Compartment Syndrome Treatment: Q&A

Hi Tom!

In the role of coach of a football (soccer) team for youth girls, I studied some of your recommended books/literature in search for methods to treat/prevent compartment syndrome and other fascia-related problems, mostly related to the lower leg. It still seems a common perception that compartment syndrome needs a surgical solution.

From what I have seen in your, and related, literature, it seems manipulation with foam rollers to be one working approach:

Learn the ONE Stretch That Relieves Plantar Fasciitis, Shin Splints, Achilles Pain, Heel Pain and Compartment Syndrome

Do you have any specific methods for manipulation that you can recommend for treatment and prevention of compartment syndrome?

Thanks for a great question. 

The technique pictured is great, but I would throttle back a bit on the claims that it is THE exercise for all these problems. Plantar fascitis, in my experience, can be sourced in different parts of the Superficial Back Line – sometimes in the pelvis, even in the neck!

For compartment syndrome, it is of course the fascial walls called septa that are defining the compartments of the lower leg. The more severe the case, the more frequent and strong the applications need to be. These techniques should be done when the syndrome is NOT flared up – in other words as preparation, not as an acute cure. The usual RICE formula should be applied in the acute stage. Continued below…

Surgery, in my humble opinion, is a bad option except in the most severe and debilitating cases, because of the scar tissue it creates, which can compound the problem in some.

Taking the general cue from the exercise in the link – slow rolling with weight applied to the area being rolled to increase the pressure – we could add other parts of the lower leg than just the front.

In all cases, keep movement of the foot going while you do the rolling – either plantar- and dorsi-flexion, or circumduction of the foot. This multiplies the effectiveness of the technique; pressure done without movement will have much less effect.

Front: Weight yourself on the roller and roll a) the front of the shinbone, 2) the anterior compartment – chiefly the tibilias anterior, and 3) the septum between the anterior and lateral compartment from just in front of the head of the fibula to just in front of the lateral ankle bone.

Side: The lateral compartment that contains the peroneal / fibularii muscles is a frequent culprit in compartment syndrome as the compartment is small and the muscles very sinewy. Lie on your side. Put the roller under the lateral knee just below the head of the fibula. Place the other foot on top to create more pressure, and roll up and down slowly, leaning forward a little or backward a little to be sure you cover the whole compartment.

Posterior: Although you want to stimulate the gastrocnemius / soleus, the chief reason for rolling the posterior compartment is to ease and create gliding in the compartmental wall between the superficial and deep compartments.

Here is a manual therapy technique for this fascial wall:

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Doing this with a ball is better than a roller. Lie supine or sit up, place one leg over the other, and move yourself over the ball (a tennis or lacrosse ball is fine), so that the line of pressure goes straight up or down the midline of the back of the leg, from the Achilles tendon to just below the knee.

You can also take your leg left and right over the ball, so that it makes a zig-zag up or down the back of your calf as you move your foot.

Inside: This is the hardest to make effective as an SMR exercise. Put the ball on a hassock or small raised hard surface. Lying on your side, put you upper leg over the ball so that it lies just behind the shinbone. To be effective, it needs to be right up against the bone. Move the pressure from just behind the inside ankle bone to just below the inside of the knee.

This last can be an exercise in frustration trying to get the placement and the pressure right, but most cases of compartment syndrome will yield to the first three, practiced often and with sufficient pressure. If the symptoms abate, keep the techniques up for two extra days, and then see if the results are lasting. If not, look to the hips.

All the best, and thanks for coaching!

Tom Myers