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Exertional Compartment Syndrome


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Alpha Crow
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posted Jan-11-2007 04:27 PM     Click Here to See the Profile for Alpha Crow   Click Here to Email Alpha Crow     Edit/Delete Message   Reply w/Quote
Ok, more doctors and more tests.

It appears that I have compartment syndrome on my left calf, apparently genetic in origin. Doctors think that when I run, the muscles swell with blood and the fascia restricts the expansion, causing the peroneal nerve to be irritated. My symptoms are ankle fatigue and slight cramping and numbness of the foot starting with the outside toes.

Anyone have any similar experiences? My doctors pretty much said they give up and don't know what to tell me other than to stop running.

I would beg on my knees for anything to help me get around this. Anything that alleviates the problem? I've done research, but not finding a lot so far.

Please help if you know anything, I'm so near tears at this point that my manliness is in question.

Thanks,
Brian

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Alpha Crow
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posted Jan-11-2007 04:55 PM     Click Here to See the Profile for Alpha Crow   Click Here to Email Alpha Crow     Edit/Delete Message   Reply w/Quote
http://www.mayoclinic.com/health/chronic-exertional-compartment-syndrome/DS00789/DSECTION=8

Most research states there is no self treatment that will work, that surgery is the only option. I'd try the non invasive methods if anyone has any advice that has experience with this. I'll even try the surgery, though the doctors are not suggesting it yet. Anyone ever do the surgery? Did it work effectively? Seems this syndrome is rare enough that the 3 doctors I've gone to do not know anything first hand about it other than studies.

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NGeorgiaTR
Cool Runner
posted Jan-11-2007 10:27 PM     Click Here to See the Profile for NGeorgiaTR   Click Here to Email NGeorgiaTR     Edit/Delete Message   Reply w/Quote
This is exactly what kept me from running for 10 years. Went through a bunch of doctors. Since nothing was broken, torn etc. they couldn't do anything. Saw a bunch of specialists and had several bone scans.

Well, my (DW's actually) midwife had a great chiropractor that she recommended. He was extremely experienced in sports medicine. I forget which certification for the specific technique but have it somewhere around here. As soon as he got me on the table, he noticed my ankle hanging strangely. He aligned it and I was off and running. It took about 3-4 runs to be pain free. I actually went back and did the c25k program from this site to make sure i came back slowly. At the beginning, I had to go back more often, but in the past two years it is getting stronger. I moved from CO to GA so had to find a new chiro here. So far so good.

The compartment syndrome was a secondary (tertiary or quaternary, etc.) symptom in my case. After some later work looking to return full strength to my legs, It was found that I had a slight spine injury, likely from my very bad mtn bike accident years ago. My hip was out of alignment, changing my gait, which affected my ankle. It wasn't until looking into all of this that I am getting significantly stronger.

so much so that I've been averaging almost 40 mpw lately and managed to make my knees sore... but thats another story of just breaking the mileage rules..

This was an incredibly annoying and frustrating experience. I had truly ruled out running ever again and was feeling the same as you, I believe. I even had a doctor ask me if I could live with it. I'm a pacifist, but I almost hit him.

I'll see if I can find the certification in my work email tomorrow and if you live in GA or CO, I can hook you up with a chiro. Feel free to email me about this.

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NGeorgiaTR
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posted Jan-11-2007 10:41 PM     Click Here to See the Profile for NGeorgiaTR   Click Here to Email NGeorgiaTR     Edit/Delete Message   Reply w/Quote
The muscle that was weakened for me was the peroneus tertius, causing swelling in the extensor digitorum longus. Its kind of cool that almost 20% of the population don't even have it. I would have been glad to be without it

Its nice that once the structural issues are corrected, the soft tissue can begin to heal.

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Alpha Crow
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posted Jan-12-2007 01:31 AM     Click Here to See the Profile for Alpha Crow   Click Here to Email Alpha Crow     Edit/Delete Message   Reply w/Quote
That may be a great idea to check into hip and back issues. While it appears to be genetic mostly (brother and father suffer from a very mild case), I know I do have a heavier stride on my left side, but I feel like that is caused by the ankle fatigue and tightness more so than natural. I will try to look into a hip alignment, I do have a memory way back when I was in marine corps boot camp and while learning to march all day on the parade deck, my left hip burned like fire after an hour out there. I know this sounds idiotic, but a drill instructor seemed to have fixed it accidentally when he saw me rubbing it and walked up and kneed me there (unofficial punishment for moving I suppose). It gave me a flash of blinding pain for a split second and then all pain was gone and didn't bother me anymore.

