CHRONIC FATIGUE SYNDROME - WHAT IS IT??

Chronic fatigue syndrome (CFS) is a condition that affects approximately 1% of the population in the United States. Without treatment, CFS often leads to disability. With treatment, including physical therapy the condition can be managed well, leading to an improved quality of life.

What is Chronic Fatigue Syndrome?

Chronic fatigue syndrome is a condition categorized by generalized fatigue that persists for 6 months or longer, and is more intense than would be expected based on the effort a person regularly exerts. Although science has yet to yield a full understanding of the underlying cause(s) of CFS, many researchers suspect impairments of the aerobic energy, immune system, and gastrointestinal systems may be responsible for the functional impairment experienced in individuals with this condition.

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How Does it Feel?

The best known symptom of CFS is “postexertional malaise,” which causes a person to feel profoundly tired even with usual daily activities or minor overexertions. In addition, people with CFS may feel generalized body pains, headaches, difficulty thinking (ie, "brain fog"), and sleep disturbances. CFS has been described by some as feeling like a flu that has persisted for a very long period of time. These symptoms may fluctuate over time.

Full recovery is uncommon in adults with CFS, although it may be more common in children with CFS. Current clinical management relates to addressing symptoms and compensating for functional deficits in order to improve daily functioning.

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Signs and Symptoms

Research has identified several symptoms of CFS, including:

• Fatigue. One of the primary symptoms of CFS is fatigue that lasts 6 months or more.
• Generalized pain.There is a significant amount of overlap between diagnoses of CFS and fibromyalgia, and some studies have suggested that 50% to 80% of people diagnosed with CFS also qualify to have a diagnosis of fibromyalgia. In both conditions, widespread distributions of pain are often present.
• Frequent headaches. Many people with CFS complain about frequent or recurring headaches, which can lead to avoiding physical activity.
• Muscle weakness. Decreased physical activity can result in general muscle weakness.
• Cloudy thoughts and confusion. CFS may make it difficult to concentrate or "stay on task."
• Disturbed sleep. Despite generalized fatigue, those with CFS often have difficulty sleeping.
• Flu-like symptoms. People with CFS report flu-like symptoms, including sore throats, muscle aches, and generalized fatigue.

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How Is It Diagnosed?

CFS is a diagnosis of exclusion, meaning that no other health problem may be responsible for the fatigue. Diagnosis of CFS is symptom-based; your physician or physical therapist will base the diagnosis on the symptoms you report. They may also conduct medical tests to rule out other medical conditions. Unfortunately, there are no diagnostic tests to confirm the presence of CFS.

Your physical therapist may be the first to recognize an onset of CFS because of its effects on your physical function. Your physical therapist may ask you:

• When do you feel fatigued and how long have you been feeling fatigued?Do you experience any widespread pain or discomfort?
• Have you noticed any significant changes in your ability to perform physical tasks?
• Have you noticed any sleep disturbances?
• Have you noticed any recent changes in your ability to think clearly?

Cardiopulmonary exercise testing, including 2 tests arranged 24 hours apart, may be used to characterize the severity of your functional impairment. In addition, your physical therapist may ask you to fill out a questionnaire in order to better understand your physical state, and to screen for the presence of other conditions.

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How Can a Physical Therapist Help?

Your physical therapist will work with you to develop a treatment plan to help ease your discomfort and improve your ability to perform daily activities.

Because fatigue, pain, and weakness are all associated with CFS, treatment will likely focus on improving short-term endurance and strength. Your physical therapist may also check for other conditions, such as depression and may refer you to other specialists for comanagement of your symptoms.

Physical therapy treatments may include:

Education. Your physical therapist will teach you strategies to help conserve energy while performing your daily activities.

Movement and Strengthening Exercises. Moving and exercising can improve your short-term endurance and strength and reduce your pain. Your physical therapist will help you identify specific movements that will help reduce your specific symptoms.

Manual Therapy. Manual (hands-on) therapy may be applied to manipulate or mobilize the skin, bones, and soft tissues to help reduce pain and improve movement.

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Can this Injury or Condition be Prevented?

Unfortunately, the actual mechanisms behind CFS are not completely understood. To date, there is no sure way to predict or prevent the onset of CFS. However, early detection of the signs and symptoms related to CFS may help in its management.

Upon diagnosis, your physical therapist will work with you to develop strategies to better understand and manage your signs or symptoms.

