Understanding Compartment Syndrome: A Physiotherapist’s Perspective.

December 15, 2024

As physiotherapists, we often find ourselves at the forefront of managing and identifying conditions that can be tricky to pin down but have serious consequences if overlooked. Compartment syndrome is one of those conditions that demands our attention. Whether you’re a weekend jogger or a seasoned athlete, it’s something everyone should be aware of.

What is Compartment Syndrome?

Let’s start with the basics. Our muscles are arranged into compartments surrounded by a tough membrane called fascia. While fascia does a great job of keeping everything in place, it’s not particularly stretchy. Compartment syndrome occurs when pressure builds up within one of these compartments, often due to swelling or bleeding and compromises blood flow and nerve function (1).

Think of it like trying to overfill a suitcase with no give. The contents (in this case, your muscles, blood vessels, and nerves) get squashed, and the result can be both painful and dangerous if not treated promptly.

Acute vs Chronic

Compartment syndrome comes in two main forms:

  1. Acute Compartment Syndrome (ACS): This is the emergency version. It usually happens after a fracture, trauma, or surgery. Symptoms include severe pain that doesn’t match the injury, numbness, and noticeable swelling. This requires immediate medical attention (2).
  2. Chronic Exertional Compartment Syndrome (CECS): This is more common in athletes and develops gradually. It’s typically triggered by exercise, with symptoms like cramping, tightness, or tingling that eases with rest (3).

The Role of a Physiotherapist

So, where do we fit in? Physiotherapists are ideally placed to spot the early signs of chronic compartment syndrome. While we don’t diagnose or manage acute cases (that’s for the surgeons), we can identify when something seems amiss and direct you to the appropriate care.

Here’s how we play a vital role:

  1. Listening to Your Story: CECS is often overlooked because it mimics other conditions, like shin splints or tendinitis. A detailed account of when symptoms occur and what makes them better or worse is crucial.
  2. Assessing Movement: If you’re experiencing pain or tightness during activities like running or jumping, we’ll evaluate your movement patterns. This helps rule out other issues and may point us towards compartment syndrome.
  3. Working with Doctors: If CECS is suspected, we collaborate with medical teams to confirm the diagnosis. Pressure monitoring tests (done by a doctor) can clarify what’s happening.
  4. Rehabilitation and Prevention: For chronic cases, rehabilitation is key! We focus on improving mobility, strengthening muscles, and modifying training routines. Sometimes, something as simple as changing your footwear or running technique can make a world of difference. If surgery (fasciotomy) is required, we’re there to guide you through recovery and get you back to your activities (4).

Managing the Grey Areas

What’s tricky about compartment syndrome is that it doesn’t always fit neatly into a box. Pain is complex, and symptoms can overlap with other conditions. That’s why physiotherapists need to stay sharp, ask the right questions, and trust their instincts when something doesn’t add up.

When to Sound the Alarm

If you or someone you know has symptoms like severe pain, numbness, or a change in skin colour (think pale or purple), it’s time to act fast and get to A&E. This could be acute compartment syndrome, and delays can lead to serious complications (5).

Final Thoughts

Compartment syndrome is a prime example of why physiotherapy is about much more than exercises and stretches. It’s about looking at the bigger picture, listening to our patients, and knowing when to seek additional support.

Whether you’re chasing a personal best or recovering from an injury, always listen to your body and never ignore persistent pain. And remember, your physio is here to keep you moving, without letting those compartments get too cramped!

Our Barnet, Cockfosters & Enfield Physio’s have tons of experience and are specialists in dealing with Compartment Syndrome. Have confidence that our specialist Physiotherapists will closely assess, diagnose & treat you in the correct & evidence-based way for all injuries. You can book an appointment here.
Blog By: Emre Oz (Musculoskeletal Physiotherapist at Crouch Physio).

References

  1. Borrelli Jr, Joseph, and David Donohue. “Compartment Syndrome: Pathophysiology, Diagnosis, and Treatment.” Textbook of Polytrauma Management: A Multidisciplinary Approach (2022): 317-337.
  2. Osborn, Col Patrick M., and Andrew H. Schmidt. “Management of acute compartment syndrome.” JAAOS-Journal of the American Academy of Orthopaedic Surgeons 28.3 (2020): e108-e114.
  3. Velasco, Teonette O., and Jeffrey C. Leggit. “Chronic exertional compartment syndrome: a clinical update.” Current sports medicine reports 19.9 (2020): 347-352.
  4. Seven, Barış, et al. “Short and long-term outcomes of multidimensional physiotherapy in cases with acute compartment syndrome secondary to carbon monoxide poisoning with prolonged forearm compression.” Journal of hand therapy (2024).
  5. Garner, Matthew R., et al. “Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century.” HSS Journal® 10.2 (2014): 143-152.

HIGH LEVEL SUPPORT

Here at Crouch Physio, we offer the highest level of support to all of our clients. This includes being able to text or email any of our specialists between appointments.
We offer this high level support because we have seen that this drastically reduces expected recovery time for our clients which allows them to get back to normal activities quicker.

EDUCATION

Here at Crouch Physio, we will make sure to educate each and every single one of our clients on their diagnosis and how to best manage when away from the clinic setting. ⁣
We do this because education has been consistently shown across literature to be one of the most important factors for a quick and efficient recovery.
So don’t just expect to come into our clinic and receive ONLY manual based treatments. Although we do offer great symptom relieving treatments, evidence shows that its effectiveness increases with good patient education.
We make sure we educate because we have seen that this drastically reduces expected recovery times for our clients which allows them to get back to normal activities quicker.

OBJECTIVE TESTING

Here at Crouch Physio, we don’t do guesswork. We use the latest technology to provide us clinicians with numerical objective data which allows us to apply the correct interventions at the right time.
Objectively assessing outcome measures also gives our patients confidence that they are improving under our care, as well as allowing them to monitor their own progress.
So whether you’re an active person trying to get stronger or a sedentary individual suffering pain/stiffness, you will know that your condition is improving with our specialist assessment tools.

TAILORED REHABILITATION

Here at Crouch Physio, we have access to the very best rehabilitation amenities, the same facilities used by premier league football players and other elite athletes.
Unlike most Physiotherapy clinics, our clients will split their time with their physio between the clinic room, gym area and our upstairs studio where you’ll find our VALD performance force-plates, allowing for a more in-depth assessment and individualised plans.
Upon your initial consultation with us, we will likely use the latest technology to obtain as much baseline data as we can, which allows our physiotherapists to make smarter/more informed decisions around client care.
Our world class facilities allow for us to safely and gradually phase our clients back to their baseline level of physical activity before injury.