Compartment Syndrome (CS) is defined as increased pressure within a closed fibro-osseous space, which in turn reduces the blood flow to the tissues in the area. The muscles in the body are divided into sections or compartments. It is within these compartments that this condition occurs. There are 2 main causes of compartment Syndrome:
1. Acute/Sudden onset - from direct trauma to the area
2. Chronic onset – from excessive exertion through the muscles within the compartment
Acute CS is a serious and dangerous condition that requires medical intervention as soon as possible. Chronic Exertional Compartment Syndrome (CECS) occurs during exercise and if left untreated can cause damage to the muscle cells.
Essentially compartment syndrome can happen anywhere within the body; however the most common occurrence of CECS will take place in either the lower leg or the forearm. For the purpose of this article, let’s take a closer look at the lower leg.
There are 4 compartments of muscles within the lower leg.
The superficial posterior compartment (SPC) contains the gastrocnemius and the soleus, more commonly known as the calves.
The deep posterior compartment (DPC), which lies deep to the soleus, contains tibialis posterior, flexor hallucis longus and flexor digitorum longus.
The anterior compartment (AC) contains tibialis anterior, extensor hallucis longus and extensor digitorum longus. This compartment is found at the front of the leg and most commonly thought of as the “shin”.
The lateral compartment (LC) contains the peroneals or peroneus brevis and longus.
Within each of these compartments, there is a supply of nerves, capillaries and of course the muscles. When the blood flow is restricted to the area, it results in the damage to the cells.
CECS occurs when there is in an increase in training or activity. When we exercise there is an increase in blood flow to the working muscles which cause them to increase in volume by between 8-20%. This is the first increase in compartment pressure.
The second increase comes from failure of the surrounding fascia to expand with the muscle, thereby constricting it and further increasing the pressure. CECS has a high occurrence in runners and those that engage in repetitive impact exercise.
Symptoms of CECS can be any of the following:
· Tightness, burning, pressure, cramping and/or pain in the lower leg every time you exercise, most commonly around the calf and shin region.
· The pain commonly occurs in both legs.
· The onset of these symptoms occurs at predictable intervals (for instance, 4 minutes into every run)
· You may also experience sudden fatigue on the top of your foot or ankle, numbness in the webbing near your big toe.
· Sometimes there may be lumps or bumps in the tissue due to small hernias.
Diagnosis of CECS can be quite difficult as there are several other pathologies that have similar symptoms. However, due to the predictability of pain onset and pain cessation upon stopping activity, a practitioner can gain a positive diagnosis in the clinic. This diagnosis can be confirmed with the use of a pressure monitor inserted into the compartment post exercise to measure the level of pressure that has been created.
CECS can be successfully treated using conservative methods. This will include a complete stop from the aggravating activity, as well as pain management techniques such as ice, soft tissue therapy, dry needling, de-loading taping and anti-inflammatory medication.
The next step will be to determine the underlying cause of the CECS. Your therapist will take a closer look at your foot, lower leg, knees and hips to assess if the cause is coming from a biomechanical misalignment in these areas.
Continued treatment will be to correct any biomechanical abnormalities as well as incorporating corrective exercises for weak muscles with continued release work of the tightened muscles and fascia in the area.
If conservative treatment is unsuccessful then surgery may be considered. The surgery involves cutting the tight fascia, called a fasciotomy. An incision is made over the affected area, and then the surgeon releases the tight tissue that surrounds the muscle.
While CECS is hard to predict, there a few ways you can help minimise your risk, these include:
· A gradual increase in endurance within your training can help the body adjust at a steady rate allowing the body the ability to get used to the increase in pressure.
· Wearing the correct footwear and having your running gait assessed to make any necessary adjustments to your running pattern
· Stretching and working on improving your flexibility can also go a long way in reducing the possibility of occurrence
So that’s an overview of how compartment syndrome occurs. If you have any questions or comments please e-mail us at firstname.lastname@example.org and we will be happy to answer them for you.
If you suffer with burning pain through the leg when you exercise feel free to call us on (08) 9486 8653 and our therapists will be happy to chat with you about the best management plan.