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84 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 1 While the lower leg is certainly the most common location for ECS, it can occur in other regions of the body as well. ECS of the forearm can occur after prolonged activities requiring significant grip strength. The condition is reported in competitive motorcycling where it is known as "arm pump," but is also reported in gymnastics, hockey, wheelchair athletics, climbing, waterskiing, and kayaking. 4 IDENTIFYING POTENTIAL COMPARTMENT SYNDROME One of the most important factors in identifying compartment syndrome is an accurate health history. Identify any recent trauma or instance where the affected area was exposed to a direct blow, trauma, or unusual sustained pressure that might indicate an acute compartment syndrome. If the symptoms came on as activity progressed, and then subsided a short time after activities ceased (without any acute trauma), a chronic exertional compartment syndrome would be more likely. The most accurate way to identify increased compartmental pressure is with an intracompartmental compression monitor. This monitor has a needle probe that is inserted into the compartment and can measure the internal pressure. However, this monitor is not always available or practical and is, of course, out of the massage therapist's scope of practice. Compartment syndromes are most often evaluated by clinical presentation and exclusion of other possible causes. The primary symptoms of a lower leg compartment syndrome include: • Aching, burning, or cramping in the lower leg • Weakness or motor dysfunction (which usually shows up as foot drop) • May be present in both limbs if it is an ECS, or just one if there is a traumatic incident indicating an acute compartment syndrome • Swelling or bulging of the area may be visible or palpable • Discoloration and/or coldness of the lower leg or foot from vascular compromise • Possible sensation of tightness or fullness in the extremity due to lack of venous return • Paresthesia, numbness, or other neurological sensations, especially in the distribution of the deep fibular nerve TREATMENT STRATEGIES Treating acute compartment syndrome involves an emergency procedure called a fasciotomy to decrease compartmental pressure. In this procedure, the surgeon makes an incision lengthwise along the compartment that allows the bulging muscles to expand outside the compartment wall until the pressure subsides. In some cases, this may take several hours, so the incision may be left open while the pressure decreases. Delaying this Conditions with Similar Symptoms Other lower leg complaints have similar symptoms to compartment syndrome, especially chronic exertional compartment syndrome, which may cause confusion. Conditions that have similar symptoms include: • Deep-vein thrombosis • Medial tibial stress syndrome • Peripheral nerve entrapment • Shin splints • Stress fracture • Tendinosis, tenosynovitis • Tumor • Vascular claudication (blocked vascular structures that reduce blood flow) Several compartment syndrome symptoms, such as neurological signs like paresthesia, foot drop, or numbness, don't occur with chronic overuse muscular problems. These symptoms help discriminate a compartment syndrome from muscle-tendon overuse problems, such as shin splints. The vascular symptoms of coldness or color changes in the extremity are also not present with shin splints. Chronic compartment syndrome, also called exertional compartment syndrome (ECS), is far more common than the acute form. ECS usually occurs as a result of repetitive activity like running or dancing. During the activity, the muscles swell and increase pressure on the compartment's contents. However, with ECS, the aggravating symptoms generally subside within about 15–60 minutes. Because the swelling subsides within a short period, it is not as serious as the acute form in which swelling can put tissue health at risk. With ECS, it is common to see pain or other symptoms begin consistently after a certain amount of time, distance, or intensity of exercise. These symptoms generally increase as exercise progresses. Once the exercise or activity is stopped, symptoms tend to dissipate, usually within about an hour.