Compartment syndrome, Sports doctor Isala

Various studies now support the use of Herzog Medical’s Sports Compressionsocks . The studies have focused on the application of the socks in calf complaints, from slight strains to ruptures in the calf, shin splints and compartment problems. A study is currently taking place at the Radboud University Medical Center into the influence of the socks on recovery, the recovery from strenuous efforts.

Research of Sports Physician Isala Clinics

Pressure in the anterior compartment of the lower leg at rest, during walking and running with and without sports compression

G.C.van Enst, sports physician Isala clinics, Zwolle

Introduction

Lower leg pain during exercise is likely to be more common than research indicates. It is a complaint that is rarely sharply asked about in questionnaires. Pain in the lower leg that only occurs during sports and actually only during certain sports (skating, running, rollerblading, walking, stepping) is usually the result of the so-called exercise induced compartment syndrome (EICS). If the pain also occurs before and after sports, then other injuries, such as periosteum inflammation (periostitis) and a stress fracture, should be considered. Why the pain occurs during exercise is not entirely clear. What is certain is that there is abnormally high pressure in the painful muscle of the lower leg. The result could be that anatomical structures, such as a muscle phascia (the wall of the muscle) are abnormally stretched and generate pain. Another explanation is that, where it is expected that the muscle blood flow during the high pressure is poor and the oxygenation of the muscle tissue falls short with a lactic acidosis as a result.

Muscles are full of capillaries, the smallest branches of the bloodstream where the exchange takes place of oxygen and nutrients (e.g. carbohydrates), but also of fluid from the blood vessel to the space between the muscle cells (the interstitium). From the same interstitium, that moisture and waste products, such as lactic acid and carbon dioxide, are discharged via venules (the smallest venous vessels) towards the large circulatory system and the heart. Lymph vessels also play a role in draining fluid from muscles towards the heart. The pressures in the capillaries, the interstitium and the venules are of great importance for the size of the transport of these substances and gases. The interstitium has a pressure that fluctuates around 10 to 20 mm Hg. In the capillaries there is a pressure of around 37 mm Hg. In the venules of about 10 mm Hg. Increasing pressure in the interstitium compresses the supplying and draining blood vessels. First usually the draining blood and lymphatic vessels and then the supplying capillaries and larger arterial vessels. The longer the pressure between that of the supplying and draining person, the longer there can be transport of substances, moisture and gases from the vessels to the muscles without it being possible to return. There is too much fluid (edema) between the cells. The pressure in the space between the muscle cells will therefore rise further and eventually rise above the pressure of the supplying vessels, so that no exchange takes place at all. From that moment on, muscles must contract using ATP from the burning of sugars without oxygen (anaerobic glycolysis). Lactic acid is formed to an increased degree and not broken down or drained.

Measuring the pressure in a muscle is done with the help of a tube in the muscle filled with water. When the muscle contracts, the pressure of the water rises in and around the muscle cells and in the tube with water. With the help of electronics, the water pressure can be converted into an electrical signal on a PC. Causes other than contraction of muscle fibers can also increase the pressure in a muscle. If the calf is pinched, there is also an increase in the pressure in the shin muscle and the weight of the lower leg that lies on a table increases the pressure through the calf even in the shin muscle.

It is often referred to as different compartments in the lower leg and forearm as if they are separated from each other. Anatomically they are indeed beautiful by separating fasciae and a membrana interossea, but in terms of hydrostatics they are not separate compartments, but are more or less one compartment. The stiffness of the fascia and in particular the membrana interossea determine the extent to which pressure can move from one compartment to another.

Sport Compressionsocks

The socks of the herzog sport compression company are used, among other things, to influence specific complaints. Patients who suffer from fluid that is poorly drained from the legs (the interstitium) via veins and / or lymphatic vessels are often fitted with socks (type A, B or C) that are (should be) exactly in size in relation to the shape of the leg. If that is not the case, there is a chance that fluid (edema) will accumulate more strongly. The cause of fluid retention is the local or generally relatively high venous and lymphic pressure relative to the interstitium, so that there is filtration of fluid from the capillary to the interstitium, but not back. Even with too low colloid osmotic pressure in the venules, edema occurs due to the poor reabsorbation of the venules.

With increased pressure in a compartment, there is too high an interstitial pressure that increases fairly quickly (in 5 to 10 minutes) due to the use of the muscle in question. First the venous discharge is blocked, then possibly the arterial supply. Due to rest, the pressure drops and the sport can often be resumed temporarily and even shorter than the first time. Whether the pain is caused by hypoxaemia of tissue or by stretching of the fascia is unknown. In addition to patients with objectified bad venous drainage, there are more and more athletes who wear supportsocks . Rarely is a bad drainage (edema) demonstrable in them. Often they have vague complaints without a clear substrate (no compartment syndrome), which seem to respond well to these socks. It is unclear what happens in the interstitium when wearing such a support stocking that does not increase the pressure in a compartment from the inside but from the outside by an attempt to reduce the space largely filled with moisture. Not only the interstitium, but also the arterial and venous pressure will rise from the outside at not too high and evenly distributed moderate pressure.

Experiment

Because our sports medicine department has 15 years of experience in measuring pressure in muscles of the back, forearm, hand, upper and lower leg during sports (walking, running, stepping, trampoline, skating board and cycling), we measured the interstitial pressures in the front compartment of the lower leg with one volunteer while wearing the Herzog sports compressionousus and immediately afterwards. More than an indication of the process that takes place while wearing such a stocking does not give such a perception in one person. After the pressure was measured at rest, during walking (4.5 km/h) and running (7.5 km/h) on a conveyor belt, the stocking was cut sitting. During cutting, the pressure could be measured continuously.

Table 1

Explanatory note Table 1

Pressing in mm Hg during rest, walking and running in one subject with and without sports compressionous. The normal values (without compression stocking) are based on observations in 8 healthy subjects.

The conclusion on the basis of this one measurement were:

• All pressures in the front compartment in these complaints free subject at rest, during and after exertion while wearing the stocking were significantly higher than without a stocking.
• When cutting the compression stocking (removing the external compressing pressure), the pressure dropped directly to the normal value.
• During rest and exercise, the subject did not get any complaints while there were pressures that are known to be abnormal.

Conclusions for practice

It was clear in this study that the interstitial pressure went up sharply while wearing the sports compressionous. Effects on not forming edema will almost certainly have this stocking. It is still unclear whether this can also affect the exercise compartment syndrome in a favorable way. However, our first experiences in practice with prescribing and wearing these sports compressionsocks with complaints that may fit the exercise-related compartment syndrome are positive.

11.06.2009