I’m not a marathon runner. In fact I don’t really even think I’m that much of an athlete. However I have suffered from chronic exertional compartment syndrome and have since had surgery to correct it. I thought I’d write about my experience here in the hopes that someone might find it useful.
A Little Bit of History
I was very active, mostly with a lot of squash, premier netball, as well as the odd game of touch rugby. I had had a tightening of what I thought were the muscles on the outside of my legs for some time and had asked various people if they knew how to stretch them. I’m fairly au fait with anatomy after studying it at school but even I couldn’t figure it out. They’d been uncomfortable mostly while I was playing netball, but I put it down to not being as fit as I could be and put up with the pain.
It wasn’t until one day I was playing squash when the pain got so bad I had to come off the court. Luckily the manager of the team I was training with happened to be a physiotherapist and mentioned that the symptoms I was describing sounded like compartment syndrome. I was training for squash nationals and playing finals netball so I didn’t want to stop. I’m also fairly stubborn when it comes to pain stopping me doing things (says the girl who walked home one day with two badly sprained ankles!) so I didn’t treat this any differently.
With squash nationals done and dusted, I moved away from the city where I first heard about compartment syndrome a few months later but began to research it online. It wasn’t until one day I left the squash court and ended up on the floor in tears from the pain that I knew I had to do something about it.
What causes the pain?
When we exercise, the body pumps blood to the muscles that are being worked, causing the muscles to swell or expand. The muscles are contained within a sheath. You know when you buy meat from the supermarket and it sometimes has that clear, stretchy stuff on it? That clear covering is the sheath. When people with compartment syndrome exercise, there’s not enough room within the sheath for the expanding muscle, therefore pressure builds and pain arises. A friend of mine once used a great analogy – it’s like trying to blow a balloon (muscle) up inside a drink bottle (sheath). It just doesn’t work.
An image depicting a cross-section of the lower leg. Image courtesy of MayoClinic.
Doing Something About it
I went to my GP who referred me to a specialist sports practitioner, who then referred me to a surgeon who specialised in compartment syndrome. Said surgeon sent me for tests (which, by the way, aren’t covered by ACC as the ‘injury’ is deemed to be progressive – kind of like RSI which, incidentally, IS covered).
Honestly, if there were a best part about having CECS, it would have to be seeing a medical practitioner about this condition and watching their eyes light up when you tell them what you have. It’s not a common condition and I think they get a little bit excited when they get to deal with something different from the norm. I digress!
By the time I got the appointment for pressure tests, I had developed drop-foot (or foot-drop as it’s otherwise known) which is when your foot makes a distinctive “slapping” sound as you walk because you can’t lift the front of your foot properly. I couldn’t walk more than 100 metres without the pain getting so bad I’d have to stop. Ten minutes after ceasing exercise, I was fine – which was probably the single most frustrating thing about the entire condition.
The Pressure Tests
I will not lie. The tests are not pleasent. Basically I had three injections of anaesthetic (in marked spots) into each leg to numb the areas for when the BIG needle gets inserted. I was then told to do an activity that causes the pain and come back to the room once it comes on. The specialist was surprised that I was back within five minutes, even though I’d continued as long as I possibly could because I wanted to be sure I got the results I knew would come.
Image courtesy of MayoClinic.
The second round of injections measure the pressure inside the compartments of your leg. Anything over 30mmHg is “surgery territory”. As a guage, my worst compartment was ~90mmHg. No wonder I was in so much pain!
As a result of the pressure tests, it was recommended that I be prioritised for surgery and I was placed on a waiting list. Through a mix of medical misadventure and me moving city again (and therefore District Healthboard jurisdiction) it took me a further 8 months before I finally got my surgery. Bearing in mind that this was around two years after I had initially consulted my GP, I was virtually unable to walk and had put on a lot of weight – a horrible side affect for someone who used to be so active.
Finally! The Surgery
The technical name for the surgery I had was bilateral tricompartmental fasciotomies, which loosely translates to having three compartments in each leg released. When I say released… they make an incision, then cut open the sheath that holds the muscle in place. It basically allows the muscle to expand as large as it needs to when you’re exercising.