• As with many conditions education is key. Understanding maintenance strategies, such as balancing periods of activity and rest, can help you live a functional life with CFS.
• Moderate, short-duration exercises may be performed without making your symptoms worse after your symptoms are well controlled with a pacing self-management program.
• Cognitive behavioral therapy and psychotherapy may also help in addressing possible associated disorders, such as anxiety and depression.

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Real Life Experiences

Angela is a small-animal veterinarian whose job requires her to be on her feet for 10 hours straight to perform surgeries during her workday.

Over the past few months, Angela has been feeling extremely tired, even on the days when her workload is light. Fearing that she could have multiple sclerosis like her sister, Angela makes an appointment with her primary care physician. He, after a thorough examination, refers her to a neurologist.

Angela's neurologist orders multiple tests, all of which comes back negative. At that point, she is given the diagnosis of CFS. Her neurologist refers her to physical therapy.

During her examination, Angela states that her fatigue tends to come and go, but she remains profoundly fatigued at all times. Angela has to stay in bed all weekend to recover from even a normal work week. She feels better earlier in the week than later in the week, but her symptoms are getting worse over time. Angela also says that she feels ill when she is fatigued, and that she also has difficulty concentrating. Angela reports that she has missed the past 3 weeks of work, due to her problems. She also reports that she feels anxious about the recent diagnosis, and that everything she has read about CFS sounds negative.

Her physical therapist identifies weakness, range of motion limitations, and muscle pain. The first cardiopulmonary exercise test reveals no abnormalities. However, the maximum volume of oxygen her body can consume is decreased on the second test, even though the test is rated as a maximal test. Her measurements suggest moderate to severe cardiovascular and pulmonary impairment on the second day, which explains her fluctuating functional deficits. Angela also experiences increased “brain fog” and body aches on the day of the second cardiopulmonary exercise test.

Following her exam, her physical therapist talks to her about her condition, and develops a strategy for physical therapy that he feels is best for her, consisting of activities and short exercises that will gently increase her strength and endurance, and help ease her pain.

Despite the complexity of her condition, Angela does well with a personalized course of physical therapy. Following several months of skilled services, she reports a 50% reduction in symptoms with her daily activities. With her physical therapist's help, Angela now feels confident that she can manage her symptoms as she performs her daily activities.

This story highlights an individualized experience of CFS. Your case may be different. Your physical therapist will tailor a treatment program to your specific needs.

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What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat CFS. However, when seeking a provider, you may want to consider:

• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
• A physical therapist who is well versed in the bio psychosocial model of care and understands the complexities of CFS.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.

• When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with CFS.

• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible. Keeping a journal highlighting when you experience pain will help the physical therapist identify the best treatment approach.

ERGONOMIC PARENTING: BEST WAYS TO PREPARE OR ADAPT YOUR NURSERY

The months following the birth of a child are some of the most rewarding for new parents—and the most challenging to a new parent’s body. Here are some tips on how using proper body mechanics within an ergonomically friendly nursery can help ease the strains and stresses of parenting.

The Changing Table

Before placing the baby on the changing table, it is essential to keep him or her at the center of your body. Hold your baby at the front-center portion of the torso, rather than on the side at the hip. Holding the baby on the hip can damage your low back and pelvic area. Additionally, carrying an infant close to your body helps you keep your center of balance and reduces strain on your back.

The table should be at the appropriate height for parental use. When changing your baby's diaper, the best table placement and height is directly in front of and slightly below the elbows. This helps avoid the type of bending and twisting that can cause injury.

Other tips:

• Place all diaper-changing materials within arm’s reach—for instance, in wide-set drawers directly below the changing area.
• You may wish to place 1 leg on a stool when you are using the changing table. This can help take strain off your backs and necks.

Bending and Lifting

Parents can practice proper body mechanics by learning to bend and avoiding twisting when picking up their child.

When you are lifting your child from a crib or stroller, stand directly in front of the child to avoid twisting your back. It is important to bend from your hips rather than from your lower back, much like rising from a squatting position.

To return your child to the crib or stroller, use the same technique, and always remember to keep your child close to your chest. If the crib rail cannot be lowered, place a stepstool next to the crib and place 1 foot on the stool to reduce strain on your lower back as you bend and lift your child.

