Chronic Compartment Syndrome

So, it's official. I have Chronic Compartment Syndrome (CCS). Here's the Reader's Digest version (and as an aside, did you know that Reader's Digest just filed for bankruptcy...I guess old people aren't reading magazines anymore!): Your leg muscles have 4 compartments. Those compartments are surrounded by connective tissue called fascia. When you exercise, your muscles swell. Normally, the fascia is sufficient in size to accommodate this swelling and all is good. With compartment syndrome, the fascia cannot support the swelling and pressure builds up...causing lots of pain.

My case seems like a pretty text-book example of CCS, which makes it a bit frustrating that it too so long to diagnose.

Basically, within about 5 minutes of doing any repetitive, jarring active (like running or playing basketball), my shins start to hurt like crazy. The pain is pretty intense, though I tried to just work through it, but it just seemed to get worse and less bearable. And with that type of pain, the mind just screams to stop since something is definitely not "right."

I first had this issue when I was a teenager playing basketball. I would hurt like crazy during long drills and especially during games. During games I would rest during half-time and then would feel quite a bit better and have less pain during the second half (now I know that the pressure was able to go down during half-time). I'd hurt by the end of the game, but withing half an hour or so, the pain would be gone and I would be on my post-game high and not think much about it. Plus I was a teenager and as we all know, teenagers can be pretty stupid.

After high school I basically didn't do anything that caused this kind of pain. I did play basketball some, but just pick-up games in the neighborhood. So my guess is that the intensity was lower and the pressure didn't have a chance to build up so much.

Fast forward to 2006 when I decided that I wanted to do a triathlon. Running hurt, but I really just assumed that it was because I was new to running and overweight, etc. I didn't do a lot of run training because it hurt so much and ended up walking during most of the "run" portions of my two triathlons. In December 2006, I ran a 5k and was nearly in tears by the end. My shins hurt so much that I could hardly walk by the end. But, the pain stopped shortly after the race. I decided to see my doctor, so went to a doctor recommended by my primary care doctor. He was supposedly a sports medicine doctor who treated a lot of athletes from SU. He thought that I had a stress injury to the shin, caused by over training and lack of calcium. He told me to take extra calcium, rest for a couple of months, and then start back slowly. It sounded reasonable, so I took extra calcium and didn't run.

In fact, I really didn't run for about 2 years. I figured if a couple of months rest was good, a couple of years would be better :)

But, when I started trying to run, the pain came right back. Thankfully my running coach referred me to a real sports medicine doctor (Thanks Teresa!!) and I started working with him to figure out what was going on. This was around Feb. 2009. The first thing he did was send me for an MRI. It really didn't show anything. So we tried a bunch of things: massage, acupuncture, injections, really smelly Chinese plasters, long ice baths, etc. Nothing worked. Then while he was at a conference, it hit him, Compartment Syndrome. He sent me to a physical therapist to make sure that it wasn't may gait or something. The PT also thought CCS. So, off to a specialist I went.

The specialist is conservative in her diagnosis of CCS and wants to rule out every other possibility before doing the pressure test because the test is expensive and painful. I had already had an MRI, so that was done. She sent me for nerve studies and also an xray of my low back. Nerve studies were negative, but I have a degenerative disc at L5S1 in my low back, so she wanted to rule that out as the cause. She did give me the option of going ahead with the pressure test right then. In retrospect I wish that I would have, since I would probably be into my recovery right now. But, she really didn't recommend getting the test at that point, yada yada yada.

Off to PT I went. She sent me to the "best" PT and told him to give me 150%. He worked really aggressively on my back for a month with no change. So, not the back.

Finally I had my pressure test and sure enough, compartment syndrome. Good news is that we have a diagnosis. Bad news is that the treatment is surgery. At this point I am so ready to be "fixed" that I am excited about it :). I see the surgeon next week and will hopefully have the surgery soon after. Since I am not working, the timing works out pretty well for recovery, etc. So, let's just get this over with!!