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Run Well! : Compartment Syndrome

We are excited to kick off a new series in partnership with Sports Injury Clinic.  www.sportsinjuryclinic.net   This site has been a well used site by me over the last year as I have worked through various injuries.  It provides the right amount of detail about the injury and tips on treatment as well.   And while we hope you don't have the need for the resources, we are pleased to offer articles in tips in the event you are dealing with a running injury.

 

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Compartment syndrome can occur in several places in the body. The most common region to develop compartment syndrome, especially in runners, is the lower leg, and more specifically, the anterior compartment of the lower leg. 

‘Compartments’ are sections of the body, in this case the lower leg, which contain muscles, blood vessels, nerves and other tissues. Each compartment is separated by a kind of connective tissue known as fascia. In total, there are 4 compartments in the lower leg (anterior, lateral, posterior and deep posterior).  

The anterior compartment, the focus of this article, makes up the front part of the lower leg, just to the outside of the Tibia (shin bone). It contains the Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus and Peroneus tertius muscles. The main function of these muscles is to dorsiflex the ankle and extend the toes (pull the foot  and toes up towards you).

Anterior compartment syndrome occurs when the muscles within the anterior compartment expand beyond the size of the fascia surrounding the compartment. Fascia is virtually non-elastic and so cannot expand with the muscles. This results in a decrease in space within the compartment and increased pressure on the nerves and blood vessels inside.

The symptoms of compartment syndrome include: 

  • Pain to the outside of the shin bone
  • Pain which increases during exercise until you have to stop
  • Pain is often described as achy pain
  • A feeling of tightness at the front of the leg
  • Pain eases gradually during rest
  • Weakness in dorsiflexing the ankle (pulling the foot up towards you)
  • Tingling or numbness may be present
  • The muscles at the front of the shin may feel tight, or even be visibly tight after exercise

 

What causes anterior compartment syndrome? 

Compartment syndrome can be either acute or chronic. Acute compartment syndrome is caused by a direct impact to the shin. Chronic compartment syndrome is an overuse injury, which comes on gradually over a period of time. This is the most common form in runners, although an acute case of compartment syndrome can develop into a chronic case if not treated appropriately. 

As already stated, compartment syndrome in runners is usually both in the anterior compartment and a chronic, overuse condition. The muscles in this compartment become overused through either overtraining or biomechanical abnormalities. This causes either the muscles to overdevelop and become too large for the compartment, or for minor swelling and inflammation to occur which reduces the space in the compartment. 

How is compartment syndrome diagnosed? 

The symptoms usually provide a pretty good indication of the condition, however the only way of determining that compartment syndrome is the cause of the pain is by measuring intercompartmental pressure. This is done by inserting a needle into the compartment after exercise. 

This is important as compartment syndrome can be misdiagnosed as a stress fracture, or sometimes even shin splints. 

How is compartment syndrome treated? 

  • Rest from aggracting activities
  • Apply ice after activity
  • Check biomechanical issues such as overpronation/oversupination
  • Ensure running shoes are replaced regularly
  • Improve flexibility of the calf and shin muscles
  • When returning to activity start very slowly and gradually increase

 

In some cases, if conservative treatment fails, surgery called a fasciotomy may be required to release the fascia and create more space in the compartment. 

To stretch the calf muscles, stand facing a wall with a wide stance and the leg to be stretched at the back. Keep the heel flat on the floor and the knee straight as you lean forwards using your hands on the wall to balance you. This stretches the Gastrocnemius muscle, the largest of the 2 muscles at the back of the lower leg. To stretch the smaller Soleus muscle, just bend the back knee slightly. You should then feel the stretch lower down the calf. 

We always advise seeking professional treatment in order to return to fitness as soon as possible and free from pain! A professional sports injury specialist may also: 

  • Perform sports massage techniques to the muscles of the lower leg
  • Use a taping tachnique to help take the strain off the muscles
  • Advise you on stretching and strengthening exercises
  • Undertake gait analysis to see if you overpronate or oversupinate and then prescribe custom orthotics

 

For more information on anterior compartment syndrome, including a sports massage demonstration, taping technique and further exercises, please visit:

www.sportsinjuryclinic.net

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In some cases, if conservative treatment fails, surgery called a fasciotomy may be required to release the fascia and create more space in the compartment.

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