My experience with chronic/exertional compartment syndrome and compartment release/fasciotomy

Disclaimer: Please do not use my experiences to diagnose yourself or someone else. If you think you have compartment syndrome please see your primary care provider or orthopedist.

I was starting to give up the idea of ever running again when I spoke with two of my former classmates whom suggested I may have compartment syndrome.  I immediately scheduled a follow up with my orthopedist to see if this was the case and what to do about it.

There are two forms of compartment syndrome: acute and chronic. Acute compartment syndrome normally occurs following a traumatic injury.  The injury causes swelling in the compartment.  The fascia around the compartment is not flexible and does not allow any relief of the pressure. This is a medical emergency and is treated with a fasciotomy.  This is an incision along the length of the skin and fascia to relieve the pressure. The second type of compartment syndrome is chronic or exertional compartment syndrome. This is often seen in athletes of repetitive sports (think running, cycling). There are multiple theories regarding what causes chronic or exertional compartment syndrome.  Some of these are biomechanics, tight or adhered fascia, or poor venous return. Most research shows that the best treatment for chronic exertional compartment syndrome is a fasciotomy.  However, it is recommended to try conservative treatment first (stretching, physical therapy). The fasciotomy or compartment release for chronic exertional compartment syndrome is not as invasive as that performed for acute compartment syndrome.

A diagnoses of chronic compartment syndrome is based based on history, symptoms and signs during a physical exam. My symptoms were pain in my lower leg and sometimes in my foot during the following activities: walking, running, stationary bike or cardio on the elliptical machine at the gym. If left untreated, the swelling in the compartment can cause compromise to nerves, muscles and arteries (ie.numbness, tingling, paralysis, tissue death).

A pressure compartment test is the "gold standard" for diagnosing compartment syndrome. For chronic compartment syndrome, the pressure in the compartment is taken pre and post exercise (1 minute after and then again 5 minutes after).  A large needle is stuck into the compartment and then a catheter is inserted to test the pressure.  My pressure was elevated at rest and then increased with exercise. This along with the clinical signs I exhibited confirmed my diagnosis of chronic compartment syndrome.

Since I had failed conservative treatment (physical therapy, stretching, taping, etc.), I decided to have the fasciotomy.

I am now one week post op.  The pain has been tolerable for the most part. I am now able to walk from one room to another in the apartment without crutches if my pain is managed. I am starting to wear the walking boot as that is what I will need to wear to return to work later this week.  The boot puts a lot of pressure on the incisions and I can not wear it for very long.  This is only the second day that I have tried wearing it. Initially after surgery I was put in a splint. However, I had that removed the day after surgery because it was putting too much pressure on my heel which caused pain and burning. The incisions look great (from what I can see; they are covered with steri strips) and I am just starting to have bruising throughout the front of my leg.

Below are some pictures of the incisions. If you are squeamish don't look. I don't think they are too graphic, but I work in health care and am somewhat desensitized to seeing clean, intact wounds. A word of warning: I wouldn't google image or video search "fasciotomy" unless you want to upset your stomach.  I have watched half a dozen surgeries and see post op incisions frequently at work, however some of the pictures and video that come up regarding faciotomies are quiet graphic (especially if you are thinking of having the surgery done!).  (Do keep in mind that most of them are for acute compartment syndrome and the surgery is much more invasive than that for chronic compartment syndrome.)

 Hanging out on the couch. Day of Surgery (DOS).

 Distal incision POD # 1. Taken just after getting the splint taken off.

Elevating my leg on the patio while enjoying the view.


As far as recovery goes, it will be a full 3 months until I am able to "return to sport," which for me is running. I will be able to bike and eventually do the elliptical prior to that 3 month mark. I will try to keep this updated throughout my recovery process.  Check the labels for "compartment syndrome" and "fasciotomy" and hopefully (this summer!) under "run"! 

Two!

Just finished my first two mile run since March! 

I changed my form a bit by leaning forward. It felt awkward, but I only had minimal back discomfort. 

I remembered my high school track coaches telling me I ran with my back arched- almost like I was leaning backwards. There are pictures floating around somewhere that prove my form was off.  

Making this little correction helped reach my seemingly illusive goal of running two miles without stopping.  