I wonder if chiro is covered by insurance at all. Doubt it, but I'll be willing to pay to try it out. Anything at this point.

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NGeorgiaTR
Cool Runner
posted Jan-12-2007 08:35 AM     Click Here to See the Profile for NGeorgiaTR   Click Here to Email NGeorgiaTR     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by Alpha Crow:
That may be a great idea to check into hip and back issues. While it appears to be genetic mostly (brother and father suffer from a very mild case), I know I do have a heavier stride on my left side, but I feel like that is caused by the ankle fatigue and tightness more so than natural. I will try to look into a hip alignment, I do have a memory way back when I was in marine corps boot camp and while learning to march all day on the parade deck, my left hip burned like fire after an hour out there. I know this sounds idiotic, but a drill instructor seemed to have fixed it accidentally when he saw me rubbing it and walked up and kneed me there (unofficial punishment for moving I suppose). It gave me a flash of blinding pain for a split second and then all pain was gone and didn't bother me anymore.

I wonder if chiro is covered by insurance at all. Doubt it, but I'll be willing to pay to try it out. Anything at this point.


Chiro is covered by most insurance.

The stiffness in the ankle is exactly what it felt like until the ankle was adjusted. The relief from the stiffness can be felt almost immediatly after adjustment. But I may be more sensitive to it as I started with the chiro about two years ago. The hip and back stuff just has helped the ankle stay aligned longer.

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me1ani
Cool Runner
posted Jan-12-2007 09:10 PM     Click Here to See the Profile for me1ani   Click Here to Email me1ani     Edit/Delete Message   Reply w/Quote

I had ecs last year and underwent three months of aggressive physical therapy. My orthopedist believed p/t should be exhausted before any invasive methods were to be considered. It worked!

I underwent a combination of ultrasound, deep tissue massage (painful, but it loosed the fascia), icing and specific calf exercises. For several weeks I ran only on softer surfaces and stretched like mad.

To date I've had no relapse even after mileage increases and resuming milage on harder surfaces.

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Alpha Crow
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posted Jan-13-2007 08:32 PM     Click Here to See the Profile for Alpha Crow   Click Here to Email Alpha Crow     Edit/Delete Message   Reply w/Quote
I think, unfortunately, I have the rare form of ECS where it's genetic. Male side of my family all has very thick limbs. My gait is off just a bit on the left side and that sets off the ECS. Appears my right side is just a hair from becoming ECS.
My forearms have always ached during weightlifting for long periods with certain exercises. Several doctors have looked at it and have said genetic ECS due to thickened muscles and not so elastic fascia. I've also heard metatarsal tunnel and mild carpal tunnel syndrome, though the symptoms don't match as closely as to ECS.

Had a lot of doctors and friends tell me maybe I'm not meant to run, but the heck if I'm giving up. I've been running for 14 years now and it's not over till I'm dead!

I'm going to chiro next week, have another muscle compartment pressure test next week also. I will try non-invasive first, but I think that surgery is probably going to be the only hope, if that works even.

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NGeorgiaTR
Cool Runner
posted Jan-14-2007 09:53 AM     Click Here to See the Profile for NGeorgiaTR   Click Here to Email NGeorgiaTR     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by Alpha Crow:

Had a lot of doctors and friends tell me maybe I'm not meant to run, but the heck if I'm giving up. I've been running for 14 years now and it's not over till I'm dead!

All people are made to run! I love when people are so helpful.

Anyway, good luck next week!

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carina
Cool Runner
posted Jan-15-2007 10:04 AM     Click Here to See the Profile for carina     Edit/Delete Message   Reply w/Quote
I had bilateral exertional compartment syndrome. I had the surgery for it back in '94 and repeated in '96. There is NO way it can be cured via chiropractic treatment. Maybe the surgery is more effective now than it was then, but it was not very successful for me (worse progosis for females). Of course, my case was very severe. If you are interested in more info, please incidate this, and I will send my current email (my email associated w/ my CR account is inactive). And yes, I have found things that help.

