Compartment Syndrome

Compartment syndrome in the lower limb is essentially where the pressure within a compartment increases to a point where the nutrients supplying the structures within that compartment are either completely or partially occluded. In our lower leg with have 4 compartments; Anterior, Lateral, Deep Posterior and Superficial Posterior. Within each compartment there are specific muscles and neurovascular structures which are contained. These groups of muscles are enclosed within a fascia which is like tight sheet. As well as bundling the muscles together the fascia has the function of providing an element of compression around these muscles. When we exercise our muscles receive increased blood flow, which cause them to expand, however the fascia remains quite rigid. In most individuals this isn’t a concern as the compartments have enough space for this expansion and contraction to occur. In a symptomatic individual, the muscles expand to a point that blood flow to the area is severely compromised and therefore pressure in the compartment increases. Compartment syndrome typically effects the calf or shin region. The main contributing factors for compartment syndrome are:
  1. Overload of training / Poor variability within training schedules – The below examples can facilitate the onset or progression of compartment syndrome
    • Running on sand/soft surfaces continually
    • Excessive sessions of plyometric training
  2. Abnormal foot mechanics – poor foot mechanics (i.e pronation/ flat feet) placing abnormal ground reaction forces/stresses through the tibia and calf muscles
  3. Poor footwear – Using flat runners/footy boots without graduating into the shoe, therefore requiring the posterior muscles to eccentrically lengthen on a repetitive basis.
  4. Tightness in calf muscles – exacerbating any pre-existing pressure changes in the posterior chain
  5. Weaknesses through the lumbopelvic region – A large proportion of poor lower limb mechanics begin with weakness in the lumbopelvic region and manifest distally.
Signs and symptoms of compartment syndrome are:
  • Deep tightening feeling in the calf or shin region, which is poorly localised
  • As a result of the above point, parathesia (pins and needles) might be experienced
  • Tense, swollen or shiny skin around the area
Diagnosis of this condition is performed by a specialist gauging the pressure in the compartment. A needle with a pressure gauge attached will be used to assess the level of pressure within the compartment. The normal pressure within a compartment is considered to be 10-12mmHg. Many sources quote that pressures above 30mmHg indicate that surgery will be required, where they essentially make an incision in the fascia which releases the built up tension. Compartment syndrome shouldn’t be ignored as 6-8hours of occluded blood flow to these compartments can result in irreversible damage. When treating compartment syndrome a physiotherapist can aid in three ways:
  1. Lumbopelvic stability
    • Addressing any deficiencies with the lumbopelvic complex, whether that is with the bone structure or muscular imbalances.
    • Reviewing core strength and stability and prescribing exercises to correct weakened areas.
  2. Correction of lowerlimb mechanics
    • We can assess your gait and review your current footwear
    • Your treatment may involve prescription of orthotics and/or re-educating your running technique
  3. Release work in the form of deep tissue, dry needling and myofascial release
    • The release work allows any toxins to be dispersed and for the muscle to be released
In summary the best way to maintain good lower limb health is to ensure variability within your training schedule, even if your training is specific to a sport and ensure proper nutrition is adhered too.
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