Is it really tibial compartment syndrome?

A hockey player who had tibial
compartment syndrome

It looks like "tibial compartment syndrome" is making a popularity comeback!  Some things come and go and this one, characterised by severe and sometimes disabling pain in the calf muscles, is no exception.

Here is an article I wrote several years ago explaining tibial compartment syndrome:
http://voices.yahoo.com/what-tibial-compartment-syndrome-runners-164380.html?cat=14

Of course there are genuine cases of tibial compartment syndrome; but, in my opinion, most cases have been incorrectly diagnosed as such.  Most are really cases of severe muscle soreness.  All recent cases that I have seen are female athletes.

Its very important that the diagnosis is correct otherwise the treatment may be completely inappropriate, useless, disfiguring and even disabling.  Treatment of tibial compartment syndrome may begin with acupuncture which may give temporary relief.  It may progress to prolotherapy or steroid injections which are next to useless (in my opinion).  When that fails, then there is still surgery to split open the muscle fascia to allow the muscles to bulge out.  These therapies are disappointing in most cases, other than the use of surgery in an acute emergency.  For chronic cases, the compulsory rest associated with surgery is probably the main driver for recovery.

Some of the "Moller" legs.  Calf muscles require
regular deep tissue massage to help them
withstand the rigours of active lifestyles.

For non-tibial compartment syndrome cases of severe, chronic calf pain the treatment is non-invasive, very safe and remarkably effective.

First: "Why is this ailment apparently more common in women than men?"

It comes down to weak collagen which means the connective tissues in the calf muscle is more easily damaged during activities like running.  Women commonly have weaker collagen due to oestrogen dominance.  Read more about this here: http://blog.garymoller.com/2012/07/why-do-some-women-bruise-more-than.html

How to relieve non-tibial compartment syndrome calf pain

• Deep tissue massage of the affected muscles once a week (if done right the relief by about the 3rd session can be no less than dramatic).
• Nutrition strategies to improve collagen strength.  Exactly what is done depends on the results of nutrition testing.
• Where appropriate, changes may be made to a woman's contraception choice to reduce the adverse effects of hormone imbalances.
• Exercises to strengthen the muscles that maintain foot posture. (refer video - wow! 290,000 views and climbing).
• Graduated return to running, keeping distances down, avoiding excess downhill and uphill running.
• Running only every 2nd or 3rd day until 100% free of any discomfort.

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About this website

The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

Are Epsom Salts safe to take for night cramps?

"I have researched your material on Epsom salts and can’t find anywhere any information

on taking them orally. I have for a long time suffered with chronic night cramps and recently

was advised to take half a teaspoon in fruit juice each morning. I started taking them a week ago, have worked

some long hours (mostly on my feet) and am pleased to say have not had cramp once.

Can you advise please are Epsom salts harmful in any way when taken orally or harmful with prolonged use

In this manner?

I look forward to your comments.

Regards Heather "
____________________________
Gary responds:
Heather, taking account of your age (54) and the additional information about your diet and your initial response to the MgSO4 salts, I can make some assumptions:

• There is a possibility that you are low in a number of minerals, including iron and magnesium.
• You may be low in Co-Enzyme Q-10

About magnesium sulphate
Magnesium, as it is found in the body is in the form of Magnesium Phosphate (MgPO4), not as Magnesium Sulphate (MgSO4). MgSO4 is typically used externally to provide a relaxing bath and as a poultice. It is taken orally as a laxative. As a magnesium mineral replacement, I do not recommend it. I would not take it orally for the long term. It is much better to take magnesium in the form that is found in the healthy body (MgPO4).

Recommendations:

• Do a course of Active Elements 4.1 and 4.2
• Do a course of AgeWise Co-Enzyme Q10

Q-10

• Take one capsule 3 per day
• 2nd bottle - take 2 per day
• 3rd bottle and ongoing - take 1 per day

Active Elements

• Take one of each 4-6 per day
• 2nd bottle and ongoing - take 2 per day

With all of the above, spread over the day and ideally take with food.

Take careful note of frequency and severity of cramps, energy levels, skin health and health in general. Always review progress at about 6-12 weeks.

Let me know how it goes and advise of any problems.

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Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

I suffer muscle cramps in my calves when running trail races

Hi Gary,
I am a 51 year old female distance runner mainly doing 20 --80k trail races. For the past 3 years every time I race I get muscle cramps in my calves and drop placings as I have to reduce my pace to a walk and or jog.

Read more here....

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Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Advice about crippling calf cramp following exhausting exercise

"I enjoy hillwalking and a few months ago did the most arduous walk yet. Next day my thighs were tight for a day and next day fine. However on this second day a knot started in my right calf and progressed to almost crippling status and remained for 3-4 weeks before suddenly disappearing. Whilst there I took anti inflam , asprin and ibufrofen gels without much relief. I went on almost as hard a walk 3 weeks ago and although filled with trepidation, nothing untoward occurred. I was on holiday this week and played a round of golf and carried my bag. Now 2 days later the cramp has re-ocurred.
Help? Whats going on?"
_________________________________________
Gary Moller advises
A muscle is a sponge pump. When it contracts, the old blood is squirted out via a one way valve system back to the heart. When it relaxes, fresh arterial blood fills the muscle. This is the "muscle pump effect" and it is as important for blood flow during exercise as the pumping of the heart muscle.

