Compartment Syndrome Diagnosis, and the Dreaded "S" Word..

What started as an annoying injury in early 2011 is going to end in surgery sometime this spring. Yes, the same spring in which I was supposed to run the Eugene Marathon, and lay down a marathon PR on the track at Hayward Field.

Compartment Syndrome was the suspect, and was confirmed when I went to see the MD on Wednesday through an Intra-compartmental Pressure (ICP) Test. This test is considered the gold standard diagnostic test for chronic exertional compartment syndrome (CECS) in terms of accuracy and reproducible. However, it is a painful and invasive procedure, which relies on the skill of the tester. In spite of those disadvantages, pressure measurements are the only available objective test. Can you tell I've done my research?


I was told to bring on the symptoms in my leg as much as possible in the couple days leading up to the pressure test. So I managed to pile of miles, some speedwork, AND hill repeats, because why the hell not. I was also told to wear my running attire and shoes for the appointment, as there would be a little running involved. Mmmkay.

Doc comes into the room, we talk marathons, and I explain my story. He gets nearly giddy about the potential of driving many large needles into my leg, and gets to work. I get an injection of Novacaine into each the 4 different compartments in my lower leg.

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 Sting and burn. Sting and burn.

Then we get into the really fun stuff. Doc pulls out one of these fun little pressure meters

and starts to beat the snot out of my lower leg. One of these babies in each of the four leg compartments. Holy hell that hurt. I put a short video below of (part of) the procedure, but be warned, it's kinda nasty.

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After the first pressure readings were taken (including novacaine, we're up to 8 needle sticks now), Doc tells me to go for a 20 minute run outside, and so kindly provides me with a loop. Errr.. Am I on candid camera? You want me to take my partially numb, bleeding leg, and go beat the crap out of it? There has to be a punchline, right? Apparently there wasn't. He told me to jog in place in the exam room upon my return, and to not stop moving until he was back in the room with me. 

One of the many things I learned Wednesday? Running on a numb lower leg is a trippy sensation. Luckily, my foot still worked, but my leg was partially numb, and my left leg was just angry that I was out pounding out more miles. Super. 

Back into the exam room, while being barked at by the nurse to continue running in place. It was the closest I've ever come to boot camp I think. Doc saunters into the room, instructs me to keep moving until he's "ready". Once he gets gloved up again, he tells me to lay on the table, and goes after those compartments again with the above torture device. Although the bonus this time is now I'm dripping sweat all over an already gross exam table and my HR is about 354. Try not to be jealous. 

When he's done, I start to get up. "Lay down, and please be still" he says. "I'm going to go get you some water, and we need to do this one more time in 5 minutes". I start laughing, and say "oh, you're hilarious". He gives me that blank doctor stare and says "I'm not kidding". Oh. 

After 5 looooooonnnggg minutes, in which I seriously debated bolting from the joint, he comes back in for another go-round. For those keeping track at home, this would be round FOUR of needle sticks, bringing the grand total up to SIXTEEN. No, not a typo. 

As he stands over his laptop, staring at some notes, he sighs. I ask what's up, and he says he needs to test one compartment ONE MORE TIME. Before I could jump off the table, there was a needle in my leg. Again. 

Finally done, he wraps me in lots of gauze and ice, while trying to break the news to be gently. 

Three of the Four compartments in my leg need to be relased via Fasciotomy, which is a surgical procedure in which they cut the fascia to relieve tension and/or pressure. 

Yes, you read that correctly. Surgery. This spring. Which means Eugene is no longer. And my sucktastic 2011 season of running continues to bleed into 2012. Awesome. 

There IS a silver lining however; more than one actually:

(1) I can run right up until the surgery, which will be no sooner than mid-March. And in that time I plan to race a 10-miler and potentially a Half Marathon. I'm going under the knife in the best shape possible. 

(2) This surgery is removing the problem that has been plaguing my training for the last couple of years. When I come out of this, I won't be sidelined by this injury ever again. And that is so damn sweet. If it happens to ever occur in my left leg? I'll take up a new sport. 

(3) While I don't know the specifics until my consultation, it doesn't appear that the recovery is too daunting. 

(4) Given the timing of the surgery, I'll have plenty of time to come out of this and train for a kick-ass late fall marathon. 2012 can still be recovered! 

More to come, but that's the current status. I'm finally not limping around today, and managed to hop on the trainer for a little bit earlier. And my plan is to try for an easy run tomorrow, and see how the leg post-jabbing holds up. 

Stay Tuned... 

Happy Training!