Acknowledgement: Marianne Ryan, PT, OCS

APTA'S INTERACTIVE BODY

The American Physical Therapy Association (APTA)'s MOVE FORWARD - Physical Therapy Brings Motion to Life campaign just released the Interactive Body model, for both men and women, to help them research conditions they've already been diagnosed with by their physician. With the help of a physical therapist, these conditions and their symptoms are manageable and many patients find success in relieving their symptoms. 

Remember, early treatment gives you the best results! You don't have to live in pain this year - let CHAMPION Performance and Physical Therapy help you put this behind you and #MOVEFOWARD.

Copy and paste the link below into your URL search box for access to APTA's Interactive Body: http://www.moveforwardpt.com/InteractiveBody.aspx

LOW BACK PAIN: WHY YOU SHOULD GET PHYSICAL THERAPY FIRST

Over any 3-month period, about 25% of Americans will have low back pain. In most cases, it is mild and disappears on its own. But sometimes the pain lingers, returns, or worsens, leading to a decrease in function and quality of life.

In an era when back pain is often over-treated, due in part to unhelpful imaging scans (like x-rays) that may lead to unnecessary surgery, narcotics, and higher costs, physical therapy is a proven and cost-effective treatment option that you should consider as a first choice.

Studies show that early physical therapy for low back pain significantly lowers the total scope and cost of care.

Here's why you should consider getting physical therapy first:

Back Pain Often Leads to Missed Work and Overly Expensive Treatment

• According to the most recent news release (December 2014) Employee Cost Index from the Bureau of Labor Statistics, more than 200,000 incidents related to back injury were reported in 2013, causing an average of 7 days of missed work.
• Direct costs to treat back problems totaled $30.3 billion in 2007. Of that, $4.5 billion was spent on prescription medications. The average expenditure per person for treatment was $1,589, and $446 for prescription medications.

Physical Therapy Is An Effective, Cheaper First Choice

• Scientific research overwhelmingly points to the effectiveness of conservative treatments, such as physical therapy, for low back pain. Despite this, and published guidelines suggesting conservative treatment as the best first option, physicians still often order imaging scans (like x-rays), prescribe narcotics, and refer patients to other physicians, including surgeons.
• A September 2013 study found that there was no significant difference in outcomes between patients who chose spinal fusion surgery, as compared to those who chose the nonoperative treatment (physical therapy).
• An award winning 2015 study demonstrated substantial potential for lowered costs and reduced health care utilization for patients who received, and adhered to, early physical therapy for low back pain.

HAPPY NEW YEAR!

The happiest of New Years to all of Johnson and Jackson County. 
WE THINK you should make your goals to HELP YOURSELF by HELPING YOUR BODY! 

Each January, Americans rush back to the gym determined to burn off holiday season calories and work toward New Year's resolutions to get into shape. Unfortunately, various studies indicate that more than half of those who join a gym or fitness club will drop out within 3-6 months.

One common reason is injury.

Below are resources developed by physical therapists that can help you avoid injury and reach your fitness goals any time of year.

http://www.moveforwardpt.com/PatientResources/VideoLibrary/detail/safe-exercise-starter-plan

HAPPY HOLIDAYS!

Whatever holiday you may celebrate, wherever our lovely KC residents end up for the holiday seasons - may it be absolutely wonderful! 

From the CHAMPION family, to yours - we appreciate the wonderful year you've given us! 

We'll just be watching Elf and eating way too many Christmas cookies. 

HAPPY HOLIDAYS, KANSAS CITY!

HOLIDAY HOURS:

December 22nd: 7 AM - 7 PM
December 23rd: 7 AM - 12 PM
December 26th: CLOSED
December 27th: 7 AM - 7 PM
December 28th: 7 AM - 7 PM
December 29th: 7 AM - 7 PM
January 2nd: CLOSED

HOW PHYSICAL THERAPISTS MANAGE PAIN

As America combats a devastating opioid epidemic, safer, non-opioid treatments have never been of greater need.

Physical therapy is among the safe, effective alternatives recommended by the Centers for Disease Control and Prevention in guidelines urging the avoidance of opioids for most pain treatment.

Whereas opioids only mask the sensation of pain, physical therapists treat pain through movement. How movement? 

