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Chronic Exertional compartment syndrome... 2020

Discussion in 'Common Training Injuries' started by CECSsadface, Mar 31, 2020.

  1. CECSsadface

    CECSsadface Member

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    Hello all, hope all is well.

    Back story

    I have recently been MD'd for a leg condition called Chronic Excertional compartment syndrome, i'm sure some have heard of it in training or some sort or another.

    I myself was Unlucky enough to have CONSISTENT symptoms and was taken out of WK12 of basic after coming of a TAB/YOMP, not for the lack of trying as the leg condition causes the leg to pretty much shut down as the muscles swell they cut off their own blood supply and in my case also pinch my peroneal nerve.

    I lose feeling in the foot and progresses up the Anterior compartment of the leg.
    Anyways.

    Question time.

    If i fix this condition VIA surgery (Which would have been in June, now later due to the virus) And have no underlying symptoms, build back endurance to that of a Traine would i be medically barred from service due to this prior injury?

    Spoken to my surgeon, this can be fixed and has a 80% sucsess rate, takes 8 weeks to fully heal and be back to running.

    Summary

    Have leg conditon, MD'd becasue of it, if i fix it via surgery and build back up to former fitness level, can i re-apply granted that i have no symptoms and have fitness level back to standard....

    Any response would be good, anything on the condition and people joining would be great.

    Tah.
     
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  2. StrSam

    StrSam Well-Known Member

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    I had the exact same condition. Had surgery to fix it (Bilateral fasciotomy) and then had to wait a year before applying afterwards. You WILL have to wait a year before applying. No ways around it unfortunately. A while to wait yes, but gives you time to properly rehab/gain more fitness, and learn any new skills that will help you (I started boxing/bjj classes)
    For my medical I had to write out an 8 week plan (or some amount of time ive forgotten) just to show that I could run, but no other obstacles since that really. I did have a chat with the physio at ctc at the beginning of training and he said I'll only really know if it healed properly, when I start packing on the weight and miles.

    Super quick response there with not much detail, so if you have more questions about rehab or anything, I'm open to all.
     
  3. CECSsadface

    CECSsadface Member

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    Thank you very much for the quick response and the Actually replying/taking it seriously, had a post up on Arrse a while back, alot of people taking the piss.

    Just happy someone else can relate to how *text deleted* of a condition this is, only fix is surgery,not like a broken leg or a soft tissue damage, at the moment i struggle walking more then 200m Without symptoms flaring.

    Going from sub 19 min 5k and sub 40min 10k to not being able to walk faster then 2mph for a few hundred meters sucks mentally and physically.

    So a few questions in regards to recovery/ rejoining.


    Q1 How long was it roughly after you hit the cutting table to be able to do loaded carriges ?

    Q2 How long roughly did it take to run at proper speed ?

    Q3 How long did it take to walk conistently with no issues ?

    Q4 Did you have Physical therapy after surgery and what week/how long was the treatment for ?


    in regards to the Report/ injury "LOG book" I have already started, although nothing will change until after surgery and back on the road to recovery.

    The Millitary doctor i had along with everyone else all said that is it, change career... not something you want to hear when it can be fixed from surgery.

    eagerly awaiting a reply.
     
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  4. StrSam

    StrSam Well-Known Member

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    Yeah, roger that feeling.

    Nothing but helpful advice here, and the odd bite for the people that need it!

    1. I had my surgery during the recruiting process, so I didnt load carry until now (years after) but I havent had any compartmental related pain whatsoever since my surgery, or on any marches so far.

    2. It took a good few months before I was comfortable to even attempt running. I had my Cecs for many many years so hadn't run at all for perhaps 6 years prior to rehab, so it was a slow slow process for me to even begin to run. To hazard a guess? 4 months to a proper sprint.

