Chronic exercise compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling, and sometimes disability in the affected leg or arm muscles. Anyone can get this condition, but it is most common in young adult athletes and runners who do activities that involve repetitive impacts.
Chronic exercise compartment syndrome may respond to nonsurgical treatment and activity modification. If treatment without surgery doesn’t help, your doctor may recommend surgery. Surgery works well for many people and may allow you to return to playing your sport.
In your extremities there are specific areas of muscles (compartments). At the bottom of the leg, for example, there are four compartments. Chronic exertional compartment syndrome often occurs in the same compartment of an affected limb on both sides of the body, usually the lower leg.
Signs and symptoms may include the following:
Pain, burning, or cramping in a compartment of the affected limb
Stiffness in the affected limb
Numbness or tingling in the affected limb
Weakness of the affected limb
Foot drop (in severe cases) if the legs are affected
Sometimes swelling or bulging as a result of a muscle herniation
Pain caused by chronic exercise compartment syndrome often follows this pattern:
It begins steadily some time after beginning to exercise the affected limb, or after a certain distance traveled or a certain intensity of exercise.
It gets progressively worse as you exercise.
Fades or stops completely within 15 minutes of stopping the activity.
Over time, you can increase your recovery time after exercising.
Stopping exercise altogether or only doing low-impact activities may relieve symptoms, although this is usually temporary relief. Once you start running again, for example, the symptoms return.
When to see the doctor
If you have unusual and recurring pain, swelling, inflammation, weakness, or loss of sensation due to exercise or sporting activity, talk to your doctor.
Chronic exercise-related compartment syndrome is sometimes confused with 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 it doesn’t improve with self-care measures, talk to your doctor.
There are a few factors that increase the risk of developing chronic exercise compartment syndrome, including:
Age. Although chronic exercise compartment syndrome can appear at any age, the disorder is most common among athletes under the age of 30 of both sexes.
The type of exercise. High-impact repetitive activity (such as running) increases the risk of developing this disorder.
Excessive training. Exercising too hard or too often can also increase the risk of chronic exercise compartment syndrome.
Other exercise-related problems are more common than chronic exercise compartment syndrome; So before more specialized tests are done, your doctor might try to rule out other causes, such as shin splints or stress fractures.
The results of the physical examination to detect chronic exercise compartment syndrome are usually normal. Your doctor may prefer to examine you after you’ve exercised to the point where symptoms develop. The doctor might notice a muscle lump, tenderness, or tightness in the affected area.
Imaging studies may be:
Magnetic resonance. A typical MRI can be used to assess the structure of the muscles in the compartments and rule out other possible causes of the symptoms. An advanced MRI scan can help assess the fluid volumes of the compartments. Images are taken at rest, with the foot moving until symptoms appear, and after exercise. This type of MRI scan has proven accurate in detecting chronic exercise compartment syndrome and may reduce the need for invasive compartment pressure testing.
Near infrared spectroscopy. Near-infrared spectroscopy is a novel technique that measures the amount of oxygen in the blood in affected tissue. The study is performed at rest and after physical activity. This helps determine if the muscle compartment has decreased blood flow.
Compartment pressure analysis
If the results of the imaging tests fail to show a stress fracture or a similar cause of pain, your doctor might suggest measuring the pressure in the muscle compartments.
This test, often called a compartment pressure measurement, is the main standard test for diagnosing chronic exertional compartment syndrome. This test consists of inserting a needle or catheter into the muscle before and after making a physical effort to make the measurements.
Because it is invasive and mildly painful, compartment pressure measurement is usually not done unless your medical history and other tests suggest you have this condition.
Options for treating chronic exercise compartment syndrome include surgical and non-surgical methods. However, non-surgical measures are usually only effective if you stop or significantly reduce the activity that caused the condition.
At first, your doctor may recommend pain relievers, physical therapy, shoe inserts (orthotics), massage, or a break from physical activity. Changing the way you step when you run or jog can also be beneficial. However, non-surgical options do not usually ensure long-term benefits for true chronic exercise compartment syndrome.
Botulinum toxin A (Botox) injections into the leg muscles may also help in treatment, but more research is needed for this alternative. Your doctor may apply numbing injections beforehand to help determine the affected area and what type of Botox dose is needed.
A surgical procedure called a fasciotomy is the most effective treatment for chronic exertional compartment syndrome. It consists of cutting the rigid tissue that lines each muscle compartment of the tissue. This relieves the pressure.
Sometimes a fasciotomy can be performed using small incisions, which can reduce recovery time and allow you to return to activities or sports sooner.
Although surgery is effective for most people, it carries some risks and, in some cases, may not completely relieve the symptoms associated with chronic exercise compartment syndrome. Some of the possible complications of surgery are infections, permanent nerve damage, numbness, weakness, bruising, and scarring.
With information from Mayo Clinic
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