Pain in the….leg?

How to treat and what is anterior compartment syndrome

Anterior Compartment Syndrome is a condition affecting the leg, typically impacting runners, dancers, and other athletes.

It can arise when the foot-strike pattern favours the heel, with a ‘lazy’ foot-slap as the front of the foot (forefoot) follows the heel to the ground. It is the job of the anterior muscles to decelerate the forefoot and control the foot slap.

If those anterior muscles are weakened or dysfunctional (such as when there is a nerve compression), they stress out and become inflamed as they try desperately to do their job. This can lead to shin splints, fallen arches, or anterior compartment syndrome.

The four muscles attached to the front of the foreleg (shown below) becomes constricted within the skin-like compartment housing them, reducing outgoing blood flow, which in turn further fills the compartment.

This causes quite a lot of pain – especially when exercising.

In this article we briefly discuss options for treatment, both with massage and manual therapy, and beyond.

The first method of treatment is usually abstinence. However as I have discovered, try telling a passionate runner or tennis player to stop running – forever (because that’s what they are looking at) – and see what happens.

For this reason I like to give them at least a chance with manual therapy assessment and treatment before writing off forever the idea of running again.

Pain medication is not usually effective at treating the condition. Conventional treatment is to surgically open the compartment to release the pressure. In many cases, symptoms return and some patients will have two, three, or even four surgeries. Even then, the pain may return.

Manual therapy treatment assesses the relative strength of the calf muscles (which tend to dominate) versus the anterior compartment muscles (tend to be weakened and overpowered), and aims to re-balance any difference.

Then the job is to reduce the pressure in the anterior compartment by gently stretching the connective tissues, thus loosening the fascia and returning blood flow.

We then teach the client the correct corrective exercises they need to improve foot strike patterns and retain the balance achieved in treatment.

This protocol is not always successful. It depends a lot on the habits and structural patterns of the client’s body. Certain elements can be corrected (such as muscle tension) certain others cannot (such as bone shape or previous surgeries).

If the symptoms persist, a foot specialist such as a podiatrist is the next port of call.

Failing that, surgery is the last option.