The Movement System is the new, widely-accepted way to approach injury and pain by the American Physical Therapy Association. It encompasses all aspects involved with an injury, from the skin to the nervous system - and everything involved, in-between. Most musculoskeletal pain is due to a discrepancy between muscle tightness and weakness which pulls bones into the wrong place to the point where it becomes painful. So what do we do to help?

Here's how:

1. Exercise. A study following 20,000 people over 11 years found that those who exercised on a regular basis, experienced less pain. And among those who exercised more than 3 times per week, chronic widespread pain was 28% less common1. Physical therapists can prescribe exercise specific to your goals and needs.

2. Manual Therapy. Research supports a hands-on approach to treating pain. From carpal tunnel syndrome2 to low back pain3, this type of care can effectively reduce your pain and improve your movement. Physical therapists may use manipulation, joint and soft tissue mobilizations, and dry needling, as well as other strategies in your care.

3. Education. A large study conducted with military personnel4 demonstrated that those with back pain who received a 45 minute educational session about pain, were less likely to seek treatment than their peers who didn't receive education about pain. Physical therapists will talk with you to make sure they understand your pain history, and help set realistic expectations about your treatment.

4. Teamwork. Recent studies have shown that developing a positive relationship with your physical therapist and being an active participant in your own recovery can impact your success. This is likely because physical therapists are able to directly work with you and assess how your pain responds to treatment.

Read more about Pain and Chronic Pain Syndromes.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more at our #ChoosePT page.

References

1. Holth HS, Werpen HK, Zwart JA, Hagen K. Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study. BMC Musculoskelet Disord. 2008;9:159. Free Article.

2. Fernández-de-las Peñas C, Ortega-Santiago R, de la Llave-Rincón AI, et al. Manual physical therapy versus surgery for carpal tunnel syndrome: a randomized parallel-group trial. J Pain. 2015;16(11):1087–1094. Article Summary in PubMed.

3. Delitto A, George SZ, Dillen LV, et al. Low back pain. J Orthop Sports Phys Ther. 2012;42(4):A1–A57. Free Article.

4. George SZ, Childs JD, Teyhen DS, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military cluster randomized trial. BMC Med. 2011;9:128. Free Article.

Author: Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC

BAREFOOT AND MINIMALIST RUNNING: WHAT DO WE KNOW?

Barefoot running and running in minimalist shoes have received much attention in the scientific literature and media over the past few years. However, only 25%-30% of runners have reported using minimalist footwear on a regular basis 1, 2, and only 2% run barefoot on a regular basis 1. In fact, only 20% have reported trying to run barefoot 2.

Advocates of barefoot/minimalist-shoe running suggest that changes in mechanics, foot strength, and impact have a direct relationship to injury reduction. A March 2014 article in the British Journal of Sports Medicine 3 reviews current research regarding barefoot running, and concludes that running injuries are the result of many factors, and running without your shoes is least likely to be the mitigating factor.

But research and debate on barefoot and minimalist running are likely to continue, in light of various reported benefits.

The most common justifications for barefoot running are:

1. It is the "natural" way of running.
2. It prevents injury.
3. It makes you run faster.
4. It strengthens the muscles of your feet.

Are these claims supported by evidence?
Let's explore each one:

Natural Running

While it is likely that humans' gait mechanics have evolved over eons, the evidence of the relationship between shoes and these changes is lacking. Shoes have been worn for thousands of years. More recently, the running boom of the 1970s resulted in distinct changes in shoes. Interestingly, since the change in shoe construction has changed dramatically over the past 40 years, the rate of injuries among runners has not. It would seem possible that this is due to 2 potential reasons 3:

1. Shoes are not related to the injuries, or
2. The features of shoes are addressing the wrong factors.

These facts should not lead one to believe that no shoes are the answer.

Prevents Injury

The theory for how barefoot running will prevent injury are based on 2 primary findings:

1. It reduces impact, and
2. It reduces the load at the knee.

Both of the above claims presume changes in mechanics occur with barefoot running, that running without shoes should result in a midfoot or forefoot strike pattern, rather than a heel strike gait. However, only 40%-50% of individuals who run barefoot adopt a midfoot or forefoot strike pattern.

Impact has been associated with stress related injuries to the tibia. By changing the strike pattern, the impact is potentially removed from the lower leg, but those impact forces are likely moved to the foot as a result. In fact, foot stress fractures have been related to increased loads.

