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Stiffness and thickness of fascia do not explain chronic exertional compartment syndrome

updated

Tags: shin pain, fascia, leg, limbs, pain problems, overuse injury, injury, running, exercise, self-treatment, treatment, controversy, debunkery, etiology, pro, massage, manual therapy

Two articles on PainSci cite Dahl 2011: (1) The Complete Guide to Shin Splints(2) Does Fascia Matter?

PainSci notes on Dahl 2011:

Biopsies of the fascial compartment of the anterior tibialis muscle were taken from several patients with compartment syndrome, with compartment syndrome and diabetes, and some healthy individuals for comparison. Although there was a lot of variability between individuals, on average there were no important differences, and in fact stiffness was 70% greater in the healthy patients — exactly the opposite of what one would expect to see if compartment syndrome was caused by stiff, thick fascia. The authors concluded that “structural and mechanical properties are unlikely to explain chronic compartment syndrome. To prevent chronic exertional compartment syndrome, it is necessary to address aspects other than the muscle fascia.”

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown.

QUESTIONS/PURPOSES: We investigated whether the stiffness or thickness of the muscle fascia could help explain the raised intramuscular pressure and thus the associated chronic compartment syndrome symptoms.

PATIENTS AND METHODS: We performed plain radiography, bone scan, and intramuscular pressure measurement to diagnose chronic compartment syndrome and to exclude other disorders. Anterior tibialis muscle fascial biopsy specimens from six healthy individuals, 11 patients with chronic compartment syndrome, and 10 patients with diabetes mellitus and chronic compartment syndrome were obtained. Weight-normalized fascial stiffness was assessed mechanically in a microtensile machine, and fascial thickness was analyzed microscopically.

RESULTS: Mean fascial stiffness did not differ between healthy individuals (0.120 N/mg/mm; SD, 0.77 N/mg/mm), patients with chronic compartment syndrome (0.070 N/mg/mm; SD, 0.052 N/mg/mm), and patients with chronic compartment syndrome and diabetes (0.097 N/mg/mm; SD, 0.073 N/mg/mm). Similarly, no differences in fascial thickness were present. There was a negative correlation between fascial stiffness and intramuscular pressure in the patients with chronic compartment syndrome and diabetes.

CONCLUSIONS: The lack of difference in fascial thickness and stiffness in patients with chronic compartment syndrome and patients with chronic compartment syndrome and diabetes compared with healthy individuals suggests structural and mechanical properties are unlikely to explain chronic compartment syndrome. To prevent chronic exertional compartment syndrome, it is necessary to address aspects other than the muscle fascia.

LEVEL OF EVIDENCE: Level II, prognostic study. See the guidelines online for a complete description of level of evidence.

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