Compartment Syndrome Massage

• The 4 compartments in the Lower Leg:
• MEDICAL TREATMENT:
• Compartment Syndrome Symptoms:
• Acute Compartment Syndrome Symptoms (Medical Emergency)
• Chronic Compartment Syndrome
• Compartment Syndrome CAUSES:
• Compartment Syndrome Massage CONTRAINDICATIONS:
• Massage Therapy Assessment:
• Massage Therapy Treatment: (CHRONIC Compartment Syndrome)
• SELF CARE:

• 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

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 gastrocnemius/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

MEDICAL TREATMENT:

• Acute compartment syndrome is treated with an immediate fasciotomy — a surgical procedure where fascia is cut to relieve pressure or tension. Compartment syndrome is a medical emergency that requires prompt diagnosis and treatment to prevent permanent damage to the muscles and nerves. If you suspect compartment syndrome, seek immediate medical attention.
• Chronic compartment syndrome can be treated conservatively with rest and stretching. If this fails, fasciotomy is performed.

Compartment Syndrome Symptoms:

Acute Compartment Syndrome Symptoms (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 fasciotomy is not performed.
• Pain is severe and persistent. Severe pain that doesn’t improve with rest or pain medication and is often out of proportion to the injury.
• Pallor: Pale or shiny skin over the affected area.
• Paralysis: Weakness or difficulty moving the affected limb.
• Paresthesia: Tingling or burning sensations. Sensation may diminish distally.
• Affected compartment hot and harder than unaffected side.
• AF dorsiflexion, extension (toes) and inversion difficult due to pain. Passive stretch of affected compartment is painful.
• Pulselessness: Diminished or absent pulse in the affected area (a late sign).

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 the leg compartment.
• Ache and tightness over entire compartment.
• Parasthesia in leg and foot with exercise.

Compartment Syndrome CAUSES:

Causes of Compartment Syndrome:

• BURNS
  • Circumferential Burns: Full-thickness burns that encircle a limb can lead to eschar formation, which restricts expansion of the underlying tissues and increases compartment pressure.
• IATROGENIC CAUSES
  • Medical Procedures: Certain medical interventions, such as tight bandaging, casts, or prolonged use of tourniquets, can inadvertently increase compartment pressure.
• INFECTIONS
  • Severe Infections: Infections causing extensive swelling or abscess formation within a compartment can lead to increased pressure and compartment syndrome.
• INFLAMMATORY CONDITIONS
  • Severe inflammation: whether from an autoimmune response or other inflammatory conditions, can cause swelling and increased pressure within a compartment.
• OTHER CAUSES
  • Prolonged Immobilization: Remaining in one position for an extended period, especially in a position that restricts blood flow, can lead to compartment syndrome.
• OVERUSE/ OVER TRAINING:
  • Chronic Exertional Compartment Syndrome (CECS): Repetitive exercise, especially in athletes, can lead to temporary increases in compartment pressure. This is more common in activities involving repetitive leg movements, such as running or cycling.
• TRAUMA
  • Fractures: Broken bones, especially in the arms and legs, can cause swelling and bleeding within the muscle compartment.
  • Crush Injuries: Severe trauma, such as being crushed by a heavy object, can lead to significant swelling and increased pressure within a compartment.
  • Soft Tissue Injury: Direct trauma to the muscles without fracture can also cause swelling and increased compartmental pressure.
• VASCULAR ISSUES
  • Reperfusion Injury: When blood flow is restored to an area that has been deprived of circulation (e.g., after surgery or prolonged tourniquet use), it can cause swelling and increased compartment pressure.
    • Bleeding: Internal bleeding from blood vessels within a compartment, often due to injury or surgery, can increase pressure.

Compartment Syndrome Massage CONTRAINDICATIONS:

• No Frictions with anti inflammatory medications
• A client with acute compartment syndrome is immediately referred for medical attention.

Massage Therapy Assessment:

• 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 (+)

Massage Therapy 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)

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.