While midfoot or forefoot striking reduces the impact forces at the knee, it concurrently increases the demand on the ankle muscles. If the logic is that reducing load in 1 structure will decrease injury, then increasing load in another structure should increase risk of injury. It is yet to be determined if either of these is true.

Faster Running

This appears to be a classic case of backwards logic. Runners adopt more of a midfoot strike pattern as they run faster. In fact, 73% of competitive runners in the 800 m and 1500 m events have a midfoot or forefoot strike pattern 11. However, during a marathon or half marathon, 88.9% of runners are rearfoot strikers 12.

It is often suggested that midfoot or forefoot striking is more economical (uses less energy) so therefore, you can run farther and faster. However, research suggests that forefoot runners and heel-strike runners demonstrate the same running economy at various speeds 13. So, faster runners are more likely to adopt a midfoot or forefoot pattern, but adopting a midfoot or forefoot pattern does not necessarily make you faster.

Muscle Strength

Evidence suggests that short foot exercises do increase the size of the foot intrinsic muscles; however, there is no evidence to suggest that barefoot walking or running has the same effect. There is little rationale given as to the reason for the foot strengthening 14.

• Are stronger feet less likely to be injured? Or,
• Are stronger feet more likely to protect other structures in the lower extremities from injury?

It is also important to remember that there are muscles originating outside the foot (extrinsic muscles) that play a significant role in foot and ankle control during running and walking. These muscle are longer and have greater force-producing capabilities than the muscles originating inside the foot. Finally, recent findings suggest little change in foot intrinsic muscle activity after running (with or without shoes), and no difference between shoes on and shoes off 10.

Conclusion

Barefoot/minimalist running is a popular topic of discussion that is, in reality, not very prevalent among runners. There is little data to support its use as a training tool or treatment for injury. Continued study on the potential risks and benefits of this technique is necessary to determine its usefulness.

 

References

1. Goss DL, Gross MT. Relationships among self-reported shoe type, footstrike pattern, and injury incidence. US Army Med Dep J. 2012;Oct-Dec:25-30. Article Summary on PubMed.

2. Rothschild CE. Primitive running: a survey analysis of runners' interest, participation, and implementation. J Strength Cond Res. 2012;26(8):2021-2026. Article Summary on PubMed.

3. Tam N, Astephen Wilson JL, Noakes TD, Tucker R. Barefoot running: an evaluation of current hypothesis, future research and clinical applications. Br J Sports Med. 2014;48(5):349-355. Free Article.

4. Trinkaus E, Shang H. Anatomical evidence for the antiquity of human footwear: Tianyuan and Sunghir. J Archaeol Sci. 2008;35(7):1928–1933. Article Summary.

5. Willson JD, Bjorhus JS, Williams DS III, Butler RJ, Porcari JP, Kernozek TW. Short-term changes in running mechanics and foot strike pattern after Introduction to minimalistic footwear. PM R. 2014;6(1):34-43. Article Summary on PubMed.

6. Hatala KG, Dingwall HL, Wunderlich RE, Richmond BG. Variation in foot strike patterns during running among habitually barefoot populations. PLoS One. 2013;8(1):e52548. Free Article.

7. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531-535. Article Summary on PubMed.

8. Dixon SJ, Creaby MW, Allsopp AJ. Comparison of static and dynamic biomechanical measures in military recruits with and without a history of third metatarsal stress fracture. Clin Biomech (Bristol, Avon). 2006;21(4):412-419. Article Summary on PubMed.

9. Ridge ST, Johnson AW, Mitchell UH, et al. Foot bone marrow edema after a 10-wk transition to minimalist running shoes. Med Sci Sports Exerc. 2013;45(7):1363-1368. Article Summary on PubMed.

10. Williams DS III, Green DH, Wurzinger B. Changes in lower extremity movement and power absorption during forefoot striking and barefoot running. Int J Sports Phys Ther. 2012;7(5):525-532. Free Article.

11. Hayes P, Caplan N. Foot strike patterns and ground contact times during high-calibre middle-distance races. J Sports Sci. 2012;30(12):1275-1283. Article Summary on PubMed.

9 PHYSICAL THERAPIST'S TIPS TO HELP YOU #AGEWELL

We can't stop time. Or can we? The right type and amount of physical activity can help stave off many age-related health problems. Physical therapists, who are movement experts, prescribe physical activity that can help you overcome pain, gain and maintain movement, and preserve your independence—often helping you avoid the need for surgery or long-term use of prescription drugs.

