Three Weeks Out - Physical Therapy, Recovery, and Questions

Hey all, sorry it's been a while - things have been busy. Last post explained my first post-op visit and left off with me excited for my first PT appointment. I went to a nice place in the Longwood Medical Area (for non-bostonians, that probably won't resonate) where they were recommended by my surgeon due to the volume of compartment syndrome afflicted patients they receive. I was still somewhat apprehensive that I might be assigned to a physical therapist that would not have significant experience with CS, but those worries were quickly placated when I met Jerry, who seemed to know his stuff.

He explained that for another week and a half, calf/ankle stretching and some very simple calf/ankle strengthening exercises would really be the only PT I would be doing, as the legs are still healing from the trauma of surgery. At about 4 weeks post-op, he explained, is when the real physical therapy would begin, with some bicycling, and, in his words, "massaging the hell" out of my legs (I assume that, among other things, it goes to break up scar tissue).

Interestingly, a reader of this blog named Tom has mentioned that his doctor advised that he should start running as soon as he could in order to break up the scar tissue. This seems to be in direct conflict with what both my surgeon and physical therapists have advised - Namely, to absolutely not run at least for the first 6 weeks, and to err on the side of not pushing it in any activity one might find themselves in. It seems that there is obviously two things that need to happen post-op - your legs need to heal, and scar tissue needs to be broken up (obviously there are additional factors, such as strengthening, but these two seem to be the crux of this conflict) - Now I would assume there would be an optimal time where the healing of the legs would reach a point that increased efforts to break up scar tissue would not compromise the recovery - the question is when that point is. So if anyone else who has been advised by a doctor as to what point they should begin running activities (and keep in mind that in both cases 4 compartments were released on both legs) then please speak up!

As for general updates on leg ability, I now can be on my feet all day with barely any pain, although I sometimes encounter swelling late in the day, however it is not too significant. Yesterday I walked all over the city, probably a combined two or three miles, with minimal discomfort. Stairs pose no issue. My right leg is still a little behind my left leg, in that the calf is tighter and flexibility is just not as far along. But overall they are still gradually improving. Next physical therapy appointment is Wednesday, so I'll keep you guys posted.....

Rolfing (ouch!), Physical Therapy, Stretching - Helpful for some things, but not exertional CS

I now faced a decision - Do I decide to go under the knife right away, or do I try to convince myself that with a little alteration of activity and different forms of massage, I can live with the condition? Obviously the latter is a little less daunting, so I quickly devoted myself to all forms of alternative treatment.

First up - Physical Therapy - Went about six times (Over the course of this entire saga, I did feel partly guilty for taking advantage of the fucked up healthcare system we are all so privileged with in the U.S.) The physical therapist admitted that she had not seen anyone be able to actually overcome symptoms of compartment Syndrome, but she would give it a try. She did all different sorts of ankle, shin, and calf massages/manipulations, but over the two and a half weeks that I attempted treatment, there was simply no progress, and I decided to move on.

Second - Rolfing - While I had not heard of rolfing until I read this article in the NYTimes (http://www.nytimes.com/2010/10/07/fashion/07rolfing.html), it is a treatment that many people I now know swear by. Why it interested me particularly for Compartment syndrome, though, was the fact that rolfing is completely devoted to resetting all the fascia in the body. And what do you know? Compartment Syndrome is fascially based! I went to a rolfer that came highly recommended, and while he did say that he has seen people afflicted with CS overcome the disorder through rolfing, it was not a high percentage. I decided to give it a try (and at about 125 a session, it was not an easy choice). Now, granted, I was warned beforehand by many a rolfer devotee that rolfing was painful - but nothing, I mean nothing, can prepare you for the actual experience - Plain and simple, it fucking hurts. Thankfully, though, my rolfer was laid back, and thus didn't mind me lashing out at him into my pillow with language that most would not approve of. I went to five sessions with him, and while I sometimes did see small improvements, it was never substantial enough to allow me to conclude that the rolfing did actually help. My rolfer did however explain how my back pain could be connected to the Compartment syndrome, as he showed me quite a startling picture of someone's fascia cut out of their body, and it really is ALL connected.

During both the PT and the rolfing, I also tried doing at-home stretches that I found on the internet that I thought might help, but I really did not see any marked improvements (although by this time I was also extremely discouraged). A couple weeks post-rolfing, and my CS had progressed to where I could not even play an hour game of basketball comfortably, and the daunting realization that surgery would be the only option if I wanted to continue my athletic pursuits slowly began to set in.

It was time to tuck my tail between my legs and, with my test results in my hand, consult a surgeon :(.

Intra-compartmental Test - HUGE needle

Judgement day came and went, and unfortunately for me, the majority of pain came a couple days after the intra-compartmental test. There are four compartments in each lower leg that are tested - The lateral compartment, anterior compartment, superficial posterior compartment, and deep posterior compartment. The way it works is the doctor takes the baseline pressures of each compartment - Basically the pressures of the compartments when you are at rest and have not been exercising. Then, you exercise for 10-15 minutes, trying to reproduce the CS pain/symptoms that you normally get. At that point, the pressures of the compartments are taken again. If a compartment is over 15 mm Hg at baseline, and over 30 mm Hg right after exercise, that compartment is positive for CS.

Sounds pretty simple, but in order to take the pressures, a needle needs to be stuck in the compartment - a big one. And 4 compartments on each leg tested twice adds up to 16 times that a huge needle went into my leg - not so fun. But while it was by no means pain-free, it wasn't excruciating. I did wince many a time, but on the whole, I've had worse. It did feel strange to run hard after getting pricked 4 times on each leg, and I actually did not reproduce the lateral pain symptoms I had been experiencing. My results are in the photo heading this post. A definite positive for deep posterior and anterior compartments, while one superficial posterior compartment was positive, and the other probably positive. Interestingly, the one completely negative test was the lateral compartment in both legs, where I thought most of my pain was coming from.

Next Post: Trying to deal with Compartment Syndrome non-surgically - Rolfing, stretching, and everything in between.