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2009-03-07 5:05 AM

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Subject: Soleus and/or Deep Posterior Compartment Syndrome
I have been battling a debilitating lower leg problem since last May and cannot seem to recover. Wondering if anybody else has experienced a similar problem and what they did / found out. I can swim and cycle just fine, absolutely no problems. I cannot run at all without "bone breaking" type pain developing one third up each of my tibias on the inside over an approximately 2 to 3 inch length. Web research, ortho folks I have seen, and physical therapy have all pointed to the soleus muscle. I have tried all of the conservative therapies for a "tight" soleus which have included multiple extended periods of rest (anywhere from 4 to 10 weeks), I've done the ibuprofen / icing / stretching route, and I just finished up 8 weeks of intensive physical therapy (3 day/week, lots of weird stretching and leg exercises) all to no avail. What happens is on an initial run, I generally can complete up to 5K with no significant problem (will feel tightness in the center of the lower leg). After that run (maybe overnight, sometimes the next day), the leg will become tender on the inside of the tibia (really kind of behind it) about one-third up the leg. On a subsequent run, this will flare up during the run and increase in intensity until it literally feels like I must have broken my legs (like someone rapped across my shins with a miniature baseball bat). This pain will continue for a couple of weeks if I don't do any running at all. After almost a year of conservatively trying to get over this, I've decided to get aggressive and am awaiting an appointment with an ortho specialist in another state. I had previous compartment syndrome and anterior and lateral releases about 5 years ago. I called that surgeon and he recommended another specialist who specifically works on the injuries for athletes. Searching the web hasn't really yielded much on this specific symptom other than a couple of references to "soleus syndrome" and mention that for recurrent cases a release of the soleus attachment to the tibia may be required in conjunction with a release of the deep posterior compartment. Anyone else either have or hear of this type of injury? Thanks in advance for anything. So frustrated dealing with the unknown. I should also note (because the symptoms do point to this as a possible cause) this has been ruled out as a stress fracture via both X-Ray and MRI. I can also continue to do leg strength routines with no pain except for leg presses and seated calves (both of which stress the soleus muscle).

Edited by Hacksaw 2009-03-07 5:09 AM


2009-03-07 12:45 PM
in reply to: #2003343

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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome

Sounds like you have real mess going on down there!!

I was going to say get checked out for a possible stress fracture, but then you dropped that into the last sentence or two of your paragraph.

You have already had compartment syndrome and went through the surgery to release that tissue.  This means that the tissue down there is probably not very "happy".  In addition, when ever we have a surgery, myofascial lines are changed and that affects the way that tissue pulls when ever we do anything and move.  This is call tensegrity - think about a spider web and how if you give a gentle pull on one side, it will affect the whole web with a pull towards that side.

Have you had anyone do specific soft tissue work?  I am not talking the little rub a dub crap they do at a spa or even the 5-10min. of soft tissue nonsense that a lot of physical therapists do.  I am talking real, "clinical" work.  Like something an active release therapist might do or a neuromuscular therapist.  Scar tissue (from training stress, overuse, surgeries) will lay itself down like a thick web, all matted up and in a variety of drections, and prevent proper soft tissue movement and lead to ischemic tissue, trigger points and myofascial pain and dysfunction.  Have a hands on manual therapist go in and work on that scar tissue to break it up and then have you perform some stretching, eccentric exercises, and then ultimately exercises which re-integrate you back to regular functional movement and re-groove patterns can do wonders for re-aligning the tissue into a parallel order and allowing it to function properly.

It is a shame you are in GA, because this is the main type of work I do (almost exclusively for athletes) and since you have been through all the doctors and ruled out many things, we could be pretty aggressive in trying to restore function.

