Dr. Marc Silberman specializes in compartment testing and the diagnosis of exertional compartment syndrome. He has been performing compartment tests for more than 10 years and is a referral source for orthopedic surgeons located throughout the Northeast and Mid Atlantic. He has presented cases at national conferences and has been published in peer-reviewed scientific journals on the topic of exertional leg pain and compartment syndrome.
Exertional Compartment Syndrome (ECS): A clinical condition where an athlete classically experiences reproducible exercise induced lower leg pain that begins at a consistent time with activity and is relieved with cessation of exercise. There may be numbness, tingling, and weakness. The presentation can be quite variable and pain may be present all the time even after cessation of exercise.
Exact cause is unknown though it is felt to be secondary to excessive pressure within the compartments of the leg leading to reduced blood flow.
Diagnosis is made by measuring pressures within the leg before and after exercise. Pressures normally rise with exercise normally rise with exercise but should return to baseline within 5 minutes after cessation of running. In ECS, elevated pressures result with exertion and remain elevated for a prolonged length of time.
Compartment Testing: Your skin is numbed with lidocaine. A manometer, as imaged above measuring the anterior compartment, is inserted four separate times into your leg to measure the four compartments of your lower limb. You will then run until symptoms are brought on, with testing repeated 5 minutes after stopping.
Treatment consists of modification of activity, addressing training error, orthotic and footwear evaluation, biomechanical (video gait analysis) evaluation and training, massage and myofascial release, and core and extremity strengthening. Once you develop compartment syndrome though, it appears the only treatment option until recently has been surgery with fasciotomy, surgical release of the compartments, which has a greater than 20% failure rate.
Botox injections for exertional compartment syndrome is a novel, non-surgical intervention that appears to have some promising results in published case studies. Dr. Silberman has successfully treated exertional compartment syndrome with Botox injections in the office. After consultation, the amount of Botox that will be used for your treatment is calculated and a prescription for Botulinum Toxin Type A (Botox) will be given to you to be filled at a pharmacy. Dr. Silberman performs Botox injections for compartment syndrome under ultrasound guidance. Botox injections for compartment syndrome are not covered by insurance.
Silberman, Marc R., Brian J. Shiple, and Steven J. Collina. "Exercise Induced Leg Pain-Soccer." MSSE 36.5 (2004):S93.
Getzin, Andrew R., and Marc Richard Silberman. "Iliac Artery Flow Limitations in Endurance Athletes." CSMR 9.6 (2010):334-337.
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Exertional Compartment Testing