Compartment syndrome results from increased pressure in the muscle compartment, usually of the lower leg. The condition leads to pain, decreased circulation and compromised muscle function.

Mechanism of Injury

The increased compartment pressure may be due to:

• increased muscle size with training
• trauma to the area that involves swelling (i.e when a soccer player is kicked in the shin, even with shin guards on)

If left unchecked, the decreased circulation to the muscles decreases the amount of oxygen available to the tissues and can lead to irreversible tissue death within the compartment.

Compartment syndrome can be chronic in nature, developing gradually over the course of playing soccer. It can also occur acutely during a single action exertion like when an athletes kick is blocked at the shin by another player. There are four muscle compartments in the lower leg (anterior, posterior, lateral, medial); the anterior compartment on the front of the lower leg is most frequently affected.

Signs and Symptoms

5 P's: paresthesia (numbness in toes), paresis (drop foot), pain (front of shin bone), pallor (pale area of skin), pulselessness (decreased pulse in foot)

Acute:

• Pain and muscle cramping during and after soccer practice and games
• Warm, tight, shiny red skin over the affected area
• Hard and tender muscle mass on palpation
• Decreased skin sensation on the foot
• Weakened muscle group (i.e. soccer player might find it difficult to control the foot for kicking)
• Increased pain with muscle stretching

Chronic:

• Pain only when certain activity level is reached and usually subsides when activity is stopped.
• Symptoms similar to but less severe than acute.

On-Site Management

P.R.I.C.E. PROTECT the area by addressing equipment (i.e. soccer cleats and turf shoes) and technique of activity (biomechanics of running and kicking). REST does not imply halting all activity, and the injured soccer player can be running in deep water, light cycling, etc. to maintain and/or increase fitness. ICE the area for 10-20 minutes to reduce inflammation. COMPRESSION is NOT recommended. ELEVATE the area after a long workout to increase circulation to the heart, this can be done while icing.

Referral. ACUTE compartment syndrome is considered a SERIOUS MEDICAL EMERGENCY requiring immediate intervention, usually surgery, to release the compartment pressure. Whenever compartment syndrome is suspected the athlete should be seen by a physician to determine the extent of the problem. Even in the chronic case, surgical intervention may be needed in recurrent symptoms.

Rehabilitation. After clearance from a physician, gentle stretching of the muscles in the involved compartment may help relieve some of the symptoms.

Promote Healing. Invariably with overuse injuries, when the athlete's pain is relieved, s/he prematurely returns to playing soccer and is re-injured. It is important, not to attempt to "play through" the pain or place continual pressure on a stress fracture, as a complete fracture of the weakened bone may result. Caution against weight bearing during severe pain. Healing occurs with rest and a combination of progressive site-specific strength and conditioning exercises and overall body conditioning.

Control Abuse. The potential for tissue overload must be adequately controlled prior to returning the athlete to playing soccer. Some effective methods for tibial stress include:

• supportive soccer cleats or turf shoes
• improving running and kicking technique
• addressing training errors (frequency, intensity, duration)
• paying attention to playing or training surfaces

Return to Activity. Only after completely healed with the physician's OK.

Prevention. Although there may be no way to prevent the initial injury, permanent damage can be prevented through immediate recognition and referral.

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