Often mis-diagnosed as shin splints ... just what are the differences and how is compartment syndrome treated ?
Calf and shin pain is a common problem in both new and established runners but there can be a number of different causes and it can be confusing. Shin splints is often the diagnosis that many reach for after a chat with the guy down the pub or Dr Google but there can be another sneaky problem lurking in the wings that doesn't respond to conventional shin splint therapy. So if you've tried the compression socks, stretching and resting but are still having shin pain read on.....
What the heck is Compartment Syndrome ?
In a nutshell it is a restriction in the blood flow to the muscles causing pain iand soemtimes associated numbness or weakness in severe cases. Our muscles ( particularly in our limbs ) are arranged in contained compartments separated by layers of tough, inelastic fascia.
Acute compartment syndrome is a potentially serious medical condition that occurs when there is a rapid increase in pressure within a muscle compartment, most commonly after a long bone is broken in the arm or leg with blood spilling into the compartment, filling it up and with nowhere to go it raises the internal pressure. This really does threaten life and limb - literally ! Prompt, usually surgical attention called a Fasciotomy is required to relieve the pressure within the compartment. ( word of warning - DON'T Google this if you are of a queasy disposition ! ).
Chronic exertional compartment syndrome ( CECS ) is is a different animal entirely and is not a medical emergency - the philosophy is the same however, an increase in pressure in the muscular compartments causing pain but the cause of the pressure increase and treatment are radically different and it's this CECS that we are concerned with in this blog.
So what causes CECS ?
The clue is in the name .... exertion. It's essentially an exercise induced muscle pain. When we exercise our muscles swell by up to 20% and some people's fascia does not ' give ' to accommodate this increased volume, the pressure builds, nerves, arteries and veins become physically compressed causing the blood flow to drop meaning less oxygen getting to the muscles. This leads to a characteristic achy, crampy type pain in the affected compartment often accompaned by pins and needles and in severe cases, a droopy foot !
Shin splints vs CECS.
So why the confusion with shin splints ? Shin splints is a generic term for pain on the front of the shin ( if we're being ' proper ' it should be MTTS but even there there is debate ..... but that's a different blog for another day ! ) but there are some key differences from CECS most notably in terms of location of pain and how that pain behaves.
Shin splints and CECS differ in where and when the pain is felt.
A 'classical' shin splint pain is often sharp, tender feeling running along the inside or slightly behind the front inside edge of the main tibia shin bone ... you know, that bit that really hurts when you whack it on something. CECS pain tends to be more of an achy, crampy, swollen kind of pain and usually higher up and little bit more lateral to this - on the top meaty part of your shin. Most crucially shin splint ( or stress fracture ) pain can occur at any point an the activity and persists AFTER exercising - CECS pain usually starts at a consistent point and subsides within a few minutes of stopping the activity. As the blood flow is restored the crampy sensations go and normal service is resumed....... until the next time.
Risk factors for CECS
There is an element of biomechanics or stiffness in the ankles and feet joints that seem to pre-dispose towards developing CECS but it's really one of those conditions that is largely down to the nature of your own anatomy and soft tissue make up. Some people's fascia just seems to be more inelastic and unforgiving. There are however a few factors that can influence development of CECS.
Type of exercise - the more repetitive loading impact activities seem to increase the risk of developing the condition .... running being a prime example !
Overtraining - ' doing too much too soon ' can be a major factor as muscles need to be trained to accept and manage a new increased load.
Best ways to treat CECS.
There's good news and bad news ...... some things we can change and others we can't .
The genetic make up of your soft tissues is pretty much pre-determined and no amount of stretching, foam rolling or sports massage will change that. Some of these measures can be great ways of managing symptoms and providing relief but it's not a long term solution for true CECS..
Managing your exercise load and volume is really, really important however and sometimes there are ways we can help you modify your activites, running patterns and training programmes to help get the muscles more ' fit ' for taking the load. Sometimes changing the type of exercise to a less impact type of exercise is enough to manage any pains.
Orthotics - some people find inserts into their shoes can improve their symptoms allowing exercise to take place
Ultimately the only way of changing the size of the muscular compartments is to surgically release them with a fasciotomy ( that's a polite euphamism for slicing through them ). This is far more controlled and less extensive than emergency fasciotomy required for acute compartment syndrome but like any kind of surgery it has it's inherant risks such as infection and excess scarring so shouldn't be considered as a first port of call for the vast majority. But, for the top flight athletes or those with ongoing nerve compression problems it can provide real relief of symptoms.
Things that may NOT help treat CECS.
As you can see there is overlap with shin splints and some of the treatments tradionally used to alleviate it nay well help CECS but there are a couple that definitely don't help !
Compression socks - I rather like compression socks for runners ( and non-runners too ! ) and if CECS is a vascular ( blood flow ) problem it's a reasonable assumption that they would help. However, the issue with CECS isn't a lack of blood getting OUT of the legs - quite the opposite - the lack of expansion in the muscular compartments reduces the blood getting IN. Compression socks generally don't help and some clients find it makes their symptoms worse.
Ice packs - look ice is a great pain reliever for many pains but in terms of CECS it's not especially beneficial - again of we think back to it being an issue with the blood flow to the muscles ice really ain't going to help !
Whilst not threatening to life or limb in the same way as the acute version of the syndrome CECS can be an annoyance to your training regime and can hamper enjoyment of your sport. If you've tried some basic measures at home that haven't succeeded then do give us a ring for a chat. We're always happy to advise and poist you in the right direction if we feel it isn't something suitable for our talents