Q & A: Chronic Exertional Compartment Syndrome

If you are experience pain or muscle aches in your legs when you exercise, you might be suffering from compartment syndrome.

When pain in the legs happens during exercise and intensifies as exercise continues, it could be due to chronic exertional compartment syndrome (or CECS), shin splints, stress fractures or various causes of compromise to blood and nerve supply to the leg.

Compartment syndrome occurs when pressure within muscles builds up, resulting in reduced blood flow and oxygen to the muscles.

Types of Compartment Syndrome

There are two types of compartment syndrome — acute and chronic. A case of acute compartment syndrome caught attention when a woman in Australia who wore skinny jeans while squatting ended up with legs so swollen that her jeans had to be cut off.

Despite this, acute compartment syndrome rarely occurs compared to chronic compartment syndrome. Individuals who frequently exercise are prone to experiencing this chronic form.

Worsening Leg Pain with Exercise

Physical activity can exacerbate your condition

If CECS is the main cause, the individual usually experiences decreasing tolerance over time as the condition worsens, with pain temporarily resolved during variable rest periods after exercise. In more severe cases, individuals also complain of neurological symptoms such as numbness, tingling or even weakness of their foot.

Causes of Chronic Compartment Syndrome

Running is the most common cause of CECS. It is most commonly seen in the young adult population, both elite and recreational runners, other endurance athletes, as well as military recruits. CECS most often occurs in the leg, with the most common areas of compression in the front area around the shin bone, on both the inner and outer aspects. However, CECS can also strike in the upper limbs and thighs.

Treating Chronic Compartment Syndrome

Do not delay medical attention if you suspect that you are suffering from compartment syndrome.

CECS is not uncommon, where a few suspected cases are identified each month. However, CECS occurs at varying degrees and is often underdiagnosed due to the delay in seeking medical attention and difficulty in diagnosis.

This being said, CECS is usually not dangerous or life-threatening. Conservative measures such as training modifications, footwear optimisation and fine-tuning running styles are usually successful in managing CECS.

Reply by Dr Teh Kong Chuan, Senior
Consultant, Sports Medicine Centre

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This article was last reviewed on 22 Nov 2023