Anterior Compartment Syndrome

What is Anterior compartment syndrome?

Compartment syndrome (also known as exertional or exercise-induced compartment syndrome) occurs when there is increased pressure within an enclosed space, which results in decreased blood flow and nutrient delivery, leading to pain and the potential for long-term damage to the tissues. Compartment syndrome can be acute (meaning it comes on suddenly), or chronic, which is the more common form - often confused with shin splints.

Anterior compartment syndrome is the most common form of compartment syndrome. The anterior compartment contains the muscles Tibialis anterior, Extensor digitorum longus, Extensor hallucis longus and Peroneus tertius.

The exact causes behind compartment syndrome are not clear. Repetitive overuse may cause a build up of inflammation has been linked to fibrosis and so a reduced elasticity of the fascia enclosing the compartment. This means that during exercise, when the muscles expand, they are unable to, resulting in increased pressure and then pain.

Chronic anterior compartment syndrome

Causes:

• Overuse and over-developing the muscle through training.
• Biomechanical problems such as overpronation or oversupination can contribute.
• At rest the blood vessels are not at capacity. During exercise these blood vessels fill up much more and expand putting pressure on the sheath.
• The sheath becomes inelastic and unable to expand.

Symptoms include:

• 'Achy' pain at the front of the lower leg, just to the outside of the shin bone.
• Pain which increases during exercise which eventually makes running impossible.
• Pain goes after a short rest but comes back again during exercise.
• A sensation of 'tightness' in the front of the lower leg.
• Difficulty in lifting the toes and foot up.
• Pain when pulling the toes and foot downwards.
• Tingling may occasionally occur.
• Examination at rest demonstrates few, if any, findings.
• The only way of confirming the diagnosis of compartment syndrome is through compartment pressure testing, involving a needle being inserted into the compartment.

What can the athlete do?

• Rest until there is no pain.
• Apply sports massage techniques to increase the elasticity of the muscle sheath.
• Stretch the calf and shin muscles.
• Apply heat and use a heat retainer.
• See a sports injury specialist.
• Make sure you have the right running shoes and they aren't worn out!

What can a sports injury specialist or doctor do?

• Prescribe diuretics (water tablets) and anti-inflammatory medication such as ibuprofen.
• Analyse your training methods, running gait and types of shoe to determine any contributory factors.
• Use sports massage techniques to stretch the muscle sheath.
• Operate. They could make a small cut or two in the muscle sheath to allow the muscle to expand out.

Acute anterior compartment syndrome:

Causes:

• An impact which causes bleeding within the compartment and therefore swelling.
• A muscle tear which also causes bleeding and swelling.

Symptoms

• A sharp pain in the muscle on the outside/front of the lower leg, usually the result of a direct blow.
• Weakness when trying to pull the foot upwards against resistance.
• Swelling and tenderness over the tibialis anterior muscle.
• Pain when the foot and toes are bent downwards.

What can the athlete do?

• Rest.
• Apply ice immediately for 15 minutes and repeat every 2 hours for the first 48 hours.
• Use a compression bandage to decrease swelling.
• This type of compartment syndrome will probably ease on its own, after bleeding and swelling decrease.
• See a sports injury professional who can advise on rehabilitation.

What can a sports injury specialist or doctor do?

• Prescribe anti-inflammatory medication e.g. ibuprofen.
• Correct any biomechanical dysfunction with orthotic devices.
• Operate. They could make a small cut or two in the muscle sheath to allow the muscle to expand out.

Rehabilitation >>