Chronic exertional compartment syndrome
Chronic exertional syndrome, also known as chronic exercise compartment syndrome, is a condition in which the muscles and nerves of the legs and arms are affected by repetitive stress. It causes pain, swelling, and sometimes disability. The condition can be acquired by anyone but is more common in athletes and young runners who are subject to repetitive impact.
Nonsurgical treatment and activity modification may be helpful for chronic exertional compartment syndrome. Your doctor may recommend surgery if nonsurgical treatments fail to work. Many people find surgery successful and may be able to return to their sport.
Each limb has specific muscle areas (compartments). For example, the lower leg has four compartments. Chronic exertional compartment syndrome can often be found in the same compartment on both sides of the body. It is usually located in the lower leg.
These signs and symptoms could include:
- Itching, burning or cramping pain in one of the affected limbs
- Tightness in the affected leg
- Tingling or numbness in the affected limb
- The affected limb may feel weak
- In severe cases, feet can drop if the legs are affected.
- Sometimes, a muscle hernia can cause swelling and bulging.
This is the most common pattern of chronic exertional compartment syndrome pain.
- Consistently begins after a specific time, distance, or intensity of exertion when you begin exercising the affected leg.
- As you exercise, your condition gradually worsens
- Within 15 minutes, the activity stops or becomes less intense.
- The recovery time from exercise can increase over time.
Your symptoms might be relieved by taking a break from exercising or engaging in low-impact activities. However, this relief is often temporary. Usually, the familiar symptoms return once you start running again.
When should you see a doctor?
Talk to your doctor if you experience recurring pains, swelling, weakness, or loss of sensation while participating in exercise or other activities.
Chronic exertional compartment syndrome can sometimes be mistaken for shin-splints. This is a common cause of leg pain in young people who exercise a lot, especially if they are involved in a vigorous weight-bearing activity like running. Talk to your doctor if you believe you have shin-splints.
It is not clear what causes chronic exertional compartment syndrome. Your muscles grow in volume when you exercise. Chronic exertional compartment syndrome is a condition in which the tissue surrounding the affected muscle (fascia), doesn’t grow with it. This causes pressure and pain in the affected limb.
Experts believe that exercise can contribute to chronic exertional compartment syndrome. You might also be experiencing an excessively large muscle, a rigid fascia around the affected muscles compartment, or high blood pressure in your veins.
Some factors can increase your chances of developing the chronic exertional syndrome.
- Age. Chronic exertional compartment syndrome can occur at any age, but it is more common in athletes younger than 30.
- Type of exercise. Your risk of developing the condition is increased if you engage in repetitive impact activities, such as running.
- Overtraining. Exercising too often or too hard can increase your chances of developing chronic exertional compartment syndrome.
If you receive the right treatment, chronic exertional compartment syndrome will not cause permanent damage and is not considered a serious condition. Chronic exertional compartment syndrome can cause pain, weakness, or numbness that may make it difficult to continue exercising or practicing your sport at the same intensity.
Exercise-related issues are also more common than chronic exertional syndrome. Your doctor might first rule out stress fractures and shin splints before proceeding to more specialized testing.
The results of physical examinations for chronic exertional compartment syndrome can often be normal. Sometimes, your doctor may prefer to see you after you have exercised enough to bring on symptoms. The doctor might notice tenderness, muscle bulges, or tension in the area.
Imaging studies can include:
- MRI. A simple MRI scan of your legs is enough to assess the structure of the compartments in your legs and rule out any other possible causes. An advanced MRI scan can also be used to determine the fluid volume of the compartments. The images are taken at rest and then moved until you feel the symptoms. After that, they are taken again after the exercise. This type of MRI scan is more accurate at detecting chronic exertional syndrome and may decrease the need to have it done.
- Near-infrared (NIRS) spectroscopy. The NIRS technique is a more recent one that measures oxygen levels in affected tissues. This test can be done either at rest or during exercise. This test helps to determine if blood flow has been reduced in your muscle compartment.
Compartment pressure testing
Your doctor may recommend measuring the pressure in your muscles compartments if imaging results do not indicate a stress fracture.
This is often known as compartment pressure measurement. It is the best way to diagnose chronic exertional compartment syndrome. To measure the muscle, a needle or catheter is inserted into the muscle.
It’s an invasive procedure that can be mildly painful and may not be done unless you are certain from your medical history.
There are both surgical and nonsurgical options to treat chronic exertional chamber syndrome. Nonsurgical treatments are usually only successful if the condition is stopped or significantly reduced.
Your doctor might recommend physical therapy, pain medication, orthotics, massage, or other treatments. It may also be beneficial to change how your feet feel when running or jogging. Nonsurgical treatments are not likely to provide long-term relief for chronic exertional compartment syndrome.
Botox injections into the legs may be able to treat chronic exertional compartment syndrome. However, more research is needed to confirm this option. To map the affected area and determine the appropriate Botox dose, your doctor may recommend numbing injections.
Options for Surgical Treatment
Fabiotomy, a surgical procedure that involves cutting open the inflexible tissue encasing chronic exertional compartment syndrome, is the best treatment. This involves removing the fibrous tissue that surrounds each affected muscle compartment. This releases the pressure.
A fasciotomy may be performed with small incisions. This can reduce recovery time and allow you to return to your sport or activity faster.
Surgery is very effective for most people. However, there are risks and it may not be able to completely relieve chronic exertional compartment syndrome symptoms in some cases. The complications of surgery include infection, permanent nerve damage, and numbness, weakness.
Lifestyle and home remedies
The following can be used to relieve chronic exertional compartment syndrome pain:
- Wear orthotics or better running shoes.
- Avoid activities that cause pain. Swimming is a good alternative if you have trouble running. You can also run on soft surfaces.
- After exercising, stretch the injured limb.
Prepare for your appointment
Your family doctor is the best place to start. Your family doctor may refer you to an orthopedic surgeon or sports medicine specialist.
These are some tips to help you prepare for your appointment.
What you can do
Ask your doctor if you have any questions before you schedule an appointment. You can make a list of:
- All symptoms, even those that are not related to your appointment
- You will need to provide some personal information such as your sport preferences, exercise type, and the frequency with which you exercise.
- You must list all medications, vitamins, and other supplements you use, as well as the dosages.
- Ask your doctor questions
If possible, get copies of any recent imaging tests. Ask your doctor’s staff for information on how to get them sent to you before your appointment.
If possible, bring a friend or family member along to help you remember what you were given.
Ask your doctor questions about chronic exertional compartment syndrome.
- What is the most likely reason for my symptoms?
- Do you think there are other causes?
- What are the tests I need?
- Are my symptoms likely to be temporary or permanent?
- Which treatments are you familiar with and what do they recommend?
- I also have other medical conditions. These conditions are interrelated. How can I manage them together?
- Are there any restrictions that I must follow?
- Do I need to see a specialist? Who do you recommend if I should?
- Do you have brochures or any other printed material I could use? Which websites would you recommend?
Ask any questions you may have.
What to expect from your doctor
You may be asked several questions by your doctor, including:
- When did your symptoms begin?
- Are your symptoms ongoing or intermittent?
- What are your symptoms?
- What can you do to help your symptoms?
- Are you experiencing symptoms that are worsening?
- What is the time frame in which your symptoms begin after you start your activity?
- What happens to your symptoms when you stop doing your activity?
- Are you feeling weak in your feet or legs?
- Are you feeling tingling or numbness?