Anterior compartment syndrome is a condition, which occurs when the muscle increases in its size and becomes too big for the sheath that surrounds resulting in pain. The compartment syndrome can be acute or chronic. The anterior compartment is surrounded by a sheath. This sheath encloses the muscles. If a muscle increases in size than the surrounding sheath, it results in a compartment syndrome. There are four muscles present in the compartment: Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius. This syndrome can affect any or all four muscles which are present in the compartment. The function of the muscles[¹] is dorsiflexion and eversion of the foot. High impact activities, such as running, put a lot of stress on these muscles.
Symptoms of Anterior Compartment Syndrome[²]
- Acute pain and tightness in the external region of the lower leg commonly caused due to a direct impact or trauma.
- Weakness in the foot which may cause foot drop or a slapping gait to occur.
- Swelling is present.
- Skin is warm to touch.
- Tenderness is present in the region of the tibialis anterior muscle.
- Pain upon flexing the foot and toes downwards.
- Paresthesias may be present.
Causes of Anterior Compartment Syndrome
- A direct force or trauma which causes bleeding and swelling inside the muscle sheath. The additional fluid produced puts extra pressure within the muscle sheath and causes pain.
- If the muscle ruptures, then it causes bleeding and swelling and pain upon pressure on the sheath.
- Overuse injuries also cause swelling and pain.
Treatment of Anterior Compartment Syndrome[³]
- Rest should be taken, but the upper body can be exercised.
- Ice or cold therapy should be applied for 20 minutes at a time. Ice should never be applied directly onto the skin, but it should be placed in a towel and applied.
- Patient should seek consultation of a sports injury professional.
- Anti-inflammatory medications, such as ibuprofen, help in reducing pain, swelling, and inflammation.
- If there are any biomechanical problems, then they should be corrected with the help of orthotic devices.
- Proper training methods should be adopted and appropriate shoes should be worn during training.
- Ultrasound therapy helps in reducing the swelling.
- Sports massage techniques can be done to stretch the muscle sheath after the acute phase has passed.
- Surgery may be required where the compartment is surgically decompressed.
3 Massage Techniques For Anterior Compartment Syndrome
Patient should seek medical advice before starting any massage or exercise.
The first and foremost equipment which is required for a massage[⁴] is a lubricant. This enables smooth gliding of hands during massage. For this purpose, the massage oils can be used or simple baby oil will also suffice. Care should be taken not to use too much oil, as it will cause lack of control during massage. Apart from a lubricant, the other equipment needed is a firm and flat surface to lie upon during the massage.
Technique 1: Effleurage
This technique is used to initiate massage and for even oil application. It also helps in warming up the tissues in order to prepare them for deep massages. Light strokes should be applied using the hand from above the ankle to the knee. The direction should always be upwards towards the heart, because this is the direction of the blood flow. Doing it the opposite way causes vein damage. After these strokes are done, the hands should be brought down the outside of the leg while keeping them firmly on the skin without too much pressure. This whole movement should be repeated using gentle stroking techniques and covering as much area of the leg as possible. This technique should be repeated for 5 minutes while slowly increasing pressure on the up strokes.
Technique 2: Stripping The Muscles
This is a common massage technique done to smooth out any knots or scar tissue present. Using the thumb of the left hand (for a left leg) deep pressure should be applied to the entire length of the tibialis anterior muscle starting from the ankle and working upwards to below the knee. This massage should be appropriately deep and should not cause any pain to the athlete. This technique can be alternated with cross frictions.
Technique 3: Cross Frictions
Firm pressure should be applied across the tibialis anterior muscle. Massage should be started from the lower third of the shin and should be slowly worked upwards. This massage technique helps in stretching the sheath surrounding the muscle and reducing the compression in the muscle compartment which is the cause of pain. This technique should be done for about 5 minutes and should be alternated with stripping the muscle.
The entire massage process should not exceed 30 minutes. If the massage is done lightly, then massage therapy can be applied every day, but deeper massage techniques should be given a day’s time to allow the tissues to “recuperate.” If the pain and inflammation increases after the massage, then it should be discontinued. Mild muscle tenderness is to be expected after extreme training. If the patient does not benefit from massage therapy and if the pain continues, then surgery may be required.