Compartment Syndrome?

[Stewy]

Following the recent Saunders MM I have severe pain within my right shin and have been unable to run since. Following 7 days of complete rest it felt better so I did 20 miles on the bike after which the pain was intense making walking difficult. The pain does ease with ice and ibuprofen tablets or gel.
I have done a little research and believe that the injury is compartment syndrome within the anterior muscle compartment (rather than shin splints).
I am sure the cause is running a MM wearing Walshes, I always race in Walshes and train wearing Inov-8's but I think the distance of a MM was too far for them to offer adequate support. I have worn orthotics during training for the last couple of years so these are not the solution.
It seems the only truly effective treatment is surgery to release pressure within the muscle compartment.
Has anyone experienced this injury or can offer any advice?

[premier physio]

The 2 causes of Anterior Compartment Syndrome:

1/ Biomechanics and soft tissue. People with tight calf muscles causes a limitation in ankle dorsiflexion. This movement is required for normal walking. The tibialis anterior muscle is the muscle which dorsiflexes the foot up. If the calf muscles are tight the anterior tibial muscle will have to overwork in order to pull the foot up and this can give rise to compartment syndrome symptoms- the muscle itself will swell and feel like a brick and cause pain- excessive foot pronation puts a further increase starin on the tibialis anterior muscle. Xs foot pronation and tight calf muscles can = anterior compartment syndrome. Remember that if you have not treated the tight calf muscles then one of the causes of the problem is still there- furthermore your orthoses should be checked to ensure they are correct for anterior compartment syndrome

2/ the second cause of anterior compartment syndrome is a purely vascular insufficiency. As you run the muscle swells so much so that it crushes the major artery in the front of the leg. the problem can become so bad that a fascial release is needed. In severe cases the blood supply can become so poor that the anterior compartment tissue begins to die and urgent treatment is needed. In order to diagnose a vascular cause of anterior compartment syndrome an assessment with a vascular surgeon is needed!!

regards

Mr Matthew Malone BSc MSc SRCh MChS HPC
Specialist Sports Podiatrist

[philgreen1968]

So unless you have pain +/_ no or prolongled cap refil (ie when you press hard on your toes then release the pressure they dont turn pink again = capillary refill time) your mostly okay. Compare calf circumferances they should be more unless equal. if you have severe pain or your cap refill times is very prolonged (> than 4 -5 secs) go to A+E ! Black toes are so 2007!!
more likely something straight forward though like shin splints

qualified in nowt, ring NHS direct!

[Stewy]

Thanks for the advice.
Premier Physio / Matthew,
My physio believes I do have 'a little bit' of Compartment Syndrome. He has recomended 2 weeks rest, ice treatment, and wearing my orthotics all the time I'm on my feet - I am complying with all of this.
He has also given me a stretching exercise - this involves kneeling down then leaning backwards to increase the tension on anterior muscle area. This seems to cause me increased pain afterwards - do you think it's a sensible exercise? I'm aware this part of the leg is difficult to stretch any other way, but I wonder if it's beneficial to be working the inflamed muscles.
I'm going to the Alps next weekend for what was meant to be a 'training' holiday, I won't be able to run now but the thought of not being able to do some decent mountain walking fills me with dread!

[premier physio]

although i havent looked at you i would concentrate on stretching the muscles in the back of your leg - calf group. the only reason the anterior muscle gets painful is beacuse its overworking to compensate for the tight calf muscles. stretch and release the calf muscles and tibialis anterior shouldnt have to work to hard. the reason its painfull is because as you do the exercise the tight calf muscles are limiting the ankle from moving upwards or dorsiflexing thus tibialis anterior is being overworked. there maybe some tightness in this muscle group but its probably the result of so much pressure being put on it! get to the route cause- probably the calf muscles and you may make better progress. but hey like i said i havent seen you so i cant be 100%

[Asteroid]

Stewy, without knowing it at the time, I had anterior compartment syndrome whenever I went running. It got to the point when after about 1/2 mile into a run the anterior tibialis muscles (both legs) became almost solid and I could hardly flex my feet when running. It was very painful and I knew something wasn't right. Only after the run did the muscles become relaxed.

A physio recommended I go for pressure tests at a hospital by a doc who was researching into the problem. The tests involved running on the spot with tubes sticking out of my shins wired to machines for several periods of time. These showed that the presure in the muscles was 4x what it should be, during running. The doc recommended cutting the fascia to relieve pressure.

I had the op (gen anaesthetic) in Oct 1985. Left with a 1-inch scar on each muscle, but doc said underneath, the length of each muscle fascia was cut. Within a few days I was jogging a few reps up and down the street - painful, mind. Not sure whether this was wise being so soon after op but no-one said not to... and besides I was much younger/naive and didn't want to miss training!

After soreness had settled down, things were (and still are) fine. I had more pressure tests in April 1986 which confirmed everything was ok. Both sets of pressure tests were painful, but things may be different nowadays.

I know it's a while ago but that's what happened. I wanted to run and needed the op to improve function and relieve the pain, the op was definitely worth it for me.

BTW Dave Moorcroft, Mary Decker, John Walker had similar ops on their calves. If only the op made me as fast

[Stewy]

MathsEd, Thanks for your post, your case is proof that the condition even at it's most severe can be cured. The thought of surgery is quite daunting but it would appear that recovery is quick.
My situation has improved, following 4 weeks of complete rest I am now starting to do some short 30-40min sessions more or less pain free.
I am ensuring that my calf muscles are stretched out 2 or 3 times a day which I think is helping.
I was surprised how quickly my injury seemed to repair itself but I'm aware that overuse may bring me back to square one - probably foolishly I'm considering racing at 3 Shires.
My other concern is wether to start cycling again yet, I'm really missing this but cycling does seem to put alot of pressure on the anterior tibialis, particularly when climbing out of the saddle.

[clarkee]

This sound like me, on a scale of 1 to 10 how painfull can this be? I am wincing when I walk at the moment following a 20 mile run at the weekend. Getting on with the stretching and to the amusement of my colleagues sitting in the office with a bag of peas on my leg.

[username]

Hello,

I've started to see a physio who reckons I've got chronic compartment syndrome. He's started to massage it but has said if they dont respond the it'll be surgery.

Anyone know how effective massage is? If it doesnt work will I be able to get the op done on the NHS or had i better start saving?

Cheers

[username]

Just in case anyones interested, I've seen a consultant who has referred me to phsio. I've got until Oct, and if its not better then its chopping time!

Really impressed with the physio, looked at other muscle groups in my legs to see if they're contributing, so I've got a set of exercises and stretches, will have to see how things go.