The zones of our body, notably in the arms, legs, and abdomen (stomach area), are divided into compartments. The compartments contain muscles, nerves, and blood vessels. Each compartment is separated by fascia, a thick sheet-like tissue that is not very elastic. The body can handle normal changes in the pressure within these compartments. For example, our tissues may swell slightly after a hard workout or a mild injury.

But pressure builds when too much swelling occurs within a compartment and the fascia does not expand to allow for the increased volume. This pressure can be more than our bodies can handle. The result is pain and muscle damage. In addition, the blood supply within and passed to the compartment gets restricted. If the condition doesn’t go away, the tissue is injured. The pressure must be relieved to avoid permanent damage.

There are two categories of compartment syndrome – acute or chronic – based on the cause and symptoms. Common signs and symptoms for both include the "five Ps":

• Pain
• Pallor (pale skin tone).
• Paresthesia (numbness).
• Pulselessness (faint pulse).
• Paralysis (weakness).

Acute Compartment Syndrome

Acute compartment syndrome is a medical emergency. It can develop as early as a couple of hours following a severe injury. With no treatment, tissue damage can occur that cannot be fixed. 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 (athletic impact, work accident, or a serious fall).
• Crush injuries (car crash, work site injury).
• Highly restrictive bandages.

Chronic Compartment Syndrome

Chronic compartment syndrome is often called "exertional" compartment syndrome. Exercise that involves repeated movements, such as walking, running, biking, swimming, playing tennis, or jumping typically cause CCS. Too much exercise, without time to recover, causes the tissues of the leg to be overworked. Development of CCS can be influenced by:

• Poor body control during movement.
• Poor footwear.
• Training on surfaces that are hard or uneven.
• Too much training.

Steroid use also has been linked to CCS.

Acute compartment syndrome. 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 the injury.
• Changes in feeling (tingling, burning, numbness).
• A sense that the limb is tight or full (from the swelling and increase in pressure).
• A limb with an odd color.
• Severe pain with stretching of the involved muscle.
• Severe pain when the involved area is touched.
• Major pain or an inability to bear weight on the involved limb.

Chronic compartment syndrome. The symptoms for CCS may be like those of ACS, but less severe and not due to an acute traumatic injury. These may include:

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

Physical therapists work together with other health care providers to diagnose and treat compartment syndrome. Your physical therapist will conduct a thorough evaluation to determine all the factors that may be contributing to your condition.

Acute compartment syndrome. ACS must be treated immediately. If you have signs of ACS after a severe injury, go to the emergency room right away for evaluation by a doctor. They can measure the pressure level in the involved compartment. If needed, surgery will be done to drain swelling and ease the pressure in the compartment. If you have this procedure, you will stay in the hospital until the pressure returns to normal and your wound heals properly. Physical therapy is vital after surgery to restore motion, strength, and function in the affected limb.

Chronic compartment syndrome. CCS symptoms can be like those in other conditions. Your doctor or physical therapist will evaluate you to rule out other possible diagnoses, such as:

• Tendinitis.
• Stress fractures.
• Shin splints.
• Oher inflammatory conditions.

Based on your exam, your physical therapist may refer you for imaging tests (ultrasound, X-ray, or MRI).

If CCS is strongly suspected, your physical therapist likely will refer you for a test called the "compartment pressure measurement." This test measures the pressure in the involved compartment before, during, and after exercise. The goal of the test is to reproduce symptoms that occur during real-life activities.

If you have CCS, your doctor or physical therapist will design a treatment program for your condition. For mild cases of CCS, you will likely be referred directly to physical therapy. In more severe cases, you will likely be referred to a surgeon.

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 (such as 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

All physical therapists are prepared through education and clinical experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with orthopedic or musculoskeletal injuries.
• A physical therapist who is a board-certified specialist or who has completed a residency in orthopedic or sports physical therapy, as they will have advanced knowledge, experience, and skills that apply to an athletic population.

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):

• Call ahead and ask about the physical therapists' experience in helping people with compartment syndrome.
• Get recommendations from family, friends, or other health care providers.
• Be prepared to describe your symptoms in as much detail as possible, and report activities that make your symptoms worse.