Anterior Compartment Syndrome Help

Triathlon Forum
1

I am slowing getting into running and have “self-diagnosed” that I may have ACS in my left leg. I am wondering if anyone has experience with this and if there are effective non-surgical ways to gradually solve this. I have no interest in surgery but I am hoping there are other ways. The sensation is hit and miss and does not come about all the time. Maybe this isnt even the real issue. Makes no difference the surface I run on and I am quite slow in general and in building up mileage.

Any insights would be appreciated.

2

What are the symptoms, timing and duration that led you to this self diagnosis?

3

Varies. Today after 15 minutes. Left leg tightness, feels hot. No real control with flexion of foot and feels like I am almost slapping the ground with foot.

4

You cannot really self diagnose compartment syndrome. It needs to be diagnosed either by skilled palpation and thorough subjective history taking, or it needs to be medically examined and you need to have a probe inserted into your leg to measure the pressure within the fascial bundle.

If you suspect that you have compartment syndrome, you need to go and seek medical attention as a matter of urgency. If this is left, it can lead to tissue death, nerve damage and in serious cases amputation of the leg or death. When you palpate the area does it hurt? I mean, really really hurt? Have you suffered from a change of sensation and/or pins and needles?

If you have already sought medical attention, what was the result? Some people have chronic compartment syndrome, but although this can sometimes resolve with non-invasive techniques, it can frequently develop into acute compartment syndrome.

Not trying to come across as overly dramatic, but as a physio who has worked in amputee settings I have seen the results of untreated conditions such as this.

5

Any swelling? Try some compression socks and ice afterwards. I’d get it checked by a md, rather than self diagnose. I’ve convinced myself I had several abnormalities via webmd.

6

There is a lot of possiblities / issues going on with Compartment Syndrome they can range anywhere from foot posture to fascia/muscular tightness etc…If it is that disabling I would reccomend following up with an ortho… the one thing you can’t go wrong with is to start to stretch the plantar flexors (classic swimming ankle flexibility stretches would work here) also targetting the posterior musculature of the Gastroc/soleus complex would be a good start.

7

If you are describing a hot sensation and loss of ankle power I would perhaps go more towards examining your lower back. Disc herniation for instance can lead to an impingement of (commonly) S1 or L5 nerves which can then de-innervate muscles at the ankle and give a change of sensation. The fact that it presents itself after 15 mins of exercise perhaps also points towards this in that as you load the Lumbar area of your back you stress the discs and hey presto.

You would however expect true disc herniation to present as a continual sensation/pain and this highlights the difficulty of trying to diagnose over the internet. I would be very surprised from what you are saying if you have compartment syndrome however. You would be in constant agony. I would go down the route of some sort of biomechanical induced nervous issue. Go get it checked out by someone qualified.

8

You cannot really self diagnose compartment syndrome. It needs to be diagnosed either by skilled palpation and thorough subjective history taking, or it needs to be medically examined and you need to have a probe inserted into your leg to measure the pressure within the fascial bundle.

If you suspect that you have compartment syndrome, you need to go and seek medical attention as a matter of urgency. If this is left, it can lead to tissue death, nerve damage and in serious cases amputation of the leg or death. When you palpate the area does it hurt? I mean, really really hurt? Have you suffered from a change of sensation and/or pins and needles?

If you have already sought medical attention, what was the result? Some people have chronic compartment syndrome, but although this can sometimes resolve with non-invasive techniques, it can frequently develop into acute compartment syndrome.

Not trying to come across as overly dramatic, but as a physio who has worked in amputee settings I have seen the results of untreated conditions such as this.

You are definitely getting way over dramatic on this. There is a huge difference between acute CS and chronic exertional CS. The chances of CECS leading to acute limb threatening issues is incredibly rare. Only chance of that is if you keep hammering through extreme pain on a regular basis. Acute compartment syndrome is typically a result of a traumatic injury to the lower leg that causes internal bleeding or swelling in the anterior and lateral compartments.

Other than that you advice is very sound. Get it checked out and if an initial examination turns up some problems go and get a pressure test from an experienced sports doc.

9

Agree with posts by Ironmike78. However, transient ACS induced by running might be an early sign. I would suggest getting EMG and nerve conduction tests before AND after inducing the symptoms. Also, ACS is associated with night cramps.

10

If it’s exertional, look into whether you are overstriding.

I had it and when I eliminated the overstriding, I eliminated the problem.

