Chronic exertional compartment syndrome

Chronic exertional compartment syndrome is an uncommon, exercise-induced neuromuscular condition that causes pain, swelling and sometimes even disability in affected muscles of your legs or arms.

Anyone can develop chronic exertional compartment syndrome, but it’s more common in athletes who participate in sports that involve repetitive movements, such as running, fast walking, biking and swimming. Chronic exertional compartment syndrome is sometimes called chronic compartment syndrome or exercise-induced compartment syndrome.

Symptoms:

The pain and other symptoms associated with chronic exertional compartment syndrome may be characterized by:

1. Aching, burning or cramping pain in the affected limb — usually the lower leg, but sometimes the thigh, upper arm, forearm or hand

2. Tightness in the affected limb

3. Numbness or tingling in the affected limb

4. Weakness of the affected limb

5. Foot drop, in severe cases, if nerves in your legs are affected

6. Occasionally, swelling or bulging as a result of a muscle hernia

Pain typically happens soon after you start exercising the affected limb, gets progressively worse for as long as you exercise, stops 15 to 30 minutes after the affected limb comes to rest and over time, may begin to persist longer after exercise, possibly lingering for a day or two.

Taking a complete break from exercise may relieve your symptoms, but usually once you take up running again, your symptoms usually come back unless you continue to stretch and do keep up to date with your rehabilitative exercises.

If you experience unusual pain, swelling, weakness, loss of sensation, or soreness related to exercise or sports activities, talk to your doctor because these symptoms may be associated with conditions that require emergency medical treatment. Don’t try to exercise through the pain, as that may lead to permanent muscle or nerve damage — and jeopardize continued participation in your favorite sports.

Sometimes chronic exertional compartment syndrome is mistaken for shin splints. If you think you have shin splints but they don’t get better with self-care, talk to your doctor.

What are the causes?

Your arms and legs have several groupings, or compartments, of muscles, blood vessels and nerves. Each of these compartments is encased by a thick layer of connective tissue called fascia (FASH-ee-uh), which supports the compartments and holds the tissues within each compartment in place. The fascia is inelastic, which means it has little ability to stretch.

In chronic exertional compartment syndrome, exercise or even repetitive muscle contraction causes the tissue pressure within a compartment to increase to an abnormally high level. But because the fascia can’t stretch, the tissues in that compartment aren’t able to expand sufficiently under the increased pressure. Imagine shaking up a soda bottle but leaving the cap on — an enormous amount of pressure builds up.

As the pressure builds up within one of your muscle compartments, with no outlet for release, nerves and blood vessels are compressed. Blood flow may then decrease, causing tissues to get inadequate amounts of oxygen-rich blood, a condition known as ischemia (is-KE-me-uh). Nerves and muscles may sustain damage.

Experts aren’t sure why exercise or muscle contraction creates this excessive pressure in some people, leading to chronic exertional compartment syndrome. Some experts suggest that biomechanics — how you move, such as landing styles when you jog — may have a role. Other causes may include having enlarged muscles, an especially thick or inelastic fascia, or high pressure within your veins (venous hypertension).

In chronic exertional compartment syndrome, exercise or even repetitive muscle contraction causes the tissue pressure within a compartment to increase to an abnormally high level. But because the fascia can’t stretch, the tissues in that compartment aren’t able to expand sufficiently under the increased pressure. Imagine shaking up a soda bottle but leaving the cap on — an enormous amount of pressure builds up.

As the pressure builds up within one of your muscle compartments, with no outlet for release, nerves and blood vessels are compressed. Blood flow may then decrease, causing tissues to get inadequate amounts of oxygen-rich blood, a condition known as ischemia (is-KE-me-uh). Nerves and muscles may sustain damage.

Experts aren’t sure why exercise or muscle contraction creates this excessive pressure in some people, leading to chronic exertional compartment syndrome. Some experts suggest that biomechanics — how you move, such as landing styles when you jog — may have a role. Other causes may include having enlarged muscles, an especially thick or inelastic fascia, or high presse within your veins (venous hypertension).

What are the risk factors?

The condition is most common in athletes under 40, although people of any age can develop chronic exertional compartment syndrome.

People most at risk of developing chronic exertional compartment syndrome are those who engage in exercise that involves repetitive motions or activity. Young female athletes may be at particular risk, for reasons unknown.

Risk factors include engaging in such sports, exercises and activities as:

  • Running
  • Football
  • Soccer
  • Biking
  • Tennis
  • Gymnastics

Overuse of your muscles or overtraining — that is, 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 any lasting or permanent damage if you seek appropriate treatment. However, if you continue to exercise despite pain, the repeated increases in compartment pressure can lead to muscle, nerve and blood vessel damage. As a result, you may develop permanent numbness or weakness in affected muscles.

Perhaps the biggest complication of untreated chronic exertional compartment syndrome is its impact on participation in your favorite sports — the pain may prevent you from being active.


Don’t try to exercise through your pain. Limit your physical activities to those that don’t cause pain. For example, if running bothers your legs, you may be able to swim. Use ice or take omega 3s until you can see your doctor and make sure this is NOT an emergency.

The following basic sports and fitness guidelines can help protect your health and safety during exercise:

  • Warm up before starting exercise.
  • Cool down when you’re done exercising.
  • Stop if you’re in pain.
  • Check with your doctor before starting a new exercise program if you have any health issues.
  • Eat a healthy, balanced diet.
  • Stay hydrated.
  • Engage in a variety of physical activities.

Sections of this article are published on http://www.mayoclinic.com/health/chronic-exertional-compartment-syndrome/DS00789