Chronic Exertional Compartment Syndrome

February 1, 2017

Chronic Exertional Compartment Syndrome, commonly known as Compartment syndrome is a painful condition that occurs when pressure within the muscles builds to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.

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

CECS syndrome refers to exercise induced leg pain resulting from muscle ‘swelling’ and an increase in pressure in a compartment of the lower leg. The muscles in the lower leg are divided into a number of separate compartments by ‘sleeves’ of thick, inelastic connective tissue. When a person exercises, blood flow is increased to this compartment and the contained muscles increase in volume (swell). When there is not enough room within the compartment for this increased muscle volume, compartmental pressure rises. This can interfere with the blood flow to the muscles and nerves in the compartment, causing pain. Factors that may contribute to compartment syndrome include an increase in the size and volume of the muscles within the compartment, unaccustomed strenuous exercise, or progressive tightening of the surrounding connective tissue ‘sleeve’.

Men and women athletes are equally affected by the problem. Athletes often get CECS in both legs. It is more common in running sports, basketball, gymnastics, soccer, field hockey, and dance. Compartment syndrome most often occurs in the anterior (front) compartment of the lower leg (calf). It can also occur in other compartments in the leg, as well as in the arms, hands, feet, and buttocks.


The pain in CECS has been thought to derive from the same pathologic processes that cause pain in acute compartment syndrome—that is, compromise of the vascular supply, which leads to myoneural ischemia. Various mechanisms have been suggested as to the cause of this tissue ischemia, including arterial spasm, capillary obstruction, arteriovenous collapse, or venous outflow obstruction.

The pain and swelling of chronic compartment syndrome is caused by exercise. Athletes who participate in activities with repetitive motions, such as running, biking, or swimming, are more likely to develop chronic compartment syndrome. This is usually relieved by discontinuing the exercise, and is usually not dangerous.

A history of severe injury can cause scar tissue or injury to the compartment sleeve. Weight gain can also be associated with increasing compartment pressures. Drugs such as anabolic steroids can cause the muscle to increase in size but the compartment does not increase to accommodate it. Supplements such as creatine might cause swelling of the muscle. Training errors including excessive training frequency, type of exercise and poor running mechanics are also associated with fatigue and swelling of the muscle, increasing compartment pressure.

The risk factors include –

  • Chronic compartment syndrome most often occurs in athletes aged under 40 years but can occur at any age.
  • Most at risk are those who exercise with repetitive motions or activity.
  • Sporting activities with particular risk include running, football, cycling, tennis and gymnastics.
  • Excessive training increases the risk.


The most common sensation when a person has compartment syndrome is pain along the lower leg. This is commonly felt from the outside of the front edge of the shin (tibia). It may include- aching, tight, cramping or squeezing pain.

Symptoms may also include –

  • Numbness
  • Difficulty moving the foot
  • Visible muscle bulging


Nonsurgical treatment – Physical therapy, orthotics (inserts for shoes), and anti-inflammatory medicines are sometimes suggested. They have had questionable results for relieving symptoms.

Surgical treatment – If conservative measures fail, surgery may be an option. Similar to the surgery for acute compartment syndrome, the operation is designed to open the fascia so that there is more room for the muscles to swell. Although surgery is highly effective for most people, it’s not without risk. Complications of the surgery can include infection, permanent nerve damage, numbness and scarring.

Weight Loss – When a person gains weight the muscle has to work harder and there is potentially more mass in the compartment which increases pressure. Keeping weight as low as is appropriate is often helpful. Some athletes experience symptoms only after returning to running after a layoff and any increases in weight during this layoff may be a factor in increasing compartment pressure resulting in pain.

Flexibility training – If a muscle group is tight, the muscles that pull in the opposite direction have to work harder than normal.

Biomechanical assessment and correction – Assessment and correction of your biomechanics may potentially be very useful.

Alternative Treatment

Arginine – It acutely improve exercise capacity. Its chronic effect results from the stimulation of muscle protein synthesis and thus, anabolism (the synthesis in living organisms of more complex substances (e.g., living tissue) from simpler ones together with the storage of energy) of muscle protein.

Branched-Chain Amino Acids (BCCAs) – BCCAs are an important source of energy in prolonged endurance exercise. Supplementation is proposed to increase endurance in long tennis matches, soccer, marathons, long-distance swimming, and cycling activities. BCAA supplementation may contribute to increased body fat loss and maintenance of a high level of exercise performance.

Chromium – Chromium is a trace mineral that is used for weight loss and for enhancement of glycemic control in the treatment of diabetes. It has been proposed for the treatment of hyperlipidemia (an excess quantity of lipid in the blood) and hypercholesterolemia (an excess of cholesterol in the blood).

Creatine – Creatine is probably the most often used and the most researched supplement taken by athletes.

Vitamin C – Vitamin C is a powerful antioxidant which concentrates preferentially in leucocytes and attenuates reperfusion-induced muscle injury.


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