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Compartment Syndrome Massage

compartment-syndrome-massageA compartment syndrome is the result of an increase in pressure within the compartments of the lower leg.

The 4 compartments in the Lower Leg:

  1. ANTERIOR COMPARTMENT: contains tibialis anterior , extensor hallucis longus, extensor digitorum,anterior tibial artery, and vein, deep peroneal nerve. (Can be caused by tightness in the gastrocs/soleus)
  2. SUPERFICIAL POSTERIOR COMPARTMENT: gastrocs and soleus
  3. DEEP POSTERIOR COMPARTMENT: tibialis posterior, flexor digitorum longus, flexor hallucis longus, posterior tibial artery, vein, and nerve, peroneal artery and vein
  4. LATERAL COMPARTMENT: peroneus longus, brevis

* (divided by dense, inelastic fascia)

* Any of the compartments may be affected, but anterior compartment is more prone ( about 45%)

* Deep posterior compartment syndrome is common as well.

Compartment Syndrome Massage

CAUSES:

  • Acute Compartment Syndrome – trauma, such as direct blow to the compartment ( medical emergency)
  • Chronic Compartment Syndrome – overuse due to overtraining, poor technique or training on hard surfaces
  • Predisposing factors:
    • Anatomical — affected compartment is smaller than normal
    • Muscle imbalances/ tightness — usually in antagonists ( ie- tight gastrocs/ soleus can cause anterior compartment syndrome due to strain on anterior compartment muscles)
    • Improper footwear — worn out, no arch support
    • Muscle type creating imbalance — tibialis anterior is phasic muscle, gastrocs/soleus are postural muscles.( one is strong and doesn’t fatigue as much while the other one fatigues faster so causes imbalance)

Compartment Syndrome

MEDICAL TREATMENT:

  • Acute compartment syndrome is treated with an immediate fasciotomy — a surgical procedure where fascia is cut to relieve pressure or tension.
  • Chronic compartment syndrome can be treated conservatively with rest and stretching. If this fails, fasciotomy is performed.

Compartment Syndrome Massage

 Compartment Syndrome Symptoms:

1. Acute Compartment Syndrome

  • Is a medical emergency. Bleeding/ swelling within unyielding compartment increases pressure. Pressure may increase to a point where nerve and arteries are compressed. Permanent damage and muscle necrosis may result if fasciatomy is not performed
  • Pain is severe and persistent
  • Skin taut and shiny
  • Affected compartment hot and harder than unaffected side
  • Sensation may diminish distal
  • AF dorsiflexion, extension ( toes) and inversion difficult due to pain. Passive stretch of affected compartment is painful.

2. Chronic Compartment Syndrome

  • Symptoms felt with exercise. Pain begins with activity and relieved by rest
  • Increased blood flow into muscle during exercise increases their size and therefore, pressure within compartment
  • Ache and tightness over entire compartment
  • Parasthesia in leg and foot with exercise

Compartment Syndrome Massage CONTRAINDICATIONS:

  • No frictions with anti inflammatories
  • A client with acute compartment syndrome is immediately referred for medical attention.

Compartment Syndrome Massage

ASSESSMENT: (chronic compartment syndrome)

  • acute compartment syndrome – refer to a medical doctor
  • Rom testing- restricted by pain. With anterior compartment syndrome, pain will be on active dorsiflexion and passive plantarflexion
  • Length tests — often short antagonists. With anterior compartment syndrome, gastrocs and soleus are short
  • Palpation of affected compartment may reveal tightness and defects in the fascia from continued pressure.
  • Tibialis posterior Tendinitis ( plantarflex and inversion) — pain will be along the course of the tendon, just posterior to medial malleolus. AR testing for tendonitis is (+)
  • Tibial Stress Fracture — pain is sharp and local to fracture site. Pain becomes constant and worse with impact.
  • DVT — local tenderness in calf. Homan’s/Ramirez test (+)

Compartment Syndrome Massage Therapy Treatment

Massage Treatment: ( CHRONIC Compartment Syndrome)

  • refer to an MD if acute compartment syndrome – no massage
  • Work to compensating structures — low back, gluteals, thighs
  • Fascial techniques, passive stretching are used to elongate short, thick fascia. Start with antagonists
  • Short gastrocs/ soleus are treated with fascial techniques, interspersed with stretching
  • Supine, quads and aductors treatment, especially Trigger points that refer to anterior leg
  • Longitudinal fascial techniques to anterior compartment to loosen fascia and reduce pressure. Passive plantarflexion to stretch
  • Any adhesions in tibialis anterior treated with cross fiber frictions
  • Effleurage and petrissage to entire limb ( toward heart)

Compartment Syndrome Massage

SELF CARE:

  • Patient rests from activities causing pain
  • Proper warm up period may help to reduce rapid bloodflow to compartment
  • Self massage to compartment borders
  • Stretching the muscles of lower leg starts with antagonists, then progress to affected area
  • Patient may need orthotics.

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