Compartment Syndrome and Shin Splints

[Mr_Slim]

Having experienced both (still rehabing from compartment syndrome) i thought i would check on the forums for some information about these conditions. The information i've found on here is... mixed. At best. Some of it is quite poor advice ("keep running, it'll get better!", "your muscles are just weak, keep running and they'll get better!")

While i'm not a physiotherapist or doctor, (so don't flame me) i've asked a lot of questions over the last few years, and have a bit of information that i can pass onto you guys. i HATE shin splints, they cost me any chance of an athletics career, and i'd like to forward this info on to you.

In regards to compartment syndrome, this is something that a lot of people don't know too much about, and often mistake it just for muscle soreness (myself included, originally). Without treatment, it can become permanent, so please read on.

SHIN SPLINTS:

Primarily experienced on the medial side of the tibia, this is a dull and sometimes even sharp pain experienced during / after running. You will feel the pain right on the part of your lower leg you can feel the tibia, and in worse cases you may even be able to feel little bumps along the medial side of the tiba.

CAUSES:

Most common cause of shin splints is due to over pronation, or an overly supernated foot. How does this cause?

Pronation can cause shin splints as the rolling in of the foot causes the muscles to be placed under an incredible amount of stress. Muscles from the medial side of your tibia originate on the tibia, and then insert on the top of the foot, after wrapping underneath. Therefore over pronation causes these muscles to stretch, much more than they should. Compound this with the fact that running can put 5-7x your bodyweight on your legs at any time, and all of a sudden you have some serious muscle tendonitis occuring. Remember those bumps i spoke about? this is the tendonitis occuring, as the muscles start tearing off the tibia. Awesome.

Supernated feet can also be a cause, similar to the pronating foot, stretching the muscles too hard and pushing too much pressure on the tendons until they simply give up. Compounding this is that a supernated foot tends not to give the cushioning support to the lower leg that a "normal" foot does. Therefore more stress on the tibia, eventually leading to stress fractures (worst case of shin splints)


TREATMENT:

- Stop Running, especially on hard surfaces! i can't stress this enough! just like any other injury. Just say you broke a rib, and you wanted it to heal. would you then get someone to lightly punch you in the chest for 30mins? NO!!! So why put your tibia's and tendons under pressure when you want them to repair? If you MUST run, try and do it on soft surfaces. the harder the surface (concrete / roads) the more stress on the tibia

- Orthotics: very useful for those who pronate. Stop the rolling, stop the muscles tearing off the bone

- Better shoes: crappy shoes don't cost very much for a good reason. they offer your feet no support, and this is very bad in the long run. if you plan to do a decent amount of running, you need shoes with support. Especially for you supernators, you need all the cushion you can get, because your foot isnt doing it for you.

- Proper Treatment: Another one i can't stress enough. Go to a physio. Get them to assess you. Speak to a podiatrist, get a running assessment done. it could be as simple as your running form, put a set of orthotics in your shoes and problem solved. but you won;t know that until you get yourself assessed.

- Ice: great as a pain relief after running. Won't really help w/ rehabilitation, but will ease the pain.

WHAT IF I JUST KEEP RUNNING - WHAT'S THE WORST THAT COULD HAPPEN?
Broken legs - thats what. you wouldn't be the first person who tuffed it out, only to find they had stress fractures (sometimes worse) and then can't run for minimum 6mths. Get it fixed early. And if you can't? Take up bike riding.



COMPARTMENT SYNDROME

Your muscles, are broken into compartments. Each compartment (each fibre for that matter) is surrounded by a layer of fascia / sheath, that expands and contracts with the muscle expanding / contracting. However when this fascia is immobile for an extended period of time, it can become very stiff, and will not expand when you need it.

When running, you will notice that the muscles in your lower leg (could be Soleus, Gastrocenemeus or Tibialis Anterior, or a combination) will become swollen as the fibres expand with blood flow, however they will be killing you with pain, and sore even to touch. This is the fascia not stretching. And this, is compartment syndrome.

CAUSES:

Primary cause is not running for a long period of time, and then all of a sudden starting running again. It doesn't even have to be a lot of running. But once the fascia becomes tight, it will not stretch unless you make it.