Here are nine things physical therapists want you to know to #AgeWell. 

1. Chronic pain doesn't have to be the boss of you.
Each year 116 million Americans experience chronic pain from arthritis or other conditions, costing billions of dollars in medical treatment, lost work time, and lost wages. Proper exercise, mobility, and pain management techniques can ease pain while moving and at rest, improving your overall quality of life.

2. You can get stronger when you're older.
Research shows that improvements in strength and physical function are possible in your 60s, 70s, and even 80s and older with an appropriate exercise program. Progressive resistance training, in which muscles are exercised against resistance that gets more difficult as strength improves, has been shown to prevent frailty.

3. You may not need surgery or drugs for low back pain.
Low back pain is often over-treated with surgery and drugs despite a wealth of scientific evidence demonstrating that physical therapy can be an effective alternative—and with much less risk than surgery and long-term use of prescription medications.

4. You can lower your risk of diabetes with exercise. 
One in four Americans over the age of 60 has diabetes. Obesity and physical inactivity can put you at risk for this disease. But a regular, appropriate physical activity routine is one of the best ways to prevent—and manage—type 1 and type 2 diabetes.

5. Exercise can help you avoid falls—and keep your independence
About one in three U.S. adults age 65 or older falls each year. More than half of adults over 65 report problems with movement, including walking 1/4 mile, stooping and standing. Group-based exercises led by a physical therapist can improve movement and balance and reduce your risk of falls. It can also reduce your risk of hip fractures (95 percent of which are caused by falls).

6. Your bones want you to exercise.
Osteoporosis or weak bones affects more than half of Americans over the age of 54. Exercises that keep you on your feet, like walking, jogging, or dancing, and exercises using resistance, such as weightlifting, can improve bone strength or reduce bone loss.

7. Your heart wants you to exercise.
Heart disease is the No. 1 cause of death in the US. One of the top ways of preventing it and other cardiovascular diseases? Exercise! Research shows that if you already have heart disease, appropriate exercise can improve your health.

8. Your brain wants you to exercise. 
People who are physically active—even later in life—are less likely to develop memory problems or Alzheimer's disease, a condition which affects more than 40% of people over the age of 85.

9. You don't "just have to live with" bladder leakage.
More than 13 million women and men in the US have bladder leakage. Don't spend years relying on pads or rushing to the bathroom. Seek help from a physical therapist.

PHYSICAL THERAPIST'S COMPARTMENT SYNDROME

Compartment syndrome is a serious medical condition that occurs when there is increased pressure in the muscular compartment of the limbs. When this pressure builds, there is restricted blood flow to the involved area that can compromise the health of the muscles and nerves. Compartment syndrome is classified as either acute or chronic. Acute compartment syndrome is a medical emergency, usually due to a traumatic injury, and must be addressed immediately to avoid irreversible consequences, such as limb loss. Chronic compartment syndrome develops over time, usually due to excessive or inefficient exercise exertion. Physical therapy can be effective to help identify the factors that may influence the development of compartment syndrome.

What is Compartment Syndrome?

Our limbs (arms and legs) are divided into compartments that contain different muscles, nerves, and blood vessels. Each compartment is separated by fascia, a thick sheet-like tissue that does not stretch.

Our bodies are able to handle small changes in the pressure levels within these compartments. For example, our tissues may swell slightly after a hard workout or a mild injury. However, when there is excessive swelling within a compartment due to a severe acute injury or chronic overuse, pressure builds within that compartment as the fascia does not expand to accommodate the increased volume. In rare circumstances, this condition can be more than our bodies can handle, and the blood supply to the area is restricted. If the condition persists, the muscle and nerve tissue can be harmed. It is essential to relieve the pressure immediately to avoid permanent damage.

Compartment syndrome is typically classified into 2 categories—acute or chronic—based on its cause and symptoms.

Acute Compartment Syndrome

Acute compartment syndrome (ACS) is a medical emergency. It can develop as early as several hours following a severe injury. If left untreated for even a few hours, irreversible tissue damage can occur. ACS most often develops in the lower leg and forearm.

ACS is typically caused by a serious injury, such as:

• A direct hit or blow to the limb (athletics, a significant fall)
• Crush injuries (motor vehicle accident, work-site injury)
• Highly restrictive bandages

How Does It Feel?

