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procedure can cause irreversible tissue damage. There can also be complications of the surgical fasciotomy procedure because nerves, veins, and arteries can be accidentally cut during the procedure. While it is unlikely that the massage therapist will be faced with an acute compartment syndrome, it is important to recognize the signs and symptoms. An acute compartment syndrome is one instance in which RICE (Rest, Ice, Compression, and Elevation), the common method for treating an acute injury, is actually a bad idea. Rest is certainly beneficial, but ice can cause decreased tissue fluid movement and that does not help reduce compartmental pressure. It is also obvious that additional compression is a bad idea for a condition where excess compression is the problem. Leg elevation could also impair the return of needed circulation. Clearly, recognition of a potential compartment syndrome should initiate a referral to a physician—and alter your treatment. Chronic compartment syndromes are most often treated with conservative and noninvasive measures. The most important strategy for addressing this condition is reducing any offending activity. Symptoms may dissipate if the client completely ceases the exercise that caused the problem to begin with. However, that solution is often not acceptable for highly active individuals. Sometimes biomechanical solutions, like foot orthotics, can alter gait in a manner that helps reduce symptoms. Changing running stride has also shown beneficial results with anterior compartment syndrome treatment. Since the primary problem in this condition is excessive eccentric load on the dorsiflexor group, teaching the individual to impact the ground with the forefoot instead of heel strike can decrease symptom occurrence in some cases. SHOULD WE TREAT COMPARTMENT SYNDROME WITH MASSAGE? A key question about treating compartment syndrome is what role massage may play. Almost any massage technique increases pressure on the tissues being addressed. As a result, it would seem that massage would not be a good idea for any compartment syndrome condition. This is certainly true with an acute compartment syndrome, where swelling is immediate and any increased pressure on the compartment can aggravate and damage the compartment contents. Massage treatment for ECS is beneficial as long as it is not performed immediately after any activity that has flared up the symptoms. For example, if a person has just finished running, is complaining of aching pain in their lower legs, and has other compartment syndrome symptoms, this is not the time to do soft-tissue treatments. On the other hand, if the person is consulting you three days after the last run and the pain has subsided, massage would be appropriate at this point. A wide variety of massage techniques may help address the symptoms of ECS. I have found any of the approaches used with other common overuse disorders of the lower leg, such as shin splints, help treat ECS. It can be advantageous to start with broad contact surface applications, such as those with the palm or backside of the fist. Slowly and gradually increase pressure as you glide along the compartment muscles to determine what pressure levels might increase existing symptoms. This is not the time to press harder and deeper, even if the client says that feels good! As treatment progresses, more specific and focused treatment (such as that applied with the fingertip, knuckle, thumb, or pressure tool) gliding parallel to the fibers within the compartment may effectively reduce muscle tension. I have also found active movement along with massage to help chronic muscular irritation that occurs with ECS. If at any point there is an increase in vascular or neurological symptoms, back off the pressure and go to a wider contact surface so that you don't increase any inflammatory reaction. Compartment syndromes are not highly common, which is why soft-tissue therapists may not be aware of them. However, inappropriate attention to a compartment syndrome can cause serious medical complications. This is another example of how a broad and comprehensive knowledge base about various potential conditions helps you provide the safest and most effective treatment for your clients. Notes 1. Alessio Giai Via et al., "Acute Compartment Syndrome," Muscle, Ligaments and Tendons Journal 5, no. 1 (March 2015): 18–22, https:// doi.org/10.11138/mltj/2015.5.1.018. 2. Moo Ing How et al., "Delayed Presentation of Compartment Syndrome of the Thigh Secondary to Quadriceps Trauma and Vascular Injury in a Soccer Athlete," International Journal of Surgery Case Reports 11 (January 2015): 56 –8, https://doi.org/10.1016/j.ijscr.2015.04.003. 3. Andreas Christos Panagiotopoulos et al., "Gluteal Compartment Syndrome Following Drug-Induced Immobilization: A Case Report," BMC Research Notes 8, no. 35 (February 2015): 35, https://doi.org/10.1186/s13104-015-1003-5. 4. John W. K. Harrison, "Chronic Exertional Compartment Syndrome of the Forearm in Elite Rowers: A Technique for Mini-Open Fasciotomy and a Report of Six Cases," Hand (New York) 8, no. 4 (December 2013): 450–53, https://doi.org/10.1007/s11552-013-9543-4. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at academyofclinicalmassage.com. CLINICAL EXPLOR ATIONS L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 85