compartmental syndrome

2010 has been the year from hell for me and looks like 2011 is starting the same way image. got injured back in april with anterior tibialis tendonitis, it hung around for a while and eventually cleared up around july/august. but then around august/september i started with a constant ache on the outside of my right leg, went to see a physio and was told it was compartmental syndrome of the anterior tibialis.

was told to rest and then start up runnign again, ive rested for 10-12 weeks and started upa gain and at first seems ok, keeping distance short and slow but then all of a sudden its back. last week it felt fine and running was ok but still slow but then today i attempted to just jog the parkrun and i was in agony.

initially i was told it was because i overpronate and i had been running in neutral shoes and after seeing a biomechanist i was advised to switch to strucutred shoes and was told to get some off the shelf orthahell orthotic insoles. im sure they have helped a bit but the problem still seesm to be ehre and not sure what my next step should be, my physio and sports masseur both say im fine and im ok to run but im clearly not and my doctor says its just shijn splints and it will clear up and there is nothing they can do.

anybody anywhere out there got any advice on my next port of call ? should i find a new physio, a decent podiatrist, get custom orthotics, get referred for surgery or just plod on ????? im pissed off and trying to at least start 2011 on somthing of a positive note.


  • Doctor, Physio, Sports Masseur, unnamed gait analyser, biomechanist, podiatrist...

    Too many cooks? 

    Could you get a recommendation from a friend, or other runners, to one good physio or one good podiatrist and follow their advice? You must feel like a pinball in a machine at the moment.

  • Sounds like wise advice from Mr Puffy. Certainly don't just plod on - somehow you must determine the exact problem and then fix it.
  • Having been in your position a few years ago i did all the same things; physio, podiatrist, gait analysis the works. I have been through that many different running shoes and none of them made any difference at all. Infact I had the good fortune to see an extremely good physio at one point, she had been physio to Royalty or so I was told, and she told me that the type of running shoe will do nothing for this type of injury and to just find a shoe that was comfortable.

    What has helped me, in my layman's opinion, are the following. Balance and propreception (questionable spelling), walking re-education (rock walk/heel to toe etc) and plyometrics. Always warm up always warm down which i know 99% of people are rubbish at because I am and and everybody I have ever run with has been too; just watch a sprinter they'll warm up for 30-40 minutes just to do a series short (less than a minute) intervals then do the reverse.

    I wish you all the best with it, just hang in there and don't push it too hard.

  • i think this is the major problem with this injury, i dont know who to see or what advice to follow. im sure my physio is very competent but constantly being told all is ok when clearly its not isnt helping. ive seen a biomechanist who told me i overpronate but nothing major and a pair of cpntrol shoes with off the shefl orthotics will sort me, they havent. do i find another physio and go down the route of having the problem treated or do i go for a podiatrist and look into orthotics, people at the runnign club have also emntioned seeing a chiropractor !

    craig - from research ive done myself ive also heard a lot of people talk about warming up well and coll down after and i do put a lot of work into those and always have, but plyometrics is not something ive ever tried so i will look into that, thanks

  • If it is compartment syndrome isn't it a congenital internal physical problem which may be aggravated by the wrong shoes but probably not cured by anything but surgery. Correct me if I'm wrong but it seems to me you don't know whether it is actually compartment syndrome or not. Surely finding that out is the first logical step.
  • Michael has a good point there. The pressure testing is a little uncomfortable, being on the treadmill with those pressure sensors stuck into the muscle compartment is a little strange but being pressure tested will give a diagnosis.

    If your internal muscle pressure is measured over 100 then it is a sure thing that there is too much pressure within the muscle compartment for any running, my pressures were nearly double that mark and I was operated on a year ago.

  • ive been seeing my physio about it for the last 2 months or so and she has said its compartmental syndrome, i havent had any pressure testing that craig mentions and she made her diagnosis from me going to see her. ive also been to see my GP and said i had been told it was compartmental syndrome but she disagreed and said it was probably just shin splints and there was no point sending me for any further tests as i just needed to rest.

    craig - did your GP send you for the pressure testing or did you do it privately ?

  • Mr sj in answer to your question I went private; I get a few health care perks through my line of work so my situation may be a little different to that of many other people.  However I was not put forward for pressure testing until I had developed a little bit of history.

  • thanks craig. ive asked around and found a physio that a few people have suggested and got an appointment on friday to see him. yet more money to spend but hopefully he may be able to pinpoint the problem and determine the next step
  • Dont take know sh#t from the doc and get a refferal to orthopaedic surgeon for diagnosis.I ran with chronic anterior compartment syndrome for 2 years and my auntie was a sports physio and nothing made it any better.tried all conservative treatments and they dont i had testing done and my pressure at resting was 50 and it should be 30 or below .so dont waste your money or time trying them the only fix is the surgery and youll be back running within 6 weeks pain free.Then you just got to hope it dont come back.
  • Agree with the comment above by scriv. Similar story my end - conservative methods of treatment didn't work for over two years, every 'specialist' I saw just wrote it off as generic shin splints. Finally went to see a podiatrist up in London in January, paid for the pressure tests to be done and surprise surprise the readings came back high, but no-where near as high as 100 which Craig posted, more like averaging 50. I had all four compartments released in both legs just over a week ago.
  • well ive finally been referred to see an orthopaedic consultant after a year of back and forwards with my GP, got an mri scan appoinement coming up but the consultant is fairly certain its chronich compartmental syndrome. he's now trying to find a hospital nearby that does the pressure testing as my local one doesnt and he's not aware of any that do.  will update when i eventually get a definitive answer and i guess the enxt step is to try and convince them to do the operation as from what ive read its one hell of a struggle to get it done on the NHS and i certainly cant afford to go privately.

     as a matter of interest, anyone who has suffered from it, have you been able to do any form of cross training whilst you stayed clear from running ? did you try cycling, swimming ?

