Chronic Exertional Compartment Syndrome
Robert H. Sheinberg, DPM

A muscle compartment is a muscle or group of muscles enclosed by borders consisting of bones and most importantly by a form of tight connective tissue called fascia. The fascia has a limited amount of flexibility and therefore has a limited ability to stretch and expand. Also contained within these compartments are blood vessels and nerves.

There are 4 compartments within the lower leg- the anterior(front), lateral(outside edge), and posterior compartment(which is separated into superficial and deep). Each compartment contains a major nerve coursing through it in addition to major and minor blood vessels. If there is an excessive expansion of the muscle size during exercise that is too great for the amount of flexibility of the fascia, the blood supply to the muscles and nerves is diminished.

Signs and Symptoms:

• Onset of pain and a feeling of "fullness" over the involved compartments
• The symptoms occur at the same point of time during exercise- "I get it 20 minutes into my run every day"
• Can be either both sides or just one side.
• Symptoms are relieved by rest, usually within 20 minutes of exercise, only to reappear with resuming exercise
• There may be a feeling of numbness in the legs/feet or a patient may feel that he or she cannot move the foot or leg as effectively as should be possible.
• The affected area may feel tight and tense
  

Diagnosis:

• A thorough history must be taken in order to rule out other causes of leg pain such as stress fractures, shin splints, and tendonitis.
• A comprehensive exam including x rays of the leg as well as examination for any biomechanical forces that may be contributing to the discomfort is necessary.
  

Compartment Testing

• In order to definitively rule out compartment syndrome, compartment testing is performed- the pressure within the compartment is measured at rest , then the patient performs exercise until the symptoms appear; compartment pressures are then measured at 1 minute post-exercise and 5 minutes post-exercise to evaluate how high the compartment pressure reads and how fast the compartment pressure normalizes

Treatment consists of a variety of options depending on physical exam

• ORTHOTICS to correct any biomechanical imbalances
• PHYSICAL THERAPY to address any muscular imbalances and decrease inflammation and pain
• MODIFYING training regimen or training/athletic surface
• SURGERY to release the tight fascial borders; this procedure is quite successful and training can usually resume in 4 weeks

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