Exertional compartment syndrome

What is exertional compartment syndrome?

Exertional compartment syndrome (ECS) is a condition that causes pain with exertion. Although the condition can occur in other compartments, 95% of cases are in the lower leg. The average age of onset is 20 years; males and females are equally affected. The condition is most common in runners, but it also occurs in other running sports including soccer, field hockey, basketball, and lacrosse.

What are the signs and symptoms?

Symptoms are typically aching pain in the affected compartment that becomes sharp as activity continues. This can develop into muscle weakness and sensory disturbance. Pain is usually quickly relieved when activity is stopped.

What are the causes?

ECS is caused by increased intracompartmental pressure within a fascial space; there are four compartments in the lower leg — one in the front, one on the outside, and two in the back (superficial and deep). Each compartment has a covering of fascia, or connective tissue. ECS occurs when the muscles expand during exercise and the fascial covering around the muscles becomes too tight. Repetitive impact activity — such as running — increases your risk of developing the condition, as well as overtraining.

How is it diagnosed?

ECS is diagnosed by examining and evaluating for other causes of the leg pain, such as shin splints, stress fractures, or trapped nerves. An MRI or other imaging may be used but the standard diagnostic test is a measuring compartment pressures with a special instrument that analyses pressure through a needle placed in the muscle. ECS will show elevated pressure from at rest to after exercise.

How is it treated?

Before interventional procedures are considered, patients are encouraged to consider discontinuing the activities that provoke the pain. You may obtain pain relief by altering the mechanics of your run. In particular, landing on the midfoot or forefoot instead of their hindfoot may decrease pain. A physical therapist or athletic trainer with expertise in running mechanics can analyze your running gait and help make appropriate modifications.

How can it be prevented?

Gradually building up activity endurance may help prevent or reduce the severity of ECS, as well as wearing the right shoes, altering gait pattern in runners, and improving flexibility.