Compartment Syndrome: Evidence Based Chiropractic & Physiotherapy Treatment

Compartment syndrome is a particularly painful condition that is the result of accumulated pressure within the muscles of the lower leg region. This pressure may progress to a significant level and cause a reduction in limb blood flow which prevents nourishment and oxygen from reaching associated nerve and muscle cells. It should be noted that compartment syndrome may be either acute or chronic in nature. Acute compartment syndrome is regarded as an immediate medical emergency. It is usually caused by a severe injury or trauma to the leg and without proper assessment and treatment it may lead to permanent muscle damage and leg dysfunction. Conversely, chronic compartment syndrome (also referred to as exertional compartment syndrome) is caused by athletic exertion or fatigue. While mostly occurring in the forearm and lower leg, compartment syndrome may also present itself in other parts of the body that have muscles contained in compartments such as the hands and feet. 

LOWER LEG ANATOMY

Compartments are groupings of muscles, nerves, and blood vessels in your arms and legs. Surrounding these tissues is a fibrous or tough membrane that is referred to as a fascia. Fascia is responsible for keeping the tissues in place and therefore the fascia is relatively inflexible. Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg. It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks. Given the inflexible nature of fascia pressure may build up within the respective compartments and in turn prevent adequate blood flow to tissues inside the compartment. Severe tissue damage can result, with loss of body function or even death. In majority of cases that we encounter in clinical practice people present with significant pain and dysfunction of the affected limb that may also demonstrate swelling.

HALLMARK CAUSES, SIGNS & SYMPTOMS OF COMPARTMENT SYNDROME

  • Acute compartment syndrome
    • Is the most common type of compartment syndrome. It is estimated that 75% of the time it is due to a traumatic bone fracture
    • Other potential causes may include crush injuries, burns, excessively tight limb bandaging, surgery, blood clots, vigorous exercise, anabolic steroid usage
    • The hallmark sign of is pain, especially when the muscle within the compartment is stretched.
    • The associated pain is more intense than would typically be expected.
    • Presence of tingling or burning may be evident
    • Muscle weakness or paralysis are considered immediate medical emergency
  • Chronic compartment syndrome
    • Typically develops of a period of weeks to months due to abnormal or excessive physical activity stress
    • Pain typically subsides when activity stops or reduces in intensity
    • Associated symptoms may include transient numbness, reduced limb range of movement, visible swelling

COMPARTMENT SYNDROME TREATMENT

Treatment for compartment syndrome focus on reducing pressure within the respective compartment. If you’re suffering acute compartment syndrome medical referral is most likely necessary. Given this, we will discuss chronic compartment syndrome treatment below.

 

Relative Rest

Rest from aggravating activities or exercises is a fantastic way to quickly minimize pain and dysfunction. It is important to recognize that this is not a long term solution to your problem.

Chiropractic & Physiotherapy

Conservative manual therapies are a brilliant option for managing compartment syndrome. Treatment may include:

  • Mobilization of the effected limb to assist with reducing pressure and swelling
  • Soft tissue massage to the associated connective tissue structures to assist with pain reduction and swelling
  • Physiological therapeutics such as Ultrasound, Shockwave therapy and low level laser treatment to assist with reducing inflammation and compartment pressure
Surgical Intervention (Fasciotomy)

If you do not respond to conservative management as expected then surgical intervention may be warranted to assist with reducing limb pressure. A fasciotomy is a common procedure to do this. This procedure involves making an incision into the thick, fibrous fascia surrounding the compartment to effectively allow the muscle and associated soft tissues more room.

WHAT DOES THE RESEARCH TELL US?

  • It is thought that hyperbaric oxygen therapy may be useful in the management and therefore resolution of compartment syndrome. Fitzpatrick, D. (1998). Adjunctive treatment of compartment syndrome with hyperbaric oxygen. Military Medicine, 163(8); 577 – 579.
  • Surgical intervention was avoided in individuals who were re-trained in gait and running patterns. Diebal, A. (2012). Forefoot running improves pain and disability association with chronic exertional compartment syndrome. The American Journal of Sports Medicine, 40(5)

ADDITIONAL INFORMATION

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compartment syndrome anatomy