Many of us have experienced shin splints at one time or another, but there is another condition of the anterior leg—Compartment Syndrome—that may be unfamiliar to you. It is important to familiarize yourself with this condition so that you can correctly identify the symptoms and take appropriate action if necessary. Compartment Syndrome can cause permanent, irreversible damage, and even death, if medical treatment is delayed.
The good news is that this condition is rare—only 0.06% of the population is afflicted by it. Compartment Syndrome occurs when the tissue pressure within a compartment of the lower leg is greater than the blood perfusion pressure. It occurs equally among the sexes and is most often detected during peak athletic years. Conditioned athletes are most at risk when their training is rapidly accelerated, putting greater stress on their bodies. Repetitive loading and exertional activities are additional risk factors.
Even if you are relatively inactive or unconditioned, if you increase your activity too quickly and take on great loads too soon, you may be at risk for developing Compartment Syndrome.
Compartment Syndrome comes on suddenly. For example, a conditioned runner may observe gradual burning in their leg as well as numbness on the back of their foot, early on in their run (about 15 minutes). There are both “chronic exertional” and “acute” forms of CS. In the chronic condition, the lower leg may feel “full” and as if it could “explode’. Numbness and burning dissipate within 30 minutes of rest, and worsen with activity.
Acute Compartment Syndrome is considered a medical emergency, and rather than being brought on by activity, it is usually a result of a single traumatic event, such as a cast being too tight, or a tibial fracture. The person affected must seek immediate medical attention. A fasciotomy is the standard procedure, performed by a surgeon, to relieve the swelling and pressure in the afflicted compartment and thereby saving the limb.
There are 6 signs, known as the 6 “Ps”, to observe in someone you suspect may have acute CS. These signs may not be present in each individual, and they come in stages.
The first main sign is severe Pain that is not in proportion to the injury sustained. Pulselessness and Pallor are also signs to look for in the later stages, but they are less common and may be poor indicators.
Parasthesia may occur 30 minutes after sustaining an injury to the nerves. Within 4 hours, motor function may deteriorate—Paresis—and Paralysis may come on 8 to 24 hours after ischemia (restricted blood flow) sets in.
It is of vital importance to take appropriate action at the very first indication that something is wrong (i.e. extraordinary and unusual pain). While it is unlikely to happen to you or someone you know, due to its low incidence rate, it is nevertheless a very real and threatening condition. We should all therefore keep the above in mind, as even a little bit of knowledge is sometimes enough to save a life.
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References:
Vizniak, Dr. Nikita A. Evidence-Informed Massage Therapy. Vancouver, Professional Health Systems, Inc., 2022. pp 816-17
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970751/#:~:text=The%20six%20P's%20include%3A%20(1,%2C%20and%20(6)%20Pallor.&text=The%20earliest%20indicator%20of%20developing%20ACS%20is%20severe%20pain.