Choking Emergencies And Infant Massage

 

More and more I’m seeing Massage Therapists offering infant massage as well as massage classes for parents to teach them how to connect with baby and give that extra bit of care to their new infant.

But what happens when there is a medical emergency with an infant in your clinic?

Do you know what to do when one of those infants starts choking?

To start, play the first video below and I’ll get into some instructions on how to handle this kind of emergency in your clinic.

It’s a valuable skill to have and is important in and out of your clinic. But keep in mind, the videos are not a substitute for taking a proper course.

So remember, if the baby is coughing that means they have an open airway it is just somewhat restricted.

We don’t do anything except encourage them to cough up whatever it is they are choking on.

You need to intervene if:

  • The baby is making high pitched noises.
  • Is too weak to cough.
  • Is wheezing.
  • Becomes rigid due to a completely restricted airway.

Have someone call 911, get an AED (if available) and start your back blows and compressions.

Make sure the baby is always supported on your thigh, so there is a solid surface to deliver your back blows and compressions against. With the baby sandwiched between your forearms deliver five back blows between the shoulder blades.

Then flip baby over and rest on your other thigh, deliver five chest compressions with two fingers land marking between the nipples. You want to deliver about a 1.5 inch compression.

Continue to do this until the object is cleared and baby starts to cry, or becomes unconscious.

If the back blows and compressions didn’t clear the airway, now you’re doing CPR.

However once the baby went unconscious there is a chance the airway opened up because of the musculature in the neck relaxing, so we “look listen and feel” for 15 seconds to see if baby has started to breathe at all.

If they’re still not breathing, we slightly tilt the head back to try and open the airway and attempt to give two breaths. If there is still a blockage and we see that no air went in with the breaths, (if air does go in and baby is still unconscious and not breathing, we still continue) we landmark between the nipples and deliver 30 chest compressions using two fingers.

We continue with 30 compressions and two breaths until the baby starts breathing on its own, or more help arrives to take over CPR.

When First Responders arrive, they will take over CPR but have some equipment and different techniques they will use to help the baby.

Hopefully if you are doing infant massage, or just know someone who has a baby, these videos will help you feel a little more confident should you ever have to deal with a choking emergency. Please remember that these videos and this blog should not be used as a replacement for taking an actual CPR course. If this is something you do a lot in your practice, please take the time to go and get the necessary training to be confident in dealing with infant emergencies, it could literally mean someones life one day. If you know someone or have a colleague that could benefit from the information here please share it with them.

Osteoporosis And My Mistake

I came around the corner just as he was sitting this elderly gentleman down.

He looked at me and said: “deal with this I’m going back to the bench”.

Fairly confused, I looked at this elderly gentleman and asked what happened?

He was on the ice taking pictures of the hockey team, as he walked off he slipped and fell on the ice.

Bearing weight on the right side was painful, but there wasn’t a lot of pain while sitting down. I grabbed his leg and passively moved it, no pain.

He called his wife (who was more than a little upset as the game had just started and now she was missing it) because I said he needed to go to the hospital.

We draped his arms over our shoulders and walked him out to their mini-van. She took him to the hospital and I didn’t see them for another year.

The Mistake

For years I have taught first aid courses to other Massage Therapists.

I have viewed the power point slide, I have repeated the information in the slide, I have highlighted the importance of the slide.

The slide I’m talking about says you should all 911 if:

  • The injury involves the head, neck, or back.
  • The injury makes walking difficult.
  • The injury involves the thigh bone or pelvis.
  • There is an altered level of consciousness.

However, things didn’t add up.

When it comes to treating injuries and dealing with first aid, one of the things we always harp on is “Mechanism Of Injury” (MOI).

We always use this as a method to quickly determine if there is a spinal, head or neck injury, to see if spinal precautions need to be taken. For those of you who have taken advanced or even basic first aid (and let’s be honest, just as the anatomy pro’s that you are) you understand the importance of stabilizing the neck to reduces possible spinal injuries.

But in this case the mechanism of injury made me second guess myself.

We always worry about further injury when a persons injury is a result of:

  • A fall from any height.
  • Found unconscious for an unknown reason.
  • A diving injury.
  • A blow to the head, neck or trunk.
  • A car accident.
  • Lightning strike or electrocution.
  • A persons helmet is damaged.

