Bodyworks: Anterior Compartment Syndrome

Symptoms
The chances are that you are an oversupinator, and you’ll feel pain brought on by exercise in the area just outside the front of the tibia, although you may find it diffuse and hard to locate. It often follows excessive uphill running, in which the tibialis anterior muscle expands and may produce fluid which stretches the compartment sheath.

Signs
An experienced sports physician will locate the pain between the tibia and fibula and may sense increased pressure within the sheath. They will check to rule out the rare but very serious condition in which this pressure is high enough to block the bloodflow into the sheath, which could cause gangrene.

Medical investigations
In rare cases, you may have the pressure within the compartments of your leg measured. More commonly, x-rays and bone isotope scanning are needed to ensure the diagnosis is correct. For resistant and recurrent cases, you’ll need biomechanical evaluation on a treadmill.

What else could it be?
Your pain could alternatively be caused by stress fractures (again!) or tibial periositis (see below). It could also come from muscle tears or tenosynovitis, where inflamed muscles within a sheath rub roughly against each other.

Self-treatment
RICE to the letter. Ice to restrict fluid formation and elevation for damage should be complemented by aspirin or ibuprofen in one of its forms to minimise inflammation.

Medical treatment
Along with other first aid, active electrotherapy by a physiotherapist will speed recovery. In rare cases, you may need an operation to open the sheath and release the pressure within the compartment, especially in the acute obstructed case.

Can you run through it?
Attempting to run through it without understanding the causes can only prolong the agony.

Recovery time
Treat it appropriately and four weeks should see full recovery, although this may be hastened and recurrence prevented if doctor, coach and athlete can work together to eliminate the causes. After recovery, changes in training should be gradual.