To understand chronic compartment syndrome, an overuse injury that typically causes calf pain, it helps to start with a little anatomy lesson. While most of us don’t think of our bodies as having “compartments”, if you use terms like “the front of my left leg” or “the back of my right thigh” then you are dividing already your body in sections. or “compartments”.
Here are the details of anatomy: Muscles, tissues and nerves are grouped together and divided into distinct sections throughout our body. “These compartments are lined with fascia, a thin envelope of tissue that surrounds and holds muscles in place,” says Jill C. Mitchell, PT, DPT, physical therapist at Thrive Physio and Wellness in Dallas, Texas. The runner’s world.
Although mild, temporary swelling in compartments, such as those in your feet, is a typical consequence of working out, as oxygen and blood flow to hard-working parts of the body, it is possible, although rare that a compartment is unable to manage this additional flow. This can lead to chronic compartment syndrome, sometimes called exertional compartment syndrome.
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What is compartment syndrome?
According to the American Academy of Orthopedic Surgeons, “Compartment syndrome is a painful condition that occurs when the pressure in the muscles reaches dangerous levels. This pressure can decrease blood flow, which prevents food and oxygen from flowing. reach nerve and muscle cells This can occur in any compartment of the body, but it most commonly occurs in the lower leg, which has four compartments (anterior, posterior, lateral, and deep).
“Effort compartment syndrome often occurs due to overtraining without enough rest, which means the tissues don’t have time to recover,” says Mitchell. “Think of it this way: tissues swell as part of recovery and, if you don’t allow enough time [for this recovery]it constantly bulges, and then the fascia leaves no room for this recovery to occur.
It is also important to note that another type of compartment syndrome, called acute compartment syndrome, can also occur. However, this problem is much more likely to be the result of an accident and is rarely related to overuse or racing.
“Acute usually occurs when associated with some sort of trauma,” Mitchell says. “It’s often a medical emergency and in that case the priority is to release that pressure.” In severe cases, surgical “decompression” may be necessary. In this procedure, doctors cut the fascia to relieve pressure in the muscle compartment. This is rarely a problem that runners with chronic compartment syndrome will face.
Identifying the Symptoms of Compartment Syndrome
The most common symptoms of chronic compartment syndrome include leg pain, unusual nerve sensations, and possibly muscle weakness. Specifically, there are “five Ps” to look for: pain, pulseless (due to poor circulation), paralysis (muscle weakness), paresthesia (numbness), and pallor (white skin, again due to poor circulation ).
“You may also find that the pain gets worse with activity and gets better with rest,” says Mitchell. “Also, stretching tends to increase pain, and the area can also be very tender to the touch.”
When chronic compartment syndrome is located in the tibia, it is sometimes confused with shin splints. “Shin splint is an overuse injury of the attachment of the tibialis anterior (tendon) to the tibia (shin bone),” Gallucci adds. “Usually the fibrous components of attachment to bone become inflamed due to surface change, shoe change, repeated blows to it, and yes, as that compartment of the tibialis anterior becomes more inflamed, it can progress to compartment syndrome if not treated appropriately.
That tightness in your shin and calf can be significant, John Gallucci Jr., PT, DPT, physical therapist and founder of JAG-ONE Physiotherapy in New York, explains to The runner’s world. “It might start out feeling like muscle tension, but most people become aware of compartment syndrome because then they start to feel numbness or tingling that can go from the shins down to the feet,” he adds.
To officially diagnose compartment syndrome, doctors use specific techniques and instruments to measure the amount of pressure in the compartment that is causing pain.
Prevent compartment syndrome
While anyone can get compartment syndrome, it’s most commonly seen in athletes under the age of 30 who play sports that require repetitive motion, like, you guessed it, running. “Compartment syndrome and shin splints are overuse injuries, so cross-training is definitely a way to reduce the incidence of both,” advises Gallucci. “Overuse” can refer to doing too many new exercises too soon, increasing mileage or activity too quickly, or not resting or stretching properly to give muscles time to recover. .
Additionally, it’s always a good idea to wear proper running shoes when exercising and to avoid continually changing running surfaces, says Gallucci. “Marathoners run on pavement, then they’ll go from pavement to grass to cement,” he says. “These slight deviations can have a rebound effect on how your muscles respond.”
Besides overtraining and wearing the wrong running shoes, impaired body mechanics (such as stepping too short or landing on your toes when running, which can put extra pressure on the front of the lower leg), as well as Poor stability can lead to chronic compartment syndrome, says Mitchell.
Treat compartment syndrome
“To really fix this, you need a thorough evaluation by a physical therapist,” says Mitchell. A physical therapist can help you improve range of motion and proper foot, ankle, and hip mechanics, which can help you avoid this condition.
Strengthening your muscles would also be part of the program, says Mitchell, including not just the calf muscles which may be weak, but other areas, such as the muscles around the hips, as well as the core. Your calf can compensate for these muscles if they are weaker than necessary for good running form.
“You may also need manual therapy to help with mobility and soft tissue healing,” says Mitchell.
Gallucci adds that “research to date has shown us that rest, ice, and reduced activity are the primary means of treatment.” He says some anti-inflammatory drugs have also been used for more aggressive treatment, but that should only be handled by a doctor.
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