The name compartment syndrome certainly sounds familiar, and I knew that in your mind it rhymes with pain too. Therefore, what do compartments have to do with our running? What is it exactly?
The lower leg anatomy
We talk about fascia before so let's quickly refresh your brains: The fascia is a solid and thick tissue, which runs throughout your whole body. The fascia is whitish (you can sometimes see it in red meat – it is very strong and difficult to cut and chew!) and there is very little blood supply!). Its primary purpose is to support organs and muscles by wrapping around them. Fascia wraps all around your organs, your brains and even all the muscles in your body but they are not very elastic. Our viscera would swell out of our bodies, and our muscles would not have the same shape without fascia.
The fascia is something very particular; it is all in one piece. E.g., ligaments attach bones, but they also have a starting point and an end. Muscles run through one bone to other and then stop. Fascia, on the other hand, is like skin, nerves, and blood vessels; it is all in one piece throughout your entire body. There is no beginning and no end.
Anything that happens to fascia in one area of your body could as well affect another utterly remote area making it very important and tricky. For example, tight fascia on the chest from an old blunt trauma could create heartburn, reflux problems, and pull the fascia wrapped around your stomach.
The one that interests us now is fascia of the lower leg. It divides the leg into three different muscle compartments (the lateral compartment, the posterior compartment and the anterior compartment) and wraps around each muscle individually. The fascia also wraps around groups of muscles and generates those compartments.
Compartment syndrome
A compartment syndrome is expected to develop when there are an increased pressure and a closed, limited space within the compartment. The compartments explained above make for very limited spaces because the fascia is not too elastic. A compartment syndrome can occur in any closed area of the body (shoulder, arm, and buttock) but the lower leg is often a target by compartment syndrome, which we usually call the leg-specific problem.
The compartmental syndrome appears to be the terms used to define the ones affecting other areas of the body. An abnormally tight compartment is usually the initial cause of a compartment syndrome. This could be the result of the quick development of the muscle bulk (which is related to the intake of steroids) or could be the result of fast growth in the teenage years (the muscles grow faster than their envelope). Or repeated trauma (a chronic type of injury where the leg muscles are not given a chance to recover fully), repeated use of drugs (usually affects more the upper extremity) and damage to the envelope (bone fracture, muscle tear, direct blunt).
Our muscles swell up a bit during exercise, that's why you notice culturists, and bodybuilders quickly lift weights before they get up on that stage in a competition. Muscles get bigger mainly because of the extra blood, nutrients and energy we pump into them. Since the fascia remains the same size during exercise session due to its lack of elasticity that increase in girth or size that creates more pressure inside the compartment.
The pressure inside the muscle keeps increasing since the compartment is a closed space and that extra pressure cannot break out. Since the fascia is usually built to allow an increase in girth, especially if you have begun workout slowly and gradually, this is not a problem. However, the pressure gets so high that it starts limiting the circulation in some unfortunate cases. The blood vessels and nerves collapse under the pressure, and they no longer function normally. The muscles involved become weak and painful. This point is where runners would slow down their pace because of the pain. It's sometimes enough to make the running bearable again by controlling the pressure, but a vicious cycle can take place if the runner does not slow down. As there is no longer a way for the muscle to evacuate used blood, the decreased circulation result in more tissues to puff up, making the muscle even bigger and then the compartment even tighter.
Signs and symptoms
The symptoms are vague making diagnosis difficult. Increase in pain in the lower leg with exercise are mainly the runner complains. The pain is more in a diffuse area and rarely at a specific point. The pain increases as the exercise progresses. This pain is usually severe that the runner has to start walking or even sit down and the only relief comes with a full break from the activity. The pain often becomes unbearable if the runner tries to run it out.
The weakness that comes with a compartment syndrome is another symptom: the muscles involved become weak and uncoordinated due to decreased nervous supply and lack of blood making it very painful. Depending on which nerve branch is affected, the doctor may sometimes find some areas of the foot or leg where the skin is numb and insensitive.
The doctor can use the signs discover to suspect a compartment syndrome and the illustration of the symptoms from the patient, but no authorized diagnosis is feasible as of yet. While the patient is running, some doctors may choose to insert pressure gages into the painful compartment to measure any abnormal increase in pressure during exercise (not very pleasant), but this is not a formal diagnosis as many other physicians could also increase the pressure.
Treatment
Any biomechanical defect could add to repeated trauma or muscle overuse. Therefore, the first thing you have to do is to ensure that your lower body (from hips down to toes) is well aligned.
Try some in-depth soft tissue therapy (with a registered massage therapist) to release the fascia and get rid of old scars if you pass the above test. Myofascial release is known as the best massage technique to improve the flexibility of the compartments. This technique result tends to last, but this is a mildly painful technique. Depending on what kind of state the compartments is and how many compartments are affected, this type of treatment may take a while before results show.
Checking how much time it takes before the pain starts is one way to measure improvement, once you’re allowed back to running. As you get better, the pain may reduce and go away faster when you have some rest, and it should take more and more time before you experience pain during your run.
Surgery must be done if all these techniques fail. The surgeon will force it to decompress by opening up the leg and cut off slits in the tight fascia. After the surgery, they have to leave the wound open for some days to ensure that the internal pressure is minimal. The surgery leaves scars in the fascia, which may later cause other problems in life, so it's somewhat a drastic solution. However, you may want to clean up and make some more room in your compartments if your legs hurt and feel tight when you run.