Mobile Massage Sydney Remedial Massage Sydney Active Release Techniques Sydney Compartment syndrome and shin splints.
In compartment syndrome there are 4 compartments that contain different muscles that are housed within fascia. The compartments are the anterior, deep posterior, superficial posterior and the lateral compartment.
This can also be known as exertional compartment syndrome (ECS) and occurs due to repetitive stress to the lower leg. The muscles well up and as the surrounding compartments are stiff and unyielding pressure builds up within the muscle. This can then put stress on the deep peroneal nerve and/or the arteries and veins with the compartment causing pain.
Compartment syndrome can also be brought on by a direct blow to the lower leg causing swelling within the compartments and this is known as acute compartment syndrome. This is much more dangerous as it can get out of control very quickly and cause much more serious outcomes such as restriction to the blood supply to the lower leg leading to amputation.
Pain deep within lower leg depending on where the tightness is. There can be neurological symptoms such as burning, tingling or numbness or weakness including drop foot as well as vascular symptoms such as coldness in the foot, colour change of aching from tissue ischemia as the blood supply is being restricted to lower leg.
The pain will often get better after the exercise has finished, usually around 30 minutes. This can be distinguished from shin splints where the pain doesn’t tend to get better after rest.
Generally client will report the symptoms coming on from a sudden increase in work load in the lower limb such as increased running or walking. Ask the client if they have received a blow to the lower leg say from soccer or martial arts.
What makes the pain worse? Ask client if the pain gets better after resting.
The swelling is unlikely to be visible as the tightness of the compartment will prevent the muscles visibly swelling, this is the cause in the first place.
There may be signs of colour change in the foot or atrophy (muscle wasting).
Generally after the aggravating activity palpating the lower leg will be extremely painful, more painful than you would expect from the level of pressure you are using. SO this can be a diagnostic tool for you discerning whether it is compartment syndrome or not.
If the client has ceased activity over 24 hours earlier or if the condition is chronic then the lower leg may not be as tender as it would have been straight after activity as the muscle swelling has diminished.
Resistive and ROM tests
AROM: there may be pain on AROM on dorsiflexion or plantar flexion especially if the muscles are swollen. In chronic compartment syndrome that is no symptomatic there will be no pain.
PROM: Same principles apply form AROM.
MRT: There may be weakness or restricted movement due to nerve impairment. Some pain may occur on resisted dorsiflexion and plantar flexion.
No Special test for compartment syndrome
Anterior shin splints, stress fracture of tibia, nerve entrapment, circulatory disorder, periostitis, vascular entrapment.
Conservative treatment includes rest, change in activity and stretching. Ice, compression and elevation may help with the swelling but it can be contraindicated in acute compartment syndrome as they may have detrimental effects on circulation.
Remedial massage can be performed ones the symptoms have settled down but deep tissue massage should be avoided when acute and symptomatic.
For chronic compartment syndrome a fasciotomy may be required to cut the fascia of the compartment to relieve some of the pressure
Shin splints is an overuse condition of the lower leg. There are 2 types of shin splints and they are differentiated by whether they affect the anterior or posterior portion of the Tibia.
Anterior shin splints can usually be felt in the proximal anterior lateral region of the lower leg. It is attributed to overuse of the dorsiflexors muscles such as the tibialis anterior, extensor Digitorum longus and extensor hallucis longus. Shin splints is caused by irritation to the periosteum where these muscles have attachments.
Posterior shin splints affects the distal medial region of the lower leg where it is called medial tibial stress syndrome (MTSS). This condition is usually caused by the tibialis posterior and Soleus muscles attachments to the medial tibia. This is also aggravating the periosteum of the Tibia.
It is usually eccentric loading that aggravates shin splints conditions.
Pain in either the anterior proximal lateral region or the distal medial lower leg. Pain usually gets worse after increased load of exercise. Pain can also occur at rest or with minimal activity. This can differentiate it from compartment syndrome which will get better with rest.
In either form of shin splints the client may report a history of repetitive activity such as running. Running downhill will usually aggravate anterior shin splints as it is eccentric for the dorsiflexion. A client who over pronates may be affected by posterior shin splints as this aggravates Tibialis posterior.
There are no visible signs on the leg of shin splints. Evidence of overpronation may indicate MTSS. Looking at the sole of a clients shoe may indicate that they overpronate.
There will usually be a lot of tenderness with both types of shin splints especially along the border of the Tibia. You may also be able to palpate some thickening of the periosteum on the border of the Tibia, either medial or lateral depending on the type of shin splints.
Resistive and ROM tests
AROM: Pain will be felt and symptoms aggravated on dorsiflexion or plantar flexion.
PROM: PROM may cause the same pain as the stretching of the muscles will pull on the periosteum.
MRT: Pain will be felt on dorsiflexion for anterior shin splints. Pain will be felt on inversion and plantar flexion with MTSS as it uses the tibialis posterior and soleus muscle.
Tibialis Posterior compression test (Shin Splints or medial tibial stress syndrome)
Client is supine on the table with hip partially flexed and the knee flexed to about 90°. Pressure is placed along the posterior medial side of the tibia and if symptoms are reproduced then it is likely MTSS.
Compartment syndrome, stress fracture, proximal neuropathy, muscle strain, myofascial trigger points, bone tumours, circulatory disorder.
Conservative treatment is the most successful treatment and shin splint usually respond well. Modifying or eliminating aggravating conditions and rest can help the irritation and damage to the periosteum heal. Orthotics can help in more severe cases caused by poor foot position.
Remedial massage can help to take some of the pressure off the aggravating muscles. Massage to the periosteum can help with healing of the tissue.
Some techniques of strengthening of Tibialis posterior muscles and working on foot position can also help with this condition.
Running styles may need to be modified.
Stretching of the calves and other lower leg muscles will be necessary.
Usually people respond well to conservative treatment and it can take between 4-6 weeks to recover from acute shin splints. Chronic cases can take much longer to heal and all aggravating activities need to be either modified or ceased.
If you are suffering from any of these conditions then please don't hesitate to contact us to discuss treatment options or to book an appointment now.