  • i just kept running because it wont get any worse than it is.try run on grass i found that better for it.but id imagine you would be fine with any of them.
  • Mr. SJ, where in the country are you? I was told that the NHS don't offer pressure testing full stop, but I'm sceptical of how accurate that is. The space between diagnosis and surgery was very small for me so I didn't do any running between then. I can understand why scriv might have run despite diagnosis- it all depends on how long you have to wait for surgery I guess, especially if you're having to wait 8+ months on the NHS?
  • im in the north east, consultant i saw said he didnt know anywhere that did the pressure testing as it was a specialised thing but he was sure it was available somewhere and was going to look into it.

    if you dont mind me asking tom, how much did it cost you to pay for the pressure testing ? and did you have the operation done privatley or was that through the nhs ?

  • Hi

    I have just started following this thread as I think I may have compartment syndrome.

    I would be interested to hear from anyone who has had the test and the surgery in the South East as I am going through the process of trying to find where to do this on the NHS.

    I would also be interested to hear from Tom who mentions having had the surgery done in February 2011 - how has the recovery been? was the surgery a success?


  • hi Nicki, sorry to hear you've been having pain. I'm 5 weeks and one day post-surgery and I guess I should be really happy with how my recovery has been coming along so far. I walked out of the hospital, albeit somewhat awkwardly, and just slowly increased the amount I was doing each day. I was on a prescription of tramadol which helped in the first week and I continued to take it for the next couple, although I reckon that was more out of habit than actual requirement. I had a follow-up with my surgeon three weeks post-op, but it wasn't particularly helpful for me in terms of what I should be doing and how much. He pretty much said he's happy with how the legs are and gave me the green light to start running again - 3 weeks post op!

    I definitely didn't feel ready to start running, so I started to do a bit of biking and cross-training at the gym instead and increasing the amount I was walking each day. I actually did my first post-op 'run' yesterday, and did a 3mins walk / 2mins run rotation for 20mins. My legs actually felt alright and I reckon I looked a lot less like Bambi than I had predicted. I wouldn't say my legs feel completely liberated of pre-op symptoms yet, pretty much because there is still some swelling which is recreating some of the tightness from before. Having spoken to a number of people who have recovered from CECS, they have simply told me to be patient and be happy with where I am at 5 weeks. 8-12 weeks is usually the time given to completely recover.

    Before this year, I've suffered with symptoms to varying degrees for the last two and a half years, in which time countless osteopaths and physios have said it's just shin splints and continue with conservative methods of treatment. I knew it had to be more serious when the symptoms were getting worse rather than better! So, a friend referred me to Dr. Nat Padhiar of London SportsCare at the London Independent in Stepney Green. At a private consultation he suspected CECS and I booked myself in for the pressure testing, which was also done by him, because I was told that it's very rare to be able to get the test done on the NHS.

    The surgery itself was also done privately by Mr. David Goodier, also of London SportsCare. I know he does operate on the NHS, but there may be a considerable waiting list. He warned me that his success rate is 85%, the 15% being when the scar tissue reforms in a dodgy way and negates the surgery - hence why self-massage is a big priority post-op!

    Best of luck, if you have any other questions fire away, but I think the best thing to do is sit down with a cup of tea and give this thread a read through:

    My posts start at the bottom of page 20 under the name 'marshellow'.

  • Thought I'd bring this thread back from the dead. Update on my injury is that after 18 months of being fobbed off by everyone I saw and being told it was shin splints, I kept pushing and pushing and eventually got referred to a specialist. We t to see him back in august and he immediately diagnosed compartmental syndrome.

    Was booked in for surgery 2 weeks ago but then it was put back and am now impatiently awaiting my op on nov 25th. Will update once I have the op and let you all know how I'm getting on
  • Should also add I got it all on the NHS
  • I started a thread on this subject a little while ago,thanx for the info on the pressure test,thats why I havent had one,mines on the NHS.

    I have my op on Nov1st,just got back from my pre-op,so its 1 week till D-day

  • Well had my op yesterday and now in a fair bit of pain ! Surgeon said it went well and they released the pressure in both compartments in the left leg, next appointment in 2 weeks to see how it's healing but fingers crossed !

    Andy - how are you getting on now ? Be interested to see how you're getting on 3 weeks ahead of me
  • Yep,,,,doing fine thanks,got a bit of infection going on at the top of the scar,aloe vera plant doing its stuff though.Im dying to get my salomons on for a short jog but have to be a bit sensible,got no pain at all,been pushing the walking at work a bit just to get the calf working..If all goes to plan im hoping to be running short distance by christmas,bit frustrating but have to be patient.Just hope its cured the problem.
  • How long after op was it that you could walk around pain free and normally ? I'm shuffling round like an old man at the moment !
  • Bound to be sore at the moment, Mr SJ!  What aftercare are you getting, or is planned for you?  Need to make sure you get on with massage and stretching as soon as possible (obv without getting the wound infected) to make sure you don't develop adhesions and scar tissue which could start the whole problem up again.
  • at the moment not getting anytthing, been given a follow up appointment with surgeon in 2 weeks and been told to take it easy until then and make sure i dont get the wound wet.

    hopefully once i speak to him then i'll get some more info regarding what i can and cant do

  • its taken a good 2 weeks to get rid of the pain and to walk comfortably..1 month on im feeling a lot more confident that things might be ok..gonna start longer walks on the flat just to get the calf moving a bit,just gotta keep saying to myself to slow down and not to overdo it
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