Chronic exertional compartment syndrome in martial arts

Last week,  I received an email from somebody who follows my Youtube Channel. He asked why I wasn’t regularly uploading videos like I used to in the past. That’s a good question and it deserves an answer:

I don’t like making crappy videos in which my performance sucks.

The next question would then be: why would my performance suck?

The answer to that one is something I debated if I would explain it or not. On the one hand, my personal life and health is nobody’s business but my own. I also don’t feel like sharing everything that goes on in my life with the entire world. I believe I already give more than enough access to my thoughts and life experiences. Finally, I don’t like people who whine each time they get a little bit injured and would rather not be seen as one of those.

On the other hand, I very much hate the macho-attitude that is rampant in martial arts and combat sports. You know what I mean; the guys who pretend like they can take everything that comes their way, they’re never hurt, they cannot be beaten, etc. I loathe that kind of immature showboating because it is both stupid and pointless. Fighting hurts. If you train to fight and/or fight a lot, you’ll get hurt regularly. If you’re unlucky, you’ll get injured and if you really push it, you’ll get chronic injuries. Pretending that this doesn’t happen is one of the biggest lies macho martial artists perpetrate.

A second aspect is the years I lived with pain and had no cure for it. If by sharing my story I can spare just one person going through that same ordeal, then it’ll be worth it.

Here goes.

 

Prelude

A bit over two years ago, I felt like crap. I was tired, weak and always in pain, in particular in my back and legs. Then all of a sudden the symptoms got worse and it felt like I had aged ten years in a month. So  I went to my MD and he did a basic examination. Not much to be found except that I scored zero on the patellar reflex test. Meaning, he hit me with the hammer and nothing happened. My legs didn’t even twitch. Then started a long downward spiral that lasted until a few weeks ago…

 

The quest for answers

My MD sent me to the hospital for a series of scans and blood work tests. Turns out I have low vitamin D, but that couldn’t explain the pain in my back and legs. The MRI showed two bulging discs in my spine, but the neurosurgeon said that couldn’t cause the pain in my legs, only that in my back. First thing was to fix those discs, which meant physical therapy and no heavy training with impacts anymore. So I cut way back on some of my favorite training and stopped all heavy bag work. Over the course of about four months, my back slowly got better (today it’s pretty much fine.) But my legs still hurt, more and more in fact, so I kept on looking for answers. In total, I visited:

  • Three professors, leaders in their field.
  • Several specialists in sports medicine.
  • Several physical therapists, each specialized in different therapies.

I also took tons of supplements one doctor prescribed, changed my diet, made a bunch of other life changes. I did even more tests and got to hear I might have MS, cancer and a host of other illnesses you really don’t want to hear about at my age… So far, none of those have turned out to be true, but there was never a clear diagnosis either and my legs kept on getting worse.

At that point, I was feeling pretty down and frustrated. After a year and a half of getting nowhere and paying a small fortune on doctors and therapies, I wasn’t any closer to getting my health back. In the mean time the pain was getting so bad I could hardly train anymore, let alone work with clients. After training almost every day for the last thirty years, being unable to train began to wear me down mentally with each passing day. What was worse, people started telling me I was imagining things and the pain was in my head. Simply because of the fact that the whole thing was going on for so long and the doctors couldn’t find what was going on, they decided I was making it all up. So I stopped talking about it altogether.

 

The change

Around March, I started working with a well-known physical therapist here in Belgium. He specializes in helping athletes with injuries and is a big name here. He was the head of the medical staff for our national soccer team and has treated tons of international athletes, so I was hopeful. Fast forward several months, a bunch of money and my symptoms had only gotten worse. One of them was a misalignment of my feet with my shinbone and it was what worried me the most for long term joint damage. When I told my therapist things were getting worse, she didn’t have much to say. When I asked when I could expect my feet to be back to normal, her response was “It’s too late for that.”

OK…

When I asked why she hadn’t told me that to begin with, there was silence. I stayed calm and polite, picked up my stuff and left. I plan to never return.