 

Patrick Ward, MS, CSCS, LMT

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2009-03-07 7:43 PM
in reply to: #2003343

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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
Well, there's a lot of scar tissue down there.  Stretching and strengthening aren't helping, so what else is there?  Make sure your pelvis is aligned - if you're still in physical therapy the therapist can check it there, and other healthcare providers can do the same thing.  ART and Graston technique will help...i'd lean towards the Graston but it all depends on what's available to you.  Also, get your feet checked.  Maybe you've got a need for orthotics, and a lack of support in the foot could be causing the issues you're having.  These are pretty standard things to do, but they can make a world of difference if that's the cause of your problem. 
2009-03-07 8:41 PM
in reply to: #2004147

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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome

chunta - 2009-03-07 6:43 PM Well, there's a lot of scar tissue down there.  Stretching and strengthening aren't helping, so what else is there?  Make sure your pelvis is aligned - if you're still in physical therapy the therapist can check it there, and other healthcare providers can do the same thing.  ART and Graston technique will help...i'd lean towards the Graston but it all depends on what's available to you.  Also, get your feet checked.  Maybe you've got a need for orthotics, and a lack of support in the foot could be causing the issues you're having.  These are pretty standard things to do, but they can make a world of difference if that's the cause of your problem. 

 

Great post.

 

Pelvic position is critical and ASTYM (same as graston except physical therapists do it) or Graston  are both great for breaking up scar tissue and if it is really matted down, they will work better than someone using their hands and doing ART.

 

Patrick Ward, MS, CSCS, LMT

2009-03-22 2:22 PM
in reply to: #2003343

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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
Let's start a club. Mysterious calf pain has been making a mockery of my running efforts for years now too. If nothing else it is nice to read this, learn from it, and at least know that I am not alone in being some sort of genetically mutated freak with bad calves and deep scar tissue. The pain thing for me has not been the "hit by a bat" sort of thing. For me the pain is like a hot knife blade going in to my calf. Given the pain the most surprising thing, as others have noted too, is that I can do everything else including biking and weights without issue. Very frustrating.

As I start my runs again this spring, I'm going to concentrate on the technique in Chi Running. I forget who the author is, but part of what he writes is to be aware of lifting your foot up off the ground using your upper leg muscles to pull your foot up off the ground RATHER THAN using your calf muscles to push up off the ground.

My first few runs have been very slow but promising, as this technique gives me a noticeably different feeling in my calves in trying NOT to use them to push off of the ground with but instead keep them a bit more passive and let the bigger upper leg muscles do the lifting.

Hope your upcoming season works out!
Jeff
2009-04-26 12:11 PM
in reply to: #2003343


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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
Hacksaw, I am suffering from almost identical symptoms and have for the last 7 years without anyone being able to determine what is wrong. In my case however the pain develops on the outer edge of my tibias (anterior side) about 1/3rd up my lower legs. The pain is usually accompanied by inflammation starting in my arch rising up the outside of my ankle and up the tibialis anterior muscle. So far, I had bilateral lower leg fasciectomies of the posterior compartments; custom made orthoses, X-rays, MRI scan and numerous orthopaedic surgeons, physiotherapists and orthopaedists all unable to work out what the problem is. I am currently waiting to have the pressure tests of the anterior compartments carried out. I did however read somewhere that your fascia incisions can close up after a while and further surgery may be required. Did your pain disappear after the surgery only to return again? I also heard a lot of good things about deep tissue massages and will try Graston technique providing I find someone in Scotland who can do it. Please keep us posted about your progress.


2009-05-04 10:21 AM
in reply to: #2003343


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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome


Edited by J_Otten 2009-05-04 10:35 AM
2009-05-04 10:34 AM
in reply to: #2003343


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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
Hi Hacksaw,

your text is something I could have written... I have EXACTLY the same symptoms, inside of the tibia, "bone breaking" type of pain, swimming/cycling is 100% fine but running/jumping kills me, ... everything. Except that I can't do leg strenghtening exercises either (like squats, which I like to do). Well, I can do them, even pain free, but the tenderness/stiffness will be worse the next day. I've also been battling this frustrating 'affliction' since April/May 2008, I've seen ortho's, massage therapists, sports doctors, tried stretching, strenghtening, got insoles (soft and hard), ... and I'm on the brink of... well no, I'm actually past the depression (I really live for sports), but I just won't rest untill I get rid of this.
So I've come to the point where I think that the release of the soleal attachment to the tibia is the only option. Looking at the symptoms and the mechanisms that cause the injury, it makes perfect sense. I've also read tons and tons about the subject, so I know more or less how things work in the lower leg.
I'd really like to hear about it if you have the surgery or if any other treatment has been succesful for you. Please, I'd really appreciate it if you could keep me updated. My e-mail is jacques_otten@hotmail.com, feel free to use that. Thanks, and good luck!

