Exertional (Chronic) Compartment Syndrome

with Rehab

ExitCare ImageThere are 4 main compartments within the leg, which are divided by thick, ligament-like tissue (fascia). The compartments contain muscles, nerves, arteries, and veins. If swelling occurs in one of the compartments, the fascia will not stretch to accommodate for swelling. This swelling results in increased pressure within the compartments, which eventually stops blood flow in the veins and arteries. The combination of pressure and lack of blood flow damages the muscles and nerves. This condition is known as compartment syndrome. Multiple types of compartment syndrome exist, including acute compartment syndrome and chronic, exertional compartment syndrome. This document is specific to chronic compartment syndrome. Compartment syndrome is most commonly associated with the leg. However, compartments exist in all limbs and can also be affected.

SYMPTOMS

  • Pain in the leg, while at rest and with motion of the foot or toes.

  • Feelings of fullness and pressure in the leg.

  • Numbness and tingling of the leg, foot, or ankle.

  • Weakness or paralysis of the muscles of the foot and ankle.

  • Cold, blue or pale foot and toes (seek medical attention immediately).

CAUSES

The cause of exertional compartment syndrome is unknown. The condition is believed to be caused by increased pressure in the compartments of the leg, due to muscle growth (hypertrophy) or a thickened fascia.

RISK INCREASES WITH:

  • Sports that require endurance training or competition.

  • Poor strength and flexibility.

  • Flaws in the fascia, where muscle can poke through.

  • Poor running technique.

PREVENTION

There are no known preventive measures. It may help to properly warm up before activity and to maintain your physical fitness.

PROGNOSIS

If recognized and treated early, compartment syndrome is usually curable. Definitive treatment usually requires surgery.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, resulting in a chronic problem.

  • Permanent injury to muscles and nerves of the leg, foot, and ankle.

Performance will be affected. You may need to stop performing, due to pain, if activity is continued without treatment.

TREATMENT

Treatment initially involves ice and medication to help reduce pain and inflammation. It may be helpful to perform strengthening and stretching exercises of the lower extremity, as well as modifying any activity that causes symptoms to worsen. These exercises may be performed at home or with a therapist. If non-surgical treatment is unsuccessful, surgery may be necessary. Surgery involves cutting (releasing) the fascia of the compartment, to reduce the pressure within the compartment. It is often difficult for athletes to return to the same level of competition after surgery for this condition.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Ointments applied to the skin may be helpful.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 to 4 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Exertional (Chronic) Compartment Syndrome

Some people are able to avoid surgery for this condition by increasing their ankle flexibility. These exercises may help you. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION- Ankle Plantar Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Use your opposite hand to pull the top of your foot and toes toward you.

  • You should feel a gentle stretch on the top of your foot and ankle. Hold this position for __________ seconds.

Repeat __________ times. Complete __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation, so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Inversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the bottom of your foot and your fingers across the top of your foot.

  • Gently pull your foot so the smallest toe comes toward you and your thumb pushes the inside of the ball of your foot away from you.

  • You should feel a gentle stretch on the outside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove your shoes and sit on a chair, preferably not on a carpeted surface.

  • Place your right / left foot on the floor, directly under your knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair, until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Gastroc, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Point your toes slightly inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Exertional (Chronic) Compartment Syndrome

Strengthening exercises are usually not helpful when managing this condition. Your physician, physical therapist or athletic trainer may add them at a later time, if they are appropriate.