This condition was first recognised in relatively unfit army conscripts who were made to do forced marches wearing heavy boots and carrying heavy loads. It is now seen principally in athletes who have a tendency to pack on the muscle.
The muscles of the lower leg are encased in fibrous sheaths and partially enclosed by the tibia and fibula bones. If the calf muscles swell, usually from excessive training too early on in the build up they may become compressed. This is because of the unusual anatomy of the lower leg with the big calf muscles and blood vessels partially wedged between the tibia and fibula bones and the exposed muscle of the shin and calf encased in a strong fibrous sheath. If the muscle grows too quickly or swells from over use, there may be insufficient room to expand. The result is a kind of tourniquet effect.
The pressure inside the muscles steadily increases as exercise progresses and the blood flow within the muscles eventually becomes insufficient to maintain metabolism and to flush out metabolic wastes, causing ischaemia which feels like a burning cramp in the affected area. This causes progressive tightening and cramping of the lower leg muscles as the exercise session progresses. Rest tends to give only temporary relief, even after several days of rest. The pain may be intense and disabling. The affected areas may feel hard and painful to press with the fingers. This condition is easily mistaken for cramp or a calf strain.
Tibial compartment compression may occur in the highly muscular person who uses an excessively “toey” running style, or who does a lot of hill climbing or sprint work that encourages excessive muscle hypertrophy. A sport like field hockey that involves an enormous amount of sprinting off the mark, sudden stopping and changing direction over an extended time may produce tibial compartment syndrome.
Compartment syndrome is a potentially serious condition because, if the blood flow through the muscles does not resume within a short period of time, the affected muscle can die. If you do suffer intense cramping pain of the lower leg during exercise and, if there is no relief within minutes of ceasing activity, consult an emergency doctor immediately and do not tolerate any waiting about – treat it as an emergency until there is medical evidence to the contrary.
Prevention is always best
Make all of your training slightly incremental over several months and include speed work at least once a week so that your muscles can gradually adapt, rather than being slammed by the unexpected.
If you are going into a new phase, such as hill work, make the transition over a week or two, rather than in just a single session or two.
Schedule recovery days and weeks as per the guidelines in this book.
Take a few extra days off if you have excessively sore muscles following a work out.
Be diligent with ensuring a nutrient rich diet, including a rich intake of magnesium. It is advisable to take up to 800mg of supplementary magnesium per day for up to three months and then continue with half that amount indefinitely.
Ensure that you have strong and flexible hips and a strong low back so that the hips and upper legs are used as your prime running muscles – if they are weak and tight, you will be forced to make excessive use of your lower leg muscles when running.
Even if your feet are perfect, do exercises for preventing pronating feet. While your feet may look perfect, this may not be the case 10-15km into a run as fatigue sets in.
Get a regular deep tissue massage of the calf muscles to keep them and the sheaths that encase them soft and pliable.
If your calf muscles begin to seize up during a run:
Stop running.
Lie down and raise your legs just a little with something comfortable such as a kit bag – not too high.
Have somebody gently massage the lower legs for several minutes, pushing the blood towards the heart.
Drink if dehydrated.
Have in your kit bag some Cramp Buster capsules. These contain a mix of magnesium and potassium. Break two capsules open, dissolve in water and drink the lot. This may help relieve the spasm.
Consult a doctor immediately if significant relief does not happen within about 15-20 minutes.
Follow the guidelines for injury management, including resuming exercise.
Continue to have regular leg massages.
Gradually resume running using the walk-run strategy as outlined in this book..
Lean your body out” over the long term if you are excessively muscular or carrying excess body weight: Go on a relatively low calories and low protein diet and do long, slow run-walks for several weeks before gradually reintroducing speed and power work. This approach will minimise the risk of excessive calf muscle hypertrophy.
Ensure that your body is not depleted of minerals, particularly magnesium, which is essential for circulation and muscle relaxation.