I was angry at hearing they’d been wasting my time but also became even more determined to find a solution. The one good thing I had gotten out of that place was the number of a sports-traumatologist with experience treating athletes. So of I went to see him. It took him less than five minutes to make a preliminary diagnosis: Chronic exertional compartment syndrome

In short, this means that when you exercise, your muscles expand as they get filled with blood. The connective tissue that is wrapped around them sometimes (they don’t know why) ends up not expanding enough and the pressure inside the muscle increases. When the condition worsens, muscles and nerves start getting “strangled” and atrophy. Then other muscles take up the slack and your movement patterns start getting messed up. Give it some more time and you start hurting in other places because of that. I was in that latest stage.

It took another bunch of MRIs and X-rays, along with a special test (warning: graphic) to make sure, but the results were conclusive: I had CECS. The only option was a fasciotomy on all compartments in my lower legs. So about a month ago, I woke up in a hospital bed and saw this when I looked down:

Chronic exertional compartment syndrome in martial-arts

A few hours after surgery.

Two weeks ago the stitches came out and all was fine. I came home, bent down a bit to take my shoes off and hear a sound like cloth tearing. The result was this:

Chronic exertional compartment syndrome in martial arts

Back to the hospital to get stitched up again…

Right now, all is reasonably well. I’m working with clients and am doing my rehab like a good boy and the therapist is confident I’ll get back to normal. But it will take more time to get all those atrophied muscles back in shape, realign my joints and fix the bad movement patterns. Until that’s done, I’m not allowed to do intense training. If I don’t train hard, I won’t be able to perform well for videos. And that’s why I haven’t made a lot of videos for my Youtube channel in the last few years, nor will I do more until I feel I can do a good job.

 

Conclusion

There are many conclusions you can draw out of all this and I leave you to do just that. I do want to point out a few things :

  • CECS is a difficult condition to diagnose. It is often missed by doctors, as was the case with me. The symptoms are similar to those of other conditions and it takes specific tests to determine it.
  • Medicine is not an exact science. I went to tons of specialists with fancy titles and none of them found what was wrong with me. The body is not a machine, you can’t just take a look and fix it right away.
  • Don’t give up. I won’t lie, I had a rough couple years going through all this. It was frustrating and depressing all in one. But what turned it around for me was getting pissed off when that therapist told me I should give up on hoping for things to get better.

I searched online for references of chronic exertional compartment syndrome in martial arts and didn’t find any. I doubt I’m the first martial artist to get this, but it appears to be rare. So if you ever start getting lots of pain in your legs and they can’t find the problem, ask your doctor if CECS could be the cause. Can’t hurt asking…

As always, good luck in your training.

Comments

  1. Thanks for posting this. I think it’s hugely valuable for all of us to realize that we need to look after ourselves, and that part of that is learning how to listen to our bodies.
    None of us is getting any younger. None of us. And I for one fully intend to try to be as mobile as possible for as long as possible if I have any say in the matter.

    Your point about medical professionals is also very important. They don’t know everything. We ALL bear a responsibility to research, test, and assess, all information, drugs and treatments, and never ignore our experiences inside our own bodies just because a doctor tells you it cannot be so.
    There is nothing to be lost by persevering. The body has a huge ability to heal., once the true problem has been identified.
    Good luck with you recovery.
    All the best,
    Maija.

  2. Hugh Wallace says:

    Thanks for sharing Wim and I hope you get better soon.

    This was really interesting to read. I’ve heard of the syndrome because it came up in the sports massage training I did in the summer so I’m surprised nobody you saw considered it. Just goes to show that all ‘experts’ are really only scratching the surface of knowledge. A timely reminder for the likes of me who wants, one day, to be such an expert!

    All the best,

    Hugh

    • I’ve been told by numerous eople that it’s easy to overlook or mistake for something else. But I’m no MD so I can’t comment on that part. I can say that it pissed me off royally to lose several years of having a functional body because of it. But such is life…

  3. Jeffrey Behiels says:

    CECS is very common in top end motorsports as well, it’s known as ‘arm pump’. Several top notch MotoGP riders get surgery all the time for it.
    Not very relevant to martial arts, just thought this might be interesting for you.