Compartment Syndrome

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. The increased compartment pressure may be due to increased muscle size with training or trauma to the area that involves swelling. 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 activity, or can occur acutely during one single episode of physical exertion. 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 are of skin), pulselessness (decreased pulse in foot)

Acute:

• Pain and muscle cramping during and after activity
• 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
• 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. shoes) and technique of activity (biomechanics of running). REST does not imply halting all activity, and the injured athlete can be running in deep water, light cycling, etc. to maintain and/or increase fitness. ICE the area to reduce inflammationl. COMPRESSION is NOT recommended. ELEVATE the area after a long workout to increase circulation to the heart.

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 activity and is re-injured. It is important, not to attempt to "run 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 activity. Some effective methods for tibial stress include: supportive footwear, improving running technique, addressing training errors (frequency, intensity, duration), and 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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