Friday, May 18, 2012

Compartmentalization: Not just a Coping Stategy!

Happy Bike to Work Day!....but not for this bike commuter... :(

Soooo.... Remember my little "fun run" on the beach? Well, the pain in my calves wasn't any better by Thursday. In fact it was worse, so I went to see my doc. Basically I screwed up. I knew better, and I screwed up. It was funny hearing him tell me that barefoot running is something that you have to start with short distances and ease into. Like I said before, I knew better! I know running, and I know that I shouldn't have gone more than a half mile TOPS in that stupid sand! Why on earth wasn't my brain turned on that day? Gah! He has ordered ice, rest, and anti-inflammatories. Oh...and no exercise. Yeah.

No, I'm taking it ok... I will flip the F out though, if I can't walk normal by Monday... I really can't think about things beyond that, or I might have a mini flip out sooner...

Compartment syndrome

Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. It can lead to muscle and nerve damage and problems with blood flow.

Causes, incidence, and risk factors

Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs from each other. Inside each layer of fascia is a confined space, called a compartment. The compartment includes the muscle tissue, nerves, and blood vessels. Fascia surrounds these structures, similar to the way in which insulation covers wires.
Fascia do not expand. Any swelling in a compartment will lead to increased pressure in that area, which will press on the muscles, blood vessels, and nerves. If this pressure is high enough, blood flow to the compartment will be blocked. This can lead to permanent injury to the muscle and nerves. If the pressure lasts long enough, the muscles may die and the limb may need to be amputated.
Swelling that leads to compartment syndrome occurs from trauma such as a car accident or crush injury, or surgery. Swelling can also be caused by complex fractures or soft tissue injuries due to trauma.
Long-term (chronic) compartment syndrome can be caused by repetitive activities, such as running. The pressure in a compartment only increases during that activity.
Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm.


The hallmark symptom of compartment syndrome is severe pain that does not go away when you take pain medicine or raise the affected area. In more severe cases, symptoms may include:
  • Decreased sensation
  • Paleness of skin
  • Severe pain that gets worse
  • Weakness

Signs and tests

A physical exam will reveal:
  • Pain when the compartment is squeezed
  • Severe pain when you move the affected area (for example, a person with compartment syndrome in the foot or lower leg will experience severe pain when moving the toes up and down)
  • Swollen and shiny skin


Chronic compartment syndrome (what I seem to have) in the lower leg can be treated conservatively or surgically. Conservative treatment includes rest, anti-inflammatories, and manual decompression. Elevation of the affected limb in patients with compartment syndrome is contraindicated, as this leads to decreased vascular perfusion of the affected region. Ideally, the affected limb should be positioned at the level of the heart. The use of devices that apply external pressure to the area, such as splints, casts, and tight wound dressings, should be avoided.[14] In cases where symptoms persist, the condition can be treated by a surgical procedure, subcutaneous fasciotomy or open fasciotomy. Left untreated, chronic compartment syndrome can develop into the acute syndrome. A possible complication of surgical intervention for chronic compartment syndrome can be chronic venous insufficiency.Surgery is needed.

Expectations (prognosis)

With prompt diagnosis and treatment, the outlook is excellent for recovery of the muscles and nerves inside the compartment. However, the overall prognosis will be determined by the injury leading to the syndrome.
Permanent nerve injury and loss of muscle function can result if the diagnosis is delayed. This is more common when the injured person is unconscious or heavily sedated and cannot complain of pain. Permanent nerve injury can occur after 12 - 24 hours of compression.


Complications include permanent injury to nerves and muscles that can dramatically impair function.
In more severe cases, amputation may be required. (Let's hope it doesn't come to that! Sheesh!)
No Ironman.....? (Don't get all drama, CG! You're going to be fine!)
Insanity. (Kidding. Sort of... Ok, I added this one.)



  1. Is there any bruising? A lot of the symptoms listed here are also the same for any tearing muscles and strains ie. normal muscle damage. Same rest advised. Ice regularly for two days, add heat next two days and start to gently stretch when muscle is heated. Tell me how it goes.

  2. No bruising. My doc felt for tears and didn't find anything obvious. He said that if I don't improve, I can get a MRI, but I doubt it will come to that. The swelling has improved some, despite the pain not improving. My calf muscles were so swollen that you could see clear outlines of them even when I wasn't flexing, and they were totally bulging out!

  3. Treat it for the worse case senario in that case C.G. No running for you just yet I'm afraid. Make sure that muscles had a good few days of being stretched gently before trying exercise on it again. Try cycling or swimming before running as they are low impact to test it. Ease back into your running and most of all don't panic your fitness won't go away that quickly!

  4. Thanks for the advice Jez. I have been dutifully resting. It is really weird though... Jesse and I watched several documentaries and I cooked this weekend. We sat around...a lot! I NEVER do that! On one hand, it is nice to just spend time sipping tea and laughing with Jess, but the other I have to watch what I eat, and blah blah blah. I probably gained 5 lbs this weekend alone (God, I wish I were kidding...)

    Today I think there has been slight improvement. I stretched my muscles before getting out of bed, and I believe that really helped. The right side has significantly less flexibility than the left, but the pain is improving at least. I can walk reasonably normal now, but a lot slower than my normal pace. Hills and stairs are a killer.

    As for starting back, I already have my plan in place. I am going to start with a swim; arms only or light legs - if tolerable. If that works out, I will continue to do that. I will only add in riding late in the week IF I am much improved. No running for me at all this week. I couldn't do it if I tried anyway. lol

  5. Thank you for informing us about this syndrome. Me and my leg vein removal center appreciates that you have shared this wonderful information to us. Have a nice day!