The most common signs and symptoms of ACS include:

• Severe pain in the involved limb that may be out of proportion to the typical response to a certain injury
• Changes in sensation (tingling, burning, numbness)
• A sense that the limb is tight or full (from the swelling and increase in pressure)
• Discoloration of the limb
• Severe pain with stretching of the involved muscle
• Severe pain when the involved area is touched
• Significant pain or an inability to bear weight throughout the involved limb

How Is It Diagnosed?

It is critical that ACS is identified and treated immediately. Following a severe injury, if an individual is showing signs of ACS, the individual should be taken to the emergency room right away for evaluation by a physician. The physician will be able to objectively measure the levels of pressure in the involved compartment. If necessary, surgery will be performed to alleviate pressure in the compartment using a procedure called a fasciotomy. During surgery, an incision is made through the skin and fascia to drain the swelling and relieve the pressure within the compartment. A patient undergoing a fasciotomy will have to spend a period of time in the hospital to ensure that the pressure normalizes and the wound heals properly. Following a fasciotomy, physical therapy is necessary to restore the motion, strength, and function of the limb.

Chronic Compartment Syndrome

Chronic compartment syndrome (CCS) is often referred to as “exertional” compartment syndrome, and is typically caused by exercise that involves repetitive movements, such as walking, running, biking, or jumping. Usually, excessive exercise causes the tissues of the leg to be overworked without time to recover. The development of CCS may be influenced by external factors, such as poor body control during movement, poor footwear, uneven or too-firm training surfaces, or too much training. There have also been cases where excessive steroid use has been linked to CCS.

How Does It Feel?

The symptoms for CCS may be similar to that of ACS, but less severe and not a result of an acute traumatic injury. These may include:

• Pain and cramping in the involved limb that usually worsens with activity and subsides with rest
• Mild swelling
• Pain with stretching
• Numbness or tingling in the limb
• Weakness

How Is It Diagnosed?

Because the symptoms of CCS are similar to many other conditions, it is important that a physician or physical therapist rules out other possible diagnoses, such as tendinitis, stress fractures, shin splints, or other inflammatory conditions. The examination may include the use of diagnostic imaging, such as an ultrasound, x-ray, or MRI to assess the tissues in the painful area.

If CCS is suspected, an individual will likely be referred to a physician for a specific test called the "compartment pressure measurement." This test is only used in cases where CCS is strongly suspected. It is performed in a medical office. During the test, the pressure in the involved compartment is measured before, during, and after exercise. The goal of the test is to reproduce symptoms as they occur during real-life activities. If CCS is diagnosed, your medical team will devise a plan to best treat your specific condition. For more mild cases of CCS, you will likely be referred directly to physical therapy. In more severe cases, individuals are likely to be referred to a surgeon to discuss the option of a fasciotomy.

How Can a Physical Therapist Help?

If you are diagnosed with compartment syndrome, your physical therapist will play an important role in the treatment of the condition, whether it requires surgery or not. Your physical therapist will work with you to design an individualized treatment program based on your condition and your personal goals. Your physical therapist may recommend:

Range-of-Motion Exercises. Restrictions in the motion of your knee, foot, or ankle may be causing increased strain in the muscles housed within the compartments of your lower leg. Stretching techniques can be used to help restore motion in these joints to minimize undue muscle tension.

Muscle Strengthening. Hip and core weakness can influence how your lower body moves, and can cause imbalanced forces through the lower-leg muscle groups that may contribute to compartment syndrome. Building core strength (in the muscles of the abdomen, low back, and pelvis) is important; a strong midsection allows greater stability through the body as the arms and legs perform different motions. For athletes engaged in endurance sports, it is important to have a strong core to stabilize the hip and knee joints during repetitive leg motions. Your physical therapist will be able to determine which muscles are weak, and provide specific exercises to target these areas.

Manual Therapy. Many physical therapists are trained in manual (hands-on) therapy, using their hands to move and manipulate muscles and joints to improve motion and strength. These techniques can target areas that are difficult to treat on your own.

Modalities. Your physical therapist may use modalities ( e.g., ultrasound, iontophoresis, moist heat, cold therapy) as a part of your rehabilitation program. These tools can help improve tissue mobility and flexibility, and enhance recovery. Your physical therapist will discuss the purpose of each modality with you.