But this guy didn’t fall from a height, so why would I worry about the injury being that extensive!?

All he did was slip on the ice, there was no fall from a height of any kind.

But like an idiot, I didn’t use the information I had taught so many times.

Walking was difficult and the injury was to the pelvis, it should have been a 911 call.

However since I didn’t think the mechanism was bad enough, I was comfortable to get him to the hospital without using an ambulance.

Photo by: CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=243621

Photo by: CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=243621

Osteoporosis

For years I taught these courses and never understood why there would be a power point slide about Osteoporosis.

NOW I KNOW!

When I saw this fellow a year or so later, he looked completely different (he had developed some other health issues well beyond his fall that night).

I asked him how things turned out, he said he had broken his hip and had to have a full hip replacement (as a disclaimer, the injury caused the hip problem, not the fact that I didn’t call 911 that day, I just should have handled things a bit better).

Osteoporosis is the leading cause of bone and joint injuries in older adults, the bones don’t have enough calcium, which makes them frail.

According to osteoporosis.ca there are some frightening statistics:

  • 70-90% 0f 30,000 annual hip fractures are a result of osteoporosis.
  • 1 in 3 women and 1 in 5 men will suffer a fracture due to the disease.
  • Without BMD (bone mineral density testing) 80% of fracture patients are not getting proper osteoporosis therapy.
  • 80% of all fractures in people over the age of 5o are a result of osteoporosis.
  • Fractures from Osteoporosis are more common than heart attack, stroke and breast cancer combined.

Think about what this means for your practice.

How many people do you see on a regular basis that are over the age of 50?

This exact situation could happen at any point in your clinic with an older person coming in for treatment. That gentleman didn’t know he had Osteoporosis, but was diagnosed with it after he fell.

If at anytime one of your patients comes in and suffers a fall on-site that seems harmless enough but there is an injury to the pelvis or thigh and makes it difficult to walk, be sure to call 911 and get them to the hospital in an ambulance. If the person suffered a fall at home and is coming in for treatment, there are some things to look out for. Check for any deformities in the area they are complaining about, along with swelling and point tenderness that could indicate possible injury.(1)  

Studies are showing how exercise and strength training are effective ways to manage Osteoporosis once a patient receives the diagnosis, which also plays an important role in building confidence to prevent future falls. As Massage Therapists we want to make sure to use the appropriate pressure when giving treatment, to avoid any injury while the patient is on your table. One study researched a L5 unilateral pedicle fracture on a 66 year old man as a result of an aggressive back massage.(2)  

Do yourself, and your patients a favour by not making either of these mistakes when trying to help them out.


References

  1. Badiyani K, Bottomley J. OSTEOPOROSIS AND ITS MANAGEMENT IN THE ELDERLY. Gerinotes [serial on the Internet]. (2014, Mar), [cited October 24, 2016]; 21(2): 11-18. Available from: CINAHL Complete.
  2. Guo Z, Chen W, Su Y, Yuan J, Zhang Y. Isolated unilateral vertebral pedicle fracture caused by a back massage in an elderly patient: a case report and literature review. European Journal Of Orthopaedic Surgery & Traumatology [serial on the Internet]. (2013, Nov 2), [cited October 24, 2016]; 23(2): 149-153. Available from: CINAHL Complete.

 

Is The Use Of Oxygen A Placebo?

Forgetting to use it could be the difference between passing and failing a Sport First Responder test.

It has a wide range of uses in an emergency care setting, especially when dealing with your athletes in an acute injury or emergency.

Using supplemental oxygen therapy has been a major part of Sport First Responder courses over the years with various reasons for application including:

  • Shock prevention
  • Cardiac Arrest
  • Anaphylaxis
  • Carbon Monoxide poisoning
  • Asthma

However recently I have been hearing rumblings, the use of oxygen may be on it’s way out as an intervention and I recently worked with a sport med doctor who doesn’t use oxygen and downplayed its effectiveness.

But this practice is so hard grained into us, that with pretty much every patient we see in an emergency setting, they get oxygen.

But do we really need it in all cases?

Why The Use Of Oxygen

The biggest reason oxygen is used in these emergency scenarios is to prevent hypoxemia, which is a decreased level of oxygen in the blood, which then leads to hypoxia (oxygen supply which is insufficient to support life).

