Compartment Syndrome....Please share what you know!
Background: I am having a "leg issue" that is really bothering me because I feel like I don't really know what the real issue is. It all started in my calf a week before my 30 mile run in March, which led to some soreness/pain around the shins. But what I am struggling now with is a "nervy/tight pain" that starts in calf....I feel it also behind the knee into my hammy and of course it reaches the piriformis. I have 2 opinions that say it was shin splints...that formed some issues in my gait/imbalance issues ect. I took 2 weeks off running after my 30 mile run to rehab the leg. It was bothering me again so I took a few more days off running...then first run back= First mile it was pretty brutal...pain/tightness calf to medial side of tibia. I noticed that my run form was all off...heard my feet "slapping", I was hunched over bit ect....I straightened up, tried to engage the glutes, and fixed my cadence. The next mile was better, third mile I felt it the LEAST and it was the "fastest" of all 3 miles. (yes only 3 
) Second run: better than first. Ran 4 miles.
I decided to go to get a free injury assessment from a local PT office around here!! They couldn't really figure it out either...they thought possible compartment syndrome, but all the symptoms don't really meet that criteria. One of the PT's there decided to do a gait analysis to see if they could figure something out. I am landing in my midline instead of straight down (it looked like I was almost crossing my legs...GEESH!) and my leg is not fully extending back because my hip are too tight. So my gait is all off which I could feel. They did some strength stuff and my right leg is weaker than left for sure. They recommended strength and mobility to see if that will correct the issue....They said this happened before my 30 miles, and had those shin splints, that 30 miles just made the one issue disrupted the flow of everything else. They suggest I give some time to the strength and mobility and it that doesnt work to go to an ortho.
I am investigating this compartment syndrome thing because I feel like the nervy pain is also tightness....and I felt it during a walk with my dad today....a lot.
So anyone have any experience with this?
Comments
Westside Chiro of Tolland
Dr. Chris Prewo
860-871-0451
He's moving on to the ankle I sprained in Oct. that has been giving me weird intermittent issues. So many parts to fix, so little time....
My doctor thinks compartment syndrome is a big possibility for me. My history is that I've always had really tight feeling calves, though my ankle flexibility is good, and struggled with shin splints for a LONG time. When I've done HIM and IM, my feet will go numb during the run. I have never recreated this in training, even with race rehearsals. Seems like I need a REALLY long time of exercise for it to happen. Then I did a half marathon a couple weeks ago and BAM, not really that same numbness, but horrendous pain.
Some doctors like to rule everything else out before doing the testing for compartment syndrome, which involves measuring pressure in the compartments with needles before, during, after a treadmill test. My doctor wanted me to do xrays and an MRI before going that route. I'm putting it off. My reasoning is that it comes and goes pretty infrequently, so right now I want to make it through the season. HOpefully I won't have any more issues (my pain has pretty much resolved) and maybe in the fall I will look into it. The treatment is either conservative, which in that case would be the same as any other shin splint sort of treatment so a diagnosis isn't too necessary, or surgery. I'm not to the point where I want surgery, so I"ll just keep on my way.
Curious to hear others thoughts and knowledge as well!
Laura,
I'm wrapping up a three month stint with an ART therapist who believes that I was suffering from compartment syndrome. My symptoms were an extremely tight calf, and pain directly behind the knee. It didn't keep me from performing all the workouts of the JOS, and didn't seem to get worse due to the workouts. When it bothered me the most was when I was lying in bed. I would notice the pain so much at night that it was hard to go to sleep some times.
During the months of therapy, the symptoms migrated away from behind my knee, up to my hammy, into the piriformis, and now into my hip flexor. It is getting better through the ART treatments as well as the strengthening and stretching exercises prescribed.
I changed running shoe models about the same time that the symptoms started. Don't know if that's to blame, but it's the only thing that I can pinpoint that changed in my weekly routine. Good luck with treatment!
Yes, this MIGHT represent compartment syndrome (measuring compartment pressures are an objective help in making this diagnosis) but there are also two other possibilities that come to mind: adventitial cyst or popliteal entrapment: both of these entities affect the artery behind the knee (popliteal). Your evaluation should include a duplex ultrasound of the popliteal artery, arterial Doppler testing with the foot in extreme dorsiflexion and plantar flexion and a careful evaluation by a good vascular surgeon. MRI can be quite helpful in making the diagnosis of popliteal entrapment - if this is done be sure the radiologist does the imaging of the popliteal artery with your foot in neutral position, dorsiflexed and plantar flexed to demonstrate any changes in the popliteal artery.
Hope this helps
Thank you everyone for your responses!! SO helpful! Going to the doc again on Tuesday and hope to get some more answers!