What is compartment syndrome
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Compartment syndrome: what it is and how to treat it

Physiotherapist Omkar Sawant explains all you need to know about compartment syndrome including causes, symptoms, treatment and prevention

What is compartment syndrome?

Compartment syndrome is defined as increased pressure in the four compartments as outlined below, leading to compromised blood flow and tissue perfusion, which leads to ischaemic pain (pain caused by a lack of circulation to the area). If untreated, it may lead to permanent damage of the tissues in the compartment via nerve and blood vessel compression. This syndrome is common among runners, athletes, military personal and triathletes.

What are the compartments of the leg?

In the lower leg, there are four compartments or fibro-osseous spaces, which contain the muscles, nerves and blood vessels. They are separated by bones of the leg (tibia and fibula), interosseous membrane and anterior intermuscular septum. This is covered by fascia which is not elastic in nature. The four compartments are:

1. Anterior

2. Lateral 

3. Superficial posterior

4. Deep posterior 

  

 

  

What are the causes of compartment syndrome?

   

There are 2 major types of compartment syndrome:

  

1. Acute compartment syndrome

  

Acute compartment syndrome often results as a secondary condition following:

-        Acute injuries and trauma

-        Muscle rupture or tear

-        Fracture of the leg bones

-        Blood disease – sickle cell anaemia

-        Extreme exercise activities

2. Chronic exertional compartment syndrome

  

The exact cause and mechanism of chronic exertional compartment syndrome is not known, but it's believed that it can be caused by repeated overuse following inflammation, which can lead to to the development of fibrosis (hardening, and/or scarring of various tissues). This causes the fascia (connective tissue) to thicken, which in turn limits the expansion of muscles during exercises, and causes compression of the nerves and blood vessels, which results in ischemic pain.

What is a trapped nerve?

  

Faulty movement patterns and weakness at the hip and core may contribute to abnormal biomechanics leading to this type of compartment syndrome.

What are the symptoms of compartment syndrome?

   

  • Burning and aching pain along with swelling in the leg while running. Gradual worsening of this problem and a decrease in running distance due to pain and discomfort. This is the most common symptom.

  • Cramping, stabbing and tightness in the leg, which gets worse as running time and distance increases.

  • The pain resolves on stopping running followed by an aching sensation.

  • No pain or discomfort noted at rest and these symptoms are usually bilateral in nature.

  • In some cases, there's also numbness and a tingling sensation in the leg and foot.

  • In severe cases, there's discolouration of the foot due to a compression of the blood vessels.

  • Nerve compression can lead to foot drop in some runners.

  • It's important to rule out tendinitis, fracture, blood diseases, shin splints and vascular diseases before narrowing down to compartment syndrome.

        

How to treat compartment syndrome?

  • Avoid pain-provoking activities for a while. Substitute pain-provoking activity with other physical activities. E.g. stop running and start cycling or swimming if less pain noted.

  • Ice application may help to reduce the pain and swelling in acute stages.

  • Anti-inflammatory medication also helps to relieve pain and inflammation.

    What's the difference between non-steroidal anti-inflammatory drugs and steroids?
      

  • Foot wear correction using orthotics may help to offload the muscle and encourage appropriate biomechanics in lower limb, thereby reducing pain and discomfort.

  • Soft tissue mobilisation helps to reduce the tension and tightness in the muscles and fascia. Myofascial release helps in recovery and reduces the strain over the soft tissue.

  • Active release technique with ankle movements has also known to be effective in these patients.


    What is ART therapy and how is it different from sports massage?

  • Dry needling or acupuncture can help to manage pain and address soft tissue mobilisation.
     

  • Some patients may also benefit from cupping techniques over the leg.  
      
  • Foam rolling can help to relieve pain and discomfort over the affected area.
      
  • Observation and analysis of movement pattern during the pain-provoking activity can help to know the areas of faulty movement strategies. This can assist to reduce the abnormal biomechanics and strain in the leg muscles.

    What is functional movement screening?
      

  • Stretching of tight muscles noted in movement analysis helps to address flexibility concerns.
  • Strengthening lower limb muscles mainly at hip and core activation can help to address the faulty running strategies, thereby reducing the strain over the leg muscles.

  • If conservative management fails, surgery is the next option. Most common surgical procedure is fasciotomy in which surgeons perform incision over the tight fascia to release the muscles.

  • Sometime fasciectomy (removal) is performed along with fasciotomy (cut) during which there's removal of the fascial tissue.

      

How to prevent compartment syndrome

    If you have any health concerns at all or are worried about injuries always consult a doctor, pharmacist or chartered physiotherapist

  

Omkar Sawant is a senior physiotherapist with Capital Physio


 
 

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