"So if i dont do bicep curls for a year, then i start again, i could get compartment syndrome in my biceps?" No. I guarantee you will use your biceps almost everyday, if not numerous times in each day. you may not be curling dumbells, but you're still picking stuff up etc.

Muscles in your lower leg (the 3 mentioned above) are not used quite as extensively, especially tibialis anterior, unless running. Calf raises will use your Soleus and Gastroc, but still not the amount of stretch experienced when running.

TREATMENT:
- STOP RUNNING Another big no no! I'll explain this further below, but once this fascia is tight, you will not get very good results stretching it with running. The bad you will do will far far far outweigh the good.

- Stretching and a crap load of it. It is very hard to stretch fascia, so you have to work at it. Stretching up to 5 or 6 times a day is not a bad thing. Make sure you stretch all 3 major muscles in the lower leg, so this can be done by stiff legged calf stretch (Gastroc.), bent leg, putting pressure on the knee (Soleus), and Kneeling, putting heels on outside of bum, sitting back and putting pressure back (Tibialis Anterior). All the compartments are linked, so you need to stretch all 3 major muscles. Pereneals can also be stretched, aim foot slightly skewed medially, knee flexion putting pressure on outside of lower leg.

- Massage: Also very important. Do it slowly, and deep as possible. Use your nuckles, or get someone else to do it. Get yourself a pain threshold as well, because you will need it, particularly on Gastrocenemus. Doing a slow, hard massage will slowly stretch out the fascia. Once again, it is a slow process, so this will also take a while.

- Accupuncture / Stretching: Imagine a rubber band. Reasonably flexible, yes? Now poke pin holes in the rubber band, and then stretch it. Much more stretchy - the integrity of it has been breached, making it more flexible. Now imagine the same concept, but on the facia of your muscles. Needle goes in the fascia, forming holes. Needle comes out, and you stretch the buggery out of them while you can, before those holes heal up.

- Surgery: The last - worst case - scenario, is that 2mths of stretching and still not better. Doctors open up your muscle, and physically cut the fascia, making it more flexible. Quite successful from what i've been told. I'd rather not find out. Very invasive surgery, don't plan on running for a few months afterwards.

WHAT IF I JUST KEEP RUNNING - WHAT'S THE WORST THAT COULD HAPPEN?
How does nerve damage sound? Pretty bad huh. Well this is what happens. The fibres expand, but the fascia doesn't. apart from the incredible pain (which most people couldn't run through, even if they tried, unless without pain killing injections) this will start to put physical pressure on the nerves, until the point where you're actually crushing them. what happens then? They die. "But i have millions of nerves, and they grow back!" Yes, true. But once a nerve dies, it dies all the way back to the source (spinal column) at a rate of 2mm per day. it then grows back at 1mm per day. thats a long time from your calves to your spine, especially for tall people. What happens in the mean time? Loss of the use of your toes, foot drop (not being able to dorsiflex) and even the loss of plantiflexion. So don't plan on squatting for a while. Walking will even be a struggle.

--------------------------------------------------------------------------

So there is my little overview on Shin Splints and Compartment Syndrome. There is some very poor information going around, and while i'm not claiming to be the be all and end all, as i assume there are many more causes / treatments out there, this highlights the main causes and primary treatments being used.

Continuing to run is the worst thing you can do, you will NOT recover from these injuries by running. Shin Splints is an overuse injury, so running will only use it even more. Compartment Syndrome is due to fascia tightness, and the good you will do from running through it is far less than the bad you will do.

I encourage anyone out there who is experiencing these pains to consult a good physiotherapist as soon as possible. Shin Splints you should also consult a podiatrist. Your physio should be able to recommend one.

Good luck to anyone who is experiencing this now. I know it is a terrible injury, and sometimes it is just due to our genetic makeup. So good luck all, and hopefully we can get some good information and good awareness about these injuries!

[groovyslick]

Excellent post!

[Mr_Slim]

thanks mate! i'd much rather have read about this in a book, than have experienced it myself, but i guess i've been able to learn a lot more by actually having both shin splints and compartment syndrome.

information i can now pass on to everyone else!

[oissorolf]

This was very informative! Thank you for it. I'm pretty sure I have compartment syndrome. I personally don't wanna go through surgery to get my graft expanded but I would like to be able to run again. You recommend to stop running. Will I ever be able to run again?

