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Tuesday, September 23, 2008
Compartment Syndrome
This being my first year returning to competitive athletics after 12 years off, I made a list of injuries I thought I should watch out for while training. On the top of the list was overtraining, knee strain, shoulder strain and IT Band tightness. These injuries are things that I felt I was prone to or would encounter due to starting a new and hard training program. Whereas none of these items have really presented its self, I never could have guessed that Compartment Syndrome would be an issue. I had the first signs of CS in February; I had a brick workout where after a long bike ride I immediate go for a run. On the run, my calves tightened up and both of my feel went numb after about 20 minutes. If I stopped running the numbness went away immediately. I chalked this up to tight calves, finished up the run and went home thinking I would have to pay more attention to stretching my calves. The following workouts that week all went fine, I didn’t have any numbness or tightness in my calves when biking or running. But again, on my weekly brick workout, the same thing occurred. This continued for many weeks, the problem only occurring on brick workouts and taking about 20-30 minutes before it would happen. Discussing this with my coach and local body workers we determined it to be Compartment Syndrome. So just what is Compartment Syndrome? In a nut shell and not being medical or scientific, Compartment Syndrome is a condition where the blood flow is blocked from getting to the feet. This can be due to a few reasons, 1. scare tissue that blocks blood supply. This situation is usually chronic- meaning the numbness doesn’t go away and you are at sever risk of nerve damage or loss of body parts. 2. Swelling or tightness of the calf muscles prevent the flow of blood, this can be caused by (a.) injury or (b.) rapid development of the calf muscle. In my many years of self diagnosis I chose option 2(b). rapid development of the calf muscle. If you are interested in the medical and scientific explanation I liked http://www.synergy-sports.com.au/PDF/Info%20Sheets%20Sports/Compartment_Syndrome.pdf or Wikipedia http://en.wikipedia.org/wiki/Compartment_syndrome. As my brick workouts started to get longer I became concerned with the amount of time my feet were numb. Doing research on the internet, I determined I could continue to train so long as my feet where not numb longer than 1 hour. Since the numbness usually started about 30 minutes into the run and my runs where only 45 minutes, it wasn’t a big deal to finish out the run, but now my runs were well over an hour and I was getting worried. This ended up not being a big deal as for some reason just as my feet would numb up at 30 minutes, it also would go away around an hour tand 20 minutes…. Just short of 1 hour of numbness and tingling. This is still cutting it way to close to be comfortable, but then again I wouldn’t call having my feet being numb being comfortable either. What is to be done? I focused on two facts and tried to work back from there. First this only happened on brick workouts so it seemed obvious that would be related to the bike and second I have been training hard and have had rapid muscle development in the lower leg. First, I tried adjusting my seat height lower to insure that I want toeing down which can tighten up the calf muscles. My coach also mentioned that Speedplay pedals can cause achilles and calf strain due to the additional play allowed in the foot. The seat adjustment didn’t make and noticeable improvement over time, and I discounted the pedals as the culprit because even though I am currently using Speedplay when the issue started I was actually on SPD pedals which do not allow any play or motion of the foot. Also, my husband a former cat 1/pro cyclist’s observation on my cycling form and foot motion was that my form is near perfect. Second, if the issue is due to rapid muscle development then the root cause is inflexible muscle fascia. This is the sheathing around a muscle, it usually grows with a muscle but is a little slower to adapt than muscles and they can get “junked up” by injury and scare tissue. I have a friend that is a Structural Integration Practitioner; this body work technique focuses on fascia so I thought I would start with him. I started seeing him about this, but didn’t have much success. Looking back on this, I can see that the reason is that Structural Integration works to align body parts by manipulation and removal of the fascia scare tissue but alignment was not my issue. I then called up another friend that does Active Release Therapy (ART), which is also a fascia based body work. ART stretches and manipulated fascia by a series of stretching motions in combination with pressure and rubbing. Here is a nice link on ART http://www.bodytechniques.com/local_resource_artFAQ.htm. I felt a difference in the tightness of my achilles after the first session and decided to continue with ART regardless of its effect on Compartment Syndrome. I immediately scheduled 3 sessions a week each for 20 minutes, the focus was on the calf, Achilles and the connection of the lower leg muscles to the back of the knee and hamstring. I started to see improvement but the problem was gone. After a month, she said that there wasn’t anything else she could do to the back of the leg, and she decided to work from the front of the leg mostly along the shin. This actually made the most profound improvements and I was actually doing some brick workouts with out any numbness. I continued this therapy 3 times a week for another 2 weeks, at which time I wasn’t having any numbness. Since then I go in every couple of weeks for a 20 minute session, I’ve only had one or two runs where there is a little tightness and a slight amount of tingling….far from being numb. After reading about CS on the internet, I would say I had a very mild case. I say this because 1) I didn’t have pain at any time 2) it would go away immediately after stopping. 3) the numbness, while uncomfortable did not require me to stop running. I attribute this to the fact that the pressure that builds in the leg can only get as high as arterial pressure, since I have a relatively low blood pressure, I don’t think the pressure was that high and it dropped immediately when I stopped running.
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