Compartment Syndrome: 4 Steps to Solving This Post-Injury Problem

November 12, 2015

Swelling, severe muscles aches and pain, the inability to move a part of your body, and excessive pressure — all are symptoms of compartment syndrome.

What is compartment syndrome, exactly? It’s a type of condition where an enclosed part of the body stops receiving blood flow and becomes overly inflamed and stiff. Often the symptoms are confused with those of shin splints or tendonitis.

Usually a side effect of surgery, intense exercise without enough rest between workouts, an injury or an episode of bleeding, compartment syndrome can come on suddenly and be extremely uncomfortable, even requiring emergency surgery in some cases to prevent a permanent disability of tissue.

While developing compartment syndrome doesn’t mean you’re doomed to experience ongoing pain in muscle, blood vessel or joint tissues forever, the scary thing is that in some cases it can cause permanent damage in as little as 12–24 hours if left untreated! That means you need to take this condition seriously and nip it in the bud.

I have four vital steps you must take to avoid permanent damage resulting from compartment syndrome.

Causes of Compartment Syndrome

In the body, certain muscles or groups of organs are connected to one another by fascia tissue, organized into areas called compartments. The body’s compartments include muscle tissue, nerves, capillaries and blood vessels that are enclosed by fascia similar to the way in which “insulation covers wires.” (1)

Muscle fascia tissue is exactly what can feel “tight” following exercise or an injury. It’s also what is massaged when someone uses a foam roller or stretches in certain ways after exercising to help with muscle recovery and prevent pain.

Fascia tends to be pretty stiff to begin with and forms the tough walls of the body’s compartments that don’t easily stretch. When someone becomes injured or wounded, blood and swelling can build up in the compartments to the point that fascia cannot expand far enough to enclose the area. The result is that pressure in the compartment caused by inflammation increases, and eventually blood flow to the tissues can be cut off, which ultimately damages the tissue inside the compartment. (2)

The longer compartment syndrome goes on, the more severe the tissue damage can become — sometimes resulting in permanent injuries, loss of mobility, and at times, even amputation or death if crucial tissue is damaged beyond repair.

Some of the common conditions that trigger the development of compartment syndrome include:

broken bones or fractures, such as in the leg or arms
injuries from car crashes
wear and tear, falls, or bone breaks due to sports-related accidents
intense exercise that causes strains or injuries (similar to shin splints, a very common running injury)
side effects after taking anabolic steroids
burns on the skin
wearing a tight cast or bandage in order to heal a wound (which keeps the compartment from moving at all)
a limb being cut off from blood flow during a period of unconsciousness (such as after fainting or getting in an accident)
following surgery, especially if the surgery involved blood vessels
when a blood clot develops in a blood vessel (especially in an arm or leg)

Symptoms of Compartment Syndrome

Certain parts of the body — especially the arms, abdomen and legs — have areas of delicate tissue that can experience a drastic buildup in pressure when swelling sets in after an injury. Increased inflammation or swelling in the area can be enough to completely stop the flow of blood, which therefore cuts off nutrient and oxygen supply. (3)

While it’s not always a very difficult or serious problem to fix, some people experience symptoms of compartment syndrome so badly that they need to head to the emergency room for immediate intervention and pain relief.

When someone experiences compartment syndrome, symptoms can include:

ongoing, deep pains or aches (especially in the limbs or abdomen, depending on where the condition develops)
numbness, tingling, light shocks, or the feeling of “pins and needles”
high levels of swelling, pressure, tightness and bruising around the injury
during exertional compartment syndrome, cramps or increased aching around the injured area as time goes on (usually in the muscles of the glutes, shins, thigh or lower leg)
increased aches and sensitivity within a half hour of starting exercise, similar to symptoms of shin splints
with abdominal compartment syndrome, a tense and distended abdomen that feels very uncomfortable
increasing pressure around the pelvic and abdomen
trouble going to the bathroom normally, such as urine stopping or slowing down
low blood pressure
rhabdomyolysis

Compartment syndrome causes & symptoms - Dr. Axe

Who’s at Risk for Compartment Syndrome?

Whenever you’re injured or recovering from surgery, some pain and swelling is completely normal and expected — but with compartment syndrome, the pain seems to be much worse than what you’d expect given the severity of the injury. Unfortunately, researchers don’t know of any way to prevent compartment syndrome from developing at this point, so instead, it’s important to know the symptoms and treat them as quickly as possible once they begin.

