What is Chronic Exertional Compartment Syndrome?
The muscle in the lower limbs are divided into compartments, formed by strong, unyielding fascial membranes. Compartment syndrome occurs when increased pressure within a compartment compromises the circulation and function of the tissues within that space. The pressure build up can cause compression on the sensory nerves as well. This pressure build up can occur acutely with trauma or from excessive running. The pressure build up when exerting yourself in running that causes pain is termed as chronic exertional compartment syndrome. This condition typically affects young endurance athletes who run excessively.
Causes of CECS
When you exercise, the blood supply to muscles increases which causes the muscles to expand. If the fascia containing these muscles doesn’t also expand from stiff muscle tissue for example, pressure builds up in the compartment. Over time and as you continue to exercise, the pressure cuts off some of the muscles blood supply, resulting in ischaemic symptoms such as pain, numbness and decreased muscle function. CECS can be a result of having enlarged muscles, having a thick or inelastic fascia surrounding the section of muscle, or high pressure within your veins.
Signs and Symptoms of CECS
- Aching, burning or cramping in the lower leg.
- bilateral symptoms are common
- Tightness in the affected muscles.
- Numbness, weakness and tingling.
- Occasionally, swelling or bludging as a result of muscle hernia.
Chronic exertional compartment syndrome often follows a particular pattern which distinguishes it from other lower leg conditions. Typical pattern of CECS:
- Begins soon after you start exercising the affected limb.
- Progressively worsens as long as you’re exercising.
- Pain decreases when the limb comes to rest, usually resolving within 30 minutes.
Conservative Treatment for CECS
Conservative (non-surgical) treatments for CECs will be implemented initially with an assessment by a Podiatrist or Physiotherapist. A definitive diagnosis of CECS requires the measurement of elevated compartment pressures. After a thorough biomechanical assessment to determine how best to treat your CECS, the following treatments may be implemented:
- Activity modification. For non operative treatment to be successful ceasing activity such as running or drastically decreasing the intensity is necessary. The introduction of a low impact alternate activity may also be of benefit such as swimming.
- Running assessment. Change in running form for example with less heel strike can result in a reduction of pain
- Ice. to ease pain. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
- Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions
- Adequate footwear. Supportive footwear may also be recommended to stabilise the foot and ankle
- Addressing strength and flexibility deficits. Although CECS is from build up in intra-compartmental pressure any imbalances in the lower quadrant from the back, hips and ankle should be addressed
- Deep Tissue Massage. Remedial Massage may be recommended to provide short term relief in symptoms.
In most cases for athletes who want to remain active referral to a surgeon to perform a fasciotomy is necessary. Surgery has a 80% success rate but operative management does have risks such as infection and DVT, therefore trying non-operative treatment is always recommended.