Chronic Exertional Compartment Syndrome

Chronic Compartment Syndrome (CECS) is a painful, chronic exercise-induced musculosketal problem in the affected limb. It is widely under recognised and often misdiagnosed as shin splints in the lower leg or as general muscle tightness from pushing too hard in the gym. Because the symptoms could be explained by a number of factors, formal diagnosis and relevant imaging can sometimes take time. 

Typical Signs and Symptoms: 

  • Aching, tightness, swelling, cramping in the affected limb which can be progressively debilitating 
  • Pins and needles or numbness
  • Can occur in one limb or both (more common) 
  • Pain typically induced by exercise and typically worsened with increased intensity, distance or time 
  • Pain subsidises within minutes of finishing activity


  • When there is increased muscle pressure in a particular muscle compartment during and after exercise 
  • Primarily affects the lower legs and is more commonly seen in the front and side of the shin bone where the compartments sit in a tighter space.
  • When exercises, blood flow increases to the working muscles to improve their capacity, but if the muscle does not expand then the pressure builds up within the compartment and causes severe pain

    Risk Factors: 

  • Age – Although anybody can develop this problem, the condition is more common in athletes under the age of 30 years
  • Exercise – Repetitive impact activities such as running, soccer, walking and jumping
  • Over training – Increasing the duration or intensity of training can increase symptoms significantly


  • Suspected with a good history and thorough clinical examination  
  • If CESC is suspected then referral to a Sports and exercise Physician is advised to discuss the relevant imaging required 
  • Diagnosis is confirmed when the pressure within the compartment exceeds normal limits. A pressure test is required for this, 

    Treatment Options:

  • Non Operative – Symptoms can be well managed and greatly relieved with activity modification, relative test, optimal biomechanics and compression. However, given the pathophysiology, if an individual wants to maintain a high level of intensive activity and CECS is confirmed on pressure testing then referral to a surgeon is advised 
  • Operative – The operation required for relief is known as a fasciotomy whereby the surgeon divides the outer layer of the muscle (fascia) to relieve pressure. 

It is important to note that chronic exertional compartment syndrome is not a life-threatening condition. It is different from an acute episode of compartment syndrome which is considered a medical emergency.