What is Compartment Syndrome?
Compartment syndrome, also known as recurrent or chronic exertional compartment syndrome (CECS), is a condition that affects the lower leg. Your lower leg is divided into four or five compartments with different muscles, nerves, blood vessels and tendons running through these compartments.
The compartment is surrounded by fascia, which helps to improve the efficiency of contraction and divide the muscle from surrounding tissue. Sometimes the pressure within one or more of these compartments increases to the point that the muscle, blood vessel or nerves are compressed. This can cause pain and loss of function. It is often found in runners as a result of the high repetitive loads that occur with running.
What Causes Compartment Syndrome?
Compartment syndrome can become evident with an increase in activity or training. As we use our muscles, there is a build-up of waste products and an increase in blood flow to the muscle. This causes the muscle volume to increase by between 8-20%, which results in increased pressure within the muscle compartment. There may also be an increase in the resting size of the muscle as a result of training. These changes are normal, with increased pressures reducing within 5 minutes of ceasing exercise.
Compartment syndrome seems to develop as a result of different anatomy.
- In some people, there is an extra ‘fifth’ compartment deep in the lower leg, with an extra sheath of fascia extending up the leg. The further the sheath extends, the greater the risk of compartment syndrome.
- The fascia becomes fibrotic or thickened as a result of a chronic inflammatory process or surgery. This leads to the fascia becoming less flexible.
In either case, pressure increases to a greater degree and takes longer to reduce post-exercise. The extra internal pressure in the compartment means reduced blood flow to the muscle and reduced oxygen for the muscle tissue. We think that the pain is due to a lack of oxygen supply. This is called ischaemic pain.
Compartment Syndrome Treatment
- PHASE I – Pain Relief , Massage, Minimise Swelling & Injury Protection
- PHASE II – Restoring Normal ROM & Posture
- PHASE III – Restore Normal Muscle Control & Strength
- PHASE V – Preventing a Recurrence
Results:
he advice that your physiotherapist gives you in conjunction with some ‘hands-on’ therapy can work to reduce your symptoms very well. Unfortunately, many people do not respond as well as we would like, usually due to their underlying anatomy. If we do not see the desired improvements, you may be referred to a sports doctor, podiatrist or orthopaedic surgeon.
Surgery
The surgery involves cutting the fascia that surrounds the muscle to allow for muscle volume increase. In some cases, surgical release is essential and urgent! Surgery is only considered if a conservative programme has failed and you want to keep exercising.
Other Treatment Options
Specific Interventions, e.g. Injection
Cortisone and other injected substances are usually not successful and are not recommended.
Massage:
Many patients find that soft tissue massage therapy is beneficial to assist your pain relief, muscle relaxation and swelling reduction. Please ask your physiotherapist if you would benefit from massage.
Acupuncture:
Acupuncture can be helpful for the relief of your pain. If you are interested in trying some acupuncture, many of our therapists are trained in acupuncture.
