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Exercise-linked chronic exertional compartment syndrome in sport

DOCTOR’S CORNER with Dr JOSEPH KABUNGO
Exercise has been found to be extremely important because of the health benefits that it has to an individual. Currently there are a lot of fitness clubs, which have mushroomed in Lusaka, and people have taken these very seriously and strictly follow their exercise schedule.
Despite exercise being important especially in the world where non-communicable diseases like hypertension and diabetes have become serious threats to health, there is also need to look at the problems associated with exercise. It is definite that the benefits of exercise outweigh the risks, which might be associated to activity.
However any one involved in any competitive or recreation sport should have basic knowledge on some of the problems, which they might encounter, and how to deal with them.
In today’s column my focus will be on chronic Exertional compartment syndrome, which is exercise, linked.
Last Sunday, Acute Compartment Syndrome which is linked to muscular injuries was talked about and the importance of recognizing it’s occurrence. Despite this particular problem being rare in sport, it becomes vital for quick recognition and taking action taken in the immediate if at all it ever happens.
I will relate some of the important similarities which exist between an acute compartment syndrome and the one which is associated to exercise which we often refer to as Exercise linked or Chronic Exertional compartment syndrome.
During the course of the week I had to respond to various issues that came up after discussing the Acute Compartment syndrome in muscular injury. One local coach from the copperbelt, narrated on one scenario that he had personal experience with.
This had to deal with the pain that is felt after tightly applying a crepe bandage by football player but in no time they stop running and immediately request for time to have the strapping or crepe bandage removed or loosened.
The coach was actually wondering whether this can be termed as a compartment syndrome. I want to shed more light on this issue again so that a distinction can be made between an acute compartment syndrome as was seen last Sunday and that one linked to exercise can be appreciated.
For the interest of my friends who missed last Sunday’s column on acute compartment syndrome, I will highlight some of the important signs and symptoms which are quite similar to those seen in chronic exertional compartment syndrome in various sports disciplines.
It will be important to differentiate the way the two conditions will show in sports men.
Acute compartment syndrome is often seen in athletes after application of a plaster of Paris (POP) to a fractured leg or arm that is undergoing a very active process after injury and this does not give an allowance for the inflammatory process to settle.
Most of the cases of acute compartment syndrome cases recorded in sports have had to do with a tightly fitting POP that is applied following a fracture either to the leg or arm. This accounts to the signs and symptoms that are seen in compartment syndrome and quick recognition of this potentially serious problem is key.
Muscular injuries of the thigh, calf and also the arm are also known to show compartment syndrome as one of the complications.
It was seen that when a muscle is injured, it undergoes processes which results in the limitation in the space were the muscle is enclosed. Other causes which are not related to sport include burns, snakebites, and certain bleeding disorders.
The reason why compartment syndrome occurs is because of the inflammation which happens in the various compartments which enclose the muscles.
Muscles where compartment syndrome occurs are enclosed in non-elastic strong fibrous sheaths which cannot allow the muscle to expand further as the result of injury.
This results in disruption in the blood supply, drainage of blood and lymphatic flow from the affected part. The nerve supply leading to the observed neurological signs and symptom are also a major component.
It was seen that typical signs of acute compartment syndrome are pain, pallor, parasthesia (numbness), paralysis and pulselessness (unable to feel the pulse). These are what are referred to, as the 5P’s of acute compartment syndrome.
Having talked about the issues relating to acute compartment syndrome, I want to draw your attention to how chronic Exertional compartment syndrome will show.
Chronic exertional compartment syndrome is a rare occurrence in sport, but it is important that this is well understood in order to reduce the fears that are associated with it and better plan on how to deal with it once it occurs.
One important feature of the chronic exertional compartment syndrome is that the signs are much more pronounced at the beginning and during exercise and these normally disappear after some one has finished exercising.
The disappearance of symptoms varies and on average takes fifteen to thirty minutes. This condition normally happens in sports such as football, rugby, athletics involving running, and many other sports involving repetitive movements.
It must be noted that chronic exertional compartment syndrome is an uncommon exercise induced neuromuscular condition that causes pain, swelling and sometimes even disability in the affected muscles of the legs or arms.
Since it is linked to exercise, it is the reason why pain which starts soon after beginning exercising and progressively gets worse as someone continues exercising has to be reported.
As seen earlier the pain usually stops after stopping exercising and the time interval might range from fifteen to thirty minutes in the affected limb (arm or leg). Over time the pain may begin to take longer than the mentioned time and might even linger on for a day or two.
This conditional will definitely affect someone’s participation in sport and taking a break from exercise will actually relieve the symptoms, but usually temporarily. Once running is resumed for instance, these familiar symptoms will appear.
Unlike acute compartment syndrome which needs immediate medical attention, chronic Exertional compartment syndrome usually takes time before someone seeks medical attention.
It is important to seek medical attention when you experience unusual pain, swelling, weakness, loss of sensation, or soreness related to sport or after doing exercise.
The mentioned symptoms might be enough warning that you are having chronic exertional compartment syndrome and you might need medical intervention.
It is vital that a sports man or even any other person who regularly exercises and experiences the symptoms mentioned to stop exercising through pain as this might lead to permanent muscle or nerve damage.
The common question is, what exactly causes this problem to occur in an individual? As mentioned above, exercise or repetitive movements causes pressure to increase in an enclosed compartment and this causes increase in compression of the blood vessels and nerves.
This in turn will result is reduction in the amount of oxygen rich blood that reaches the respective body part (muscle), a condition refereed to as ischemia. Muscle tissue ischemia is very pain painful and will need attention so that so that the trigger for this is managed.
The nerves and the muscles may sustain damage as result of this and hence the need to seek prompt medical attention when you experience strange pain in your legs during exercise.
It is not well understood why exercise or muscle contraction causes this increase in pressure in muscle compartments of some people leading to chronic Exertional compartment syndrome.
However some suggest that this increase in pressure has to do with some biomechanics on how someone moves, such as landing during running or jogging. Others have also attributed the increase in pressure to muscle enlargement or a high pressure within the veins.
All in all, compartment syndrome whether acute or chronic always requires that appropriate medical steps are taken in order to correct the situation. It is important to pay extra attention to any pain arising in the muscles, especially if it is accompanied with numbness, swelling and even weakness in the leg.
This might be a warning sign of this rare but important condition due to participation in sport. However, I still encourage you to maintain a programme of regular physical exercise, because the benefits outweigh risks that are associated with exercise.
If at all you experience this sort of problem, it is important that medical attention is sort and this has to be done in an institutional with appropriate expertise and experience.
I recommend a program full of static exercises in individuals who repeatedly encounter this problem. Static exercises are better regulated and this will prove to be very beneficial to a person with a well-known problem of Chronic Exertional Compartment Syndrome.
Lastly but not the least I want to congratulate my friend Janny Sikazwe for successfully representing Zambia and the entire continent at the recently held FIFA Club World Championship in Japan.
To all my friends who regularly follow my column and greatly contribute to it, I wish you a wonderful Christmas period and indeed a great New Year!!!!!
For questions and comments write to Dr Kabungo JosephEmail Address: zengajk@yahoo.com or kateulejk@gmail.com

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