However there is also a risk of using too much oxygen which results in hyperoxia (too much oxygen in the system), if oxygen therapy is not used properly it can lead to complications, which also depends on the condition your patient is dealing with.

It turns out that hypoxia (which is determined by using a pulse oximeter) is the only evidence based reason to give oxygen to a patient.

The other reasons are based on the assumption that it will help prevent hypoxia and relief of symptoms in an emergency setting.

Shock

I’m sure we all remember what shock is from our time in college, but there is more than one type of shock and we should all be familiar with the various types.

Medical shock is the type we are mainly worried about as opposed to emotional or psychological shock resulting from a traumatic experience or an emotional event.

When someone is suffering from or going into shock, the body is redirecting blood to service the internal organs and keep them alive, which is why you will often see the persons skin turn pale, cool and clammy.

The extremities are not getting the blood supply they’re used to.

But within the classification of “medical shock” there are further classifications of types of shock:

  • Anaphylactic
    • life threatening allergy to a substance
  • Caridiogenic
    • failure of the heart to pump sufficient blood to the body, usually occurs with cardiac arrest
  • Hypovolemic
    • lack of blood in the body
  • Neurogenic
    • failure of the nervous system to control the size of blood vessels causing dilation, common with head and spine injuries
  • Respiratory
    • the lungs fail to get sufficient oxygen into the bloodstream, common with breathing emergencies, respiratory arrest
  • Septic
    • intake of a poison causes blood vessels to dilate

Within the license of a Sport First Responder we would treat all of these types of shock the same way, by putting the patient on oxygen at a 10L flow along with keeping them warm.

In the case of someone having a heart attack (caridogenic shock) there are studies showing the use of oxygen in the first 12 hours may be unwarranted, however would still be appropriate for the sport first responder or until the patient reaches the hospital.

But in some cases with angina attack, oxygen can help with pain relief.

This is also because in the stressful environment of being a first responder, to determine exactly when it is appropriate to administer oxygen (signs of dyspnea or heart failure), so would more efficient to give it to everyone until arrival at hospital.

Common breathing emergencies like breathlessness or asthma should only be treated with oxygen if there is hypoxia present, this is one of those areas where we have always put oxygen on a patient .

In dealing with traumatic injuries that would typically cause hypovolemic shock a study showed that only half of adult trauma patients actually required the use of oxygen in pre-hospital care, yet it was still being administered to everyone.

When it comes to using oxygen therapy for shock it looks like a bit of a mixed bag as to when it’s appropriate to use it and when it is not.

However our Sport First Responder guidelines at this point still say that oxygen should be used to either help prevent or to deal with shock.

 

Photo by: Offutt Air Force Base

Photo by: Offutt Air Force Base

Strokes, COPD And Other Emergencies

I know these aren’t typically seen in the Sport First Responder setting but it’s still important information to know in case you ever have to deal with it.

Again, these are all instances where oxygen would always be put on a patient having an emergency.

New research is showing us that it may not be the best approach.

In patients having an acute COPD (Chronic Obstructive Pulmonary Disease) we have always been told that high flow oxygen is the method to treat the situation.

Studies have shown that using reduced flow oxygen actually decreased the risk of mortality by 58% (1) and leads to worse clinical outcomes. (2)

Using oxygen with someone who is suffering a stroke is also coming under skepticism even though it too has always been promoted as an acute therapy. I’ve used it on patients several times because of the recommendations.

But newer studies are saying that unless there is hypoxia present, the use of oxygen should be avoided (although it is also referring to the first 24 hours of hospitalization).

The same article points out that unless hypoxia is present with a pregnant woman or someone experiencing breathlessness, oxygen should be avoided.

However there is still hope for our friend Oxygen.

Someone with carbon monoxide poisoning should still be given Oxygen. It reduces the level of carbon monoxide in the blood in 40 min compared to 4-5 hours just breathing regular air. 

