 Easy
on the shins
Shin
splints are not the only causes of shin pain that can result from
exercise.
Lt Ricky Su looks at Anterior Compartment Syndrome (CS)
The
facts
The elements involved
Anterior CS involves the muscle group on the outer border of the
shinbone. The muscle group involved contains four muscles whose
action is to pull the foot and toes back.
What
happens?
During exercise, the muscles swell from increased blood flow. If
the sheath that surrounds the muscle (fascia) does not allow the
muscle to expand sufficiently, the result is increased pressure
in the compartment. This increased pressure compresses the arteries
and veins, decreasing blood flow to the muscles. The muscles become
painful as they are deprived of oxygen and waste products build
up.
How
does it happen?
Anterior CS is influenced by factors that are both external (extrinsic)
and internal (intrinsic) to the body.
Extrinsic factors include things such as training errors, poor technique,
poor shoes and inappropriate training surfaces.
Intrinsic factors include poor lower limb alignment, muscle imbalance
or inadequate flexibility.
How
do I know?
Diagnosis can be confirmed by certain scans (thallium scans) or
pressure testing the muscle compartments before and after exercise.
Signs
and symptoms
Pain
experienced in the outer muscle group of the shinbone during exertion
or activity. This pain usually subsides rapidly when exercise ceases.
- The
shin muscles may swell or feel "tight" to touch.
- Severe
cases can result in some weakness or a sensation of tingling in
the foot/toes.
CS
treatment
Conservative
treatments
- Soft
tissue massage and release techniques to restore the flexibility
in the muscles and the sheaths surrounding them.
- Stretching
programs.
- Ice
for pain management.
- Anti-inflammatory
medication if prescribed by a doctor.
- Lower
limb bio-mechanics assessment.
- Orthotics
or inserts for footwear.
- Modification
of training program.
Surgical
treatment
Surgical management is considered only on the failure of conservative
treatment and on the advice of the orthopaedic specialist. Surgical
management may consist of either:
- A
release of the sheath around the muscle group/compartment called
a fasciotomy.
- The
removal of the sheath surrounding the muscle group/compartment
called a fasciectomy.
After
treatment
- Passive
and active range of motion exercises to prevent scarring in the
muscle sheath.
- Pain
management.
- Mobilisation
with crutches within the first week, weight bearing as tolerated.
- Progressive
rehabilitation program which includes stretches, strengthening
and functional task training.
In
summary
Due to the physical nature of Defence work and training, members
are susceptible to anterior compartment syndrome.
This can be prevented by awareness of the factors that cause compartment
syndrome and strategies on how to prevent injury including comprehensive
stretching programs.
Information
For more information on compartment syndrome contact your local
physiotherapist or medical officer or contact me at ricky.su@defence.gov.au
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