My next short term goals: run 3 times/week, run 3 2 mile runs without pain over the course of a week, run a 5k!!!  

Long term goals: run 6 miles, complete a 10k then a 1/2 marathon. 

I would love to complete the marathon I'm signed up to do in November, but it doesn't look like that is going to happen this year.  

For now, I will be happy with running two (very slow) miles. I am happy, but not content.  I must keep trying to do more. 

On another fitness note, The Best Man and I finally joined a gym.  We have been going at least 3x/week, doing a little cardio, a lot of weights and loads of stretching.  I'm hoping this will help with returning to run. I need to continue to strengthen my hip abductors and stretch my hip flexors and piriformi. 

Run happy! 

Back on track....

I'm on fire this week! I have run 1.5 miles. TWICE!

Okay. So this may sound wimpy, but its the farthest my body has let me run since the marathon in March.

Here's hoping I can run Richmond in the fall! 

(Okay, let's be honest. I will probably have to downgrade to the half. But hey. Its a start!)

Back to running...one half mile at a time

Over the past month I have slowly gotten back into running. One. Slow. Half. Mile. At. A. Time.

It's disheartening to have old people walk briskly past me while I am warming and ask that I move along faster.

However, it does feel good to feel the wind in my hair and the ground moving under my feet. If only for a half mile at a time. It's better than nothing, right?

I have already signed up for the Richmond Marathon in November. This means I need to start training in ONE MONTH.  Yikes.

No longer a hop a long!

Today is my first day without the boot. We did a lot of errands so its a tad sore, but otherwise I am doing well. I am so glad to be rid of das boot! It was really starting to hurt my back due to the height difference between footwear.

I had my second PT visit today and continue to do a lot of glute medius strengthening. 

Will keep you posted as I continue to recover and dream of a world were I can run as much or as little as I want without consequenses.

Tendonitis

The good news is I don't have a stress fracture. The bad news is I have tendonitis. Immobilizing my foot in the boot continues to help, as does ice and rest.

I am learning to walk in the boot, but it still throws me off balance every now and then. I plan to wear hiking boots to work this week instead of the boot and a sneaker which would likely make me off kilter all day.

I ran a marathon on Sunday, what did you do?

I'm not sure if I mentioned this, but I decided to run a marathon before turning 30. I had been wanting to do it for years now and figured I should shoot to do it before the big 3-0. Some how The Best Man felt obligated or inspired to do this with me.

Training had been going well until mid January, when we ran 18 miles. My right hip started "talking to me" and then began screaming. I had to limp the last 2-3 miles home. I had "gluteus medius syndrome" from muscle imbalances related to my SIJD (sacroiliac joint dysfunction). With this injury and started a new job our training was slim to none the 6-8 weeks preceding the race. 

The race itself went well. I felt sluggish around miles 14-15, but managed to slog on.  The Best Man began to complain of knee pain a few miles later and we ended up walking a good bit of the last 5-6 miles.  We lumbered across the finish line in just under 5 hours. 

Sub 5 hours isn't sub 4, but it sure looks better than having my time start with a FIVE. 

I had a lot of energy at the end of the race and was dreaming about signing up for another marathon before we even finished. Must. Get. Sub. 4:30. 

Needless to say I was really sore the days following the race, but nothing that was unexpected.  That is, until a few days later.  Monday we took it easy and got to see a taping of Jay Leno.  Tuesday we walked around the San Diego Zoo all day (Amazing!).  Wednesday we had planned to run, but I wasn't feeling up to it just yet, so we walked twice.  The second walk was on the beach. Afterwards, I noted what I thought was a gnarly trigger point lateral to my distal tibia (that's shin bone for you lay persons). 

I tried to massage it out, stretch it out, iced it, took ibuprofen. It was bothering me all Thursday at work and got worse after lunch when I was forced to limp around due to the pain. That evening I tried to diagnose my self like any self respecting hypochondriac would. With all the bending and twisting and tugging I made things worse. 

I couldn't get an ortho appointment until Monday, so I went to urgent care and had some x-rays taken. I am currently sporting a fashionable air cast walking boot while waiting to hear back about the x-rays. Wish me luck!