Even though studies have started to question the use of oxygen in emergency settings, it is still imperative to stick to your local guidelines when responding to an emergency with your athletes. Most of the studies outlined in this post were based on the reading of gas exchange in the bloodstream using a pulse oximeter. Your average Sport First Responder probably doesn’t have one of these in their kit, so it is ALWAYS better to err on the side of caution. Another caveat for the use of oxygen (that I have seen first hand at emergency scenes) is distracting your patient. Having a mask on that is delivering oxygen brings some comfort to a patient, especially with breathing emergencies. I’m not sure it could be considered a placebo effect, but it definitely helps to calm a patient down. The point of this post wasn’t to tell you not to use oxygen anymore, you most certainly should. It was more just to make you aware that there could be changes coming down the road and the next time you re-certify, things might be a little different. In the meantime continue using your O2 cylinders and keep those athletes safe.

 

References:

1. Ntoumenopoulos G. Using titrated oxygen instead of high flow oxygen during an acute exacerbation of chronic obstructive pulmonary disease (COPD) saves lives. Journal Of Physiotherapy [serial on the Internet]. (2011), [cited September 12, 2016]; 57(1): 55. Available from: MEDLINE with Full Text.

2.Cameron L, Pilcher J, Weatherall M, Beasley R, Perrin K. The risk of serious adverse outcomes associated with hypoxaemia and hyperoxaemia in acute exacerbations of COPD. Postgraduate Medical Journal [serial on the Internet]. (2012, Dec), [cited September 12, 2016]; 88(1046): 684-689. Available from: CINAHL Complete.

How Massage Therapists Can Recognize And Deal With A Heart Attack

“I have had a few times in practice where I’ve caught a myocardial infarction and called 911, if this has yet to happen to you, be forewarned, it will” – Robert Libbey RMT

 

I’ll never forget that day walking into the hospital.

He didn’t look like himself and wasn’t acting like himself.

He was too young for this to happen and I was too young to really understand it.

Years later he told me the story about, feeling chest pain at home and thought there was something wrong so he jumped in the car and headed to the hospital.

Halfway there he lost the use of his arms and had to steer with his knees.

My dad was in his thirties and had a heart attack. I use this story whenever I teach a First Aid course. You wouldn’t think an otherwise healthy guy in his 30’s would suffer a heart attack, let alone one with two young boys and a wife at home.

Thankfully he survived but had an issue with his heart a couple years later.

We had to change the way we did things, the way we ate and the way we lived.

He wasn’t sure how to recognize what was happening that day or even acknowledge that it was a heart attack.

How about you?

Could you recognize it if this happened in your clinic, or to one of your family members?

Differentiating Chest Pain In Your Massage Therapy Clinic

I’ve said it before and will continue to harp on it.

As healthcare professionals this is something we really need to be able to pick up on, which isn’t always easy to do.

If someone is having a heart attack, they really don’t want to admit it. Their mortality is staring them in the face at this point and realizing that something major is going on isn’t an easy thing to face, in fact most people will completely deny the possibility they are having a heart attack.

That day my dad didn’t want to admit things might be worse.

It would have been fatal if things has progressed anymore on the drive to the hospital. Thankfully he didn’t drive off the road when he lost the use of his arms.

We need to realize the differences in pain to understand whether someone is having a heart attack, indigestion or if something muscular is going on.

If you are going through your typical assessment before a treatment and your patient is having brief chest pain as a result of bending or breathing deep, it’s probably not a heart attack.

Some even feel that it is, or starts as indigestion. However, if it is a heart attack it will continually get stronger over time.

If someone is having a heart attack I have heard it described as “an elephant sitting on my chest”.

While writing this post, I called my dad to ask what the pain was like. He said:

“It felt like someone drove a sword through my chest, pain down both arms and through to the back, it was ten times worse than having any kind of indigestion”

The pain can range from mild to a description of squeezing, or tightness and constricting to a crushing feeling in the chest.

If one of your patients is having chest pain and it lasts longer than ten minutes, it’s time to get them some help.

Signs And Symptoms For Massage Therapists To Recognize

These are going to be a bit different between women and men.

As my dad mentioned he had pain going down both arms. Generally, it will be in the left arm as well as going up the neck and into the jaw. These signs are pretty much the norm when it comes to men.

With women, they quite often get low back pain. Women can also exhibit some soft signs, which are a little harder to pick up on, but just as important to understand and read because it sometimes goes unrecognized.

Some of these can be stomach pain, flu symptoms and some chest pain that changes with the level of activity. These symptoms are also common in those with diabetes and the older population.

There are a few other signs that usually don’t get talked about much (at least in basic First Aid courses).

