Posterior compartment syndrome (deep)

What is the deep compartment?

The deep posterior compartment is a sheath containing muscles in the lower leg that lies just behind the tibia bone. Compartment syndromes arise when a muscle becomes too big for the sheath that surrounds it causing pain. Compartment syndromes can be acute or chronic

Acute posterior deep compartment syndrome can occur as a result of:

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

Symptoms include:

• Pain in the shin when you kick, jump or go up onto your heels ?
• Do the symptoms go after a period of rest only to return again when you start exercising again ?
• Pain when you pull the toes and foot downwards.

What can the athlete do?

• Rest, but try to exercise your upper body or cycle if it is not painful.
• Apply ice or cold therapy for 20 minutes at a time but not directly onto the skin. Place in a wet tea towel.
• See a sports injury professional who can advise on treatment and rehabilitation.

What can a sports injury specialist or doctor do?

• Prescribe anti-inflammatory medication e.g. ibuprofen.
• Apply sports massage techniques.
• Correct any biomechanical dysfunction with orthotic devices.

Chronic posterior compartment syndrome can occur as a result of:

• Over use and over developing the muscle through training.
• 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.

Symptoms include:

• Pain when pulling the toes and foot downwards.
• Pain in the shin when you kick, jump or go up onto your heels ?
• Do the symptoms go after a period of rest only to return again when you start exercising again?

If the pressure inside the muscle compartment increases this can cause traction on the periostium (sheath surrounding the bone) which can lead to shin splints.

What can the athlete do?

• Rest until there is no pain.
• Apply heat and use a heat retainer.
• See a sports injury specialist.

What can a sports injury specialist or doctor do?

• Prescribe diuretics and anti-inflammatory medication.
• 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. For more information on surgery for posterior deep compartment syndrome, including answers to these questions: When is surgery indicated? What techniques are used? What happens afterwards? Are there any complications? Click here.