By the way, The Asics LA Marathon was awesome! The course started at The Dodgers Stadium and went west towards the coast to end near Santa Monica Pier. We got there early and were pleased we were able to hang out inside the stadium for the two hours prior to the start.  What a treat! There were so many great spectators along the course (with the exception of the bit near the end through the VA) cheering, clapping, and handing out goodies (oranges, water, beer, pretzels, candy). There were a few tough hills near the beginning of the race, but otherwise nothing to complain about.  The weather was perfect. The medal and technical tee were top notch.  I would definitely do it again.  Oh and did I mention it was on St. Patty's Day which meant I had an excuse to wear my all time favorite color: GREEN! 

Gearing up for vacation

My Kid Brother and A Girl Named Leney will start making their long journey here in just over 4 hours. My Sassy is driving them from Richmond to D.C. at 1 PM EST.  They will then catch a flight to us here in SoCal. The Best Man and I will play tour guide for a WEEK!

This week will be spent walking on sandy beaches, toasting in wine country, beading for the girls and surfing for the boys, gazing at the animals at the San Diego Zoo, strolling down numerous piers, perhaps riding a feris wheel, enjoying sunsets, touring LA, hopefully spotting a celeb or two- just to name a few things.

So excited!

 Oh, and The Best Man and I may or may not be running the LA Marathon on St. Patty's Day.

"You're the easiest patient all day"

I don't know why I ever go to the doctor. They never spend enough time with me and never tell me something I don't already know.

I went to an orthopedist today to get my hip checked out. Turns out I have gluteus medius syndrome and can ease back into running and continue taking ibuprofen. Great. So keep doing what I'm doing, but slowly add mileage.

"You're a physio, you know what to do."

Well, sure, but I wanted some 'roids. And maybe a PT script since I can't analyze my own running. I didn't get a chance to ask for either of these.

"You're the easiest patient all day."

Well, yes, that's because you did a 30 second physical exam and a 2 minute history.

Thanks, glad I paid my $45 copay.

Valleys and Canyons

Yesterday we went through the Valley of the Gods and then Monument Valley.  Valley of the Gods, appears to be the less known or at least less visited of the two.  We went "off roading" on a cinder path through the valley.  The enormous orange and red structures jutted out of the ground haphazardly.  It was neat for the first 3-4 miles.  It was a 17 mile journey.  We stopped half way and had lunch then bounced and rolled out of there. 

Monument Valley was a complete and utter zoo.  There were hundreds of tourists, most of them foreign.  It was funny to see how different cultures pose for pictures.  Though I'm sure The Best Man's handstands and my jumping for pictures were amusing to them.  One of the tourists tried to cut in front of everyone in the bathroom line.  When it was my turn.  This did not go over well with me.  I told her there was a line and she apologized in broken English.  I'm going to assume this was a cultural difference and not that she meant to cut in front of 5 women in line.  We got our pictures at the viewing spot and left because we didn't want to deal with another 1-2 hour drive over a dirt road.  And this time with more people.

Then we ended the day in Bryce Canyon.  We didn't have time for a several hour hike, so we opted to go out as far as we were comfortable before turning back.  Looking down from along the rim provided the best view of the canyon, though it was interesting to see the "hoodoos" up close as we made our way to the bottom of the canyon. 

The next morning we started our day with a run along the rim trail.  We logged in just over 3.3 miles and got many stares from old travelers huffing and puffing as the leisurely strolled along.  Next stop, Zion.

Though it is only a 2-2.5 hour drive between Bryce and Zion the weather changed drastically.  We were so cold over the night and had to keep moving to stay warm during our morning run.  When we arrived in Zion, I couldn't change into less clothing fast enough.  First, we found a campsite, The Best Man set up the tent while I made lunch.  After eating we did a 3 mile hike that included some waterfalls (minimal water, but tall in height).  We just had a gourmet dinner of Chef Boardi Ravioli.  Such is camping life.  We have several more days to explore Zion.  Then it's off to the Grand Canyon before heading to California! 

Please note, the first part of this post was written yesterday.  I do not have the battery power nor patience to correct the wording. 

Testing, one, two, three

It's been a while. I know.

Here's the news.

I got married. We went to Greece for our honeymoon. Then we moved to Boston.

It has all been amazing.