[biggunds]

I wish I would have seen this over 2 years ago.

I was 290 pounds out of shape, and lazy. Started to train MMA and I went from walking 1/4 mile to class, to running 2-3 miles a day, training BJJ and kickboxing 4 days a week, lifting weights 3 times a week and doing hundreds of plyometrics 3 days a week. Well needless to say I dropped to 215 in 8 months, looked and felt great, but I sustained a neck injury which effected my right shoulder as well. Had a surgery on my shoulder in January 2009 and started to rehab and run again about 4 months later and noticed that about 15 minutes into my workout that I could not feel my legs. They were numb as if that "sleeping feeling" you get when you lay on your arm to long and cut off ciruclation. I thought that maybe I should start my workouts walking for a little bit then start running, but noticed even walking caused my legs to go numb. I tried the elliptical and bike and both caused the numbness feeling in my legs.

Well after about 8 months and another surgery on my shoulder later that year, I went in for a check up and the doctor decided to send me to a specialist on compartment syndrom. ( I like most people have never heard of this before). The doctor tested fluid levels in 3 compartments on each leg, and he told me a good number would on the tests would be 15-16. Well my anterior compartments tested 58 and 59.

I am on day 3 after my surgery and I have not walked around much (obviously) because I have 4 incissions 2 on each leg. One is middle/outside of the shin and second in about 2 inches above the ankel on the outside of the shin. My doctor told me because of the numbers and the fact that I cant feel my feet half the time, is the reason he made 4 incissions and not just 2.

He told me the 3 major reasons people get compartment syndrom are 1. going from inactiveness to over-training, 2. steriod use, which allows your muscle to grow faster then the fascia grows. 3. trauma to the area.

Well 2 of the 3 that he indicated to me I have done. I barley worked out and then started to run alot, and kickboxing (live sparring, heavy bags and fights) which kicking probably thousands of times a day caused my compartment syndrom.

I guess I just really wanted to tell my story to let anyone that reads this to basically just start out slow and make gradual goals. In less than a year since I weighed 215, I am actually now heavier then I was before I started training. I weighed in before my surgery at 310?? I have lost my motivation, because I can not use my shoulder anymore than 40% right now and both of my legs are hurt.

Feel free to comment and respond with anything.

[Daveg77]

I know this is an Old post but I wanted to re-vitalise it.

I am currently suffering from Compartment Syndrome in my lower right leg and here is my 2 pennies worth.

Please STOP running. Thats one thing you should never do. If your running and you get pain , pins and needles or numbness, this is your body telling you to stop. !! You could be Causing the swelling in your compartment to put pressure on the nerve endings and pressure on the arteries partially stopping blood flow to that part of the leg. Continuing through the pain could cause the blood to stop completely and possible muscle necrosis (basically Acute Compartment Syndrome).

While I was pretty lucky in diagnosing Compartment Syndrome ( 6 Months ) , It took a lot longer to diagnose what caused it in the first place (1 Year ). My Orthopeadic Surgeon and Podiatrist said it was nearly always down to Running Gait. An Abnormal pattern when running puts additional stress on the muscles as opposed to the bones.

In my case I have anterior Compartment Syndroem caused by an abnormal running gait ( I heavily over pronate when I run) This is the first I knew and have been playing rugby for 25 years.

If your a serious sports person or runner I suggest you see a Podiatrist FIRST. You will prevent a lifetime of pain from this and many other injuries.

[SurgeonBrah]

What you guys are talking about is a more chronic condition otherwise known as chronic exertional compartment syndrome. Some decent info here:
http://www.mayoclinic.org/diseases-c...n/con-20026471
True acute compartment syndrome is a true limb threatening surgical emergency requiring urgent fasciotomy to preserve neural function.
Many different definitions but generally accepted is clinically severe pain on passive stretch to the affected compartment and pain disproportionate/unresponsive to opiate analgesia.
Measurement wiseacre compartment with a pressure > 30mmHg or within30mmHg of diastolic blood pressure warrants urgent fasciotomy also.
Mostly occurs post trauma but can occur after extreme exercise also.
If you guys experience the symptoms I mentioned above please seek emergency care ASAP.

Good post mate, stay safe.