Karen

[This message has been edited by carina (edited Jan-15-2007).]

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NGeorgiaTR
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posted Jan-15-2007 03:16 PM     Click Here to See the Profile for NGeorgiaTR   Click Here to Email NGeorgiaTR     Edit/Delete Message   Reply w/Quote
I don't know about the bilateral part, does that involve both the lateral and the anterior compartment simultaneously (and maybe the posterior, also)? That sounds unbelievably painful. Just having it in the anterior compartment was bad enough for me.

I do know that, at least, ECS in the anterior compartment can be cured by chiropractic treatment.

[This message has been edited by NGeorgiaTR (edited Jan-15-2007).]

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carina
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posted Jan-15-2007 07:59 PM     Click Here to See the Profile for carina     Edit/Delete Message   Reply w/Quote
Sorry I didn't clarify which compartments were involved. Bilateral means both legs. As for compartments, I had all four compartments on both legs (anterior, posterior, lateral, and deep posterior). True, it is not necessary to have surgery for anterior CS, unless it doesn't respond to other types of treatment. I know some chiro docs can do wonders.

Because I had both legs affected, they had to do the surgeries separately. When I recovered from one enought to walk without pain, they did the other one. Unfortunately, even though I had a great surgeon, the surgery was not successful, so it had to be repeated a couple years later.

Even after the second round of surgeries, I was marginally better, but still in constant pain during my run. I could run, but only with massive doses of ibuprofen, and I couldn't run very far. Cross training, for the most part, did not hurt (of course, it depended on the sport; I could not do, for example, the revolving staircase). To some extent, I learned to live with the pain, but I couldn't do what I really wanted: run the marathon.

For sixteen years, I ran on megadoses of ibuprofen. I also tried deep, "crime-scene" massage, which was helpful for short periods of time; that is, it did not provide lasting relief. I also used the Stick (www.thestick.com) before EVERY run. The Stick is GREAT. I can't recommend it highly enough. I use the Sprinter stick, which is a very rigid stick, and it is ideal for dense tight calf muscles.

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irishgator1
Cool Runner
posted Jan-16-2007 10:24 AM     Click Here to See the Profile for irishgator1   Click Here to Email irishgator1     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by carina:

For sixteen years, I ran on megadoses of ibuprofen. I also tried deep, "crime-scene" massage, which was helpful for short periods of time; that is, it did not provide lasting relief. I also used the Stick (www.thestick.com) before EVERY run. The Stick is GREAT. I can't recommend it highly enough. I use the Sprinter stick, which is a very rigid stick, and it is ideal for dense tight calf muscles.


Carina- I have a question for you regarding the Stick. I just got mine a couple of weeks ago and have been using it on my outer shin muscles. I also have what seem to be compartment-like issues- painful burning in shin muscles, numb feet, and not being about to pick my feet up off the ground when running. The physical therapist said it's tight shin muscles but even with PT and using the stick, the problem is still there. Do you roll over the calf muscles as well as the shin muscles?

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carina
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posted Jan-16-2007 06:54 PM     Click Here to See the Profile for carina     Edit/Delete Message   Reply w/Quote
Irishgator, I roll all over the calf muscle. Just don't roll on bone. Anywhere there is meat, you need to roll. I roll vigorously, to the point of getting out of breath, but that is what works for me. Also, you might not have the right Stick for your muscle type. The original Stick, which is the one you can get in running stores, isn't rigid enough for me. You can go to their website (thestick.com) to see the other models. They aren't cheap, but they are definitely worth the investment.

I am personally not a big fan of PT (many folks swear by it though). However, if you have persistent numbness in your feet (and it isn't resolved by loosening your laces), I would get it checked out by a sports doc.

