Riding with Compartment Syndrome

Fire. That’s what chronic exertional compartment syndrome feels like. The fire eventually leads to strange kind of numbness where you can’t decide if your legs are actually about to fall off or if you just really want them to.

Image result for legs hurt gif
fairly accurate

CECS, in a nutshell, as defined by the Mayo Clinic:

When you exercise, increased blood flow to working muscles expands them. If the connective tissue (fascia) that binds the muscle fibers in a compartment doesn’t also expand, pressure builds up in the compartment. Over time, the pressure cuts off some of the muscle’s blood supply.

So basically, the fascia ends up strangling the muscle itself. Hence a lot of burning, which eventually leads to numbness when the blood supply has finally been cut off completely. Sometimes you also get cramps and your legs can swell up. All very fun things.

Image result for chronic exertional compartment syndrome
I have lateral

Luckily CECS it isn’t something that follows you around 24/7. Honestly, I never even knew I had it until I started running a lot. I’d always had issues with riding in regular fillis stirrup irons, especially if my stirrups were short, but I brushed it off as some kind of flexibility issue. I would only get about 10 minutes into a ride before my lower legs and ankles were absolutely burning. The arrival of wide footbed irons was a major godsend for me and helped alleviate a lot of the pain. They’re an absolute necessity for me now.

What really brought this condition to light for me was several years ago when I was doing a lot of triathlons. It got so bad that I was to the point of being in pain pretty much all the time, so I finally went to a doctor. The first one had no clue, thought it was maybe shin splints or a blood clot, ordered an MRI which revealed nothing, and then finally sent me to a specialist. Within just a few minutes of talking to me he knew exactly what it was.

 

For riding by itself, CECS isn’t so bad. I feel it most when I’m jumping, or especially on cross country. A short stirrup combined with a lot of two point and weight in my heels will have my feet numb within about 5 minutes, with a whole lot of burning going on during that time. This is part of why you’ll often see my feet in more of a “home” position in the stirrups on XC. It helps alleviate some of the pain.

TRRemy1

 

The bigger issue is running, especially if I’m running a lot when I’m also riding a lot. The two activities combined seem to be a little bit too much for my legs to take. Hot weather makes it even worse, and of course both of the half marathons I’ve done have been pretty excruciating. For my second one it happened to be almost 70 degrees that day and the entire last few miles were done with completely numb legs that ended up feeling like pure fire for days afterward. I generally have to cut my running activity way down in hot weather, and try not to ever run on days where I’m planning on riding in the jump saddle. Sometimes I have to break the ice packs out.

There really isn’t a whole lot you can do for CECS. The doctor said we could try a custom orthotic, to see if changing my biomechanics might help. Of course, those aren’t covered under my insurance and were quoted to me at $450 a pop. I asked him how often that actually helped (maybe half the time) and how much it helped reduce the symptoms (maybe 30-50%). Not really worth it to me. They mostly suggest that you cut out whatever activities cause it to flare up. If it gets particularly bad they can do a surgery that requires cutting the fascia and results in spending several weeks unable to use both feet. That’s a no for me.

So I try to manage it just by being smart about my activities, and planning my days carefully. Runs need to happen on dressage days or non-riding days, and the hotter the weather is, the shorter the run needs to be. For riding I tend to keep my stirrups a hole longer in my jump saddle until I’m actually jumping, and I do stick my feet further in the stirrups for long conditioning rides. I will probably always require a stirrup with a wide footbed, since for whatever reason it seems to help stabilize things and make everything more bearable. I will never have a particularly deep heel position. Whenever we stop for a break I often take my feet out of the stirrups and leg my legs hang to get some bloodflow back. Otherwise I just do what equestrians everywhere do all the time about all kinds of things… I just suck it up.

18 thoughts on “Riding with Compartment Syndrome

  1. I’ve never been diagnosed with CECS (actually, I’d never heard of it until I read your blog entry), but I’ve had a lot of issues with my fascia seizing up as the result of Lyme. My internist suggested I go to PT for myofascial release. It’s pretty painful, I’m not going to lie. Basically, it’s a prolonged session on a fascia roller but with someone else doing it to you. That said, it’s changed my life. I’m so much more comfortable day to day now and have MUCH more flexibility and range of motion. Like I say, I don’t know squat about CECS, but it might be something to look into. Hope you feel better!