Jacques

Edited by J_Otten 2009-05-04 10:37 AM
2009-06-24 10:49 PM
in reply to: #2003343


1

Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
Once again, I have very similar problems to hacksaw AND J otten. How are you guys going with it?

Any ideas.

If we all pool what works for us it hopefully we can end this!

Thanks
2009-06-25 10:16 AM
in reply to: #2003713

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Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome

Patrick Ward - 2009-03-07 1:45 PM

Have you had anyone do specific soft tissue work?  I am not talking the little rub a dub crap they do at a spa or even the 5-10min. of soft tissue nonsense that a lot of physical therapists do.  I am talking real, "clinical" work.  Like something an active release therapist might do or a neuromuscular therapist.  Scar tissue (from training stress, overuse, surgeries) will lay itself down like a thick web, all matted up and in a variety of drections, and prevent proper soft tissue movement and lead to ischemic tissue, trigger points and myofascial pain and dysfunction.  Have a hands on manual therapist go in and work on that scar tissue to break it up and then have you perform some stretching, eccentric exercises, and then ultimately exercises which re-integrate you back to regular functional movement and re-groove patterns can do wonders for re-aligning the tissue into a parallel order and allowing it to function properly.

This is the exact thing that I was thinking.  Its a whole lot less invasive than surgery.  Active Release Therapy (ART), Myofascial Trigger Point Specialist, Kenesis Myofascial Integration (KMI) and different specialties that might be able to help. 

Good luck

2009-06-26 1:46 AM
in reply to: #2003343


6

Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome
All the previous advice is great, and I know you already ruled out stress fx by way of x-rays and MRI. But for one x-rays will only show a stress fx if it is really far along on the point of almost turning into a true fx or by the signs of healing, and MRI looks at soft tissue it is not reliable for looking at bones. I would recommend asking your doctor for a bone scan. They are a lot more sensitive to stress fx. 

Regardless based on how far along this injury seems the only way its gonna get better is rest, following all the previous advice and get your training affect by ways of low impact training swimming, biking, and aqua jogging. A good physical therapist of athletic trainer can advice you in those regards.

Good luck I hope you get better.  


2010-01-07 12:22 PM
in reply to: #2003343

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Peachtree City, GA
Subject: RE: Soleus and/or Deep Posterior Compartment Syndrome

J Otten & Katherine91,

Sorry, I did not really monitor my post after the first 6 weeks or so. I came back upon it as I was looking for posts regarding stress fractures. I can provide a brief update here (more details via PM if anyone is interested). I had surgery in May 2009 for release of the posterior and deept posterior compartments and release of the soleus. I can say that this surgery was a 100% success for me. the surgeon ended up finding a rupture of the soleus due to the tight fascias. Recovery was pretty quick from this which I attribute to 1) skill of the surgeon (this one was way better that my fasciotomoies of the lateral compartments) and 2) fitness which I had maintained through cycling. I walked out of the hospital the next day without crutches even though both legs were cut (granted I was high as a kite on  Vicodin but still...). Within 3 weeks of the actual surgery, I was biking around 3-4 hours per week.  Istarted stairclimbers and ellipticals within a month and was back to track racing (bike velodrome) within 6 weeks. Within 8 weeks I began running again. Now the only downside (which is due entirely to my own eagerness/stupidity) is that since I had plenty of cardio fitness (due to biking) and sufficient leg strength (from strength training / elliptical, etc), I was easily able to outperform my own legs since they were not used to the impact of running. Thusly, I now have a stress fracture in one of my tibias. Even though its disappointing to be down again, I know this will heal and I'll be back running. I had worked up to comfortably running 10K distances before the wheels started falling off at Thanksgiving. So all in all, my course of treatment was exactly what was needed for my condition. It is often very, very difficult to determine the source of the problem / injury, particularly in the lower leg. I really had to work to find the right surgeon and to educate myself on all possible sources of the problem to get it right. Very frustrating I know, but patience and diligence will pay off. Granted there are plenty of risks associated with something as invasive as a fasciotomy but it comes down to "how bad do you want to be able to run again" which is what my surgeon asked me before cutting.

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