Let's talk about the calf muscles. Strain, bruising, mineral imbalance, dehydration, sheer exhaustion or overly unusual and intensive work may cause the muscle to go into a state of cramp. The muscle knotts up and is unable to relax. When this happens the muscle pump effect is lost altogether and the muscle causing further accumulation of metabolic wastes and further cramping. A vicious cycle begins and may remain for years. Muscles commonly affected are those in the back side, the calf and the shoulders.

Action to take

• Gently stretch the affected areas using the stretch and hold for about 10 seconds method. Do not over stretch. One good stretch per day is usually more than enough.
• Firmly massage the affected areas every 3-4 days. This is best done by a massage professional. The relief can be immediate and lasting when done properly. 3-6 sessions usually brings about a permanent resolution. The occasional top-up is recommended.
• Redress any tissue mineral imbalances. Start by completing the Active Elements Online Assessment and then contact me to review the results.
• If you have heavy exercise coming up that you are not used to, consider taking an anti-cramp supplement a day or so before and during the exercise and for a day after. Other supplements include Red Seal Crampbuster, and Nutra-Life Magnesium Complete. The Floradix Calcium and Magnesium Tonics are wonderful!
  
• Have a warm Epsom Salts bath

Finally, maintain a high level of overall fitness all year so that you are always ready and able to take on all but the most arduous of adventures!

Advice sought about post-exercise muscle cramp

"I enjoy hillwalking and a few months ago did the most arduous walk yet. Next day my thighs were tight for a day and next day fine.

However on this second day a knot started in my right calf and progressed to almost crippling status and remained for 3-4 weeks before suddenly disapearing. Whilst there I took anti inflam , asprin and ibufrofen gels without much relief.

I went on almost as hard a walk 3 weeks ago and although filled with trepidation, nothing untoward occurred. I was on holiday this week and played a round of golf and carried my bag. Now 2 days later the cramp has re-ocurred.
Help? Whats going on?"Gary Moller comments:
This 41 year old male appears to be in reasonable shape; but definitely overdid things by doing a hike that appears to have been partially unplanned, turning into a 16 mile hike over and around a couple of mountain peaks. It is understandable that he suffered a quite severe calf strain/cramp that has not resolved.

It may never completely resolve unless dealt with properly.

Here are some observations and advice:

Should one take anti-inflammatories?
In most instances, the answer is "No!"This is because anti-inflammatories may interfere with the processes that lay down healthy collagen scar tissue. If this process is interfered with, the resultant healing may be weak and prone to further injury. Inflammation is healthy: it is the body's mechanism for bringing blood, nutrients and other resources to the injury site. It makes no sense to suppress this mechanism with drugs. These drugs can also interfere with digestion and therefore your nutritional status. While it may have the injured limb back in action sooner (this is questionable anyway) this may be a fool's gain.

The only "anti-inflammatories" that might help are natural ones. Kordel's MSM is one as are Omega oils like fish oil, flaxseed oil and olive oil. Evening Primrose oil is very beneficial. These enhance the healing process rather than interfere with them.

Re-mineralise the body
I doubt there is a 40+ year old male or female who leads an active and stressful life that is not deficient in minerals, principally magnesium. Exhausting exercise chews through magnesium and may result in disabling muscle cramps and failure to recover. In conjunction with the minerals is the need for rich supplies of the B group of vitamins.

So, my advice is to top up with a magnesium supplement and a B group supplement. You can also add a lengthy soak in an Epsom Salts bath which relaxes the muscles while supplying sulphur and magnesium through the skin.

Minerals can be obtained from a bone broth that is consumed daily and this is additional to a course of magnesium supplementation.

Take the guessswork out of supplementation and improve your health by ordering a hair tissue mineral analysis. Although $225 it is well worth the cost.

Massage the injured limb
It is highly likely, if not inevitable that there are still painful knots within the calf muscle that was injured. The uninjured limb may be similarly affected but to a lesser degree. As long as these knots remain there will be ongoing pain and limitations on ability to exert oneself. The risk of further injury is great and rest alone is never the solution. Deep tissue massage is the solution but only commence this 2-3 weeks after the dietary measures have had time to kick in.

Deep tissue massage causes damage to the unhealthy tissue that forms the knot within the muscle. The damage is in carefully controlled doses, stimulating the body's natural healing processes to lay down new healthy tissue to replace that unhealthy tissue. It is painful but highly effective - but only if your nutritional status is healthy.

Deep tissue massage the calf muscle to break down and soften any hard knots and injury-prone spots within the body of the calf. This requires about 30 days to have a lasting effect done every 3-4 days. Get this done by an experienced therapist. If in Wellington I can do this for you.

Do a steady buildup in fitness next time
Recovery includes a steady increase in fitness over about three months and then maintaining a high level of fitness indefinitely through consistent weekly exercise and good nutrition.

Think specificity: If your most challenging past time is hiking mountains, even if only a couple of times per year, then the bulk of your weekly fitness training should be geared towards preparing for these hikes. That means getting outside and doing a lot of walking over tracks and trails. Training in a gym on a treadmill, elliptical and lifting weights are beneficial; but should not be the principal fitness training for hiking. Hiking each week is best.