Compartment Syndrome: A Primer
Athletes who exercise on hard surfaces often experience lower leg pain, and they assume that the condition is shin splints, an inflammation of the tissue that covers the larger of the two bones in the lower leg.
But physicians refer to lower leg pain as medical tibial pain syndrome, a reference to one of several possible leg conditions, including chronic exertional compartment syndrome (CECS). CECS is an often misdiagnosed ailment that's received an increased amount of attention from athletes and sports medicine professionals.
According to the American Academy of Orthopaedic Surgeons, it becomes a painful and potentially dangerous condition when pressure within the muscles builds to extremely high levels. This prevents oxygen and nutrients from reaching nerve and muscle cells. The condition can be acute, which indicates a medical emergency and needs to be treated by a physician immediately, or it can be chronic compartment, which is not a medical emergency but one that needs medical attention. The symptoms below describe what to look for in each case.
How Compartment Syndrome Happens
Chronic compartment syndrome develops when excessive training or swelling makes muscles temporarily too large for the compartments in which they're contained. The compartments are made of an inelastic membrane (fascia) that doesn't readily expand. The resulting pressure compresses nerves and restricts circulation, causing pain.
The symptoms only appear during exercise, not when the person is at rest. Some examples of how compartment syndrome might occur are when a football player takes a heavy blow to the thigh from an opponent’s helmet or when a motorcycle falls on a rider's leg.
Who’s at Risk for Compartment Syndrome
Compartment syndrome is most common in the legs of runners, soccer players, and other athletes who place high demands on their leg muscles. It can affect muscles in the forearms and legs of kayakers, race walkers, cyclists, swimmers, canooers, rowers, gymnasts, and body builders.
Symptoms for Acute Compartment Syndrome
- Acute muscle pain or cramping feeling
- Swollen, shiny skin overlying the compartment
- Bleeding within the muscle compartment
- A feeling or tightness, tingling, or burning in the muscle
- Pressure must be relieved quickly. If not, permanent disability or death is possible.
Symptoms for Chronic Compartment Syndrome
- Pain that develops during exercise
- Pain, usually in the leg, subsides with rest.
- Symptoms often apparent in both legs
See a doctor to measure the pressure in the muscle or muscle group. This will help rule out other underlying conditions and determine the appropriate treatment (including surgery).
- Nonsurgical treatment may not be effective.
- Apply ice applications for 15-20 minutes during the period before seeing a doctor.
- Take aspirin, ibuprofen, acetaminophen, or naproxen for pain/inflammation.
- Don't wrap the leg (because it might increase pressure).
- Don't try to play through the pain.
- Stop the activity that causes the discomfort.
- Modify your training program (perhaps change your running surface, athletic shoes, or running technique).
Incorporate these prehab exercises for the arch of the foot:
- Sit in a chair and make a slight arch with your foot, keeping the big toe on the ground and holding for several seconds.
- Repeat this for 8-10 reps and make it more difficult by standing or doing only one foot at a time.
For a stronger pillar (hips, torso, shoulders):
- Pillar Bridge Front, Lateral, and Lateral Jumping Jack
- Glute Bridge Progression: Glute Bridge, Marching, One Leg, Padded, and Physioball
- Cable Lift - Lateral Half Kneeling
- Cable Chop - Lateral Half Kneeling
How to Avoid Compartment Syndrome
Prevention may not be possible, but awareness of the symptoms and early treatment may prevent complications.
Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.
- Steve Smith, PT, DPT, SCS, CSCS, Manager, Performance Physical Therapy Services Athletes’ Performance, Florida
- American Academy of Orthopaedic Surgeons
- Sports Injuries: Prevention, Treatment and the Healing Process (The Cleveland Clinic)