It was an overnight stay in Middlemore Hospital for me (and I’m thankful it was only one night!). When it was time to go home, I actually managed to stand up with my legs supporting my full weight while I got dressed. The only piece of advice I can give you is DON’T DO THIS. You may think you won’t move, but you will and it hurts! I was in a wheelchair to start of with, but given crutches before I left the hospital.
Healing Time
I have two scars on each leg – one on the outside above my ankle bone about four inches long and one on the inside of my leg toward the front about midway up my lower leg – about three inches long.
My compartment syndrome surgery scars.
The advice I had read and was given was that it should be around 12 weeks until I could get 100% back into sport. This wasn’t the case for me, however. I went back to work two weeks after surgery (I recommend taking longer – perhaps another week) and even though I held a sedentary position, my ankles and feet would swell up enormously after keeping them “down” for the day, even though I had tried to elevate them as much as I could.
Swollen feet and ankles!
My employer at the time was less than supportive, even though I’d requested that I work from home. If you can, I would definitely aim for three weeks to recover. I was walking without crutches after one week but would still get pain and swelling in the week following. My recovery wasn’t aided by a minor infection in one of the wounds either, so I now have a more prominent scar than I would have otherwise.
Getting back into the Swing of Sport
So, after my two years of not being able to do anything, I was finally free to get back into sport! Unfortunately for me, I don’t think my body was as keen as my mind was and I was bogged down with miscellaneous injuries over the coming year (including prolapsed discs in my back and strained calf muscles). It’s now been around 15 months since I had the surgery and I’m finally uninjured enough to get back on the exercise wagon – enough to hopefully start losing some of the 20kg I packed on over the time I was involunteerily inactive.
Even when running now, I get numbness in my toes and feet. Areas of my leg, ankle and foot are still numb due to the nerves being severed during surgery but I’m hoping to get most of that feeling back. I still get some fatigue and soreness in the same areas as before but nowhere near the amount of agony I was in pre-surgery. My legs are also a funny “shape” because the muscles bulge out in places they didn’t bulge before, but it’s purely asthetic and I knew to expect that. They are though, still a lot more svelt and “spongey” to the touch than they were pre-surgery. My poor legs.. what an ordeal!
Further Information
If you have any questions, you can contact me or leave a comment on this post.
Here are some websites I found useful:
MayoClinic – Chronic exertional compartment syndrome (Highly Recommended)
12 Comments
Your blog is fantastic. I have just had this surgery this week and was googling to try and find out more about my legs in terms of the recovery process. I have had some really wierd sensations and dreadful pins and needles, but your article has put a smile on my face again, I too did lots of running with my refereeing career and it just got so painful. I will take your advice about work too, I was planning on going back after 1 week, but the surgeon told me 3 weeks, so perhaps I had better listen! thanks again for sharing your information!
Regards
Helen
Well done erana on such a impressive overview, and thanks heaps for this posting and your advice!
I have had the issue with minor walking (or even standing) for about about 15 months and started support process via GP etc 4 months ago. So I am at about the mid stage of medical diagnosis. Pressure tests over 70mmHg have meant referal to the surgeon for more testing and I expect the same operation. I have had some physio massage in the mean time and their recomendation was that I could restart my biking which has helped to reverse my increasing weight!
I am not so keen on the “nerves being severed during surgery” part and its affects.
Do you think having the operation privately via a surgeon that has done this operation before, will make any difference, or had the surgeon at Middlemore done this op before and this is a standard side effect? Maybe I should find out what this costs if I go privately?
Hey there! Thanks for your comment.
The surgeon I had was a specialist in his field who also has a private practice in Auckland, so is very experienced in performing this kind of surgery. I think it’s a risk that you undertake with this kind of procedure, though I’m not sure how much the severity varies. Mine is definitely “liveable” for the most part. It feels odd sometimes but nothing too terrible. The numbness I get when running could be partly the shoes I have (I’m still trying to find the “right” shoes!) – it’s definitely not numb all the time.
I too investigated the costs of getting this kind of procedure done privately and I think it came out around the $6,000 mark. There are resources available on the Southern Cross website that will outline the costs (though it’s based on 2008′s figures – still, $5,000 – .. pretty sure they would have gone up since then) – here’s the link: http://tinyurl.com/yjpb42r.
Hope this allays some of your fears. Honestly having the surgery is the best thing I could have done. Good luck with the biking and your impending surgery!