There are several different kinds of compartment syndrome, including: acute, chronic, exertional and abdominal. The most common type of compartment syndrome is acute compartment syndrome, meaning it only lasts for a limited period of time. It can develop quickly (over a few hours to a few days’ time), and usually (in about 75 percent of cases) it’s caused from an injury like a broken leg or arm.

When someone experiences a bone break or is healing from another injury, acute compartment syndrome can develop due to bleeding, fluid retention (called edema) and an increase in inflammation — which are all signs that the body is trying to heal itself. While normally swelling in the case of an injury is life-saving and beneficial, when it keeps a group of tissues from receiving enough blood and oxygen, it becomes a serious problem. The pressure and pain can set in either shortly after the injury or can develop a few days later, such as when surgery is performed or a cast is put on the injury to stabilize a fracture.

While acute compartment syndrome is much more common, longer-term cases of compartment syndrome called chronic compartment syndrome can develop that last for up to several weeks. This type is sometimes caused from ongoing vigorous exercise that the body cannot adjust to, called exertional compartment syndrome. Exertional compartment syndrome is most common in parts of the body that are stressed most during heavy physical activity. The shins, knees, glutes (buttocks) and thighs are all susceptible, especially when someone has been overtraining.

As the name implies, the body becomes overly exherted and can’t repair tissue well enough to prevent increased inflammation and pressure. Shin splits are very similar to exertional compartment syndrome and cause a lot of pains and aches in the muscles, tissue and bones of the lower legs after high levels of repetitive movements or exercise.

Abdominal compartment syndrome is another rare but serious type usually caused by a severe injury, surgery or illness that rapidly increases swelling. Car accidents or other trauma, surgeries, infections, internal bleeding from the abdomen, and pelvic fractures are some events that can trigger abdominal compartment syndrome, which can be life-threatening if it’s left untreated. The biggest risks for permanent injuries and serious side effects come from blood being cut off from the abdominal organs — including the liver, bowels and kidneys, which we rely on for life-saving functions every hour of every day.

Usually, people with abdominal compartment syndrome need to be hospitalized and can become critically ill or even put on life support. One of the scary things about this condition is that most people haven’t heard of it and don’t recognize their own symptoms, so they might mistake it for another type of injury and wait a period of time before going to the emergency room or calling the doctor.

4 Steps to Solving Compartment Syndrome

While eating a diet high in anti-inflammatory foods, exercising in a healthy way, resting enough between workouts, and foam rolling or stretching after workouts can all help lower swelling, these habits still might not be enough to prevent compartment syndrome in some cases.

It’s still definitely a good idea to practice these things anyway, since they prevent injuries and pain in addition to lowering the risk for compartment syndrome, but if it’s already set in, you need to start treatments right away. The goal of treating compartment syndrome is to help reduce pressure and improve blood flow to the area that’s affected.

Is it likely that you’ll be able to fully recover from compartment syndrome? Yes, especially if you treat symptoms right away. The good news is that promptly diagnosing the problem and taking steps to reduce it usually results in no permanent damage.

Luckily, the muscles and nerves inside the compartment recover well if they aren’t left cut off from blood flow for too long — however, if it takes a while for a diagnosis to be made, permanent nerve injury and loss of muscle function are possible within just 12–24 hours (called Volkmann’s ischemia). This is especially true in people who are unhealthy in other ways, have suffered injuries before and are more sedentary, since their muscle tissue isn’t as flexible or resilient.

If you have a feeling you might be dealing with compartment syndrome, here’s how to treat the condition as quickly as you can:

1. Visit Your Doctor ASAP

Some types of severe compartment syndrome are considered to be surgical emergencies, so you want to visit the emergency room or your doctor right away to figure out how bad the swelling and pressure have become. For acute compartment syndrome that can damage tissue quickly, no effective nonsurgical treatment option exists at this time, so you’ll likely have to have surgery performed that involves an incision into the fascia covering the affected compartment (called a fasciotomy).

Surgery works by opening the fascia so there is more room for the muscles to swell, receive blood flow and then heal themselves. Instead of tissue being “trapped” under fascia and not being able to expand normally, tissue has more room to decompress. If this doesn’t work, removing part of the fascia (fasciectomy) is also sometimes needed.

