How to treat anterior compartment syndrome

Remedial massage therapist James Maddock has specific training to treat anterior compartment syndrome.

Anterior Compartment Syndrome is a condition affecting the lower leg, typically impacting runners, dancers, and other athletes.[footnote] (2009). Compartment Syndrome -OrthoInfo – AAOS. Retrieved from[/footnote]

How does it happen?

It arises when the foot-strike pattern favours the heel, with a ‘lazy’ foot-slap as the front of the foot (forefoot) follows the heel to the ground. The shin muscles must work to slow down the foot slap.

Over time, those muscles become weak or dysfunctional (such as when there is a nerve compression), they stress out and become inflamed as they try desperately to do their job. This can lead to shin splints, fallen arches, or anterior compartment syndrome.

The four muscles attached to the front of the foreleg (shown below) becomes constricted within the skin-like compartment housing them, reducing outgoing blood flow, which in turn further fills the compartment.

This causes quite a lot of pain – especially when exercising.

In this article, we briefly discuss options for treatment, both with massage and manual therapy, and beyond.

Sth Melbourne Brunswick East

Who’s a fan of abstinence?

Melbourne is a city of sports lovers. Footy, fun runs, tennis, soccer, hockey and everything else – all are at risk of anterior compartment syndrome. Nobody wants to stop doing something they love.

Even so, the first method of treatment is usually abstinence. However as I have discovered, try telling a passionate runner or tennis player to stop running forever (because that’s what they are facing) and see what happens.

For this reason, I prefer to give them at least a chance with manual therapy assessment and treatment before forever writing off the idea of running around again.


Pain medication is not usually effective[footnote]Rasul, A. (2017) “Acute Compartment Syndrome Treatment & Management: Approach Considerations, Renal Protection, Indications for Fasciotomy.” Retrieved from[/footnote] at treating the condition. Conventional treatment is to surgically open the compartment to release the pressure. In many cases, symptoms return and some patients will have two, three, or even four surgeries. Even then, the pain may return.

Assessment and treatment

Manual therapy treatment assesses the relative strength of the calf muscles (which tend to dominate) versus the anterior compartment muscles (tend to be weakened and overpowered), and aims to re-balance any difference.

Then the job is to reduce the pressure in the anterior compartment by gently stretching the connective tissues, thus loosening the fascia and returning blood flow.

Following that, the client learns the correct corrective exercises that they need to improve foot strike patterns and retain the gains we achieve during treatment.

Your mileage may vary

This protocol is not always successful. A lot of it depends on the habits and structural patterns of your body. Certain elements, such as muscle tension, length and strength, can be corrected. We here at Massage Dot Melbourne can assess and treat for these aspects.

Certain other elements, such as bone shape or previous surgeries, cannot be corrected with massage therapy.  In those cases, or if the symptoms persist despite massage treatment, a foot specialist such as a podiatrist, sports physio, or orthopedist, would be the next port of call.

Failing that, surgery is the final option.

Further reading

What is remedial massage therapy?

What is myofascial cupping?

What can I expect from a remedial massage appointment?