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Chronic exertional compartment syndrome (CECS)
An overuse injury common in young endurance athletes
In athletes with lower leg pain, CECS was found to be the cause in 13.9% - 33%.
*This is likely under diagnosed as most recreation athletes will discontinue or modify their activity level at early symptom onset
Common in runners and most often involves the anterior compartment
Occurs due to increased pressure within the fascial compartments, primarily in the lower leg
Symptoms are bilateral 85 - 95% of the time
Exercise increases blood flow to leg muscles which expand against tight surrounding noncompliant fascia. This, in turn, increases compartment pressures and eventually reduces blood flow which leads to ischemic pain. Pain usually begins within minutes of starting exercise and experienced athletes can often pinpoint the time/distance required for symptom onset.
Symptoms are primarily pain (tightness, cramping, squeezing) but may also include paresthesias and numbness. Symptoms gradually abate with cessation of activity.
Diagnosis: Although some physicians’ make a clinical diagnosis based on Hx and exam, definitive diagnosis requires measurement of compartment pressures both at rest and post exercise.
Nonsurgical treatment: activity modification and rest
Surgical treatment: >80% success with anterior and lateral compartments vs. 50% with deep posterior compartment.