    3. I was off crutches after 2-3 weeks and could walk to a certain degree. Lots to build up from that point though.

    4. Had rehab at the hospital for 2-3 months, starting after a month perhaps. Lots of ankle knee and hip strengthening, balance work etc. Was great, and I still do a lot of the stuff every now and again.

    It's a tough injury to recover from, from what the physio told me. He said there have been people that get through training with it; about 50/50 chance from what hes seen (relating to RM only)

    Focus on getting the surgery and rehabbing the Fxck out of your ankles/hips after your surgery, before even thinking about loaded Carries and sprinting though.

    Was a long time ago so my timings/months might be off, but any more questions, feel free
     
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  5. CECSsadface

    CECSsadface Member

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    Lots of caution, good. I myself have had this for a while, but never knew what it was. it NEVER got to the point where it was really painful, only the odd numbness and that "Tightening", Always thought it was fatigue and carried on, it was only until;

    Everything was going well until i came of the final TAB for the role fitness test at 6miles 20kilo after 800m or so my leg was in clip, i could not doriflex both feet, 30 seconds to a minute later and i was good to go again, but the symptoms would come back VERY fast perhaps 100m ?

    I'm making sure the surrounding area is as loose as it can be with also maintaining strength, calves have always been bodybuilder level in terms of size and Vasculatity, now i know why after the diagnosis.

    Was the Hip/ ankle strengthining due to inactivity due the Injury or simply due to the traumer caused by the surgery, overall my foundtion of strength is strong, like i said losts of running and milage through the legs recently, although the last run i did was back in august so i'm hoping i can retain the fitness level alot now more so for recovery needs.

    and in terms of the symptoms coming back, have you ever had a issue with it ? Any issues with the Nerves "Waking up" a guess to how long that took ?

    and the big question.. Scars, I'm not worried about them, i'm curious to the healed state years after the Operation.

    I know there is two ways, a massive 6-9 inch incision or the more discreate two 2-3 inch ones.

    I'm going to go ahead and say that the reason for such a long recovery is becasue of the compartments released, i have issues only in the Anterior compartment, i think it would be best to get them all opened up to increase the likelyhood of the operation succeeding though.

    what sort of things where said about the surgery before the go ahead ?

    Just some details about it, its like trying to find star dust with a google search.
     
  6. StrSam

    StrSam Well-Known Member

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    Ah I remember many a tear shed during sports or during attempted runs because my legs stopped working with the worst pain imaginable. I'm very glad you haven't had to experience it.

    I think my whole leg and hip needed strengthening mainly because of the inactivity, but it definitely 100% was needed for me to start running again after surgery. You'll pretty much need to re-teach your muscles to walk again (atleast it feels like that) so you'll be doing a lot of rehab for sure.

    No symptoms since my surgery, 100% pain free. Dont remember my nerves ever needing to 'wake up' as they were very much awake for the next few weeks! Lots of painkillers needed afterwards.

    Yeah no worries about scars. Super small scars you can barely notice. Will take a picture and show.

    Get as many compartments released as they let you, but usually itll just be anterior and lateral if it's the pain you describe. The other compartments would require more incisions at other parts of the leg and wouldn't be worth the doctors' time.

    Not much was said before surgery apart from success rate, details of the surgery etc. Nothing youd need to know in advance, unless you have specific questions about it? Here for more questions if needed also.
     
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  7. StrSam

    StrSam Well-Known Member

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    15856734405511469697420673201669.jpg

    Gen can hardly see it.
     
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  8. JWJ

    JWJ Venerated Contributor

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    I had bilateral CECS, and was told by the Lympstone rehab team and my surgeon it was a very severe case of it and not normal; however, I'm about 8 months post-surgery and still in rehab essentially. I can run and do normal activity, however still have symptoms and daily pain/discomfort, and haven't ran more than 2 miles (on the advice of sports therapist) to allow a full recovery.

    Be aware that it may take significantly longer to return to full fitness, and you will have to be proactive in your own recovery. Do not try to cut ahead of your body, take it as slowly and carefully as you can, and do go and find a decent physio/sports therapist to see on a regular basis to guide your recovery after surgery.
     