Here are a few of the other things that you may see:

While you won’t see this every time, they are all signs that can help you make a decision as to what is happening with someone or how severe their condition is.

https://flic.kr/p/5ZsuFK

Photo by: Alessandro Bonvini

What Massage Therapists Can Do To Help

The first thing we need to do as Robert mentioned is call 911.

Stay calm!

When you call 9-1-1 the dispatcher needs some information from you and the calmer you stay, the better!

They need your address and this is the most critical piece of information because if they can’t get that from you, they can’t get help to you.

They will also ask for your return phone number. They need this to be able to call you back and get more information or to help the crews on their way locate you. It is also so that if you need help they can coach you through what you’re doing.

They will also try to get as much information about the patient as they can. Age, sex, physical condition, level of discomfort, pain and surroundings are all critical information for the arriving crew to have before they get there, so they know what they are getting into.

After that call is made, getting the patient into a position that provides them with the most comfort is the best thing we can do for them. Usually, this is going to be in a seated position leaning forward, but just go with whatever position they say is most comfortable.

Now I know most clinics aren’t going to have this on hand, but getting them some aspirin is going to help things out. And it has to be Aspirin, not Tylenol or Ibuprofen…Aspirin.

It works as a blood thinner so it can help relieve tension on the heart as well as help diminish clots. 

All too often this goes unrecognized or people don’t want to admit it, so they don’t ask for any help. Unfortunately, this could be fatal as it leads to cardiac arrest and the need for CPR.

The more you can do to recognize and be aware of what’s going on with your patients, the more you’ll be able to help and prevent things from getting to that point. Being able to recognize and differentiate the pain a person is experiencing is key to understanding what’s going on with them. Also knowing that the signs and symptoms can be different between men and women can go a long way to recognizing that there is an emergency happening. And remember, this is the only time it’s okay to ask about erectile dysfunction drugs!

“Heart disease is no laughing matter. After my father suffered a massive heart attack, I realized just how serious heart disease can be” – Cheryl Hines

The One Thing Every Massage Therapist Should Have In Their First Responder Bag

Blood is leaking from his left leg.

The players get him to the bench and throw one arm over the AT’s shoulder, I grab the other one and we hobble him down to the treatment room.

Once he’s on the treatment table we start cutting gear off.

He’s been cut by a skate over the Extensor Retinaculum on his left ankle with the tendons exposed. The AT immediately grabs gauze and puts pressure over the cut to control the bleed. He’s gonna need to go to the hospital.

Let’s back up a few hours.

Pregame Warmup, Massage And Treatment

That day started like a  typical Saturday afternoon.

Stop at Tim Horton’s to grab coffee’s around 4:45, at the rink by 5pm.

Step into the dressing room, talk with a few of the players, then into the treatment room.

Have a quick chat with the Athletic Therapist about some injuries etc. going on with players and have our coffee’s.

One by one players came in for treatment.

I do some pre-event massage and help players with their warm up. The A.T. gets to work taping and working on some nagging injuries.

One of the management team comes down to inform us there will be a first aid company in the stands tonight, since none of the Dr’s could make it to the game (it was league rules to have a doctor or a certain number of First Responders in the building for every game).

The first aid company is there to help with any fans at the game and back us up if we need any help.

Pregame skate starts at 6:35, we go and watch one of the players to see how he’s skating with a chronic groin injury.

7:15 puck drop.

Halfway through the 1st period there’s a crash into the boards that resulted in the injury from the beginning. But dealing with the injury wasn’t the difficult part.

The Inexperienced First Aid Attendant

In walks a young man who works for the first aid company, he looks about 18 years old, accompanied by an older gentlemen that just kind of sits back and watches.

The young man immediately attempts to take control of the situation pushing his way around. Me and the AT look at each other somewhat dumbfounded by what’s going on.

He tries to take a pulse (dorsalis pedis) on the injured side. He can’t get it and exclaims “we need to cut the other skate off so that he can compare”.

Of course he can’t get a pulse, the AT is holding pressure on the injury right above to stop the bleeding. He cuts the other skate off while we tend to the injured leg.

Once he gets the skate off he continues to follow protocol, takes the pulse and has the player wiggle the toes on his good leg. He continues to follow protocol and asks the player to wiggle the toes on his bad leg.

Now we’re getting angry!

In as stern a voice as possible I yell out “DO NOT WIGGLE YOUR TOES!”.

