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ASK MR. EDGE

October 2008

Mr. Edge is a qualified skate technician with years and years of experience. He can answer your questions on boots, blades and foot problems related to your equipment. Questions will be answered in SKATING magazine and later posted on the web site.



The following information was passed along to me from Sarah Stegman of Los Angeles.

Apparently, Sarah experienced what she thought was shin splints. After extensive testing, she was diagnosed with Chronic Exertional Compartment Syndrome (CECS). Similar to shin splints, CECS is condition that is often misdiagnosed.

Sarah started having problems while doing her double toe. In extending her front leg, she felt a stabbing electric pain on the outside of her right leg, about an inch or so above the top edge of the boot. The pain then extended to right below her knee.

By the end of the session, her leg felt cramped and stiff. Upon taking her skates off, she noticed a lump on the outside of her leg where the pain had felt the worst. Knowing she was due for a long rest following an upcoming surgery for another sports-related injury to her hip, she decided to stop skating. In the meantime, the pain in her right leg seemed to go away. However, almost immediately after resuming her jumping routine, the pain returned. The pain soon became unbearable and she had to see a foot and ankle specialist. Fortunately for Sarah, he was able to immediately identify the problem and recommend the proper course of treatment.

Here's what MayoClinic.com says about CECS.

Definition:
CECS is an exercised induced neuromuscular condition that causes pain, swelling, and sometimes may cause disability in affected muscles of the legs and arms. Most often occurring in the lower legs, CECS can arise in both beginning and experienced athletes in sports that involve repetitive movements (i.e. jumps)

CECS is difficult to diagnose, partly because the affected area will look quite normal and may not even be swollen.

Symptoms:
The most common symptom is pain during exercise. The pain and other symptoms are often characterized by:

    1. Arching and cramping pain in the affected area during exercise
    2. Feeling of intense pressure and tightness
    3. Weakness, numbness or tingling
    4. Occasional swelling or bulging as a result of a muscle hernia
    5. In severe cases, footdrop due to nerve damage in the leg
Symptoms of CECS usually come and go in a typical pattern. Symptoms usually begin soon after you start exercise or certain activities (jumping). If you continue, the symptoms worsen. When you stop your activity, the symptoms usually go away within a few minutes or hours. However, if you continue to repeat the same exercise over a period of time, the symptoms can develop sooner, be more severe, and take much longer to subside.

Taking a long break will usually relive your symptoms, but once you start your routine again (jumping), the symptoms usually come back immediately.

Causes:
In CECS, exercise or simple repetitive muscle contraction causes tissue pressure within a compartment (groupings of muscles, blood vessels and nerves encased by a thick layer of connective tissue called fascia) to increase to an abnormally high level. However, because the fascia can't stretch, the tissues in that compartment are unable to expand.

As the pressure builds up, nerves and blood vessels become compressed, blood flow decreases and damage results to the tissues involved.

Treatments:
Options to treat CECS are few. Take your pick – conservative and surgical, with conservative methods being much less effective.

Conservative:

    Pain medications
    Stretching or strengthening regimens
    Taking a break from your daily skating routine
    Adopting different biomechanic techniques
    Consider switching to a different sport
    Surgical treatment involves cutting open the fascia of each affected compartment and removing part of the fascia.
One other possible reason for such a condition might involve skating in boots that are too stiff, for an extended period of time. If you're unable to bend in your boots, someplace other than the ankle joint has to absorb the impact of your jumps. Make sense?

Until next time,

Mr. Edge

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The opinions of Mr. Edge are his own and do not necessarily reflect the opinions of the U.S. Figure Skating or SKATING magazine. Remember, if you have problems with your feet, check with a doctor – the problem may very well be with your boot, but it could be more serious. Check with your local pro shop for more information about boots and blades.