Overview
Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling, and sometimes disability in the affected muscles of the legs or arms. It occurs when there is increased pressure within the muscle compartments, leading to a reduction in blood flow and oxygenation. This condition is most common in young adult runners and athletes who participate in activities that involve repetitive impact. Symptoms include pain, swelling, and sometimes disability in the affected muscles. Treatment options may include nonsurgical approaches and activity modification, with surgery being recommended if these options don't provide relief.
Understanding the disease
Symptoms
The symptoms of chronic exertional compartment syndrome include aching, burning or cramping pain in a compartment of the affected limb, tightness in the affected limb, numbness or tingling in the affected limb, weakness of the affected limb, foot drop in severe cases if legs are affected, and occasionally swelling or bulging as a result of a muscle hernia. The pain typically begins consistently after a certain time, distance, or intensity of exertion, progressively worsens as you exercise, becomes less intense or stops completely within 15 minutes of stopping the activity, and over time, recovery time after exercise may increase. Chronic exertional compartment syndrome is most common in male and female athletes under age 30 and is more likely to occur in activities involving repetitive impact, such as running.
Risk Factors
The risk factors for developing chronic exertional compartment syndrome include:
- Age: The condition is most common in male and female athletes under age 30.
- Type of exercise: Repetitive impact activity, such as running, increases the risk of developing the condition.
- Overtraining: Working out too intensely or too frequently can raise the risk of chronic exertional compartment syndrome.
Development
Chronic exertional compartment syndrome (CECS) develops when the muscles in the affected limb (usually the lower leg) experience repetitive impact activity during exercise, such as running. This causes the muscles to expand in volume, but the fascia, the tissue that encases the muscle, does not expand at the same rate. This creates pressure and pain within the affected compartment of the limb. The condition is more common in young athletes who participate in activities involving repetitive impact, and it can also be caused by excessive muscle enlargement, inflexible fascia, or high vein pressure.
Assessment and Diagnosis
Triage
If you suspect chronic exertional compartment syndrome, you should see a doctor if:
- You experience persistent or recurring pain, swelling, or numbness in the affected muscles of your arms or legs during or after exercise.
- Your symptoms are severe or worsening, affecting your daily activities or ability to participate in your sport.
- Home remedies and conservative treatments, such as rest, ice, compression, and elevation (RICE protocol), do not provide relief.
- You notice any signs of weakness, muscle wasting, or changes in sensation in the affected area. A doctor can help determine the underlying cause and recommend appropriate treatment options, which may include nonsurgical interventions, activity modification, or surgery. Early diagnosis and proper management can help prevent complications and ensure a faster recovery.
Diagnosis
To diagnose chronic exertional compartment syndrome, your doctor may first try to rule out other causes, such as shin splints or stress fractures, by conducting a physical exam and reviewing your medical history. Imaging studies, such as X-rays, magnetic resonance imaging (MRI), and near infrared spectroscopy (NIRS), may also be used to assess the condition. The most reliable method for diagnosing chronic exertional compartment syndrome is compartment pressure measurement, which involves inserting a needle or catheter into the affected muscle before and after exercise to measure pressure. This test is typically reserved for cases where other tests and your medical history strongly suggest chronic exertional compartment syndrome.
Management and Treatment
Complications
One potential complication of chronic exertional compartment syndrome is overtraining, which can further aggravate the condition and lead to pain, weakness, or numbness. If left untreated, these symptoms might prevent the individual from continuing to exercise or participate in their sport at the same level of intensity. While chronic exertional compartment syndrome is not a life-threatening condition, it can result in a decrease in quality of life and overall functioning for the affected individual.
Home Remedies
It is important to consult a healthcare professional for proper diagnosis and treatment recommendations for chronic exertional compartment syndrome.
Treatment
The treatments for chronic exertional compartment syndrome may include nonsurgical treatment and activity modification. Nonsurgical treatment options can help alleviate symptoms, but may not provide a permanent solution. Activity modification, such as taking a complete break from exercise or performing only low-impact activities, might temporarily relieve symptoms. However, these measures usually only provide temporary relief, and symptoms tend to return once the exercise regimen is resumed. If nonsurgical treatment doesn't help, your doctor might recommend surgery. Surgery for chronic exertional compartment syndrome is often successful and may allow individuals to return to their sport. It is important to note that the effectiveness of treatment may vary from person to person, and surgery is only recommended if nonsurgical treatments do not provide relief or if the condition is severely impacting daily life. It is best to consult with a medical professional for personalized advice and treatment options.
Preparing for medical consultation
To prepare for an appointment for chronic exertional compartment syndrome, you should:
- Gather personal information: Make a list of your sports activities, exercise routines, and supplements you take, including doses.
- Bring a list of medications: Create a list of all medications, vitamins, or supplements you are currently taking.
- Request recent imaging tests: If you have had recent imaging tests, ask the doctor's staff to forward them to your doctor before the appointment.
- Bring a family member or friend: Consider bringing a family member or friend along to help you remember the information you receive during the appointment.
- Prepare a list of questions: Compile a list of questions to ask your doctor, including inquiries about the cause of your symptoms, necessary tests, treatment options, managing other health conditions, and following any restrictions or avoiding certain activities.
- Mention other health conditions: If you have other health conditions, discuss how you can manage them together during the appointment. Preparing for the appointment will help you make the most of your time with your healthcare provider and ensure that you receive the necessary information and guidance for managing your chronic exertional compartment syndrome.