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.

Shin Splints? Back Pain? Frustration! Part II

During the aforementioned four weeks (the time between when the numbing, tingling, pain in my shins began to cut down my runs, and when I actually went to a doctor) I began to suffer from a gradually debilitating lower back pain. It started subtly, but it got to the point, that by the end of four weeks, I couldn't even reproduce the numbing/tingling sensation in the lateral shins because my lower back was not even permitting me to run the required amount to bring on the leg symptoms!

I frantically went to two orthopedists, who, after hearing my history, concluded that I was first having shin splints, and gave me the company line that due to extremely tight hamstrings, my back was acting up. Solution? Physical Therapy for the back, and rest from running (which I could not do anyways due to the back).

Physical Therapy helped, and I got my lower back to be once again compliant with running - and then to my surprise, the symptoms in my shins came back even worse than before, along with an ever-shifting lower back pain (sometimes more lateral, sometimes down in the upper buttocks, and sometimes even closer up to the mid-back) that was bothersome, but not nearly as painful as pre-physical therapy back pain.

It was then that I decided to seek a third opinion from a back specialist, whose diagnosis has informed all my treatment since then. When I gave her my history, she stopped me at what I described as shin splints - When I told her my exact symptoms, she replied, "that sounds much more like compartment syndrome" - and then she tried to put the pieces together - This is what she theorized: When I continued to run through the CS pain, I had to alter my gait due to the lack of function of my lower leg muscles, which consequently completely threw off my biomechanics, thus aggravating my back. As my back got aggravated, I began to compensate with other muscles, thus weakening my back/core further, which required physical therapy. She suggested I get an intracompartmental test, as that is basically the only way to test for exertional compartment syndrome (unless you live near a place that is experimenting with the MRI diagnostic procedure).

That is one thing I have not seen on any site with people detailing their CS symptoms - anyone else experience any sort of back pain in conjunction with the CS?

Next: intracompartmental test - kinda sucky

Shin Splints? Back Pain? Hip Impingement? Compartment Syndrome? Frustration! Part I

The numbing sensation began about a year ago. I was doing my usual 3.5 mile run around my college's indoor track. About 2.5 miles into it, a tingling sensation I could only describe as strange developed in both lower legs, localized to the lateral shin area. I would estimate that I had been doing the 3.5 mile runs three times a week for around 2-3 months before this "sensation" began. I simply wrote it off as an outlying random pain and forgot about it.

The next time I ran, however, the tingling sensation began earlier in my run, and progressed to the point where finishing the 3.5 mile run would be uncomfortable, so I stopped after 3. Being a 22 year old who loves to self-evaluate, I immediately went back to my dorm room, plugged my symptoms into google, and wala, I had my diagnosis - shin splints. Sure, there may have been a tiny difference here and there between what different sites described as shin splints, and the symptoms I was experiencing, but not enough to put any doubts in my mind, especially because of the ubiquity of shin splint diagnoses in the young athlete arena.

So I took the many websites' advice; I rested for a couple weeks, took some ibuprofen in anti-inflammatory doses, and iced (which, coincidentally, is also what is prescribed to people who initially have CS type pain also). Sure enough, two weeks later, I was back on the track, and for my first couple runs, also pain-free. The numbing, tingling sensation, however, came back with a vengeance. No longer did it just become a sensation, but when I would attempt to push myself, both my legs felt pressurized and numb, to the point where I simply could not use my lower leg adequately propel my body, and simply had to stop. I thus decided to modify my runs to 1.5 miles. When I would run 1.5 miles, the numbing/now slightly painful sensation would come around mile 1, but I would always be able to finish the last half mile, while sucking up the pain.

I had about 4 weeks left in my spring semester, so I told myself that I would continue running, and then see a doctor when I returned home. Unfortunately, during these 4 weeks is when things took an unconventional turn.

Compartment Syndrome Blog - Let's Get To The Bottom Of This (Pre-op, Post-op, Fasciotomy Details)

Wow...where to begin. The last year has probably been the most frustrating physically I have ever encountered, and it's entirely possible that it all stemmed from one condition; Exertional Compartment Syndrome. When I was first told I might have the condition bilaterally, I did what most people looking for answers do - went on the internet and attempted to find out as much about the condition as possible. It was quite disheartening, though, when I slowly realized that this was still a rare (if not rare, then at least under diagnosed) syndrome, and there was a significant dearth of helpful information on the subject.

Basically, I felt that the exertional CS content on the web consisted of two different but equally flawed sources of information: 1. Summaries about the condition on sites like wikipedia, mayo clinic, emedicine etc. that would give the standard physiological background, list of symptoms, and then treatment options. Many sites would actually claim (incorrectly) that most cases of CS could be resolved non-invasively through PT and the like.

The second source of incomplete information were sites like runners forum.

These, in my opinion, were more helpful than the standard info sites, but still lacked the specificity and detail that I would have liked to see in order to more accurately assess my options.

There were, however, a couple blogs about the entire process, and it was these that I found the most helpful, as one could actually see if progress was made post-surgery (and if so, what exercises/PT was instrumental to the progress), or if complications arose.

Unfortunately, though, I found comprehensive CS blogs few and far between, so I promised myself that after surgery I would try to blog my progress, and in the process, maybe allow a couple readers (if there will be any) to glean a little more information about it, and also, possibly attract fellow post-op CS patients who could share any nuggets of information they deem helpful. I got my surgery yesterday, and my first blog post will merely just detail the last year of my life as pertaining to CS, and then I will provide periodic updates, which will be as detailed as possible about my recovery.

A lot of stretching is done after surgery!

But what I feel is of paramount importance is for this really to be interactive. Even if I detail every thing about my CS process, that is still only one experience; what will make this blog truly helpful is if people who have had any sort of CS ordeal to detail their respective challenges and successes in DETAIL. Don't be afraid that by going into too much detail you will begin to bore readers. Believe me, people who have made the effort to come to a site like this want all the information they can get.

Much love to all,

John