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Chronic Compartment Syndrome – More than pain

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No one should experience chronic pain. It is a difficult but inevitable part of health care. It directly impacts physical, mental, work, social, family & overall quality of life. It is more than pain.

 

Compartment syndrome (CS) is a medical condition causing excessive pressure build up inside an enclosed muscle space in the body. This excessive pressure build up results in insufficient blood supply to the tissue within that space, commonly experienced within the lower leg, causing severe pain, poor palpation of pulses, decreased range of motion of joints, numbness & other sensation changes, & can be limb/life threatening if left untreated.

 

It is estimated that nearly half a million cases are diagnosed every year within Australia, yet treatment modalities for this seriously debilitating condition are still very minimal. RICER, anti-inflammatory/pain medications, massage, dry needling, stretching, orthoses, physical therapy & anti-inflammatory focused nutrition guidelines seem to be some of the only non invasive measures for treatment before looking into surgical interventions including fasciotomies (invasive surgery that involves cutting the fascia & the muscle to relieve the pressure).

 

There is multiple causes for CS, though it is most often due to injury, such as fractures that cause bleeding into a muscle, which then causes increased pressure in the muscle itself. This pressure increase causes nerve damage due to decreased bloody supply. It is interesting to note that roughly 90% (some would argue a higher percentage) of neurological disorders have one thing in common; diminished blood flood issues. If there is such a high relationship between CS and diminished neurological condition, we should therefore explore options for revascularisation & blood flow promotion to these areas, right? This is why high power laser was an option of choice due to its photobiomodulation, cell regeneration & revascularisation properties.

 

Below is the timeline of a patient that was initially diagnosed with medial tibial stress syndrome (MTSS or shin splints), then progressing to CS 12 years ago while in the army undertaking pack marches daily with 60kg+ packs, which two years after diagnosis lead to a medical discharge from the defence force.

 

Patient: Matt. M

Age: 30 years old

Occupation: Ex-Military commando

 

2008 – Diagnosed with Bilateral Compartment Syndrome and shin splints from over exertion and excessive exercise

2009 – Bilateral fasciotomy no improvement in pain or condition

2010 – Medical discharge from the army and told no more medical treatment could be done to improve my injuries or quality of life and that chronic pain was something I have to deal with from then on.

2010 to 2018 I dealt with the chronic pain as best I could until a workplace injury in Oct/Nov 2018 exacerbated my condition.

2018 – Further testing from multiple specialist diagnosed me with Bilateral Popliteal Artery Entrapment  as well as still having elevated compartmental pressure in the range of requiring immediate surgery. 

2019 – First Popliteal surgery in May on the right leg and September the left leg. Post surgery scans showed the artery was no longer entrapped on either leg. After each surgery I was treated by a physio and performed my own physical fitness training within the limits of my pain threshold. No significant improvement.

2020 – No improvement to my chronic pain levels. July had 3rd party post surgery testing performed which has shown the artery on both legs is still entrapped when after physical exertion. With compartmental pressure x4 higher than normal limits, & meaning I had to leave the work force due to pain levels.

2020 – August, treatment with Milner Biomedical began. September 3rd party post-surgery retesting to be carried out.

 

Once a week treatments of laser therapy over the last 3 weeks (3 sessions), has lead to a drastic increase in ankle joint range of motion (6cm knee to wall test to 13cm within 3 treatments), enabling Matt to undertake some stretching protocols that he hasn’t been able to do due to pain in years, a delayed onset of pain while undertaking stress testing post treatment (pain onset after 4 calf raises to now 16 unbroken raises before onset of pain) & reducing pain from 10/10 on a visual analogue scale (VAS) at the end of each day to a 6-7 VAS by the end of each day post treatment.

 

Amazing results given the extent of this chronic condition & the levels of pain he was experiencing daily (reaching a 10/10 on a VAS by the end of every day), all previously controlled through medication, rest, zero activity & surgeries with minimal improvement.

 

We look to continue high power laser treatment as an alternative modality for the management of chronic compartment syndrome with the aim to return to work, reduce pharmaceutical use, & eventually, return to full capacity of exercise & daily living pain free.

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