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EXERTIONAL COMPARTMENT SYNDROME IN THE ATHLETE
A Commonly Missed Diagnosis By Dr. Michael M. Cohen, DPM, FACFAS
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and sensory testing after exertion will aid in and the symptoms persist despite exhausting confirming the diagnosis and specifying the conservative treatment, surgery may be required splints. compartment affected. During strenuous activity if the athlete intends to continue the sport. The There many causes of leg pain in athletes. All blood flow increases to the leg causing the surgery involves releasing or cutting the tight too often, they are lumped together under the volume and weight of the muscle to increase fascia using a technique called fasciotomy. This term shin splints which most sports medicine by about 20%. As a result, the muscle fibers allows the muscle to expand during exercise. physicians do not consider a true diagnosis. attempt to swell but are restricted by the tight Complication rates are rare when done by an Stress fractures, tendinitis, medial tibial stress surrounding fascia. Immediately after activity the experienced surgeon and may include bleedsyndrome are all examples of maladies referred leg may feel tense or tender with deep message ing, wound breakdown, and numbness. Also, to as shin splints. However, one commonly or passive stretch. Runners may find that a bubble symptoms can redevelop several years after a missed diagnosis often confused with shin or several bubbles are visible in front of the fasciotomy in a small percentage of patients splints is exertional compartment syndrome leg which we refer to as fascial hernias. These as a result of the fascia reforming. The results (ECS). Exertional compartment syndrome (ECS), are areas where the fascia may have become of the procedure however are generally very also known as exertional induced compartment weak allowing the muscle to herniate through gratifying and has allowed many athletes to syndrome or chronic compartment syndrome due to the excessive internal leg pressure. The remain active in their sport. is a unique condition where an athlete experi- physical exam during rest is otherwise generally Dr. Michael Cohen has a marathon PR of 2:37 ences muscle pain in the legs with weakness unremarkable. X-rays, magnetic resonance at age 21; 2:50 at age 39 and at 50 was a top 3 of the ankle as a result of increased muscle imaging, vascular studies and other imaging age group finisher in both the ING Miami and pressure in one or all four compartments of the exams are used to rule out other diagnosis but Disney Half Marathons. In 1997 he placed third leg. Patients with this condition will typically are not helpful, as they are always normal in ECS. overall in the Florida Gatorade Duathlon series. note the onset of symptoms at a fixed point To confirm the diagnosis the sports physician Michael M Cohen, DPM, is a Board-Certified ranging from 5-30 minutes into an activity, at a will need to measure the pressure in each comFoot and Ankle Surgeon and Diplomate of the specific level of intensity, with symptoms usually partment of the leg with a special instrument American Board of Foot and Ankle Surgery. He occurring in both legs. The most characteristic much like a tire gauge. In normal patients, the is a Fellow of the American Board of Foot and feature of (ECS) is that it is exercise induced pressure difference between rest and activity is Ankle Surgeons and Board Certified and and never present at rest. The vast majority of small, while those with ECS will have a dramatic Diplomat of the American Board of Podiatric patients with ECS are runners who range from increase in pressure readings after activity. Medicine. He practices with the Foot, Ankle, the occasional jogger to the elite Olympic level and Leg Specialists of South Florida specialrunner. It is not unusual to see unconditioned ECS is not an emergency izing in lower leg injuries and reconstructive athletes develop these symptoms after beginning Exercised-induced compartment syndrome surgery of the foot and ankle. The South Florida an exercise program. Occasionally the probis not to be confused with acute compartment Institute of Sports Medicine in Weston is lem is recognized in high-level cyclists as well. syndrome which is considered a surgical emerlocated at 1600 Town Center Blvd, Suite C, gency. Typically, acute compartment syndrome (954) 389-5900 and in Pembroke Pines at Why does this happen? is a result of a traumatic injury causing a similar 17842 NW 2nd St, (954) 430-9901. There are generally 4 compartments in increase in compartment pressures due to www.SouthFloridaSportsMedicine.org the leg, each is surrounded by tight tissue hemorrhaging. In this situation, the pressure resembling a thick saran wrap which holds the cannot be controlled easily and the delay in compartment in place and separates it from the treatment may cause permanent muscle and adjacent compartments. Patients with ECS will nerve damage. In contrast, people with exercomplain of cramping, burning, tightness and weakness of the ankle with exercise. Some cise-induced compartment syndrome will find will also develop numbness in the foot and that the pressure is relieved completely with rest. describe a foot slap due to ankle weakness ECS is generally not considered an emergency.
hen shin splints are not s hin
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during running. This may cause the runner to trip as a result of the foot not being able to clear the ground just before landing. Pain will force the athlete to stop at which time symptoms completely resolve after resting a few minutes. The symptoms are reproducible with exertion and should be recreated in the office setting with an exercise challenge such as running on a treadmill or stair climbing. Specific muscle
What is the treatment?
A period of rest and avoiding high-intensity activities can be tried. Often more experienced athletes will recognize the level of intensity provoking symptoms and attempt to exercise just below that threshold. Muscle retraining by running more efficiently may also improve symptoms. However, if the diagnosis of ECS is clear
40 / Our City Davie / November 2022 / OurCityMedia.com