I am now getting back into running. Last month we ran a 10k in CT in just under an hour.

Last weekend we ran The Devil's Chase 6.66 miler in Salem, MA. We made it in 1 hour and 4 minutes.

Next up: begin training for my next half marathon: The Dallas Rock 'n' Roll next March. I'm hoping that The Best Man (now, The Best Husband) and I will actually be able to run it together- assuming I can keep up with his long legs.

In other news, I just got asked to be in the wedding party of a good friend from high school. I am so excited! I love a good excuse to talk about weddings and dresses and shoes!

Run!

Today I was able to run a whole two miles without foot pain. This may not seem like much, however, I am very pleased!

MapMyRun.com | View 2 Mile Loop From The Y in Greenville, South Carolina

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I ran two miles at PT yesterday. This is kinda a big deal because that's half of what I was up to before I wrecked my foot with too much running. Also, I'm not hurting like I was after the first time I increased my mileage up to a whooping 1.5 miles. I had a doctor's appointment on Tuesday. The ortho doc pretty much discharged me- I can go back on an as needed basis. I'm going to try running outside this weekend, which will be the first time off of the treadmill. I'm stoked that I can finally run outside again...after almost 1/2 a year! Wish me luck!

My Stride

I am in the process of finding my stride, or my running mojo if you will. I've started taking my running clothes to work with me every day so I have no excuse not to run as soon as I get off work. This has worked 9 out of 10 times.

I am obsessed with a park that is half way between work and home. I have no excuse to keep driving when I have my running shoes on and the pavement is calling my name. There are numerous trails to keep me from getting bored. I can run by a jet (I'll let The Best Man tell you what kind it is, I'm not sure), waterfalls, and horses depending on which turn I take. Best of all, I feel safe. I'm not running on the road or in an unsafe area. I've been working out 6 days a week all month and running 4 or 5 of those days. I'm trying to get in a base of 12-15 miles a week before I start training for the next race (TBD?).

Not only has the frequency of my running and my mileage increased, but so has my stride. I was running anywhere between 10 to 11 minute/miles (closer to 9 on the treadmill because it forces me to go faster). 3 out of my last four runs have been JUST under 9 minute/mile. I'm hoping I can keep this up as the weather begins to warm up.

PS. Happy Birthday, Queen TK, the coolest, wino, crazy cat lady, CI ever! :)

PPS. I'm jealous of everyone who got snow! HUMPH!

Short Cut!

Due to crazy family drama that resulted in my being in the ER with my mom Sunday night until 4 AM, I broke down and went to sushi last night anyway. Boy, was it good. Before that the only human interactions I had were with the lady in financial aid (who was not happy about me asking if I could call to confirm that she actually sent my transcript) and various cranky and/or unmotivated people at the Y. A little wasabi, plus some eel and a few laughs with a red head can really cheer one up.

After 5 hours of studying slash chatting it up with KO today, I went for a run.

Its amazing how finding an evasive short cut while running can cheer me up after a few miserable days! Nothing is more exciting about avoiding busy streets that lack sidewalks than getting to run by a horse instead! Seriously cool. Thanks, Masters Laura!

Allergic to Running???

Due to a newly acquired hole in my face (a whole other ghetto fab story in and of itself) I haven't worked out in a week. I haven't run in longer do to a multitude of reasons which boil down to not making the time. After posting about the potential halves, I realized I better get back into it! So, I hit the pavement this evening!

I got hives. From what exactly, I'm not sure: running or friction or the heat. I've gotten hives in the cold before (did you know doctors can actually diagnose you with being "allergic to cold"?? I don't have this diagnosis, but my friend's sister does. It must be true.). I've gotten hives a few times running as well, but this has normally been in the cold, so I assumed that was the culprit. I've noticed these rashes on the treadmill where it's obviously not cold. This leads me to believe that maybe I'm getting this reaction due to friction? I get these reactions in places where my shorts or shirt rub on me as I move. No, it's not chaffing.

Any ideas?

So, I didn't break any records today. I was actually very, VERY slow. But, I should note that afterwards, I visited Laur & The Boys, and ended up walking with Laur & Mojo (the same exact route of my run). Hopefully, if I'm not too sore tomorrow, I'll be able to find another spot with which I can slowly get acquainted.