The kid looks at me like I’m from outer space (since I’m not following his first aid protocol), the AT looks at him and says: “who the hell is in charge here?”

A little stunned the kid looks and says “well I’m the first aider” (meanwhile his partner, the older gentlemen is just standing watching).

The AT says “there’s over 30 years experience between the two of us, now smarten up and get the hell out of our room”.

I had a big grin on my face.

After he leaves, another team volunteer comes down and we ask him to call an ambulance. The first aid kid comes back and tells the volunteer (who is at least three times his age) to go outside and wait for the ambulance and direct them in.

If looks could kill, he would have been dead three times over.

He was directed to go outside and wait for the ambulance and was shocked that he would have to do such a thing.

Ambulance arrives and we package the player up and pass on all the information they need. The first aid kid continually tries to put his two cents in while the ambulance attendants give him a look like they wanted to pat him on the head and feed him a cookie for a good job.

The player is sent off and we are cleaning up the room.

The kid comes back in and says “good job guys, thanks a lot”. I’m pretty sure I had to restrain my AT buddy… and yet the kid never did thank me for saving his life that night.

As much as I know the kid was just trying to help, it taught me a valuable lesson.

Our anatomy knowledge is one valuable tool. When he took his First Aid course he never had to memorize the Origin, Insertion, Action of muscles.

Your average First Responder isn’t going to know terms and structures like:

Things just aren’t taught that much in detail in a First Responder course (heck I had to open the textbook, just to make sure I was naming things right).

I went through three of my First Responder Instructor books and the best I could find is that students would learn:

I don’t say all of this as an insult to First Responders or the program, it’s just they don’t need to know that much (even though some go on to higher level paramedics and learn more) because their biggest job is to stabilize someone until more advanced help arrives.

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Your Massage Knowledge Makes You A Better First Responder

When the player got to the hospital he immediately went into surgery. I don’t recall which tendons were repaired but it required surgery nonetheless.

It’s hard to know if it was just the initial skate blade cut that did it, or if it was once the player started wiggling his toes that caused the most damage.

If you’re working at sports events (or anywhere else for that matter) remember:

  • The people you are there for are YOUR responsibility  and you are in charge (along with other AT’s, Chiro’s, Physio’s that are working)
  • The average first responder or paramedic does not have the anatomical knowledge that you have
  • Put your knowledge to good use and don’t be afraid to help out, even when things are a little unsettling
  • Always keep your first responder license up to date

At most emergency scenes paramedics are in charge but in this case, when it comes to your players, you are the first line of care.

You have probably noticed at most big sporting events, the team trainers and doctors rush out onto the field, ice or track before any ambulance is there.

This is your scene and you pass it off to the paramedics or first aid team after your assessment and treatment, or when you need more help.

Remember to always be respectful when you’re dealing with first responders at these kind of events, it’s best to work together for the safety and outcome of your patients.

Knowledge is a powerful thing. Using your anatomical knowledge will make for greater success in any emergency medical situation. However there should always be one person in charge of a scene. Usually whoever is most experienced should take control and direct the other medical team members what to do. Or whoever’s license is higher (I’m not about to tell one of the team Doctors what to do) since they will have far more training and experience. If you’re dealing with people who are less experienced, don’t be afraid to respectfully take control.

Looking at them and saying “who the hell is in charge here?” may not win you any points with them, but sometimes you just need to get your point across!

How Massage Therapists Can Deal With Compartment Syndrome

The cracking sound echoed through the arena.

He went down to block a shot and when the puck hit him, we knew it was bad.

He couldn’t put any weight on one leg. Once he started to get up a teammate helped him to the bench.

We carried him to the treatment room and started stripping and cutting gear off.

He had severe pain around his shin, where he had blocked the shot. We carefully cut away his shin pads and compression socks.

The area was getting swollen and red throughout his shin. We couldn’t feel a pulse in his foot.

I thought it looked bad, but didn’t realize just how bad. Fortunately I was surrounded by people with more experience who are much smarter than me (yes I know, that’s not difficult to find!). They immediately realized that the player had to go to the hospital.

What I thought was a contusion, could actually have been a life threatening emergency if not handled properly. After things calmed down and we got him sent to the hospital, I asked why this was such a big deal. In unison the team Doctor and head Therapist looked at me and said:

“Compartment Syndrome”

Recognizing Increased Compartment Pressure

When this happened I was still a student and honestly a pretty fresh student Massage Therapist.

