Exercise-Induced Compartment Syndrome

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Exercise-Induced Compartment Syndrome is a neuromuscular condition that causes pain, swelling and sometimes even disability in affected muscles of the legs or arms. The condition can occur in both beginning and seasoned athletes in sports that involve repetitive movements, such as running, fast walking, biking and swimming.

In exercise-induced compartment syndrome, the repetitive activity causes tissue in the affected muscle area, or compartment, to swell. That, in turn, increases pressure within the compartment, leading to a decreased blood supply to the muscles. This can cause injury to the muscle and nerves, sometimes resulting in permanent damage.

People with this syndrome typically experience pain that begins with activity, progressively worsens and then stops when at rest. As the condition worsens, however, the pain can take longer to subside.

Exercise-Induced Compartment Syndrome is uncommon and sometimes goes undiagnosed. It's not known how many people may be affected, but the number of diagnosed cases has been rising in recent years. The condition seems to affect primarily young athletes in their 20s, although younger and older people also can develop the condition.

Exercise-Induced Compartment Syndrome can be difficult to diagnose, partly because the affected limbs generally look perfectly normal — they may not even appear swollen. Unfortunately, conservative treatments typically aren't helpful. However, surgery to open the compartment and decrease pressure is usually highly successful, allowing recreational and serious athletes alike to return to their cherished sports.


Symptoms:
The hallmark of chronic exertional compartment syndrome is pain during exercise. The pain and other symptoms often are characterized by:

Aching or cramping pain in the affected limb during exercise

A feeling of intense pressure or fullness in the affected limb

Tightness in the affected limb

Numbness or tingling in the affected limb

Weakness of the affected limb

Footdrop, in severe cases, if nerves in the legs are damaged

Occasionally, swelling or bulging as a result of a muscle hernia

. . . Muscles affected
This syndrome most often occurs in the lower legs. However, it also occasionally occurs in the thighs, the upper arms, the forearms and the hands.

Most people with this syndrome in the lower legs have symptoms in both legs, not just one. The pain and pressure are typically located in the calves or the outer sides of the lower legs.

In more severe cases involving the legs, you may develop footdrop, sometimes called foot slap, while walking or running. With this symptom, you may notice that your forefoot seems to strike the ground unusually loudly and forcefully, making a distinctive slapping sound.

. . . A pattern of symptoms
Symptoms of exercise-induced compartment syndrome usually come and go in a typical pattern. For instance, symptoms usually begin soon after you start exercise or certain activities. If you continue exercising, the symptoms worsen.

Once you stop exercising, the symptoms typically go away within a few minutes to hours. However, over time, in people who continue to exercise despite the pain, the symptoms can developer sooner, be more severe and take longer to go away, sometimes lingering for a day or two.

Taking a complete break from exercise may relieve your symptoms, but usually only temporarily. Once you take up running again, for instance, those familiar symptoms usually come back immediately.


Causes:
Your arms and legs have several groupings, or compartments, of muscles, blood vessels and nerves. Each of these compartments is encased by a thick layer of connective tissue called fascia (FASH-e-uh), which supports the compartments and holds the tissues in place. The fascia is inelastic, which means it has little ability to stretch.

In exercise-induced compartment syndrome, exercise or even simply repetitive muscle contraction causes the tissue pressure within a compartment to increase to an abnormally high level. But because the fascia can't stretch, the tissues in that compartment aren't able to expand sufficiently under the increased pressure. Imagine shaking up a soda bottle but leaving the cap on — an enormous amount of pressure builds up.

As the pressure builds up within one of your muscle compartments, with no outlet for release, nerves and blood vessels are compressed. Blood flow may then decrease, causing tissues to get inadequate amounts of oxygen-rich blood, a condition known as ischemia. Nerves and muscles may sustain damage.

Experts aren't sure why exercise or muscle contraction creates this excessive pressure in some people, leading to this syndrome. Some experts suggest that biomechanics — how you move, such as landing styles when you jog — may have a role. Other causes may include having enlarged muscles, an especially thick or inelastic fascia, or high pressure within your veins.


Treatment:
Options for treatment of exercise-induced compartment syndrome include both conservative and surgical methods. However, conservative measures have proved much less effective.

. . . Conservative options
Your doctor may initially recommend trying pain medications, stretching or strengthening regimens, orthotics, taking a break from exercise, or adopting different biomechanical techniques, such as changing how you land when you jog. However, these kinds of conservative options typically don't provide lasting benefits.

You can also consider switching to a different sport. For instance, if your symptoms are related to jogging, try biking instead. Many people, however, aren't willing to give up a beloved sport.

. . . Surgical options
Surgery is the main treatment for exercise-induced compartment syndrome, and the most effective. But it's also the most invasive.

Surgery involves operating on the fascia — that inelastic tissue encasing each muscle compartment. Surgical methods include either cutting open the fascia of each affected compartment or actually removing part of the fascia. In either case, this release or decompression means the compartment is no longer trapped by the unyielding fascia, giving it room to expand when pressure increases.

Although surgery is highly effective for most people, it's not without risk. Complications of the surgery can include permanent nerve damage, numbness and scarring. In addition, since your muscles will no longer be encased by fascia, they may bulge out during exercise, creating a cosmetic concern.

There also are different ways to perform each type of surgery. For instance, surgery that involves smaller incisions may leave smaller scars but could make it more difficult for your surgeon to navigate through the internal tissues — muscles, nerves and blood vessels, leading to a higher risk of complications. In addition, some surgeons prefer making just one incision, while others prefer two. Be sure to talk to your doctor about the method that's best for you. And also be sure to follow post-surgical instructions your doctor will give you to ensure a smooth return to your sport.

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