DEFINITION

Exertional Compartment Syndrome (ECS) of the leg is a condition characterised by exercise-induced pain and swelling of the leg that may be accompanied by weakness and loss of sensation in the affected area.

DESCRIPTION

Exertional Compartment Syndrome (ECS) is characterised by pain in the leg which is caused by an increase in the pressure in one of more of the muscle 'compartments' within the leg. There are four 'compartments' in the leg, each containing muscle, nerves, blood vessels, bone and connective tissue which are all surrounded by a non-elastic casing. The pain associated with ECS is caused by increased fluid pressure or muscle swelling within these compartments. In athletes, this may be aggravated by exercise-related increases in muscle size. The casings of the compartments do not stretch to compensate for this pressure increase, so the tissues inside these compartments are compressed. Nerves within the leg compartments are compressed, which causes acute pain. The blood vessels are also compressed so that the blood supply to all the tissues within the compartment is reduced, causing a condition known as ischaemia.

There are two types of ECS: acute and chronic. Chronic ECS is the most common type and it tends to occur in athletes under the age of 40. Acute ECS tends to occur in relatively inactive people who undertake an episode of strenuous exercise. Patients with chronic ECS (usually athletes) experience pain during training and for a certain time afterwards. Their condition has a gradual onset, although their condition can develop into acute ECS if training schedules increase. Chronic ECS sufferers experience pain at a set time after exercise commences or after a certain level of intensity has been attained. The pain is present in both legs in 50-70% of sufferers. In chronic ECS, pain subsides within about 20 minutes after exercise. Patients with acute ECS experience more severe swelling, excruciating pain and damage to the muscle compartments that is not related to the intensity of their exercise. Acute ECS is a damaging condition that usually requires surgical intervention.

PREVENTION

The best way to prevent this condition from occurring is to undertake graded training. This means gradually building up endurance and not doing too much too soon. Wearing appropriate footwear for training also helps to prevent ECS.

TREATMENT OPTIONS

As with all conditions, your Doctor should be consulted. Your Doctor will diagnose and treat this ailment. The diagnosis is usually done by taking an elevated intramuscular pressure reading. Your Doctor may refer you to a sports Doctor or Physiotherapist for specialised treatment.

Diagnosis is made by a procedure that measures the pressure inside the affected muscle compartment using a small needle and pressure-measuring device both before and after exercise.

Acute ECS is surgically treated with a technique called fasciotomy, in which the non-elastic sheath that surrounds the muscle compartment is cut open to relieve the extreme pressure within the compartment. Chronic ECS is managed by altering factors such as an athlete's training intensity, training surface, shoe design and with exercises that stretch and strengthen the affected area. Orthotic shoe devices may also be recommended to decrease stress and impact on the affected compartment. If symptoms persist or worsen, surgical intervention may be required, after which the athlete can generally return to full training within 8 to 12 weeks.

PHARMACIST'S ADVICE

Ask your Pharmacist for advice. 1) Your Pharmacy stocks a range of support garments which help to provide protection to support structures of the body during exercise e.g., bones, ligaments, joints and muscles. 2) Ask your Pharmacist about orthotics (shoe inserts). These may help to provide extra cushioning, shock absorption and correct biomechanical faults. 3) Preventing Compartment Syndrome is the best way to approach the problem. Treatment involves prompt diagnosis and complete rest for an extended period may be recommended.

ORGANISATIONS and SUPPORT GROUPS