In the Night Farm…Your Ride is Here.

Posts tagged “endurance rider compartment syndrome

Pain and Gain

Well, Jammer finished Tough Sucker II strong and sound.  I finished.  We had a fun ride — especially after hooking up with Jodie & Sonny and Chris & Anna around mile 12 — but it wasn’t my most painless ever.

At the start, Jam was impatient but cooperating.  I held him in as we walked to the start, chatting with another rider…and then I flew through the air!  No gathering.  No ear shift.  No warning at all.  Just a big, huge, double-barrel kick-buck that sent me sailing right over his head without so much as touching the saddle or grabbing for mane.

I was up on my feet again almost as soon as I hit the ground.  Where’s my horse?  Is he ok?  What the HELL just happened?

Jam had stayed put, looking surprised and alarmed (in retrospect, he could have had the grace to throw in some guilt), and seemed unharmed. Despite all the people around, nobody really seemed to have any ideas why he bucked.  His tack looked fine.  It hadn’t felt like a spook.  I dunno.  My best guess is that it was a combination of his interference boots (which do make him stompy until he calms down a bit; I probably shouldn’t have put them on until the second loop) and sheer exuberance.

Ahem.  Inappropriately expressed exuberance.

Anyway, I mounted back up and started trotting while I assessed my injuries.  I seemed to have landed on my back-left side.  It gradually became apparent that my elbow and hand got the worst of it.  Something was moving strangely in my middle knuckle, like a tendon snapping back and forth across the joint when I flexed my fingers.  Fortunately, I was able to hold the reins without much trouble — and good thing, because Jam was full of vim and vigor.

I worked to control his pace for most of those windy, blustery 50 miles.  We finished in 6:35 and pulsed right down, trotted out, and walked back to the trailer with all A’s.

Well, Jam walked.  I limped.

It wasn’t just the fall.  True, my hand and elbow still hurt (especially the hand, which refuses to do things like remove tupperware lids) but X-rays say nothing is broken.  My bigger concern was the now-familiar ache in my shins.

For quite a few 50’s now, I’ve had trouble with shin pain.  It occurs in both legs, though the left is always worse.  By about 20 miles, they are swollen and sore along the outside of my shin bones, and after 50 miles, they look like someone beat them with a 2×4 — only there was no impact.  All that swelling and bruising is from pressure and bleeding on the inside.  It hurts like hell, and it takes a couple weeks to recede.

So, as long as I was at the doc getting my hand X-rayed, I asked about the shins.  They ruled out my #1 suspicion of shin splints because the injury was higher and more to the outside of each leg than you’d get with splints.  No apparent stress fractures, either.  I had to move on to a sports medicine doc (actually two, because I’m big on second opinions) to get a diagnosis:

Compartment syndrome.  Specifically, chronic exertional compartment syndrome.   Anterior and bilateral, in my case.

One of the sports med docs actually treats another endurance rider with the same issue, though it is much more commonly associated with runners.  Basically, the muscles in the calf are bundled into four “compartments” bound by fascia.  Fascia isn’t particularly flexible, and in certain people, the muscles can get too large for their fascia sheaths, which results in pain, bruising, and compromised circulation (from the swelling) when they participate in certain activities.

Great.  Even better, this particular malady doesn’t come with a cure.  There’s a surgery available in which they slit the fascia in order to relieve pressure on the muscle, but results are mixed and the condition can recur.  Fortunately, neither doc thought I was a candidate for surgery just yet.  They suggested a variety of more conservative approaches, the most important of which are calf stretching (so the muscles in the front of my shin have less tension against which to fight when I drop my heel to ride) and orthotics (because I overpronate, which puts extra strain on the affected muscles).

Management with ice and ultrasound are also on the table, though of course that’s impractical during a ride.  I’m looking into compression sleeves (Doctor Google offers mixed opinions on compression sleeves for compartment syndrome) and foam rolling.  I already eat an anti-inflammatory diet, but I’ve added some additional nutritional support — most notably, cod liver oil — to assist further.

I’ve found very little on the web regarding compression syndrome in endurance riders, or equestrians in general, though shin pain comes up a lot in forum discussions.  I wonder if most people assume, as I did for way too long, that it’s “just” shin splints.  (If this is you, it might be worth getting checked out, because the circulation issues associated with chronic compartment syndrome can eventually cause long term issues like foot/ankle weakness.)

Anyway, the orthotics and stretching seem to be doing a lot of good; I’ve put in long hours conditioning lately and haven’t had any trouble.  The real test will come next weekend at Fandango, where Jam and I plan to attempt his first back-to-back 50’s.

Jam, by the way, looks fantastic.  He positively inflated with muscle after Tough Sucker, and is raring to go.  (Not not literally this time, I hope!)  We’ve been focusing on polite pacing during our rides because as we increase distance, we’ll need to slooowwww dooowwwn.  It might be a bit of a battle during the first loop on Day 1, but tough tarts.  He’s gotta learn.

LowerLeslieGulch5-10-14 003