About 2 months ago, I fell at my apt. And hit my head on a desk, which caused me to lay there unconscious. I laid there for about 9 hours before a friend found me. My calf area was about the sizebof both of my thighs put together. Once I reached the hospital, all 7 doctors had no clue what was wrong with me. Of course, I don’t remember the first 2 weeks of being in the hospital. I ended up being put in ICU for a week and a half. My fever reached 105 and my kidneys started failing. The doctors told my family I probably wouldn’t make it. I was in the hospital for a month and I have been out a month. I have to tell you that I’ve never experienced pain like this in my life. It lasts 24/7!! For those of you that can walk, consider yourself so lucky. I’m in a wheelchair and my whole life has changed. I had never heard of this syndrome until it happened to me. Believe me it’s alot more prevalent than we think. Good luck to all of you.
Thank you for posting this. I had my bilateral compartment release in 2005 and I haven’t been able to do anything at all. I have gained 40 #, can’t run anymore or even walk without having excruciating pain in my calves at night. My right knee has meniscus issues too and the compartment release seems to have flared up knee problems.
Needless to say, I am frustrated, 5 years post op.
Hi!
I just wanted to write to say thanks for writing this blog. It really prepared me for the pressure tests and the surgery (that I had 2 1/2 weeks ago). I was diagnosed with this after I couldn’t put up with the pain any more and went to physio. I play alot of sport (soccer), go to the gym and swim – some days after soccer I couldn’t walk it was so bad.
My recovery is going well. I’m back at the gym on the bike only until I see the surgeon before Christmas and back at work. My left leg is giving me some trouble, and some of my toes on my left foot get numb when I exercise, but I’m hoping that will gradually go the more exercise I do. The scars are long, but skinny and I’m keeping them taped up so they don’t stretch. I can’t wait to start running with no pain!!!
Once again, thanks!
Gillian
No problem Gillian! Glad my blog helped you out a bit. Good luck with your recovery
Finally found something about some in New Zealand with exertional compartment syndrome!
I have just been privately to see a sports medicine doctor and told that compartment syndrome is top of his list as to the pain i get in my calves, after being referred from my Physiotherapist. Only to get the pressure test done privately is $350 to confirm diagnosis, and the private surgery in Wellington now costs 10-11k..
Would you recommend going privately vs publicly? I’m not sure my pressures would be high enough to receive surgery as “quickly” as you. If I have to wait over a year to receive the surgery publicly (if I even qualify to go on the waiting list).
Cheers,
Rebecca
Hey Rebecca. It really depends on you. I know that I couldn’t afford to fork out $11k for private surgery (since it wasn’t covered by insurance), so I decided to wait. I don’t think the pressure levels would effect how long you have to wait, but I guess you never know. Have you had the pressure tests yet? I had to pay for them myself regardless but at least once you’ve got them done you’ll know for sure whether you’re dealing with CECS or whether it’s something else.
So, if I were you and if you can’t afford the $11k, I’d say give the public system a go and see what happens. If you get fed up with waiting, contacting the Ministry of Health is a good place to start. By the time I’d had my surgery I had a guy there who was fighting the battle for me
Best of luck!
Hey all, just got 4 compartments released bilaterally for compartment syndrome, and I’m writing a blog about the whole experience in order to share information.
http://compartment-syndrome-explained.blogspot.com/
Hope you enjoy!
It’s been 3 1/2 years since i had lower leg compartment syndrome surgery. I am still in pain on a daily basis. Underwent all the testing and therapy required post-op. Nothing helped. I did purchase a compression sleeve on-line, which does lessen the pain and get me thru the day. I’ve stopped all physical activity because of it. The biggest problem is that i am a PE teacher and constantly on my feet.
I had surgery October 24 after two and half years determing what it wasnt. The specialist knew it was compartment syndrome but wanted to ensure it was correct diagnosis. What was suppose to be two days off ended up being eight weeks. He severed a vein and cut a nerve, which is why we have the numbness. He had to reopen the cut to release the blood pooled inside. Very painful and more stitches. To date I still have pain and can only walk very short distance. I am doing pilates and other things to try and get back into shape. I just hope that some day I can walk the distance again. I have completely given up the idea of running again.