Compartmentalizing

via redstatebluestate.mlblogs.com

Instead of overreacting and calling Colby Rasmus a bust, or talking about Matt Holliday not living up to his mega contract, saddling us with a massive albatross, or our offensive binge and purge cycles, or our freak pitcher (not pitching) injuries, let's talk about something happy. Let's talk about something interesting.

How about compartment syndrome?

A lot of what I'm going to put down has already been posted in daily threads, so I'd like to h/t prophetjohn, ribbij, and anyone else who has nefdex'ed this information. On the other hand, I think it's a good idea to compile it, and I think I have a few things to add.

First, a story.

My cousin was a teenager and a driven athlete. She swam competitively, raced in triathlons, and spent the majority of her free time racing and training to race. Her only problem was herself. She as too driven. She was too obsessed with pushing herself harder, going farther, faster, and she had an incredible pain tolerance. Before she was 18, she had already had rotator cuff surgery, and she had her acetabular labrum repaired in the middle of the summer at the height of her season because the pain and weakness had become unbearable. When she talked about subtle calf pains and numbness in her feet, it was just another of her stories. How was the race? What's causing you unbearable pain now?

She still has both her legs, and she's still walking and working out the way normal people do, but the peak of her athletic endeavors has passed, and sometimes I have to carry her if the kids are hanging out and she has to walk too far. Even after surgery to release the pressure built up under the tissues in her legs, she suffers symptoms of compartment syndrome or nerve injury, and it's a pretty frightening and very disabling problem for distance runners. I knew her situation was bad when she told me the doctor had recommended useless acupuncture treatments to help her get her mind off of the injury.

Zooming back out, I think the disease has been pretty well described here: Compartments exist all over the body. Your brain is inside one. Your heart is inside one that is inside a larger compartment that contains many of your organs. Muscles are grouped with nerves and blood vessels and they are constrained inside compartments of connective tissue. The syndrome is a result of the expansion of the muscle inside the fascia, which causes the pressure inside to rise.  While any body compartment with confined bleeding or muscle expansion can cause symptoms, the syndrome that we are talking about usually refers to a problem in the lower legs or the forearms where anatomically the muscles are tightly confined

Usually the result of this increased pressure is severe pain during movement, along with tingling and numbness that result from restricted blood supply and compressed nerves. While the prognosis for more acute cases of compartment syndrome is usually good (stop the bleeding, heal the damage, cure the syndrome), it can be a bigger problem for athletes with chronic compartment syndrome. Conservative treatments like therapy and cortisone are not usually recommended, and often surgery is required.

Kyle Lohse has been having effectiveness problems for some time, but it's unclear how long his compartment syndrome has lasted or how severe it is. As a chronic condition it has probably been developing for months or years, and I'm not sure exactly of the relationship between his injury last season and his injury this season.

Because Kyle's problems last season started with a contusion, it's possible that his initial problems more closely resembled acute compartment syndrome, but considering the surgical intervention he is now set to undergo, I think his problem is chronic and could even be unrelated or at least not entirely attributable to his repeated contusions last season.

My cousin's surgery had them cutting straight down the fronts of her legs parallel and almost the entire length of the shin bone to create space for the muscles to expand. Kyle's surgery should be similar, but because the actual muscle involvement is unclear, it's possible that he will undergo a less invasive procedure. Because of my experience with my cousin and other runners, I can't say I'm excited about his prospects and I hope his surgery is substantially different and more successful than theirs.

Here's to happier times, and I hope Kyle makes it back from this one. If not, I'll try to forget the contract and remember things like this: