Chronic Exertional Compartment Syndrome

Exertional compartment syndrome is a problem that happens when exercising. It affects the muscles and nerves in your legs or arms, causing pain, swelling, and sometimes making it hard to use them. This can happen to anyone, but it's more common in young, active people like runners and athletes who do activities with lots of repeated movement or impact.

The good news is that you might not need surgery. Often, changing how you exercise and resting can help. Your doctor might suggest ways to modify your workouts or recommend other non-surgical treatments. If these don't work, surgery might be an option. Many people who have surgery find it successful, which could help them get back to their favorite activities.

Your legs and other limbs have different muscle groups, sometimes called compartments. For example, your lower leg has four. Chronic exertional compartment syndrome (CECS) often affects the same muscle compartment on both sides of the body, most commonly in the lower leg.

CECS can cause several problems:

• Pain: You might feel a dull ache, burning sensation, or cramping in the affected muscle compartment.
• Tightness: The affected limb might feel tight or stiff.
• Numbness or tingling: You may experience a pins-and-needles feeling in the affected area.
• Weakness: You could lose some strength in the affected limb.
• Foot drop (serious cases): In severe cases, especially if your lower legs are affected, you might have trouble lifting your foot.
• Swelling or bulging: Sometimes, you might see swelling or a bulge in the affected area, like a small hernia in the muscle.

The pain from CECS usually follows a pattern:

• It starts after a specific amount of activity: The pain typically begins after you've been exercising for a certain amount of time, run a certain distance, or worked out at a certain intensity.
• It gets worse during exercise: The pain gets progressively worse as you continue exercising.
• It goes away quickly when you stop: The pain usually lessens or disappears completely within about 15 minutes of stopping the activity.
• Recovery time gets longer: Over time, the time it takes for your pain to go away after exercise may increase.

Resting completely or doing very gentle activities might temporarily relieve your symptoms. But, usually, when you resume more intense activities like running, the pain returns.

If you frequently experience unusual pain, swelling, weakness, numbness, or soreness in your muscles while exercising or playing sports, see a doctor. This could be a sign of a problem.

Sometimes, a condition called chronic exertional compartment syndrome (CECS) is confused with shin splints. Shin splints are a more common cause of leg pain, especially in young people who do a lot of running or other activities that put a lot of pressure on their legs. Shin splints often get better with rest and home treatment. However, if your shin splint pain doesn't improve with these simple measures, it's important to see a doctor.

Chronic exertional compartment syndrome happens when a muscle swells during exercise, but the surrounding tissue (called fascia) that holds it in place doesn't stretch enough. This creates pressure within the area, causing pain. Exactly why the fascia doesn't stretch properly isn't fully known. Think of it like trying to put a balloon that's already full of air into a too-tight box. The balloon (muscle) expands but the box (fascia) doesn't, building up pressure and causing discomfort. This happens repeatedly with exertion.

Chronic exertional compartment syndrome (CECS) is a condition where pressure builds up inside muscle compartments, often during exercise. Several things can make you more likely to get it.

• Age: While anyone can get CECS, it's most often seen in athletes, both men and women, who are under 30. This isn't to say older people can't get it, just that it's less common in them.

• Type of Exercise: Activities that involve repeated impacts, like running, are a major risk factor. This is because the repeated impact on the muscles and surrounding tissues can increase pressure within the compartments. Other activities that put repetitive stress on muscles, such as cycling or jumping, can also increase risk.

• Overtraining: If you work out too hard or too often, your risk goes up. Pushing your body beyond its ability to recover can lead to inflammation and increased pressure within the muscle compartments. This is not just about exercising too long, but also about lifting too much weight or doing too many sets in a workout. It's important to listen to your body and allow for adequate rest and recovery between workouts.

Chronic exertional compartment syndrome (CECS) is a condition that causes pain, weakness, or numbness. It's not a serious or life-threatening problem. However, if you don't get treatment, the pain and other symptoms can make it hard to keep up with your usual exercise or sports activities. While the condition itself usually doesn't lead to permanent harm, proper care is important to manage the symptoms and help you return to your normal activity level.

Dealing with exercise-related pain? Many common issues, like shin splints or stress fractures, often cause similar symptoms to chronic exertional compartment syndrome (CECS). So, your doctor will likely check for those first.

