What is Compartment Syndrome?

Compartment syndrome occurs when excessive pressure builds up inside an enclosed muscle space in the body. The high pressure in compartment syndrome impedes the flow of blood to and from the affected tissues, causing pain, numbness and tingling. There are 2 types of compartment syndrome, chronic exertional compartment syndrome and acute compartment syndrome.

What structures are involved? 

There is swelling in the compartment between the muscles and the surrounding fascia (a thin sheath of fibrous tissue enclosing the muscles) of that compartment. The swelling impedes all surrounding structures, including arteries, veins and nerves.

Depending on the compartment, the musculature involved includes:

  • Superficial posterior compartment: soleus and gastrocnemius muscles
  • Deep posterior compartment: tibialis posterior, flexor hallucis longus, flexor digitorum longus
  • Lateral compartment: peroneus longus, peroneus brevus
  • Anterior compartment: tibialis anterior, extensor hallucis longus, extensor digitorum longus

What causes chronic exertional compartment syndrome?

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. The muscles are covered by a tough fascia to keep them in place, which does not expand or stretch easily. Therefore when there is a build-up of pressure within the compartment and the facia does not expand outwards, the pressure forces the compression of structures within the compartment, such as blood vessels and nerves, leading to diminished blood perfusion, pain, numbness and/or cramping.

What are the symptoms and complications?

Chronic exertional pain syndrome results in inadequate perfusion and ischemic-related symptoms, including:

  • Aching, burning or cramping pain in the affected limb — usually the lower leg
  • Tightness in the affected limb
  • Numbness or tingling in the affected limb
  • Weakness of the affected limb
  • Foot drop, in severe cases, if legs are affected
  • Often occurs in the same compartment of both legs
  • Occasionally, swelling or bulging as a result of a muscle hernia

Pain due to chronic exertional compartment syndrome typically follows this pattern:

  • Begins after a certain time, distance or intensity of exertion after you start exercising the affected limb
  • Progressively worsens as you exercise
  • Subsides within 10 to 20 minutes of stopping the activity
  • Over time, recovery time after exercise often increases

Taking a complete break from exercise or performing only low-impact activity might relieve your symptoms, but usually only temporarily. Once exercise is started again the symptoms will likely return.

If exercise continues beyond the pain limit and the muscle continues to swell it may lead to ACUTE COMPATMENT SYNDROME, a severe and irreversible form of abnormally elevated intramuscular pressure that leads to tissue necrosis, permanent loss of function and possible amputation if left untreated. This is a clinical emergency requiring surgical intervention.

How to treat chronic exertional compartment syndrome?

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence. These are:

  • Early Injury Protection: Pain Relief & Anti-inflammatory Tips
  • Regain Full Range of Motion
  • Restore Foot and Ankle Control
  • Restore Normal Lower-limb Function
  • Restore Lower-limb Strength
  • Restore High Speed, Power, Proprioception & Agility
  • Return to Pre-injury Activities

Clinicians will work with patients to develop an appropriate rehabilitation plan with emphasis on proper technique, gait retraining, and return to activity in a step-wise fashion. Over a period of weeks, with clinical guidance, patients will slowly increase activity intensity and duration and add sport-specific activities and exercises to their rehabilitation program as long as they remain pain-free. Patients should scale back any exercises that exacerbate their symptoms or cause pain.

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