Tibial compartment syndrome in running sports

Tibial compartment syndrome condition was first recognised in relatively unfit army conscripts who were made to do forced marches wearing heavy boots and carrying heavy loads. It is now seen principally in athletes who have a tendency to pack on the muscle.

This elite athlete has been able to manage his calf pain without surgery or drugs by following the guidelines outlined here

If the lower leg muscles swell, usually from excessive training too early on in the build up they may become compressed. This is because of the unusual anatomy of the lower leg with the big calf muscles, nerves and blood vessels partially wedged between the tibia and fibula bones and the exposed muscle of the shin and calf encased in a strong fibrous sheath. If the muscle grows too quickly or swells from over use, there may be insufficient room to expand. The result is a kind of tourniquet effect.

The pressure inside the muscles steadily increases as exercise progresses and the muscles swell and the blood flow within the muscles eventually becomes insufficient to maintain metabolism and to flush out metabolic wastes, causing ischaemia which feels like a burning cramp in the affected area. This causes progressive tightening, swelling and cramping of the lower leg muscles as the exercise session progresses. A viscious cycle takes hold. Rest may give only temporary relief, even after several days of rest. The pain may be intense and disabling. The affected areas may feel hard and painful to press with the fingers. This condition is easily mistaken for cramp or a calf strain.

Tibial compartment compression may occur in the highly muscular person who uses an excessively "toey" running style, or who does a lot of hill climbing or sprint work that encourages excessive muscle hypertrophy. A high intensity sport like field hockey that involves an enormous amount of sprinting off the mark, sudden stopping and changing direction over an extended time may produce tibial compartment syndrome.

Compartment syndrome is a potentially serious condition because, if the blood flow through the muscles does not resume within a short period of time, the affected muscles and nerves can die. If you do suffer intense cramping pain of the lower leg during exercise and, if there is no relief within minutes of ceasing activity, consult an emergency doctor immediately and do not tolerate any waiting about - treat it as an emergency until there is medical evidence to the contrary.

Prevention is always best

Make all of your training slightly incremental over several months and include speed work at least once a week so that your muscles can gradually adapt, rather than being slammed by the unexpected.

If you are going into a new phase, such as hill work, make the transition over a week or two, rather than in just a single session or two.

Schedule recovery days and weeks in your training schedule rahter than train intensely every day.

Take a few extra days off if you have excessively sore muscles following a work out.

Be diligent with ensuring a nutrient rich diet, including a rich intake of magnesium. It is advisable to take up to 800mg of supplementary magnesium per day for up to three months and then continue with half that amount indefinitely.

Ensure that you have strong and flexible hips and a strong low back so that the hips and upper legs are used as your prime running muscles - if they are weak and tight, you will be forced to make excessive use of your lower leg muscles when running.

Even if your feet are perfect, do exercises for preventing pronating feet. While your feet may look perfect, this may not be the case 10-15km into a run as fatigue sets in.

Get a regular deep tissue massage of the calf muscles to keep them and the sheaths that encase them soft and pliable. If you are in Wellington I can do this for you.

If your calf muscles begin to seize up during intense exercise:

Stop running or whatever it is you are doing.

Lie down and raise your legs just a little with something comfortable such as a soft kit bag - not too high and do not compress the back of the knees

Have somebody gently massage the lower legs for several minutes, pushing the blood towards the heart.

Drink if dehydrated.

Have in your kit bag some Cramp Buster capsules. These contain a mix of magnesium and potassium. Break two capsules open, dissolve in water and drink the lot. This may help relieve the spasm. Take plenty of vitamin C to help offset the free radical damage over the next few days.

Consult a doctor immediately if significant relief does not happen within about 15-20 minutes.

Continue to have regular leg massages.

Gradually resume running using the walk-run strategy and stay close to home.