Diagnosis

Other exercise-related problems are more common than chronic exertional compartment syndrome, so your doctor may first try to rule out other causes — such as shin splints or stress fractures — before moving on to more specialized testing.

Physical exams for chronic exertional compartment syndrome are often normal. Your doctor might prefer to examine you after you've exercised to the point of bringing on symptoms. Your doctor may notice a muscle bulge (herniation), tenderness or tension in the affected area.

Imaging studies

Your doctor might suggest imaging studies such as MRI or near infrared spectroscopy (NIRS). A typical MRI scan of your legs can be used to evaluate the structure of the muscles in the compartments and rule out other possible causes of your symptoms.

A newer, special MRI scan can help assess the fluid volumes of the compartments during exercise. It has been found to be accurate in detecting compartment syndrome, and may reduce the need for the invasive compartment pressure testing.

NIRS is a newer technique that uses light wavelengths to measure tissue oxygen saturation in your blood. This helps to determine if your muscle compartment has decreased blood flow.

Compartment pressure testing

If imaging studies fail to uncover an abnormality such as a stress fracture or similar cause of pain, your doctor might suggest measuring the pressure within your muscle compartments.

This test, often called compartment pressure measurement, is the gold standard for diagnosing chronic exertional compartment syndrome. Because it's invasive and mildly painful, involving insertion of needles into your muscles, compartment pressure measurement usually isn't performed unless your medical history and other tests strongly suggest you have this condition.

Treatment

Options to treat chronic exertional compartment syndrome include both non-operative and surgical methods. However, non-operative measures are typically successful only if you stop or greatly reduce the activity that caused the condition.

Non-operative options

Your doctor may initially recommend pain medications, stretching or strengthening regimens, orthotics, massage, a break from exercise, or the use of different biomechanical techniques, such as changing how you land when you jog. However, non-operative options typically don't provide lasting benefit for true chronic exertional compartment syndrome.

Surgical options

Surgery is the most effective treatment of chronic exertional compartment syndrome. Surgery involves operating on the inelastic tissue encasing each muscle compartment (fascia). Methods include either cutting open the fascia of each affected compartment (fasciotomy) or actually removing part of the fascia (fasciectomy). Surgery relieves the pressure.

Although surgery is effective for most people, it's not without risk. Complications of the surgery can include infection, permanent nerve damage, numbness and scarring.

Lifestyle and home remedies

To help relieve the pain of chronic exertional compartment syndrome, try the following:

  • Use athletic shoe inserts (orthotics) or wear better athletic shoes.
  • Limit your physical activities to those that don't cause pain, especially focusing on low impact activities such as cycling or an elliptical trainer. For example, if running bothers your legs, try swimming. Or try running on softer surfaces.
  • Apply ice to the affected area after exercising.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. He or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

Here's some information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as fasting before having a specific test. Make a list of:

  • Your symptoms, including any that seem unrelated to the reason for your appointment
  • Key personal information, including what sports you participate in, the type of exercise you do, and how much and how often you exercise
  • All medications, vitamins or other supplements you take, including the doses
  • Questions to ask your doctor

Get copies of recent imaging tests you've had, if possible. Ask your doctor's staff how you can get these forwarded to your doctor before the appointment.

Take a family member or friend along, if possible, to help you remember the information you're given.

For chronic exertional compartment syndrome, questions to ask your doctor include:

  • What's the most likely cause of my symptoms?
  • Are there other possible causes?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available, and which do you recommend?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there restrictions I need to follow, such as avoiding certain activities?
  • Should I see a specialist? If so, whom do you recommend?
  • Are there brochures or other printed materials I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you several questions, such as:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • How soon do your symptoms start after you begin your activity?
  • How quickly do your symptoms resolve after you stop your activity?
  • Do you notice weakness in your legs or feet?
  • Do you have numbness or tingling?
Aug. 04, 2017
References
  1. Meehan WP. Chronic exertional compartment syndrome. www.uptodate.com/home. Accessed Dec. 3, 2015.
  2. George CA, et al. Chronic exertional compartment syndrome. Clinics in Sports Medicine. 2012;31:307.
  3. Compartment syndrome. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00204. Accessed Dec. 3, 2015.
  4. Rajasekaran S, et al. Exertional leg pain. Physical Medicine and Rehabilitation Clinics of North America. 2016;27:91.
  5. Ringler MD, et al. MRI accurately detects chronic exertional compartment syndrome: A validation study. Skeletal Radiology. 2013;42:385.

Chronic exertional compartment syndrome