Doctors often find no obvious problems during a normal physical exam for CECS. Sometimes, they'll want to examine you after you've exercised and are experiencing symptoms. They might feel a bulge, tenderness, or tightness in the affected muscle area.

To get a better look, doctors may use imaging tests:

1. MRI (Magnetic Resonance Imaging): A standard MRI scan of your legs can help doctors see the structure of the muscles in the affected areas and rule out other possible problems. A special type of MRI can measure the amount of fluid in the muscle compartments before, during, and after exercise. This detailed MRI can accurately diagnose CECS, and it may avoid the need for a more invasive test.

2. Near Infrared Spectroscopy (NIRS): This newer test measures how much oxygen is in the blood of your affected muscles. It's done both at rest and after exercise. Lower oxygen levels might indicate reduced blood flow to the muscle compartment, a possible sign of CECS.

3. Compartment Pressure Measurement: If the imaging tests don't show a clear cause for your pain, your doctor might suggest measuring the pressure inside your muscle compartments. This is considered the most reliable way to diagnose CECS. A needle or thin tube (catheter) is inserted into the muscle to measure pressure before and after exercise. This test is more involved and slightly uncomfortable, so it's usually only done if other tests suggest CECS is the problem.

In short, doctors usually start with simpler tests to rule out other causes of exercise-related pain. If those tests don't provide enough information, they might use more advanced imaging techniques or the pressure measurement test. The choice of test depends on your specific situation and the results of previous tests.

Treating Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) happens when pressure builds up in the muscles of your legs during exercise. This pressure can cause pain and other problems. There are different ways to treat it, both without surgery and with surgery.

Nonsurgical Treatments:

Often, the first steps to treat CECS are nonsurgical. These methods usually work best if you stop or dramatically cut back on the activity that's causing the problem. Your doctor might suggest:

• Pain relievers: Over-the-counter or prescription pain medications can help manage discomfort.
• Physical therapy: Exercises and stretches can help strengthen the muscles and improve flexibility.
• Orthotics: Special shoe inserts can support your feet and ankles, reducing stress on your legs.
• Massage: Massage can help relax muscles and reduce tightness.
• Rest: Taking a break from the activity that causes the pain is often essential for healing.
• Changing running form: Learning to run or jog with better technique can lessen pressure on the affected areas.

While these methods can help with some cases of CECS, they often don't provide long-term relief for severe or chronic cases.

Injections:

Injections of Botox (botulinum toxin A) might also be used. Botox relaxes the muscles, which can help decrease pressure. However, more research is needed to fully understand how effective this approach is for CECS. To determine the right dose of Botox, your doctor may use numbing injections to precisely locate the affected area.

Surgical Treatment (Fasciotomy):

If nonsurgical options don't work, surgery is often the most effective treatment for CECS. This surgery, called a fasciotomy, involves cutting the tough tissue that surrounds the affected muscles to relieve the pressure.

• Minimally Invasive Surgery: Sometimes, the fasciotomy can be performed through smaller incisions. This may lead to a faster recovery time and a quicker return to your normal activities.

Risks of Surgery:

While surgery is often successful, it's important to understand that all procedures carry risks. Possible complications from a fasciotomy include:

• Infection: A risk with any surgery.
• Nerve damage: This can cause permanent numbness or weakness.
• Bruising: Common with any surgery.
• Scarring: A potential side effect of the surgery.

Ultimately, the best treatment plan for CECS depends on the severity of your condition, your activity level, and your individual response to different treatments. Discuss all options with your doctor to determine the best course of action for your specific situation.

Chronic exertional compartment syndrome (CECS) can be painful. Here are some ways to ease the discomfort:

• Support your feet: Wearing proper shoes and using orthotics (special inserts for your shoes) can help. Good support reduces stress on your limbs, which can lessen the pain. Choosing shoes that fit well and provide proper arch support is crucial.

• Adjust your workouts: Don't push through pain. Focus on activities that don't hurt, especially low-impact options like cycling or using an elliptical machine. If running causes pain in your legs, try swimming or switching to softer surfaces like a track or grass instead of concrete. This is about finding activities that challenge your body without causing the pain of CECS.

• Stretch it out: After exercising, stretch the affected limb. Gentle stretching can help increase blood flow and reduce muscle tightness, both of which can contribute to CECS pain. This is important to help your muscles recover properly and prevent future pain.