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  2. wow I had no idea!! That is amazing you do all that with that syndrome!! UGH I cant run anymore due to my heel spur and my right ball of my foot goes numb in the stirrup all the time when I ride but I blame the heel spur and plantar fasciitis. And i could never go back to the nonwidebed stirrups ever again! I cant imagine!

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  3. Yeah I didn’t even know this was a thing. I’ll check this out for sure. I’ve always had ankle problems – despite loving to jump my toes would always be so numb and painful. I have to be careful how short to make my stirrups and to slowly shorten them hole by hole. I definitely don’t have as much pain as you, and it is much worse in winter versus summer, but I always thought it was my shoes being too tight or cutting into my ankles or too tall boots very painfully digging into the backs of my legs. Switching to the wide composite stirrups has helped me exponentially, but I’ve been looking into a few other stirrups that I’ve heard really help. Thanks for this, really.

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  4. That sounds miserable. I give you a ton of credit. While I would definitely suck it up and ride through it too, that condition would DEFINITELY be the excuse I need to never run again. (I’m always looking for one, because I hate running so much. But I also hate being fat, so running it is.) I’m glad the wider stirrups help you at least.

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  5. I have this same issue. I always get it with the regular fillis irons when I’m jumping, but like you if I leave my stirrups a little longer and use the wide foot bed stirrups it is mostly controlled. I ride dressage now, jump about once a week, and I do not have this problem in my dressage saddle.

    I also thought it was just an ankle flexibility issue that was driving the pain. Never diagnosed, but I have the exact same symptoms and have taken the same measures that seem to help for the most part.

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  6. Interesting. I do do not think that I have CECS but my feet constantly go numb when I am riding. Even on the flat I have to take my feet out and shake them a bit. I also get terrible cramps in my legs and feet. It is quite crazy to see because it is not just your normal calf cramp. I get them down the front of my leg and in my feet to the point that my toes will be pointing all different directions!

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  7. I also suffer from CECS in my lower legs. Not only that, but I have also experienced acute rhabdomyolysis in one leg, too!

    Unfortunately (or fortunately?), my CECS was so bad that I had a fasciotomy done on my left leg about 10 years ago, as it got to the point where I couldn’t ride at all. It absolutely helped, but apparently I could end up having to repeat the surgery in the future.

    From what I hear, there’s a doctor somewhere in WY or MT that’s experimenting with Botox injections for CECS? Sounds interesting….

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  8. Ick. You are enough of a researcher that I’m sure you have thought of this, but I will say anyway. Have you tried any of the more “out there” modalities tai chi, yoga, energy release, etc? How about nutrition? Could you be allergic? Or eating XX increases/decreases the severity of the symptoms. Western medicine has some great answers, but not all of them. Even if they think they do.

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  9. That’s sounds horrible! I definitely had no idea.
    I know that wide bed stirrups are a lifesaver for me as well though! Without them, I am generally half crippled when I get off (thanks to my screwed up SI joint).

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  10. Oh damn! That sucks! I’ve kinda wondered if I have it minorly, as my legs go numb when my stirrups are short. But, instead I decided I have have piss poor oxygenation in my blood. Lol. I can’t imagine the burning. Ouch.

    Side note. A friend of mine had an issue that required her tendons to be cut. It sucked, but totally changed her life. Might actually be worth the layup time.

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  11. Wow, this answers everything I have experienced for literally years. I always thought it was flexibility issues, or my boots weren’t wide enough, or I had too much weight in my stirrups and that’s what was causing the pain and numbness. With normal gym training I just thought it was part of the pain of working out lol. Trying to dismount even a 15.2 horse sends literal daggers up my entire body if I try to get off while numb. It always feels like my bones are compound fracturing inside my body. It’s nice to have an answer (and cheaper so I stop buying boots and stirrup irons trying to correct the issue) but not so nice knowing there’s no fix for it.

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  12. I totally have this in my calves and just thought I was a big out of shape wus until I read this. 5 min of trotting and my legs will burn for the rest of the ride. Really takes some of the enjoyment out of the ride. I’m going to ask my favorite massage therapist about this – I hate it when they work on the fascia but if it makes riding more enjoyable… it would be worth every painful second.

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  13. This is a somewhat wild shot in the dark, but what about compression socks? Fake has some excellent ones that I occasionally ride or gym with, and although I don’t have CESC, my feet don’t go numb when I ride with these and my calves feel less stressed after a gym work in them.

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