I was fortunate enough to be able to start volunteering with a hockey team to get some sports experience. I had never heard the term “Compartment Syndrome” (aka: Volkmann’s Ischemia) at that point, or if I had, I didn’t remember it.

Later in Massage school we briefly talked about it, but more from the standpoint of how to treat it post surgery.

When we learned about it in school, we only talked about Compartment Syndrome happening around the shin. Turns out that it can happen in other compartments as well.

I learned that the forearm is another common place for it to happen because the Athletic Therapist used to quiz me on things like that.

Also, did you know that part of Scaphoid doesn’t have vascular supply, so if it gets broken the bone can die? More things he used to quiz me on.

Anyway, in researching for this article, I came to find out that any osteofascial compartment can have a Compartment Syndrome. Areas with deep fascia that is very strong that enclose compartments can be subject to a Compartment Syndrome.

The most common areas are the flexor compartment of the forearm and anterior tibial compartment of the leg. The hand, abdomen, glutes, thigh and upper arm can also be affected.

Acute Compartment Syndrome is a buildup of pressure in one of these compartments due to an injury. It can be both limb threatening and life threatening if not treated properly and in a timely fashion.

As swelling increases in a compartment, blood flow creates more pressure on the structures inside, causing capillaries to collapse and begins to starve the area of oxygen and nutrients.  The nerves can hold up for two to four hours and the muscles can only survive for six hours before becoming permanently damaged.  

Photo by: Hernan Pinera

Photo by: Hernan Pinera

What Causes Compartment Syndrome

There are a number of things that can cause Compartment Syndrome to take place. So having a good knowledge of the mechanism of injury is our biggest help in recognizing what’s going on:

If any of these things have happened and you’re not quite sure if this is a medical emergency, better safe than sorry, have the person sent to the hospital.

But there are some tell tale signs to look for that will help make your decision.

Pain is going to be your first indication that something is wrong. But the pain may not seem to be normal compared to the injury.

Now that you’ve established that this is a medical emergency, it can’t be treated the same way you would typically think to do it.

If there is a long bone fracture in place you can’t put a splint in place as you normally would for a fracture. Anything restricting the area must be cut away to allow the area to swell. Putting on a splint or bandage is only going to make the Compartment Syndrome worse.

However any movement is going to aggravate the pain, so you will have to manually support the injured limb/area as best you can with the help of others around you.

If there is no fracture to the area then it can be treated as you would other soft tissue injuries.

Immobilize the limb as best you can (without bandaging it) and apply ice to the area. If possible, elevate the limb above the heart to help decrease circulation to the area.

But the most important thing you can do is call 9-1-1 and get the person to more advanced medical care as soon as possible.

Once in the care of the hospital, surgical interventions will take place in order to relieve the pressure. A “fasciotomy” is performed, where surgeons cut the muscle and fascia in order to back off the pressure and hopefully save the surrounding tissues.

Massage Therapy And Compartment Syndrome

I actually wrote this article with some encouragement from a former student (thanks, Chelsea).

I wasn’t sure what topic to write on and she told me Compartment Syndrome would be a good topic because we didn’t learn a lot about it in college.

Holy was she right!

Just in doing research on this one I came to learn more about the different compartments that can be affected. I had no idea that the glutes, thigh and upper arm were also at risk. Nor did I know much about Chronic Compartment Syndrome and how it is an overuse injury from excessive vigorous exercise.

The biggest takeaways are just to remember the mechanisms of injury that can create a Compartment Syndrome. Much like the player in the story at the beginning, blocking that shot caused a bad bruise that led to Compartment Syndrome of the anterior lower leg. Always be careful and check (especially with traumatic injuries) if there is a long bone fracture or circulation impingement.

As you assess the injured area, look for pain that doesn’t seem suitable to the injury, increases with muscle stretching and burning/tingling sensations around the area. If you follow your First Aid protocols and take things step by step, you should have no problem figuring out exactly what is wrong. 

Recognizing all of the above could possibly save a limb or a life, the next time you have to treat a Compartment Syndrome.

Now if I could just get that Athletic Therapist to keep quizzing me on things, I might get a little smarter!