Compartment Syndrome Physiotherapy
Compartment syndrome is a very serious medical condition, and can cause loss of limb and even life.
It happens when the presurre in the muscle compartments is very high that it squeezes and compresses, causing lack of blood flow to the areas, and this can compromise the structures there. Think of it like asphyxiation to the cells nearby – the cells that lack blood flow + high pressure, can be damaged and even die.
Compartment syndrome is either
- Chronic (long term, slow)
- Acute (sudden, intense)
What’s compartment syndrome?
So our entire body (including our limbs such as hands and legs) have compartments that contain different stuff like:
- muscles
- nerves
- blood vessels
- tendons
- etc
and each compartment is separated by fascia, which is like a very thick organic sheet of tissue that is firm and doesn’t stretch well. In the issue of compartment syndrome, what happens is sometimes with a very hard workout or injury (even mild or moderate ones), the tissues can swell.
If there’s excessive swelling within the compartment, be it due to acute injury or chronic overuse, it can cause pressure to build in that compartment because the think fascia just cannot expand to accomodate the swelling. This is bad news for the tissue that’s swollen.
In rare situations, this can cause the structures that are being compressed to be damaged (think of it as a strong compression pressure plus lack of circulation) and even die.
It’s vital to relieve the pressure to avoid and minimize permanent damage.
2 kinds of compartment syndrome
Acute compartment syndrome
Acute compartment syndrome (ACS) is a medical emergency – it can develop as quick as few hours after an injury, and if untreated for a couple of hours, it can cause irreversible tissue damage.
ACS typically happens in the lower leg (calf) or forearm.
The most common causes of ACS are serious injuries, such as
- A direct hit or blow to the limb due to sports or a bad fall
- Crush injuries from motor vehicle accidents or work injuries injuries
- Bandages that are bound too tight
What does acute compartment syndrome feel like?
Most patients report
- Severe pain in the involved limb that’s unusual to the type of injury
- Changes in feelings and sensation such as tingling, burning, numbness
- Feel that the affected limb is tight or “stuffed full” from the swelling and increased pressure
- Limb will start to discolor unusually
- Severe pain with movement of the involved structure or muscle; even when touched or pressed
- Difficulty and inability to bear weight throughout the involved limb because it’d cause so much pain
How is ACS diagnosed?
ACS are medical emergencies that needs immediate treatment – if the individual shows any signs of ACS, they need to be brought to the Accident & Emergency department of any hospitals for immediate evaluation and treatment by a doctor.
The doctor will determine the pressure in the compartment and determine if it’s necessary for emergency surgery to relief the pressure in the compartment.
This procedure is called fasciotomy. During the surgery, the doctor will make an incision through the skin and fascia to immediately
- drain the excess swelling
- relieve the pressure within the compartment
A patient who has undergone fasciotomy will have to spend quite some time in hospital to heal and ensure that the internal pressure normalizes as well as as the wound heals well. During hospital stay and even after, the patient will usually require physiotherapy or hand therapy to restore
- full movement
- strengthe and power
- function
- pain relief
Chronic Compartment Syndrome
CCS is usually called “exertional” compartment syndrome, because it’s usually cause by activities and exercise that has repetitive movements, such as
- walking
- jogging
- running
- jumping
- cycling
- roller blading
- skiing
- skating
- swimming
The issue typically lies with the limb being overused or overworked without sufficient rest (or time to recover).
Patients who develop chronic compartment syndrome may also have other factors that contribue, such as
- poor footwear
- too much training
- poor body control
- training on uneven or hard training surfaces
How does CCS feel like?
The symptoms for CCS may be similar to that of ACS, but it’s usually not as intense or severe:
- ache and pain in the involved limb that worsens with activity but improves with rest
- swelling that comes and goes
- pain / ache with stretching or movement
- tingling or numbness in the limb
- weakness of the affected limb
How is chronic compartment syndrome diagnosed?
The symptoms of CCS can be similar to other conditions such as stress fractures and shin splints, as well as tendinitis or other inflammatory conditions, so the doctor and physiotherapist need to do proper assessment and differential diagnosis to rule out and diagnose proper.
Sometimes, diagnostic imaging such as ultrasound, xray or MRI imaging may be required (MRI’s the most accurate but also the most pricey) to assess and diagnose the tissues and injury. If the doctor suspects CCS, then the patient will most likely be referred to a doctor to determine compartment pressure levels.
This test can be done in a medical office where pressure in the involved compartment is measured before, during and after exercise. The goal of this test is to replicate symptoms as they happen like in real-life.
So if you’re diagnosed with chronic compartment syndrome, your doctor will advise and plan the best route to treat you. For milder cases, you may be referred to see physiotherapists or hand therapists. Severe cases may require surgery (fasciotomy) where you will referred to a surgeon to discuss / consider options.
How physiotherapy can help
If you’re diagnosed with compartment syndrome (acute or chronic), physiotherapy will play a fairly important role in your treatment and recovery — whether you need surgery or not.
Ideally, you wont need surgery, and the physiotherapists will work with you and build a treatment program specific to you and your need:
- manual therapy: hands-on, manual therapy is the first and foremost treatment, to move, mobilize and manipulate joints and soft tissue, which can help to improve range of motion as well as bring down swelling and pain
- range and movement exercises: which has multiple effects and benefits, from increasing the joint range of motion, improving circulation in the affected limbs as well as improve strength and activity tolerance
- strengthening: strengthening and balancing out imbalanced forces in the lower leg muscle groups can help treat compartment syndrome. The physios will also help you build your core muscle strength (abdomen, lower back and pelvic muscles) which will provide greater stability and performance of your hands and legs.
- treatment modalities: such as
-
- heat therapy: paraffin wax bath, electrical heat pack, infrared lamps
- ultrasound therapy
- cold therapy: cold packs, cold massage rollers, ice machines for hands and legs
If you’re diagnosed with compartment syndrome (acute or chronic), physiotherapy will play a fairly important role in your treatment and recovery — whether you need surgery or not.
Ideally, you wont need surgery, and the physiotherapists will work with you and build a treatment program specific to you and your need:
- manual therapy: hands-on, manual therapy is the first and foremost treatment, to move, mobilize and manipulate joints and soft tissue, which can help to improve range of motion as well as bring down swelling and pain
- range and movement exercises: which has multiple effects and benefits, from increasing the joint range of motion, improving circulation in the affected limbs as well as improve strength and activity tolerance
- strengthening: strengthening and balancing out imbalanced forces in the lower leg muscle groups can help treat compartment syndrome. The physios will also help you build your core muscle strength (abdomen, lower back and pelvic muscles) which will provide greater stability and performance of your hands and legs.
- treatment modalities: such as
-
- heat therapy: paraffin wax bath, electrical heat pack, infrared lamps
- ultrasound therapy
- cold therapy: cold packs, cold massage rollers, ice machines for hands and legs
Where To Next?
- Go to Home / Start
- Learn and find out more about your pains (bones, muscles, joints, tendons, ligaments, nerves etc) at Pain Conditions & Injuries
- Visit our shop to see products we recommend for pain relief, heating, treatments and more
- Contact us
