Chronic Exertional Compartment Syndrome
The etiology of chronic exertional compartment syndrome (CECS) is not completely understood. It is described a diffuse pain and tightness in the lower leg, thigh or forearm.
The consensus on the cause of pain is that exercise causes an excessive increase in intramuscular pressure. The abnormal pressure increase causes local muscle and tissue ischemia.
The lower leg is divided into four compartments .Each compartment contains muscle, nerves, and vascular structures. Each compartment is divided by fascial sheath. This syndrome can occur in any compartment, but the anterior and lateral compartments are most commonly involved.
CECS can be characterized as a diffuse pain in the lower leg that occurs during exercise. Symptoms may not develop until 24-48 hours later. It usually subsides with rest but only after awhile. Sometimes a ‘second day’ phenomenon may occur in which the pain may be more intensive the next day after exercising. There can be associated cramping and tightness. There also may numbness and tingling in the foot and/or leg. There also may be some pallor. Passive stretch of the affected area can exacerbate the pain. CECS can be difficult to diagnose since the symptoms usually reside with rest. A more definitive diagnosis is made by measurement of intracompartmental pressures. Post-exercise measurements have been shown to be most effective and are usually done with a slit catheter, microtip pressure method, wick catheter, microcapillary infusion and needle manometer.
The consensus on the cause of CECS is a sudden increase in the training intensity or volume or an activity that significantly stresses the lower leg such as running hills.
Conservative treatment options include rest, ice, stretching and strengthening the involved muscles. Orthotics and wearing more appropriate shoes may be considered. A modified training program should be incorporated that is guided by symptom onset. Surgical management by fasciotomy is the final solution for failed conservative measures. Depending on the individual, patients can expect to return to light activity with 2 to 4 weeks and full return to sport by 6 weeks.