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  9. Johnny_Anonie

    Johnny_Anonie Moderator

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    Fantastic posts @StrSam and @CECSsadface

    This thread will hopefully prompt another CEC sufferer to get checked out. From my limited experience, I noticed that diagnosis of chronic exertional compartment syndrome is commonly delayed. I assume this is due to the lack of education and a tendency to write any pain in the lower leg of as ‘shin splints’.

    Patients often only seek medical attention at a late stage, as they believe it to be a less serious disorder. Am I right in thinking it presents as a burning, aching, or bursting pain in both legs, which occurs only during phys and completely ceases at rest?
     
  10. JWJ

    JWJ Venerated Contributor

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    Personally I completely agree. I had this condition for years and put it off as “well running is uncomfortable for everyone so I guess this is just how it feels” - I wasn’t aware running shouldn’t be painful in my legs, and at worst put it down to shin splints.

    For me, symptoms presented as a hard to describe sensation in the lower leg, accompanied by clear pain down the anterior side of the shin starting at mid calf running to my ankle. The pain was aching but during exertion felt like a sharp bursting pain, and during longer activity like a bleep test or 6 mile run, felt like a physical “metal” rod of pain; and eventually my lower legs would be unable to lift properly.

    I was not standard in that my symptoms did not fade immediately after exercise, and I had constant weak symptoms throughout the day, being a general ache and that hard to describe feeling of pressure in my legs.

    CECS can be unilateral, and can be symptomatic without exercise, but differs from shin splints in the area of the shin/leg that feels discomfort.

    My advice for anyone at CTC: If you think you have shin splints, go to fresh cases. Yes it risks being huntered for a few weeks if it is only shin splints, but if you catch CECS early, you’ll potentially save your career and years of treatment.

    For applicants: If you feel pain in your lower leg, rest and give it a few weeks of stretching, rest and icing. If it doesn’t fade, see your GP.
     
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  11. CECSsadface

    CECSsadface Member

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    I hope others in a similar position do find this post helpful, as i have.

    Coming back to your point about shin splints, i feel the only reason that i was refered to a surgeon so quickly (2 months) is becasue the millitary physio who diagnosed me used to work at the exact same hospital i was refered to and was a former college of the NHS physio i saw.

    before i said about being MD'd at said the location of my training, he thought it was shin splints. Even though i have NEVER had a single injury in my 6 years of cycling, Running or swimming and that in my opinion still to this day, someone who has built up conditioning like myself would find it VERY hard to get "Shin splints"

    I am very foutunate to have been sent to DMRC-SH and seen by specialists who confirmed CECS and also gave me a copy of the report.

    Without that i would be overlooked by people as CECS is so uncommonly diagnosed, yet is actually quite Common in athletes that do Running or skiing.
     
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  12. JWJ

    JWJ Venerated Contributor

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    Only reason I was diagnosed quickly was Lympstone has a massively over proportionate rate of CECS, and the doctor happened to be an expert researcher on the condition.
     
  13. CECSsadface

    CECSsadface Member

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    Again i agree 100% CECS for me started as a Dull ache, even after years of running 30+miles a week it suddenly hit me, i had no idea that it was CECS, other wise i would not have went to basic.

    Symptoms progressed in basic as you get no rest, so the pressure buildup could not go away.

    In short before Training no issues other then a dull ache which felt like fatigue.

    in 10 weeks of alot less milage this dull ache changed into a weakness of the tibialis anterior and limited Dorsiflextion (Abillity to move foot and even in longer sustained efforts the whole ankle ROM)

    Quite a bit before the weakness the pain is quite hard to explain, but if you push through it like i did on a 5 mile TAB, you'll soon realise something is not right, the whole leg was numb from my foot to below my knee .

    After it started to happen on my last 6 mile TAB I came out of the group and said "I'm done" The pain.. i mean *text deleted*ing hell.