Try running with your foot landing directly underneath or landing on your midfoot and not your heel. You can also think of running right behind someone so close that your foot can’t reach out in front of you.

11

I started this thread a couple years ago and kept updating it to describe my history with compartment syndrome, surgery, and recovery. I hand interior and anterior in both legs. There are pictures and a running diary of my recovery. Feel free to PM me with any specific questions.

Good luck. The test SUCKS, but, in the end, it is well worth it.

http://forum.slowtwitch.com/gforum.cgi?do=post_view_flat;post=2373299;page=1;sb=post_latest_reply;so=ASC;mh=25;

Also, here is a summary of my symptom prior to diagnosis:

Started while I was training for IMCDA. I had gotten up to 16 miles for my long runs. I would get to 14 miles and the pain would be excruciating. Then it came on at 10 miles, then 6 miles. Within 3-4 weeks, I could not even run 3 miles without intense pain.

My upper legs (above the knee) felt like they were full of spider webs. They felt tight and like they did not move. The felt restricted. But, they did not hurt. My lower legs felt like they were in a vice. Felt like they were being squeezed and crushed. It was brutal. For me, it stopped immediately when I stopped running. I could walk without issue, but, could not run at all. It really felt like they were being crushed by a vice.

When I was not running, but, would walk or stand for long periods of time, the felt really tight, like I was wearing compression socks, but, did not hurt. When I ran, it was vice time.

I felt the difference immediately after surgery. When I woke up, it felt like my legs were breathing for the first time is quite some time. Even with the compression bandages on, I could feel a release in my lower legs. Even though they hurt like hell to walk on for a couple days, overall, they felt so much better.

I started having the symptoms in late March and had my surgery on June 24 of 2009.

12

Get ‘the stick’ and use daily on the lower leg, it worked for me. Also lot of stretching after and extra stretching in the shower/sauna after workouts. For runs 8mi and over I use compression socks and ice after.

Running mechanics is also a potential contribution. Consider stair workouts to improve your lower leg strength.

13

Haven’t read all the replies, but x2 on what Ironmike78 said…

In an acute case, ACS is a medical emergency! If you read enough online, you should know the complications of not seeking prompt medical care.

14

Haven’t read all the replies, but x2 on what Ironmike78 said…

In an acute case, ACS is a medical emergency! If you read enough online, you should know the complications of not seeking prompt medical care.

From the OP info there is absolutely no indication that this is an acute issue. This is a typical runner getting ‘shin splints’ occasionally during runs. If this was ACS the leg would already be gone by the time the OP got a chance to write and read these replies.

“The sensation is hit and miss and does not come about all the time. Maybe this isnt even the real issue. Makes no difference the surface I run on and I am quite slow in general and in building up mileage.”

15

I am slowing getting into running and have “self-diagnosed” that I may have ACS in my left leg. I am wondering if anyone has experience with this and if there are effective non-surgical ways to gradually solve this. I have no interest in surgery but I am hoping there are other ways. The sensation is hit and miss and does not come about all the time. Maybe this isnt even the real issue. Makes no difference the surface I run on and I am quite slow in general and in building up mileage.

Any insights would be appreciated.

I had this years ago. Saw an orthopod but didn’t want to even consider surgery. Had the worse disabling pain 15’ after getting off the bike for the run portion that would take another 10’ to go away. Almost left the sport. Long story short, I remembered that it all began after I got new cleats (as it only occurred in one leg). Repositioned my cleat placement and it went away. Never had it again. Good luck.

16

In what way did you reposition the cleats?

17

Cheers for the message. I think I am too new to the forum and am not allowed to send private messages. In terms of who you should see I would recommend a medically trained professional - as a physio, I am biased and would suggest this, but depending on your preferences there would be nothing wrong with a sports doctor, chiro or osteo. Good luck.

18

You need to get a real Diagnosis from an Orthopedic before you think about weather or not surgery is the right thing.
What are your symptoms? I had Bil. lower leg compartment syndrome, I too diagnosed myself but followed it up with a pressure test with an Orthopedic surgeon then I scheduled my surgeries. I had too much pain, swelling, neurological issues to pass on the surgery. I could not do what I love to do for an entire season but I would not change that for anything. I looked at it as a well needed rest and now I am better that ever!

19

In what way did you reposition the cleats?

I believe I was too supinated (on the outside of my foot) in my cleat position so that when I was pedaling. When I would run, I think my run mechanics was all screwed up. I ended up moving the cleat so there wasn’t so much pressure on the outside. Good luck.