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irishgator1
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posted Jan-17-2007 01:47 PM     Click Here to See the Profile for irishgator1   Click Here to Email irishgator1     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by carina:
Irishgator, I roll all over the calf muscle. Just don't roll on bone. Anywhere there is meat, you need to roll. I roll vigorously, to the point of getting out of breath, but that is what works for me. Also, you might not have the right Stick for your muscle type. The original Stick, which is the one you can get in running stores, isn't rigid enough for me. You can go to their website (thestick.com) to see the other models. They aren't cheap, but they are definitely worth the investment.

I am personally not a big fan of PT (many folks swear by it though). However, if you have persistent numbness in your feet (and it isn't resolved by loosening your laces), I would get it checked out by a sports doc.


Thanks. I have the travel version- not sure if it's rigid enough but it certainly leaves my shins all painful when I'm done (the same feeling after the PT gets done with the myo-fascial massage thing). I'm only using it on my shins and not my calves so I'll give that a try.

The depressing thing is, my sports orthopedist prescribed PT. I've seen 2 sports podiatrists and two sports orthopedists and none of them is taking me seriously, or at least I feel like that. They keep saying it's shin splints, and it may well be, but I've had shin splints before and in my case, they were sharp shooting pains in my inner shin muscles. This pain is a burning, duller pain- the kind that you get if you were to flex your foot and keep like that until it really started to burn.

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carina
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posted Jan-17-2007 09:19 PM     Click Here to See the Profile for carina     Edit/Delete Message   Reply w/Quote
Irishgator, what did the compartment test show? Compartment syndrome isn't so rare. It is rare compared to shin splints, but it is actually underdiagnosed. Interesting, I can't do any forearm exercises either. I used to do reverse grip bicep curls, and it made my forearms feel like they were going to explode.

Are you able to run at all? I definitely feel your pain. It took a long time for me to figure out what was wrong with me (fortunately, I had access to a medical library), because everyone told me that I had shin splints. It is very very frustrating. Anyway, once I self diagnosed, I found a doc who had a lot of experience with compartment syndrome. Still, not much is known about it.

For what it's worth, I've been symptom free for two years, and I have been able to run marathons again. I gave up dairy in all forms (for health reasons), and since then, I have been pain free. (No milk protein, e.g., caesin or whey.) The docs think it is coincidental, which is hard for me to believe, considering I had symptoms for 20 years and four unsuccessful surgeries. Again, this is what worked for me; I am not suggesting that it can *cure* compartment syndrome, but it may be worth a try.

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Alpha Crow
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posted Jan-23-2007 12:53 AM     Click Here to See the Profile for Alpha Crow   Click Here to Email Alpha Crow     Edit/Delete Message   Reply w/Quote
Carina, I'll take any advice you have. Looking at thestick.com now. I have to go tomorrow for the 3 sets of compartment pressure testing... sheesh, the at rest one was not pleasant to say the least.

The doctor is thinking it is the lateral muscle only that is causing the nerve pressure. Measurements show it swells a bit more than the right side.

Was your case genetic or injury related, Carina? I'm really hoping this surgery will help. Apparently I have very mild cases of pressure issues in forearms and calves, but it is only debilitating in the left calf to foot.
Makes sense now, always wondered why my family and I would get bad calf cramps during sports and heavy training.

Thanks for the well wishes and advice, all is appreciated. I do quite a bit of cross training to keep my cardio decent, but running is my addiction and momma didn't raise a quitter

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me1ani
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posted Jan-25-2007 02:03 PM     Click Here to See the Profile for me1ani   Click Here to Email me1ani     Edit/Delete Message   Reply w/Quote
In December I started ART (Active Release Therapy) with a sports chiro for plantar faciitis- hes also been working on my shins. Its been quite helpful.

I also recently have been using a TP massage baller kit that is similar in theory to the stick, but much more effective, IMO.


me1ani

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me1ani
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posted Jan-25-2007 02:13 PM     Click Here to See the Profile for me1ani   Click Here to Email me1ani     Edit/Delete Message   Reply w/Quote

Heres the link to the massage tool if anyones interested:

http://www.tptherapy.com/


me1ani

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runnerparris
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posted Jan-27-2007 06:13 PM     Click Here to See the Profile for runnerparris     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by me1ani:
In December I started ART (Active Release Therapy) with a sports chiro for plantar faciitis- hes also been working on my shins. Its been quite helpful.

