What is Compartment Syndrome?

Do you enjoy jogging outside or do you prefer the treadmill? Going outside for that run can give you that chance for a little ‘you time’. But do you ever get caught in your stride with a pain in your shins where it becomes slightly numb, you can’t run properly and your feet slap down to the ground and you begin to sound like a wildebeest escaping the jaws of a lion? If the answer is yes then you maybe suffering from Compartment Syndrome or more commonly referred to as Shin Splints.

What are Shin Splints?

Shin Splints is a name given to a group of injuries that can happen to your shin area. Most health professionals will tell you that Shin Splints don’t actually exist because it doesn’t refer to just one complaint, but is the “umbrella” name given to a range of complaints that can occur in the shin area.

The injuries covered by Shin Splints are Compartment Syndrome which applies specifically to the tibialis anterior muscle (found on the front of your shin and is used to raise your foot upwards), stress fractures to the tibia or fibula bone caused by repeated loading or jumping (these bones are the two bones that make up your lower leg) and medial tibial stress syndrome. This last one is periostitis of the inner section of the tibia bone. In English that means an inflammation of the connective tissue that surrounds the bone.

How is Compartment Syndrome caused?

Compartment Syndrome is caused by overuse or a sudden impact. In our lower leg the sheaths that surround the muscle are very tough and don’t have much ‘give’ to them. That means if the muscle inside the sheath needs to expand the sheath will not allow it. The expanding muscle therefore has nowhere to go, but the muscle grows in size regardless and the pressure starts to increase within the sheath. This expansion presses down on nerves which will cause the pain and the lack of movement comes from the inability of the muscle to change shape inside the sheath. No muscle movement: no foot movement.

Examples of the causes

An external cause like an impact from a kick or collision can cause bruising to the muscle. As bruising is internal bleeding, the swelling from this can cause the Compartment Syndrome. This example though is fairly rare and you would certainly know if you have been hit hard enough in the shins for it to have an effect.

Another cause is from overuse, especially if you are on a hard surface and have not prepared for it correctly or are not wearing the correct running shoes. Overuse or excessive use does not necessarily mean that you have to do a lot before it can kick in, it just has to be a lot for your muscle. So if you have not run for a long time and you suddenly start, even after 5 minutes you could start to feel the symptoms because your muscles are just not prepared for it. Even highly trained athletes can suffer from this if they suddenly change their routine.

The most common cause, in my opinion is from the tibialis anterior just not being trained enough to do the work asked of it. People new to exercise are far more likely to suffer from this as the muscles are not only not trained to do the job asked of them, but they are simply not strong enough.

Flat sole trainer, no good for running

 

What does the Tibialis Anterior muscle do?

This muscle raises your foot upwards and whilst this seems fairly pointless in itself, we do use it a lot in everything from walking to sport. The raising of the foot is important as we bring our leg forwards, not only does it help us to avoid the toes clipping the ground on the way through but it allows us to get the foot ready to plant the heel down on the ground as we take a step. The next bit of walking is the tibialis anteriors piece de resistance as it slows down the foot touching the ground. This prevents any slapping of the foot and acts like a shock absorber as well as efficiently allowing the toes to come down ready for them to push off as the foot moves towards the back of our body in our walking gait.

What to do if you are suffering from Compartment Syndrome?

If you are at the acute (early) stages, where there is pain in your lower leg, then you can see your doctor who will examine you and (more likely than not) prescribe you an anti inflammatory medicine to help reduce the swelling inside the muscle. However there are some methods you can use on your own.

Cooling the area will help reduce the swelling. Using some frozen peas wrapped in a towel can really help. Make sure you don’t put ice directly in contact with the skin as you can give yourself ice burns. Always use a towel to separate the ice from the skin.

Another technique you can use in addition to the cooling is elevation. When seated or lying down make sure that you elevate your leg higher than waist height if you are seated and higher than the rest of your body if you are lying down. Gravity will help the excess blood leave the muscle. I advise that you rest and do not go back to training for at least a week. Go to your doctor and get it checked out properly, do not do the activity that causes it again until your muscles are ready.

Make sure that you are using proper trainers (sneakers) that do not have a flat sole. The flat sole puts excess stress on the tibialis anterior muscle. This extra stress nearly always manifests itself as Compartment Syndrome. Pick trainers that have a separate heel and ball of your foot section, this will allow your feet to roll down and ease the pressure on the muscle.

Exercises you can do to improve the muscle condition

These muscles are like every other muscle in your body and need to be trained properly to make them able to do their job efficiently. This takes time and does not happen overnight, you are going to have to be stubborn and persistent. To start with do not run outside on the hard concrete, use a treadmill ideally or run on grass. Now this bit is very important: run only for the length of time just before the pain in your shin starts. A very difficult one to gauge, but just when you feel that lack of control in your feet, then just stop running. That is it, quite easy really. The next time you can try and run that bit further before you stop. Then slowly but surely your times should get longer and longer before you have to stop. This shows that the muscle is getting stronger and it won’t take too long before you can run without the pain at all. You can do this sort of training once a day.

…and another exercise

Diagram showing the toe raise exerciseAnother exercise you can do to specifically work on these muscles are toe lifts. Lean with your back against a wall with your feet about a foot distance away from the wall. Keeping your back flat against the wall raise the toes of both feet so that both the toes and balls of your feet are off the ground. When they are as high as you can get them then lower them slowly back down to the ground. Repeat this 20 times or until you feel them getting tired (again, you need to stop before any pain comes). Do 3 sets of these (a total of 60) as many times as you can in a day but at least twice. When you find it becoming easier then increase the number from 20 to 30 and keep going. When you can do three lots of 50 you will have trained them enough and you should be able to re-introduce the activity that caused the Compartment Syndrome. However make sure you always stop before it starts to really hurt.

And a Warning…

It is really difficult to give advice to people that I do not see face to face, so it is down to you to see your doctor to get an official diagnosis of your injury. Only then can you take this information and act on it. Whilst the weakness is the most common form of Compartment Syndrome, there are other causes of pain in the shin that won’t be helped by these exercises. These include stress fractures, back problems and tumors. So please make sure you get a check up before you try and fix the condition yourself. If it does turn out to be Compartment Syndrome of the tibialis anterior, then these exercises will help – as a fellow sufferer I can guarantee it.

Good luck with your training and remember to be safe!