From ice skating to curling, the exciting sports during the Winter Olympics have a lot of science behind them. Follow our coverage here to learn more.
Sprinter Lindsey Vonn has won acclaim not only for her ability in the sport, but also for her ability to persevere. Committing to compete despite tearing her ACL just more than a week before the event at this year’s Winter Olympics, the decorated American skier crashed just seconds into the race, breaking her left leg in multiple places. And in an Instagram post on Monday, she revealed her injury was even more complex and life-threatening than we knew.
The Olympic skier revealed that she developed compartment syndrome, a rare but serious condition that can be life-threatening and limb-threatening.
On supporting science journalism
If you like this article, please consider supporting our award-winning journalism by subscribes. By purchasing a subscription, you help secure the future of impactful stories about the discoveries and ideas that shape our world today.
We asked experts to explain what compartment syndrome is and why it’s so dangerous.
What is compartment syndrome?
Every muscle and organ in the body is encased in a tough layer of tissue called fascia. Jason Lee, chief of vascular surgery at Stanford University School of Medicine, likens it to a thin envelope or sleeve.
Fascia holds your muscles in place when you run, for example, and prevents your organs from being pushed around when you cough or sneeze. But the robustness of this tissue can have disadvantages.
After someone experiences significant trauma to the body—such as a high-speed ski crash that breaks their leg—the surrounding muscles can quickly bleed and swell. As the swelling increases, pressure builds in the area between the muscle and the fascia. But because the fascia is so strong, it can withstand that pressure. That can become a problem: If the pressure rises too much, it blocks blood flow to the area. Eventually, the blood stops flowing completely, which can result in tissue death and nerve damage – that’s compartment syndrome.
“That’s where it ends up being a limb-threatening condition,” says Matthew Apicella, a physician at NYU Langone Health who is board-certified in emergency and sports medicine.
“When you start to get tissue damage or tissue necrosis, which is when that tissue starts to die, the literature would say that can happen just four to eight hours after the compartment syndrome starts to happen,” he says.
What are the symptoms of compartment syndrome?
Not everyone with an injury like Vonn’s will experience compartment syndrome. Apicella says current research suggests it occurs in anywhere from 1 to 10 percent of all fractures, and it’s more common in the long bones of the body. And, says Lee, “the more severe the injury, the higher the likelihood of developing compartment syndrome.”
Both he and Apicella say that one of the main ways doctors detect compartment syndrome is when a person begins to experience extreme, unexpectedly high levels of pain. “In medical training, we’re taught to look for the 5 ‘Ps,'” says Apicella. The first P stands for pain out of proportion to the exam. The other P’s are pallor, paresthesia, which means tingling or numbness in the area, paralysis and pulselessness in the affected limb.
When someone has compartment syndrome, the first P can be a giveaway: “When you press on (the injury site), it doesn’t hurt that much because there’s often numbness, but they’re sitting there in excruciating discomfort,” says Lee.
How to treat compartment syndrome
Compartment syndrome is characterized by a build-up of pressure, so the only real treatment for the condition is to relieve that pressure. “If you just let something swell and swell and swell, the skin will literally break,” says Lee.
To prevent that and to get the blood flowing again, doctors perform what’s called a fasciotomy, which is essentially a controlled break in the skin. Long, deep incisions are made on either side of the injury, giving the swollen muscles some room to move and relieving pressure build-up.
“A fasciotomy can be a life- and limb-saving procedure where, if you decide not to make the cut and let it expand, the nerve can die, leading to permanent muscle damage that never lets a person walk again, or, in the worst case scenario, the need for amputation,” says Lee. But it also means a longer and more complicated recovery, he says, because you have to heal from the incisions as well as the original injury.
And while he can’t comment directly on Vonn’s case, Lee says that sometimes the condition can actually be triggered by the surgeries needed to fix the original injury.
Immediately after an operation like Vonn’s, where doctors adjust the leg, a phenomenon called reperfusion occurs, says Lee. With reperfusion, the surrounding tissues that were starved of blood flow and oxygen suddenly get the blood flow back. This rapid rebound can actually make swelling worse and compartment syndrome more likely.
Both experts emphasize that compartment syndrome is not common for the everyday athlete, but it is something to be aware of. “It’s important to know that if you have a fracture and you start having worsening pain, then it’s time to see a doctor to be evaluated by someone who is going to rule out these signs of compartment syndrome,” Apicella says.