I also recently have been using a TP massage baller kit that is similar in theory to the stick, but much more effective, IMO.


me1ani


Not positive yet...but I too seem to have had success with the ART.

A few months ago my shins started tightening at the start of my runs...felt like they were rubberbands twisted as tight as they could go...almost like they were going to explode. At first, I could just slow down and relax and it would go away, then got progressively worse. Last weekend I did a half-marathon and it was the worst yet...I had to stop and rest my legs 3 times in the first 4 miles and run really slow...Somewhere between 4-5 miles they loosened up and were perfectly fine for the remainder of the race.

I haven't gone to the Dr. or gotten a compression test. But I did go to a chiro that does the ART. He also rubs really hard on the grizzly spots to work out any adhesions. I ran 13 miles this morning with only minor discomfort on 1 side instead of both for the first few miles...no problem after that.

I'm keeping my fingers crossed that it isn't a temporary fix...I'm terrifed about the whole surgery thing if it is indeed compartment syndrome.

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DavidGreen2
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posted Jan-27-2007 09:38 PM     Click Here to See the Profile for DavidGreen2   Click Here to Email DavidGreen2     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by me1ani:

Heres the link to the massage tool if anyones interested:

http://www.tptherapy.com/


me1ani


Just got one myself this week and man does that little thing cause some pain. I am hoping it helps with my shin splints.

Dave

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me1ani
Cool Runner
posted Jan-28-2007 03:27 PM     Click Here to See the Profile for me1ani   Click Here to Email me1ani     Edit/Delete Message   Reply w/Quote

The ART is terrific. I was lucky to have a podiatrist here in NYC that is a triathlete, who recommended a chiro who is an longtime ART instructor. He is amazing (Dr. Rob DeStefano).

I've been going 2x a week for a month and once a week for two weeks.

Its made a lasting difference- no more chronic discomfort. No return of my compartment syndrome and my plantar faciitis is resolving! Its also helping with my hip flexor tendinitis (which may be a tear in my labrum-yikes!). Thats a whole other matter!


Dave-

Try the TP massage footballer on your soleus also.


Me1ani

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DavidGreen2
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posted Jan-28-2007 08:22 PM     Click Here to See the Profile for DavidGreen2   Click Here to Email DavidGreen2     Edit/Delete Message   Reply w/Quote
Will the TP roller help my shinsplints?

Dave

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runnerparris
Cool Runner
posted Jan-28-2007 10:45 PM     Click Here to See the Profile for runnerparris     Edit/Delete Message   Reply w/Quote
quote:
Originally posted by me1ani:

The ART is terrific. I was lucky to have a podiatrist here in NYC that is a triathlete, who recommended a chiro who is an longtime ART instructor. He is amazing (Dr. Rob DeStefano).


Me1ani


Glad to hear you have had non-surgical relief..Everytime I hear somebody say surgery is the only cure it makes me cringe.

Just the one session made a huge difference for me...I'm not one of these placebo people who believes in voodoo, but hes very close to making a believer out of me. I have a deep tissue message scheduled with somebody this week and i intend to go back and get the ART done at least one more time. It's not 100% gone, but the difference is unbelievable.

It's expensive because my insurance doesn't cover it, so I am limited as to how often I can go, but he also helped with my IT band..

Dave- I use the foam roller for calves, shines quads, hams, just about everything...when I'm feeling good I sometimes forget and then I end up in trouble again.

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CrazyEye
Cool Runner
posted Jan-30-2007 04:27 PM     Click Here to See the Profile for CrazyEye   Click Here to Email CrazyEye     Edit/Delete Message   Reply w/Quote
I didn't have time to read all of the replies, but here's my story...

My symptoms began with severe pain in my anterior tibialis after running only 10 minutes. The pain would go away within about 15 minutes of stopping. It was excrutiating to walk during that recovery time. I went to a sports medicine doctor who prescribed 8 weeks of PT. I would recommend this for you too, to see if any weak muscles are causing your calf to work harder than it should. PT didn't help me, so I was sent to an orthopedic surgeon who ruled out anything besides ECD. He prescribed custom orthotics. INSTANTLY, these worked - from my first run in them up until now, over 3 years later.

I hope your solution is as easy as mine was. Good Luck.

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