Athletic Injuries Update: Shin Splints vs. Compartment Syndrome

Compartment syndrome is a lower leg injury that can be acute and very serious, or something chronic, and more manageable. Often times, athletes with lower leg pain, automatically shake off their pain and consider it to be “shin splints.” Although acute compartment syndrome is not a very common problem in athletes, chronic exertion compartment syndrome is more common than you think. Not sure how to tell the difference between shin splints and compartment syndrome? Keep reading this article for keys to signs, symptoms, and treatment options for shin splints, acute and chronic compartment syndromes.

To start off with a small anatomy lesson, there are 4 compartments in the lower leg. These 4 compartments contain muscles, bones, nerves, arteries, and veins. Each compartment is separated by fibrous connective tissue called fascia. The purpose of this fascia is to house all the muscles, nerves, and blood vessels together, and keep them wrapped to work optimally together. When skeletal muscle contracts to allow the knee and foot to go through the ranges of motion they are designed to go through, this fascia that surrounds the muscles performing the range of motion, is naturally designed to have some elasticity to it, and expand as the muscles contract. When an individual’s muscles are compromised because the fascia is not able to expand, compartment syndrome symptoms begin to take over.

ACUTE COMPARTMENT SYNDROME:

This is a SERIOUS problem for an athlete, as there is a lack of blood supply due to excessively high pressure within one of the 4 compartments in the leg. When the fascia of the lower leg has become inelastic, confinding the space where the muscles, nerves, and blood vessels live, fluid begins to retain within the compartment, pressure in the compartment increases, and blood supply is shut off. In a nut shell: Fluid and or blood accumulate within this compartment. THIS IS A SERIOUS MEDICAL EMERGENCY & THE ATHLETE SHOULD BE REFERRED TO THE E.R. IMMEDIATELY!

Causes:

Acute compartment syndrome usually doesn’t “just happen”. There is usually a bout of trauma to the lower leg at some point: a crush injury, bad muscle bruising from trauma, hemorrhaging or vascular occlusion. Occasionally, prolonged exercise, or post-surgical/casting/bandaging can result in acute compression syndrome.

History, Signs & Symptoms:

1. Persistent pain that gets progressively worse. The symptoms do not go away with resting after exercise. Pain is often disproportionate from the injury that happened. IT DOESN’T JUST GO AWAY!
2. Visible swelling with tense muscles
3. Spotty bruising or discoloured skin (red and hot)
4. Tenderness at and below the compartment that is involved
5. Pain with stretching the involved muscles
6. Muscle weakness…if you contract the muscle, it may also be painful.
7. Pulses are usually normal, however in very serious cases; a decrease in pulses (at the foot and ankle) could be present.
8. “Stocking” numbness, tingling, anesthesia (entire foot feels numb, tingly, and dead)

Management:

1. Call 911 immediately or get to the E.R.
2. Do NOT elevate the leg as this will further decrease the pressure in the arteries.
3. Remove any constrictive clothing or bandages.
4. Ice is probably okay, unless it causes more pain
5. Potentially, surgical decompression will be performed if critical enough.

CHRONIC “EXERTIONAL” COMPARTMENT SYNDROME:

This form of compartment syndrome is induced by repetitive physical activity, particularly running. It can be difficult to diagnose from shin splints, however symptoms during a flare up of this injury, will suspect you to something a little more severe than shin splints. The most common regions affected are the deep posterior compartment (which houses the foot and toe flexors, ankle dorsiflexors, arteries and nerves).

History, Signs & Symptoms:

1. Gradual onset of “crampy” pain sensations.
2. Symptoms begin after a consistent time or running or distance
3. Relieved rapidly by resting
4. Potential short term neurological or vascular symptoms: foot and leg numbness, tingling, deadness)

Management:

This type of compartment syndrome does not respond particularly well to conservative treatment, however it can be managed through an important season. Limiting the amount of running, ice baths after practices and games, and myofascial release and lymphatic drainage can all help. Improving training techniques can help, as well as correcting biomechanical and anatomical factors contributing to the sport. Surgery can be done to release or remove the surrounding fascia of the compartment involved.

SHIN SPLINTS:

The term “shin splints” is a generic, catch all term for leg pain that is brought on by running and jumping activities. Often shin splints are misdiagnosed for stress fractures and compartment syndrome as they all present with similar symptoms. Shin splints often involve muscle strain, tendinitis, or periostitis (inflammation of the outer most layer of bone). Pain often presents along the inner or outer portion of the tibia, the large bone in the lower leg.

Causes:

1. Overuse (runners, dancers, gymnasts, volleyball, basketball, or other impact sports)
2. Improper foot wear, poor conditioning
3. Muscle imbalances at the thigh, leg, and foot.

Symptoms:

1. Pain on the shin bone (either side) with small lumps or nodules sometimes present along the muscle attachments. Pain most often occurs at the beginning of activity, and again afterwards.

Management:

1. RICE: Rest, Ice, Compression, Elevation
2. Reduce physical activity
3. Strengthen weak muscles determined by a practitioner
4. Lengthen tight muscles
5. Tape
6. Changing shoes.

Dr. Sarah Ytsma is currently practicing chiropractic in both Chatham and Blenheim. She takes a special interest in athletic injuries, as athletics were a large part of her high school and post-secondary school careers. She played 4 years of varsity softball as a fastball pitcher for the Wayne State University Warriors before attending chiropractic school in St. Louis, MO. While completing her chiropractic internship, Dr. Sarah was granted a position with Logan College of Chiropractics “Biofreeze Sports & Rehabilitation Clinic” as a senior intern to work with athletes from Mizzou and local high schools and colleges. You can find more info on Dr. Sarah at www.drsarahytsma.ca.