Understanding chronic exertional compartment syndrome

The muscles of the lower leg lie within spaces enclosed by connective tissue, known as compartments. During exercise, muscle volume temporarily increases. If pressure within a compartment rises substantially, exercise-related pain and neurological symptoms may develop. Symptoms typically subside once exercise stops.

• Symptoms regularly occur after a similar duration or intensity of running or another reproducible activity.
• Pain, tightness or pressure increases during exercise and improves with rest.
• Tingling, numbness or temporary weakness may also occur.
• Examinations at rest or existing imaging do not adequately explain the symptoms.

Whether pressure testing is appropriate in your case is decided after taking your history, examining you and reviewing existing findings.

Exercise-related lower-leg pain can also be caused by medial tibial stress syndrome, a bone stress reaction or stress fracture, muscle and tendon problems, nerve irritation or vascular problems. Additional investigations are guided by the individual findings.

Treatment depends on the cause, the muscle compartment involved, sporting demands and personal goals. Depending on the findings, changes to exercise load, physiotherapy, running technique or training may be considered. For persistent, significant symptoms and a clear diagnosis, a surgical opinion on fasciotomy may be appropriate. This operation opens the tissue surrounding a muscle compartment to relieve pressure. Benefits, limitations and possible risks are assessed individually.