Compartment syndrome, particularly chronic exertional compartment syndrome (CECS), is a condition that can significantly impact athletes and active individuals. It’s characterized by pain and pressure in the muscles of the legs, and sometimes arms, during exercise. This occurs because of swelling within the muscle compartments, areas of muscles enclosed by tough membranes called fascia. Understanding this condition is crucial for effective management and returning to activity.
What is Compartment Syndrome?
To understand CECS, it’s important to grasp the concept of muscle compartments. Imagine your muscles are grouped into sections within your limbs, each wrapped in a tight layer of fascia. This fascia is not very flexible. During exercise, muscles naturally increase in size due to increased blood flow. In compartment syndrome, this normal muscle swelling during exertion leads to increased pressure within the compartment because the fascia cannot expand sufficiently. This elevated pressure can reduce blood flow to the muscles, causing pain, tightness, and sometimes numbness or weakness.
Chronic exertional compartment syndrome differs from acute compartment syndrome, a medical emergency usually caused by severe injury. CECS is exercise-induced and symptoms are typically predictable and related to activity level.
Non-Surgical Management of Compartment Syndrome
For many experiencing compartment syndrome, especially in its early stages, non-surgical treatments are often explored. These methods aim to alleviate symptoms and allow individuals to continue their activities, although their effectiveness can vary.
Physical Therapy and Orthotics
Physical therapy can be recommended to improve muscle flexibility, strength, and running mechanics. Orthotics, or shoe inserts, are sometimes used to correct foot and ankle biomechanics, which might contribute to leg pain. However, it’s generally noted that these approaches offer limited relief and often do not enable a return to pre-symptom activity levels for most individuals with CECS.
Activity Modification and Cross-Training
A primary recommendation is to modify or avoid the specific activities that trigger compartment syndrome symptoms. Identifying and reducing the intensity or duration of these activities can help manage pain. Cross-training, involving low-impact exercises like swimming or cycling, can be a valuable alternative to maintain fitness without exacerbating symptoms.
Surface and Running Technique Adjustments
Interestingly, the surface on which you exercise can influence compartment syndrome symptoms. Some athletes find their symptoms worsen on harder surfaces like concrete compared to softer surfaces like running tracks or grass. Experimenting with different surfaces may provide relief. Furthermore, adjusting running technique, such as transitioning from a heel strike to a forefoot strike, can modify muscle activation patterns and potentially reduce symptoms, depending on which compartments are affected.
Surgical Options for Compartment Syndrome
When conservative treatments fail to provide adequate relief and allow a return to desired activity levels, surgery becomes a viable option. Similar to the procedure for acute compartment syndrome, surgery for CECS involves a fasciotomy.
Fasciotomy: Releasing the Pressure
A fasciotomy is a surgical procedure designed to relieve pressure within the muscle compartment. It involves surgically cutting the fascia surrounding the affected muscle compartment. This releases the tight constraint, creating more space for the muscles to swell during exercise and improving blood flow.
Elective Procedure and Recovery
Unlike surgery for acute compartment syndrome, which is an emergency, surgery for chronic exertional compartment syndrome is typically elective. The incision for CECS surgery is often smaller than for acute cases. Recovery involves rehabilitation to regain strength and mobility.
Surgical Outcomes and Diagnosis
Surgery for chronic exertional compartment syndrome in the legs generally yields excellent results, particularly when addressing the anterior and lateral compartments. Outcomes are less predictable when the posterior compartments are involved. Accurate diagnosis is paramount for successful surgical intervention. Precise identification of the affected compartments through pre-operative testing, such as compartment pressure measurements, is crucial to ensure surgery targets the correct areas and maximizes the chances of a positive outcome.
Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of compartment syndrome or any medical condition.
