Before therapists read the clinical case sent to SOMI by our former student, Brenda Howell, LMT, CMMP, Program Director of the Institute for Massage and Bodywork Therapy in Fayetteville, NC, we would like to address a few key points about the important subject of this case: Leg Compartment Syndrome.
The average occurrence of Chronic Leg Compartment Syndrome in the general population is 7.6%. (Orlin et al., 2016). Considering that the US population is 240 million, we have a staggering number of patients who suffer from different degrees of Leg Compartment Syndrome – more than 18 million!
Yes, Leg Compartment syndrome is a very unpleasant condition that greatly affects the physical abilities of many patients. However, many therapists don’t know that Leg Compartment Syndrome may result in leg amputation or even kill the patient.
If it is not treated early, and a person continues excessive physical activity, Leg Compartment Syndrome may trigger a very dangerous condition called Rhabdomyolysis. In this case, remnants of injured muscle tissue hit the bloodstream, causing severe edema, which in severe cases requires opening all leg fascia (fasciotomy) or leg amputation due to the death of soft tissue by compression. Finally, as a result of Rhabdomyolysis, remnants of injured muscle tissue may reach the liver and kidneys, shutting them down, and it causes sepsis and the patient’s death in 60% of all cases! (de Meijer et al., 2003)
Unfortunately, our family witnessed such a horrible event firsthand. Recently, the grandson of our dear friend was undergoing firefighting cadet training, and the school subjected him to several days of strenuous training in hot conditions. A recently married, young, healthy guy passed away. It started as Leg Compartment Syndrome and ended up with severe Rhabdomyolysis!
Please pay attention to this case, as the clinical application of the Medical Massage protocol for Leg Compartment Syndrome is extremely effective and important. Brenda successfully resolved 6 (!) years of pain and dysfunction, giving the patient his life back and his professional career. We can be the first line of defense and prevent similar tragedies from happening in the future.
Case Study: MEDICAL MASSAGE of Recurrent Compartment Syndrome in a Law Enforcement Officer
by Brenda Howell, LMT, CMMP
Fayetteville, NC
INTRODUCTION
Chronic exertional compartment syndrome (CECS) is a condition characterized by pain, tissue swelling, and neurological symptoms exacerbated by even mild physical activity. It greatly limits athletic and occupational performance. While surgical fasciotomy to open all fasciae is considered the standard intervention, recurrence rates of CECS and incomplete resolution remain a clinical challenge.
This case study documents the successful resolution of recurrent CECS symptoms following the application of the Medical Massage protocol, after prior surgical release (fasciotomy) and rehabilitation failed.
CASE PRESENTATION
A 28-year-old male law enforcement officer presented with a six-year history of exertional pain in the left posterior calf, burning pain at the ankle, and swelling with numbness of the foot after less than two minutes of running. Symptoms persisted despite a four-compartment fasciotomy performed in January 2023, followed by 3–4 months of postoperative rehabilitation.
Lumbar compression testing for L2–L3 and possible femoral nerve irritation assessment were negative. Compression testing was positive along the tibialis anterior muscle belly and fascial insertions at the lateral tibia. Multiple periosteal trigger points were palpated along the tibia and fibula.
The patient’s functional goal was to pass the North Carolina SWAT team physical exam, a requirement for continued career advancement.
INTERVENTION
The patient underwent 25 manual therapy sessions between October 2023 and May 2024.
- Early Phase (Sessions 2–7): Drainage, Myofascial release, Connective Tissue Massage, and skin kneading targeting anterior, lateral, and posterior compartments. The goal is to decrease interstitial edema and reduce fascial tension
- Intermediate Phase (Sessions 8–10): Introduction of Periosteal Massage to address tibial trigger points; treatment limited to small areas due to pain sensitivity. The goal is to eliminate active trigger points formed in the periosteum of the tibia and the insertion of the superficial and deep fascia
- Progressive Phase (Sessions 11–15): Aggressive Periosteal Massage with full leg decompression. The goal is the complete elimination of periosteal trigger points
- Pre-exam Phase (Sessions 16–17): Stretching and Post-Isometric Relaxation techniques prioritized; patient successfully ran a 9-minute mile without swelling. The goal is to restore the anatomical lengths of leg muscles in each compartment and reset muscle spindle receptors.
- Exam Outcome (Session 18): Patient passed the SWAT physical exam, reporting mild tenderness but no numbness. The goal is to eliminate residual tension in the soft tissues.
- Maintenance Phase (Sessions 19–25): Continued decompression and clearance of remaining trigger points; later visits addressed training-related musculoskeletal complaints. The goal is periodic maintenance.
RESULTS
- Resolution of exertional swelling and numbness in the left leg.
- Restoration of running capacity without recurrence of compartment symptoms.
- Successful completion of SWAT physical exam and entry into advanced training.
- No symptom recurrence reported during follow-up treatments through May 2024.
DISCUSSION
This case illustrates the critical role of Medical Massage in addressing persistent CECS symptoms even after surgical intervention has failed. Addressing soft tissue layer by layer and performing Periosteal Massage, in combination with decompression and connective tissue techniques, played a central role in reducing compartment tension on the leg muscles and restoring functional capacity. The patient’s high motivation and adherence to rehabilitation significantly contributed to the positive outcomes.
Further investigation is warranted to explore Medical Massage as a complementary or alternative strategy for CECS, particularly in populations requiring high-level physical performance.
REFERENCES
de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BGM, Drenth JPH. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med. 2003;29:1121–5.
Orlin U. R., Haabesland Lied I., Stranden E., Irgens H.U., Andersen J.R. Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy. Scand J Pain, Vol. 12, July 2016: 7-12
ABOUT THE AUTHOR
Brenda Howell is a licensed massage and bodywork therapist with over a decade of professional experience, including more than eight years dedicated exclusively to medical massage therapy. She is a graduate of the Science of Massage Institute Medical Massage Certification Program.
Brenda is the founder and owner of Healing Hands Body Therapy as well as the Institute for Massage and Bodywork Therapy, where she combines clinical expertise with a commitment to advancing education and standards within the profession.
Brenda’s dual role as clinician and educator reflects her broader mission: to elevate the field of massage therapy as an integral component of comprehensive healthcare, while empowering both clients and students through the healing and restorative power of skilled touch.
Category: Medical Massage
Tags: 2025 Issue #2