Compartment syndrome & cycling performance

[sim-o]

16 months ago I was diagnosed with CECS (chronic exertional compartment syndrome) in the posterior calf muscle compartment, both legs. This fun little injury presents itself in the form of an excruciation burning sensation in both calf muscles when walking uphill or running. It gets worse as you increase intensity, duration and load of exercise. Think of the burning you get as lactic acid builds when climbing a hill on the bike, and multiply that a few times . The only way to fix it is to go under the knife and have a Fasciotomy to release the tension.

It does not appear to affect cycling in the same way, since you are not loading the calves in the same way, or to the same degree. Because I was happy to drop running, and continue cycling, I opted not to go for the surgery at the time. All up, I've been putting up with the discomfort of this for over 5 years (yea, it took 3-4 years to work out what it was).

What I'm not sure about, and what I can't find any information about on the "Googles" is; what impact, if any, does this condition have on performance in cycling?

I've significantly increased the amount of cycling I've been doing since Xmas last year (about ~4h up to ~9-10h p/wk), and whilst I've had reasonable gains in my FTP (from ~195W up to ~215W), my general power numbers are still pretty damn low as a whole. This is despite cycling for nearly 5 years now, and having periods of increased training and with a variety of training approaches.

All-time best effort power levels according to Strava (w Andrew Coggan power profile level added):

* 5s - 950w (12.84 w/kg) - Cat 5/Fair on Coggan's
* 1m - 408w (5.51 w/kg) - Untrained/non-racer on Coggan's
* 5m - 280w (3.78 w/kg) - Upper end of Cat 5/Fair on Coggan's
* 20m - 220w (2.97 w/kg) - Upper end of Cat 5/Fair on Coggan's

These numbers reflect the reality in the weekly group ride where I constantly get dropped, especially on hills, false flats and into head winds. It always seems to be the really intense efforts between one minute and five minutes that I really struggle with particularly. Shorter efforts or longer with more of a respite in between are no problem. I'm now wondering whether my calf muscles do flare up, and perhaps some of the "lactic acid" sensations are coming on quicker because of a lack of functionality in the calf muscle?

Does anyone have any insight or information that might be of use with regards to Compartment syndrome and performance in cycling?

[moosterbounce]

I was told about 18 years ago I had compartment syndrome in probably both legs in the tibialis anterior - runs down the front outside of the shin. I said no to the MRI to determine whether this was the case or not, and at the same time said no to surgery. I figures inwaspast the age of playing state hockey and wasn't going to ever get back to this level after being told for 4 years I had everything from shin splints to being unfit. At the time it was a 50%chance of fixing but you'd only know after 12 months or so of rehab.

That being said, my neighbour had both done recently and was running his fastest 5km times within 8 months.

Anyway...back to the original story. I started cycling after this as running and jumping sports were out of the question. At the time I played hockey, soccer, and volleyball. It was time for a new sport. Long story follows and after cycling, my shins didn't cause me issues...but it took a couple of years to get to no pain when walking fast. Then one thigh started playing up - ITB.

In talking with my physio, we looked at glute strength and she videoed me running. I was so out of alignment and my glutes were definitely strength free. So we treated that and I was running 5km again with no pain. Apparently, recent thoughts for shin issues have physios looking at glutes and hip stability. This is very different to how I was initially treated. But the new way of thinking worked for me.

Now I know nothing about how compartment syndrome relates to cycling and power output except to say that it took several years of riding to be pain free when walking. I don't know if it helped with muscle strength or if it was the long break with no impact.

I'm currently still getting back to normal post knee surgery, but I've never been able to climb (a speed hump gives me a panic attack), but I reckon I'm not a bad sprinter over short distances. Also, I can power up a short sharp hill. I've never measured power, but now I have a lot more going on that I pacts me!!

Obviously different muscle that effected me, but I'd speak to a reputable sports physio to see if there are other non surgical options. If you still hurt walking up hill, I'd suggest there would be an impact to anything you did not just cycling. What other treatment options have you been looking at?

[sim-o]

Thanks for the reply mooster.

I've tried various conservative treatments from two different physios and also a podiatrist. Treatments attempted include; massage, accupuncture, various forms of stretching, strengthening of the calf, electrotherapy, ultra sound therapy and orthodics. Unfortunately none of them had any significant effect.

The sports doctor who diagnosed me with compartment syndrome did the compartment pressure test, which is where they stick you with a huge needle before and after running to test the pressure levels. She tested more than one compartment on each leg, and pretty much all of them were well above the "normal" range.

[malnar]

I can't speak about chronic compartment syndrome, but I have had (leg saving) fasciotomies for acute compartment syndrome. Assuming there's smooth sailing post op (no infections, etc) I'd imagine you could be back on an exercise bike within a few weeks & riding within a month or 2 but of course you should speak to your surgeon & physio.