    After i got into the saftey truck my leg went back to normal within minutes.

    So anyone who has symtoms of their legs "Sezing up" get it looked at if it does not go away, spoken to people myself who went undaignosed for over a decade, long story short the nerves where a mess. get it checked as soon as possible, the longer you leave it the higher chance of it not being fixed from the surgical release.
     
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  14. CECSsadface

    CECSsadface Member

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    I'm very lucky to have been seen by people who have seen the condition lots of times, i know alot of service members got it fixed in the States, just a little less support for recruits here.

    And yes, i can imagine alot of the Potential Royal marines get this and sadly like myself get discharged, all you can hope for is that it has not progressed long enough so you can get it fixed and that the medical personel you get seen by get you a copy of the report so you can get help after being Discharged.
     
  15. CECSsadface

    CECSsadface Member

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    Yes that is correct the underlying symptoms, if you push through the Burning and aching as i did in training for 4 miles after the symptoms started the leg gets worse and worse.

    pretty much the blood going to the muscles makes the muscle bigger, the muscle can not extrude outward of a sheathe of fascia, so it has to expand inward (Where the nerves and blood supply run) the muscle effectivly cuts of the nerve and its own blood supply, if you keep pushing through it just holds the blood supply off.

    when you stop/rest it gets better as the blood is no longer needed to get alot of oxygen to the exterted muscle (Obviously needs more oxygen when the muscle is working harder)

    the cutting off of the Blood and pinching the nerve then stops you from moving anything lower then the cut off point.

    Very painfull and at rest you are completely normal, can even lift weights and stand/ walk SLOWLY.
     
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  16. HEF_RM

    HEF_RM Valuable Contributor

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    I got medically discharged in week 3 of training due to compartment syndrome in 2016. Had two operations to fix it over the course of 2 years. Now in week 9 of training. So any questions with anything please ask away. Cheers
     
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  17. Harry McRunFast

    Harry McRunFast Valuable Contributor

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    Is there anything that can be done to reduce the chances of developing this?

    It sounds awful! Sympathies to you lads!
     
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  18. Johnny_Anonie

    Johnny_Anonie Moderator

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    No.

    CECs by increased intracompartmental pressure within a fascial space. Why some are predisposed to this and others aren’t isn’t known. It may be genetics but there isn’t a sure fire way to avoid.

    The lower leg is divided into four compartments. The anterior, lateral, superficial posterior, and deep posterior. Why increased pressure occurs in some is unknown.
     
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  19. JWJ

    JWJ Venerated Contributor

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    I had a chat with a few different surgeons about this. As Johnny alluded to, its not really known how CECS develops and the process that happens physiologically leading to it. Theres a few theories but none are really accepted at this point and research is ongoing.

    They all however, said that you should be proactive with stretching and properly warming up - the same advice you've heard before. A proper warm-up and warm down after every training session, along with regular stretches (don't stretch without warming up), combined with a training plan that progressively builds up distance and pace, gives you the best chance of reducing the odds of developing any injury. Additionally, overpronation and rear-foot landing has been linked to CECS, though its not known if this is incidental or casual.

    Personally I think quite a few people at CTC have CECS, to some degree, and just ignore the symptoms or think its just general aches/shin splints. Some studies found that CECS is the cause of nearly a third of chronic anterior leg pain for example.
     
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    Last edited: Apr 4, 2020
  20. JWJ

    JWJ Venerated Contributor

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    Promisingly, for those who are affected despite having surgery (which is more common than not), there is a novel treatment that's slowly gaining ground. Instead of surgically relieving pressure, they inject Botulinum toxin A (Botox) into specific parts of the muscle and this seems to relieve symptoms and prevent the patient requiring surgery.

    Its been tested in the US military and soldiers have been able to return to fitness, with no symptoms after 12 months+; hopefully, ongoing testing proves it to be a safe and effective treatment.
     
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