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Chronic Compartment Syndrome

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Chronic Compartment Syndrome

What is it?

Chronic compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability most commonly in the leg muscles. The condition can happen in anyone however it is most commonly seen in runners.

Close to the knee joint this tendon crosses a bony lump known as the lateral femoral condyle. Repetitive exercise such as running and cycling can aggravate a bursa (fluid filled sac)which lies between this bone and tendon creating inflammation; this is known as iliotibial band syndrome (ITB) or runner’s knee.

How is it caused?

The exact cause is unknown, however, it is associated with an increase in muscle compartment pressure with exercise.

With exercise, muscles expand in size due to an increase in blood flow. The muscles in a compartment are held in place by a stocking-like connective tissue called “fascia”. If the fascia fails to expand as the muscles expand, the pressure in the compartment builds up. In time, the build up of pressure starts to restrict blood flow to the muscle.

Risk factors for developing the condition include young age (most commonly seen in athletes under 30), increased muscle bulk, repetitive impact sport such as running and overtraining.

If treated early, chronic compartment syndrome is unlikely to cause any long-lasting damage.

What are the symptoms?

Chronic compartment syndrome causes pain or cramping with exercise. This pain settles when activity stops. It most commonly occurs in the leg.

Symptoms may also include:

  • Numbness
  • Difficulty moving the foot
  • Visible muscle bulging

Chronic compartment syndrome is sometimes misdiagnosed as shin splints. Shin splints is another common cause of leg pain in young people who participate in vigorous weight-bearing activity, such as running or fast-walking.


A thorough history and examination will be performed to rule out other possible causes of lower leg pain. Your doctor may examine your leg to check you have no tendon pain (tendonopathy) and will commonly arrange an X-ray to rule out a stress fracture of your shinbone (tibia).

In order to confirm chronic compartment syndrome, your doctor will perform compartment pressure monitoring (see Fig.1) before and after exercise. If the pressures remain elevated after exercise then you have chronic compartment syndrome.

What is the treatment?

Non-operative treatment

Physiotherapy and orthotics (inserts for shoes) play an important role initially. A running assessment on a treadmill may well identify poor running technique which when corrected can easily rectify running pains.

Some people benefit from simply avoiding the aggravating activity, while others will improve by changing the surface they run on, for example switching from tarmac to running track or grass.

Surgical treatment

If non-operative treatment fails, surgery may be required. The operation involves releasing the fascia surrounding the leg muscles to provide them more room to expand with exercise.

Usually, the surgery involves a skin incision on one or both sides of the lower leg.

Surgical is generally very successful but carries a few small risks including infection and nerve injury.

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