[sminns]

Thanks for the reply mooster.

I've tried various conservative treatments from two different physios and also a podiatrist. Treatments attempted include; massage, accupuncture, various forms of stretching, strengthening of the calf, electrotherapy, ultra sound therapy and orthodics. Unfortunately none of them had any significant effect.

The sports doctor who diagnosed me with compartment syndrome did the compartment pressure test, which is where they stick you with a huge needle before and after running to test the pressure levels. She tested more than one compartment on each leg, and pretty much all of them were well above the "normal" range.

I have compartment syndrome in my calves and forearms. The testing doc said I have the second highest pressure levels he's ever seen in the legs. I can't play soccer, jog/run, train martial arts, or lift weights for the purpose of bodybuilding - I have done all these sports but had to give them up due to pain. I had a quote to get the fascia release surgery in all compartments but didn't have the funds so just had to change sports, plus my wife doesn't want me to have the long scars.

I began cycling a year ago and I would say I only feel about 10% of the pain I usually feel during sport and that's only after a hard week with about 10+ hours under the belt. My speeds and power have steadily increased and I don't feel the compartment syndrome is hindering my performance, but that's just me, I assume pedalling technique, cadence, terrain, secondary muscle strength would all play a part in the onset.

Sim-O have you tried varying your pedalling technique? Or have you noticed any one thing sets it off while cycling? I have my cleats as far back to the mid foot as I can so I don't engage the front of my foot as much which is one of my triggers for setting off calf compartment pain.

[sim-o]

I have compartment syndrome in my calves and forearms.

It's great to hear I'm not the only one with this! Do you find it affects you more when climbing hills with intensity?

Sim-O have you tried varying your pedalling technique? Or have you noticed any one thing sets it off while cycling?

I find my muscles fatigue quickly the more I involve my hamstring/calf in the pedal stroke. I'm speculating that it increases the pressure in the compartment and therefore it doesn't allow proper blood flow and clearance of lactic acid. I therefore tend to favor my quads more, which is contrary to what the experts teach for increasing cycling performance.

I find my legs burn the most in really intense 1-5 minute efforts (well duh - but perhaps more so than normal?), especially on false flats and climbs where you have less respite between each pedal stroke (i.e. you're constantly using pressure to maintain forward momentum). But it's really hard to distinguish between what's normal burning and what's not, especially now that I've had the condition for so long. All that I can say is that my performance overall is less consistent and improves at a significantly lesser rate to riders of equal base level and training quantity/quality as me.

[trailgumby]

One of the other posters mentioned having the cleats as far back as possible? I have found this a significant aid to reducing the frequency of calf cramps, and it may be of assistance to you.

[sminns]

I have compartment syndrome in my calves and forearms.

It's great to hear I'm not the only one with this! Do you find it affects you more when climbing hills with intensity?

Sim-O have you tried varying your pedalling technique? Or have you noticed any one thing sets it off while cycling?

I find my muscles fatigue quickly the more I involve my hamstring/calf in the pedal stroke.

Personally I don't have one particular thing with cycling that sets it off, as I mentioned after a long week I can definitely feel the pressure build up that I know wouldn't subside if I was cycling a few hours every single day, but nothing that causes acute symptoms such as a game of soccer would do.

I really try and use only my hammies and glutes when pedalling and use my ankle as the fulcrum, maybe it's just experience but if I engage my quads and stiffen my ankle which brings in the calves I feel like it would bring on the compartment syndrome down there.

[NeillS]

Interesting thread. I cannot envisage a problem with calf compartment syndrome causing lactate/fatigue metabolyte clearance problems from the glutes, quads or hamstrings, largely because these muscle have their own blood supply and drains which occur locally (that is, the vein for the quadriceps for example will not connect to any of the feeds/drains for the calf) so in theory there should be no major causal reason for the compartment syndrome inhibiting your performance.

To go further, I would change to a true midfoot cleat position and reassess any improvements. I've been able to reach an FTP of 4.5w/kg using midfoot cleat position exclusively over the last 12 months. There is pretty much no calf involvement in the stroke whatsoever. I'd be interested to hear if you have any improvement using such a position.

[sim-o]

To go further, I would change to a true midfoot cleat position and reassess any improvements. I've been able to reach an FTP of 4.5w/kg using midfoot cleat position exclusively over the last 12 months. There is pretty much no calf involvement in the stroke whatsoever. I'd be interested to hear if you have any improvement using such a position.

I'm definitely interested in giving it a go. My current shoes don't have the capability for moving the cleats back any further. Any recommendations for shoes?

[NeillS]

Cheap shimano R087's are the easiest, you just have to redrill the three holes further back and cut out a bit of the plastic webbing reinforcement on the inside of the shoe to be able to move the steel insert rearwards. Aim to have the centre of the cleat right underneath your navicular.