Athletes who have a chronic lower leg injury resulting from overuse, such as running on hard surfaces or excessive exercise, may be suffering from either shin splints or chronic compartment syndrome. If the latter condition has been caused by a sharp increase in training intensity, it is often called exertional compartment syndrome (ECS).
Acute compartment syndrome (CS) is the more serious form of this condition, usually resulting from bleeding or swelling in the hours following an injury. It results from excessive pressure building within an enclosed body space, or fascial compartment. A fascial compartment refers to a group of organs or muscles that are surrounded by strong webs of connective tissue called fascia.
Fascias are unyielding fibrous walls that cannot easily expand. If blood or other fluids accumulate inside an injured compartment, the internal pressure can become dangerously high, impeding adequate blood flow to the compartment’s tissues. It may result in severe tissue damage if untreated, even loss of body function or death. These are some of the risks associated with acute compartment syndrome.
While acute CS is a medical emergency requiring immediate attention, chronic CS is a different condition that can be treated with massage therapy. Chronic CS usually results from the repetitive impact of exercise, which causes extreme pressure to build in the muscles, depriving the compartmental area of blood flow and oxygen.
Here is a closer look at the difference between acute and chronic CS and how massage therapists can help treat the latter.
Acute Compartment syndrome may be caused by a direct force or trauma, such as a broken leg or arm, receiving a karate kick or blocking a hockey puck, crash injury, burn, blood clot, anabolic steroids, surgery to blood vessels, or overly tight compression or bandaging of a limb. If the area becomes numb and there is loss of distal pulse, it may be an acute medical emergency requiring immediate attention.
Chronic compartment syndrome is most commonly experienced by athletes undertaking rigorous repetitive motion, such as runners or cyclists. Improper footwear, running on hard-flat surfaces or suddenly changing the intensity of training may cause excessive pressure to accumulate within the muscle compartments, resulting in numbness or tingling. It most commonly occurs in the lower leg or forearm, although it can also affect the thigh, upper arm (such as in motocross racers), hand, glutes, or abdomen.
Pain that seems excessive compared to the nature of the injury may indicate compartment syndrome. Other symptoms include extreme muscle tightness, burning sensations, and pain when exercising, described as cramping, sharp or stabbing.
Symptoms of chronic CS are similar to anterior shin splints, which is one of the most common overuse injuries affecting the lower leg, characterized by pain at the beginning of the activity (such as running downhill) and muscle soreness returning after the activity has ceased, even hours later at rest. Chronic CS is less likely to be painful long after the activity, or with manual resistance or stretching. If paresthesia (a “pins and needles” tingling sensation) is present, chronic CS is more likely the cause, because shin splints have no nerve involvement.
Professionals with massage therapist training treat chronic compartment syndrome by focusing on reducing the troublesome pressure in the body compartment. Soft tissue massage therapy can effectively restore circulation, reduce swelling, and assist pain relief and muscle relaxation.
Treatment involves positioning the affected limb at the level of the heart with light strokes to the heart following the direction of blood flow. Massage therapists use the effleurage technique to warm up the tissues, slowly increasing pressure on the up strokes. Various myofascial release techniques are used to strip the muscle and smooth out knots or scar tissue while cross fibre frictions can help stretch the sheath surrounding the muscle and reduce painful compression in the compartment.
Registered massage therapists may alternate these techniques learned in massage therapist school, communicating regularly with the patient to ensure they are not causing pain. The patient should abstain from the aggravating activity and is assigned a homecare regime including stretching to help reduce healing time.
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