Exercise Induced Compartment Syndrome

exercise induced compartment syndrome

Exercise Induced Compartment Syndrome, also called Exertional Compartment Syndrome, is a condition that may be the cause of activity induced leg and foot pain - particularly in runners. The pain of Exercise Induced Compartment Syndrome (EIC) may often be confused and misdiagnosed for other causes of activity related pain in athletes. Typically the pain associated with EIC is brought on by a specific distance of running or a duration of activity and relieved by a period of rest. Pain maybe severe enough to limit the level of activity. 

Exercise Induced Compartment Syndrome occurs because the lower leg (below the knee) is divided into compartments.  These compartments are surrounded by a tight fibrous covering called fascia. Within the compartments are various groups of muscles, blood vessels and nerves.

As activity increases, the muscles of the leg require increased blood flow and oxygen. With exercise, the muscles expand in size. In the normal leg, the fascial tension can accommodate an increase in muscle size but in an affected leg, the fascia is tight and blood flow to the muscles is restricted. This restriction of blood flow causes ischemia that results in leg pain and eventually will compromise muscle function of the leg, ankle or foot. This condition will correct itself and the pain will stop after a period of rest of up to 30 minutes.

The most common compartment that is affected in the leg by EIC is the anterior compartment, but any compartment may be affected. The anterior compartment houses the muscles of the leg that primarily dorsiflex the ankle and toes.  In other words, the anterior compartment allows the runner to heel strike before the push off phase of gait.

Other causes of leg pain that can be confused with EIC are most commonly Medial Tibial Stress Syndrome (shin splints), Stress fractures of the leg and in some cases spinal stenosis. 

The diagnosis should be made by a qualified clinician through history and physical exam. At times, the physical exam maybe very normal at rest.  An MRI is not helpful unless to identify an associated fascial defect or to rule out other causes of pain.

At Foundry Sports Medicine, we are fortunate to have the ability to make the correct diagnosis by having the athlete exercise in our gym and measure intracompartmental pressures in the leg both pre and post exercise. These measurements will confirm the correct diagnosis.

The treatment for EIC depends on which compartment and the severity in which it is affected. With some cases, orthotics and physical therapy for stretching and strengthening may be all that is required. Other patients may require a small outpatient surgery to allow them to return to full function.

If you have pain with a specific running distance or duration of any activity in your leg similar to what I have described you may want to come in to our clinic and let us evaluate and advise you. My goal is to keep you active and healthy.