Thursday, November 11, 2010

Team Singapore Asian Games Athlete Has Compartment Syndrome? No Way

My first patient at 830 am today was an interesting case. The patient (who shall remain anonymous) was told that he/she had compartment syndrome and he/she had so far received acupuncture/ needling with current, massage (many times), electrical stimulation plus other treatment on the leg and foot etc but did not get better at all.

Now my patient is due to fly out to Guangzhou to represent Singapore for the Asian Games early next week and presented this morning with tingling sensations on the lower third of the right leg and the patient also complained there was decreased sensation there and also had pain in the web space between the big and second toe. Now those of you (who are physiotherapists) reading this should already be thinking to yourselves that nooooo, this cannot be a case of compartment syndrome.

If a patient has compartment syndrome he/she will complain of pain, paresthesia (or pins and needles), the limbs (usually legs) being very tight, tense and full of pressure. Temporary paralysis sometimes occurs. It usually happens to athletes at the start of the season after their break when they train too hard, too soon. The muscles expand and they fill up the space in the legs and "squeeze" the nerves there leading to sensations of tightness, pressure or pins & needles as the connective tissue that separates each section or compartment does not stretch hence leading to the term.

Now, my patient is at the tail end of the season (not at the start of the season and certainly not after a break from training), the symptoms he/she complains of doesn't resemble compartment syndrome at all I thought. Why? My patient's pain did not subside after training/ cessation of activity. In compartment syndrome, with cessation of physical activity, the muscles will stop working and subsequently stop squeezing on the nerves and the patient's pain/ pressure/ tightness should settle (but did not).

The biggest clue to me was the pain between big and second toe. This is a definite L5 (deep branch) nerve root distribution (which I confirmed after checking my patient's lumbar spine).

After assessing my patient fully, I treated my patient's spine and nerves, taped his/her foot and taught a nerve stretch and I just found out my patient was better and able to train later.

Well, I am no longer working at the Singapore Sports Council and I can only treat the athletes that come and look for me at our clinics. So my best wishes to Team Singapore at the Asian Games.

All the best at the Asian Games, Team Singapore. Do us proud.

*Picture shows treatment of my patient before coming to see me

No comments:

Post a Comment