If fascia cannot stretch far enough to enclose the compartment, a skin graft might be needed to cover the wound so it can heal. Your doctor might also recommend taking anti-inflammatory medicines while you heal.

Keep in mind that while a healthy diet isn’t enough to prevent or reverse compartment syndrome, it certainly doesn’t hurt. Load up on anti-inflammatory foods to help flood your body with as many healing nutrients as possible.

2. Remove Constricting Casts or Bandages

Sometimes, wearing tight bandages or casts after surgery can cause compartment syndrome, so if that’s the case your doctor will immediately remove these and decide how else to treat the injury. If you’ve been suffering from a fracture or sports injury, you’ll want to talk to your doctor about taking off any splints, casts, dressings or braces. These can increase the pressure in the area and actually making the condition worse, instead of helping.

If you started wearing a brace you bought yourself to stabilize an injury, check with a physical therapist or orthopedic if it’s actually necessary or if it should be removed so circulation can improve.

3. Rethink Your Exercise Routine

Chronic exertional compartment syndrome develops in athletes and people who exercise intensely most often, such as runners or dancers. That’s because repetitive motions and overtraining can cause dysfunction in musculoskeletal tissue in the legs and arms. For example, shin splints are similar to developing compartment syndrome in the lower legs, and this condition is common among runners. (4)

While there’s so many proven benefits of exercise — lifting your mood, hormonal balance, giving you more energy and taking care of your heart, just to name a few — recovering properly from exercise before doing more is crucial for preventing injuries.

Your muscle, joints and ligaments all need time to repair themselves after a tough workout. But in some cases, injuries caused by repetitive exercise can’t be solved from rest alone. Unfortunately, a lot of people need to stop doing the triggering activity all together, at least for some time while body heals. (5)

Doing the same types of movements over and over again, such as running or dancing, can sometimes cause changes in how your muscle tissue connects to bone, since scar tissue can form that causes abnormal adhesions to develop. The risk for exertional compartment syndrome is greater in people who do the same types of exercises, especially when they’re vigorous, so your best bet is to vary your works (by cross-training, one of the best running tips for beginners) and take enough rest days.

Build up to vigorous exercises slowly — it’s recommended by no more than 10 percent mileage or time every week — and make sure to stretch properly afterward. If you’re prone to pain in your arms or legs after workouts, try gentler and less impactful exercises for a while like swimming, low-impact weight training, using a rowing machine or possibly cycling.

4. Seek Out a Physical Therapist

If you’ve developed chronic compartment syndrome that isn’t severe or considered an emergency, nonsurgical treatments like physical therapy and wearing shoe inserts (called orthotics) can help lower swelling. You can also consider trying reflexology, foam-rolling the painful area (especially after workouts), massaging the stiff muscle and joint tissue on your own, or infrared sauna therapy. (6)

A physical therapist can help determine what might be contributing to your pain, such as improper form when running or shoes that don’t support your feet and legs well enough when exercising. Physical therapy will help you work on stretching the fascia tissue and bringing blood flow to the affected compartment, while also tailoring an exercise routine for you that won’t contribute to more inflammation.

Physical therapists often have tips that can help lower inflammation that you might not even be aware of — for example, some people notice symptoms of their compartment syndrome are worsened when they exercise on hard surfaces (like a track or the road) versus softer surfaces.

How to Know If You’re Experiencing Compartment Syndrome

Look out for the symptoms listed above if you recently experienced an injury, trauma or surgery, or if you exercise vigorously and have noticed an increase in pain and swelling. Tell your doctor, physical therapist or another health care provider right away so he or she can review your case, talk to you about any history of injuries, do a physical exam and run any necessary tests. Early treatment is the best way to prevent permanent damage and preserve tissue health, so it’s better to be overly cautious rather than to let compartment syndrome go unnoticed.

A proper diagnosis of compartment syndrome usually requires direct measurement of “pressures” inside the specific compartment, which is sometimes measured from performing a needle test. While it doesn’t sound pleasant, a needle or catheter might need to be inserted into the swollen area that’s attached to a device that can measure pressure, giving your doctor an accurate idea of how much swelling is going on internally. Some doctors also use imaging tests, blood tests or other lab tests to check for blood pressure and other signs.

If it’s determined you have compartment syndrome, use those four steps to overcome the condition and get your body back to normal!