Education. Your treatment will include education about how to safely return to your previous activities, particularly if your condition required a fasciotomy. Your physical therapist may recommend:

• Wearing more appropriate footwear
• Choosing more appropriate surfaces and terrain for exercise
• Pacing your activities
• Avoiding certain activities altogether
• Mastering strategies for recovery and maintenance of good health (e.g., allowing your muscles and joints proper rest time)
• Modifying your workplace to lower risk of injury

How Can a Physical Therapist Help Before & After Surgery?

In the event that your case of compartment syndrome requires surgery (either due to an acute injury or chronic condition), postoperative physical therapy will be essential to a successful recovery. Your physical therapist will be in close communication with your surgeon regarding the nature of your procedure, expected timelines for healing, and your progress during rehabilitation. As a health care team, your providers will develop a plan to ensure your body has adequate time to heal, while incorporating strategies to restore your motion, mobility, strength, and function.

Real Life Experiences

Caleb is a 14-year-old baseball player. One hot summer day, he and his best friend Bobby decided to get in some batting practice at the ballpark down the street. Unfortunately, the batting cages were being replaced, so they decided to practice on the actual field. Caleb offered to pitch first, as he knew Bobby needed more work on his batting to get ready for fall tryouts.

A few hits into the second bucket of balls, Bobby nailed a pitch right back at Caleb. The baseball hit him very hard in the side of his calf. He fell to the ground and was in a great deal of pain. He tried to get up, but had a hard time putting weight on his injured leg. Bobby felt so bad, he carried Caleb home on his back. That afternoon, Caleb started to feel better and was able to limp around the house. However, his leg still hurt a lot, and after dinner, he noticed his lower leg was extremely swollen, tender to touch, and warm. Caleb said that his toes were tingling, and he was having a more difficult time walking because his leg felt heavy and weak. He showed his dad, who immediately recognized that this was no ordinary bruise and took Caleb to the emergency room.

Upon examination by the emergency room medical team, Caleb was diagnosed with acute compartment syndrome. His injury required a fasciotomy to release the compartment and allow the swelling to dissipate so the pressure would decrease. He had surgery that night, and spent several days recuperating in the hospital. Bobby brought him ice cream every day.

One week after he left the hospital, Caleb was referred to physical therapy. His lower leg had lost a lot of muscle mass, his skin was very tight and tender around his incision, and he was still nervous about bearing his full weight on the injured leg. Caleb knew he would miss his fall baseball season, but was hoping to try out for JV basketball that winter. After a comprehensive evaluation, his physical therapist developed a rehabilitation plan based on Caleb's goals, and drew up a timeline for reaching them.

For the next several months, Caleb and his physical therapist worked on restoring motion at his knee and ankle. She gently stretched the muscles of his lower leg, and progressively began incorporating strengthening exercises into Caleb's routine. She also designed a home-exercise program that Caleb followed diligently.

Once he was able to walk normally without pain, Caleb and his physical therapist started working on more advanced strengthening exercises, building up to running, jumping, and "cutting" activities. Toward the end of his rehabilitation, they performed basketball-specific drills. His physical therapist was in constant communication with his surgeon, parents, and coaches to make sure everyone was on the same page regarding his recovery.

Three months later, Caleb attended basketball tryouts and made the JV squad as the starting point guard! Luckily, Bobby made the team, too. Caleb and Bobby were thrilled to be back playing sports together—although Caleb often reminded Bobby that he owed him ice cream for the rest of his life.

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of compartment syndrome. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Irion V, Magnussen RA, Miller TL, Kaeding CC. Return to activity following fasciotomy for chronic exertional compartment syndrome. Eur J Orthop Surg Traumatol. 2014 March 25. [E-pub ahead of print.] Article Summary in PubMed.

Davis DE, Raikin S, Garras DN, et al. Characteristics of patients with chronic exertional compartment syndrome. Foot Ankle Int. 2013;34(10):1349–1354. Article Summary in PubMed.

Gill CS, Halstead ME, Matava MJ. Chronic exertional compartment syndrome of the leg in athletes: evaluation and management. Phys Sportsmed. 2010;38(2): 126–132. Article Summary in PubMed.

McCaffrey DD, Clarke J, Bunn J, McCormack MJ. Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma. J Trauma. 2009;66(4):1238–1242. Article Summary in PubMed.
 

* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.