race.

Lindsay Chirdiron cools off in Pathfinder Reservoir while McGinley opts to keep his feet dry to protect from blisters which are exasperated by wet skin. Every adventure racer has his own routine for blister prevention; McGinley uses Vaseline and puts bandages over vulnerable skin. Racers also received care from a medical team – headed by Dr. Jerry Realing of Wyoming Medical Center – at each transition camp. (McGinley’s caution was all for not, though, since the team later swam in Alcova to collect an optional checkpoint.)

The team bikes from Miracle Mile to Alcova on the third day, one of about 200 miles they would bike throughout the race.

Team members enjoy a much deserved rest at Alcova.

Another day, another 15 miles to hike. This stretch led the team through the hills and valleys of Alcova.

Evening clouds gives the team a reprieve from the heat.

With two members per canoe, the team takes a nice ride down the North Platte as they make their way toward Casper. As McGinley pointed at familiar sites along the river, his teammates kept joking, “All we’re trying to do is get Joe home.”
Race directors can torture you at the end of the race or they can reward you. “This was definitely a reward,” McGinley said. “Almost like a victory lap.”

For the last leg of the race, participants belly-boarded the rapids at Casper Whitewater Park. Here, Chirdiron catches a wave. It was the first time McGinley went through Casper’s rapids.

Boogie boards in tow, the team makes the last climb to the finish line at Mike Lansing Field.

McGinley relaxes and chats with his wife, Diane, at the finish line on Sunday. For most adventure races, starts and finishes are isolated affairs – just for the racers. Not at Cowboy Tough. McGinley thinks, start to finish, the race was a huge success for Wyoming.
“It showcases the outdoors, the landscape and the vastness of the state. And it showcases the people. The people really make the difference. A lot of the out-of-state teams did comment on that and they really fell in love with the State of Wyoming.”

Looking decidedly less fresh than the portrait at the starting line, the team poses with a sponsor, Tom Thorson of Black Hills Bentonite.

So you want to be an adventure racer?

You’re in pretty good shape, maybe you’ve run a half marathon or two. You think you might be able to take your fitness racing to the next level.

Dr. Joe McGinley, an adventure racer for nearly 10 years, offers these tips for those thinking about adventure racing.

1. Hook up with an adventure veteran: That’s what McGinley did. McGinley is a member of Racing with Giants, an adventure racing community in California that puts together teams for races of all kinds – from shorter races, called sprints, to the multi-day affairs like Cowboy Tough.

He worked his way up through the ranks, going through their training programs. He’s now on the elite team, but when he started, he was the rookie.  He competed in sprints with veteran racers and started signing up for longer events.

“ If you are an athlete or do outdoor activities, you can get in involved in this,” he said.

He’s also willing to help or train with people interested in the sport. Email him at mcginley@mcginleyinnovations.com.

2. Learn to read a map: Orienteering and map reading are the hardest parts, McGinley said. Read books on mapping points and using a compass.

“That’s the main part of these races. Anybody can train, anybody can exercise and build their endurance, but navigation is what makes or breaks most teams,” McGinley said.

3. Build your confidence: Start with short races and work your way up to learn when something is or isn’t dangerous. Sprints also teach you about your own body – what it needs to keep going mile after mile.