Chronic exertional compartment syndrome
Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles of your legs or arms. Anyone can develop the condition, but it's more common in athletes who participate in activities that involve repetitive impact, such as running.
Chronic exertional compartment syndrome may respond to non-operative treatment and activity modification. If non-operative treatment doesn't help, your doctor might recommend surgery. Surgery is successful for many people, and might allow you to return to your sport.
The signs and symptoms associated with chronic exertional compartment syndrome might include:
- Aching, burning or cramping pain in the affected limb — usually the lower leg
- Tightness in the affected limb
- Numbness or tingling in the affected limb
- Weakness of the affected limb
- Foot drop, in severe cases, if legs are affected
- Often occurs in the same compartment of both legs
- Occasionally, swelling or bulging as a result of a muscle hernia
Pain due to chronic exertional compartment syndrome typically follows this pattern:
- Begins after a certain time, distance or intensity of exertion after you start exercising the affected limb
- Progressively worsens as you exercise
- Subsides within 10 to 20 minutes of stopping the activity
- Over time, recovery time after exercise often increases
Taking a complete break from exercise or performing only low-impact activity might relieve your symptoms, but usually only temporarily. Once you take up running again, for instance, those familiar symptoms usually come back.
When to see a doctor
If you have unusual pain, swelling, weakness, loss of sensation, or soreness related to exercise or sports activities, talk to your doctor immediately. Don't try to exercise through the pain; that can lead to permanent muscle or nerve damage.
Sometimes chronic exertional compartment syndrome is mistaken for shin splints, a more common cause of leg pain in young people who do a lot of vigorous weight-bearing activity, such as running. If you think you have shin splints but they don't get better with self-care, talk to your doctor.
The cause of chronic exertional compartment syndrome isn't completely understood. However, it's associated with increased pressure in a muscle compartment with exertion.
When you exercise, increased blood flow to working muscles expands them. If the connective tissue (fascia) that binds the muscle fibers in a compartment doesn't also expand, pressure builds up in the compartment. Over time, the pressure cuts off some of the muscle's blood supply.
Some experts suggest that how you move (biomechanics) might have a role in causing chronic exertional compartment syndrome. Other causes might include having enlarged muscles, an especially thick or inelastic band of tissue (fascia) surrounding a section of muscle, or high pressure within your veins (venous hypertension).
Chronic exertional compartment syndrome is a musculoskeletal condition brought on by exercise. It can affect muscle compartments in any of your limbs but occurs most commonly in the lower legs. The lower leg has four compartments, and any one or all of them can be affected.
Certain factors increase your risk of developing chronic exertional compartment syndrome, including:
- Age. Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in male and female athletes under 30.
- Type of exercise. Repetitive impact activity — such as running or fast walking — increases your risk of developing the condition.
- Overtraining. Working out too intensely or too frequently also can raise your risk of chronic exertional compartment syndrome.
Chronic exertional compartment syndrome isn't a life-threatening condition and usually doesn't cause lasting damage if you get appropriate treatment. However, continuing to exercise despite pain can be difficult if severe weakness or numbness is present.
Other exercise-related problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes — such as shin splints or stress fractures — before moving on to more specialized testing.
Physical exams for chronic exertional compartment syndrome are often normal. Your doctor might prefer to examine you after you've exercised to the point of bringing on symptoms. Your doctor may notice a muscle bulge (herniation), tenderness or tension in the affected area.
Your doctor might suggest imaging studies such as MRI or near infrared spectroscopy (NIRS). A typical MRI scan of your legs can be used to evaluate the structure of the muscles in the compartments and rule out other possible causes of your symptoms.
A newer, special MRI scan can help assess the fluid volumes of the compartments during exercise. It has been found to be accurate in detecting compartment syndrome, and may reduce the need for the invasive compartment pressure testing.
NIRS is a newer technique that uses light wavelengths to measure tissue oxygen saturation in your blood. This helps to determine if your muscle compartment has decreased blood flow.
Compartment pressure testing
If imaging studies fail to uncover an abnormality such as a stress fracture or similar cause of pain, your doctor might suggest measuring the pressure within your muscle compartments.
This test, often called compartment pressure measurement, is the gold standard for diagnosing chronic exertional compartment syndrome. Because it's invasive and mildly painful, involving insertion of needles into your muscles, compartment pressure measurement usually isn't performed unless your medical history and other tests strongly suggest you have this condition.
Options to treat chronic exertional compartment syndrome include both non-operative and surgical methods. However, non-operative measures are typically successful only if you stop or greatly reduce the activity that caused the condition.
Your doctor may initially recommend pain medications, stretching or strengthening regimens, orthotics, massage, a break from exercise, or the use of different biomechanical techniques, such as changing how you land when you jog. However, non-operative options typically don't provide lasting benefit for true chronic exertional compartment syndrome.
Surgery is the most effective treatment of chronic exertional compartment syndrome. Surgery involves operating on the inelastic tissue encasing each muscle compartment (fascia). Methods include either cutting open the fascia of each affected compartment (fasciotomy) or actually removing part of the fascia (fasciectomy). Surgery relieves the pressure.
Although surgery is effective for most people, it's not without risk. Complications of the surgery can include infection, permanent nerve damage, numbness and scarring.
Preparing for an appointment
You're likely to start by seeing your family doctor or a general practitioner. He or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.
Here's some information to help you get ready for your appointment.
What you can do
When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:
- Your symptoms, including any that seem unrelated to the reason for your appointment
- Key personal information, including what sports you participate in, the type of exercise you do, and how much and how often you exercise
- All medications, vitamins or other supplements you take, including the doses
- Questions to ask your doctor
Get copies of recent imaging tests you've had, if possible. Ask your doctor's staff how you can get these forwarded to your doctor before the appointment.
Take a family member or friend along, if possible, to help you remember the information you're given.
For chronic exertional compartment syndrome, questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes?
- What tests do I need?
- Is my condition likely temporary or chronic?
- What treatments are available, and which do you recommend?
- I have other health conditions. How can I best manage these conditions together?
- Are there restrictions I need to follow, such as avoiding certain activities?
- Should I see a specialist? If so, whom do you recommend?
- Are there brochures or other printed materials I can have? What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
- When did your symptoms begin?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- How soon do your symptoms start after you begin your activity?
- How quickly do your symptoms resolve after you stop your activity?
- Do you notice weakness in your legs or feet?
- Do you have numbness or tingling?
Lifestyle and home remedies
To help relieve the pain of chronic exertional compartment syndrome, try the following:
- Use athletic shoe inserts (orthotics) or wear better athletic shoes.
- Limit your physical activities to those that don't cause pain, especially focusing on low impact activities such as cycling or an elliptical trainer. For example, if running bothers your legs, try swimming. Or try running on softer surfaces.
- Apply ice to the affected area after exercising.
Last updated: August 4th, 2017