An exercise-induced nerve and pain condition that causes swelling, pain, and disability (sometimes) in the negatively affected muscles of the arms or legs is called chronic exertional compartment syndrome (CECS). While anyone may develop this syndrome, it mostly occurs in young adult runners and athletes who engage in activities that require repetitive impact.
Sometimes, this condition can be treated with activity modification and nonsurgical treatments. However, if you do not respond to previous treatments, physicians may recommend surgery that is successful for most people with CECS.
Symptoms
Generally, the limbs have specific compartments (muscle areas). For instance, the lower leg has 4 compartments. In most cases, CECS negatively affects the same compartment of the affected limb on both body parts (commonly in the lower leg). Check below some symptoms that people with CECS usually experience:
- Burning, cramping, or aching pain in one compartment of the affected limb
- Tightness
- Weakness
- Numbness or tingling in the affected limb
- Foot drop (in severe cases)
- Swelling or bulging caused by a muscle hernia
Usually, the pain caused by CECS follows this pattern:
- Starts after a specific distance, intensity, or time after beginning exercising
- Significantly worsens with exercise
- If you stop the activity, the pain usually lessens within 15 minutes
- Generally, the recovery time increases over time
Most people get relief from symptoms with a complete break from exercise or performing low-impact activity. In any case, this relief is temporary.
It is advised to see a doctor if you experience recurrent pain, swelling, weakness, loss of sensation, or soreness when exercising. In addition, CECS is frequently mistaken for shin splints (a more common cause of leg pain). If you think you have shin splints or the pain does not go away with self-care, do not hesitate to visit a doctor.
Causes
Healthcare providers do not fully understand why it happens. In normal circumstances, the muscles expand in volume while exercising, but in people with CECS, the affected muscles do not expand. As a result, it puts pressure and causes pain in the compartment of the negatively affected limb.
Some studies suggest that how you move when exercising plays a role in chronic exertional compartment syndrome. Check below for other possible causes:
- Excessive enlargement of the muscles during exercise
- Inflexible fascia that surrounds the affected muscle compartment
- Increased pressure within your veins
Risk Factors
While physicians cannot determine the exact cause of CECS, they identified some factors that may increase your risk of developing it. Examples include:
- Age – While CECS may occur at any age, people under 30 years old are more likely to develop it.
- Exercise type – The risk of developing CECS increases with repetitive impact activity (such as running).
- Overtraining – Heavy workouts or too frequent intense exercises also elevate your risk of developing CECS.
What Are the Long-term Effects of Chronic Exertional Compartment Syndrome?
People with CECS may experience some long-term effects (also known as complications), especially without treatment. These include:
- Functional impairment – It prevents you from continuing exercising at the same level.
- Nerve damage – While this complication happens rarely, it may cause temporary or permanent nerve damage that leads to numbness, tingling, or weakness in the affected limb.
- Psychological impact – You may experience psychological distress and reduced quality of life due to chronic pain caused by CECS.
- Surgery complications – For example, infections, bleeding, and nerve damage.
Diagnosis
There are multiple exercise-related problems that occur more frequently than chronic exertional compartment syndrome. Therefore, doctors usually perform tests and examinations to exclude other conditions that cause similar symptoms. For example, shin splints, stress fractures, and others.
In most cases, the outcomes of physical examination are normal, and physicians may perform tests while you exercising. Check below some tests used to diagnose the condition:
- MRI (magnetic resonance imaging) scans – This test is used to get detailed images of different structures and organs of the body. Moreover, advanced MRI scans may help assess the fluid volumes of the compartments, and images are usually taken when you rest, move, and after exercise. This test can diagnose CECS.
- Near infrared spectroscopy (NIRS) – This is a specific test used to measure the oxygen amount in the blood. It is usually performed at rest and after physical activity.
Compartment Pressure Testing
When imaging test results do not identify a stress fracture or similar cause of pain, physicians may perform a compartment pressure measurement, which is considered a standard for diagnosing CECS. It involves a needle or catheter (a long and flexible tube) inserted into the affected muscle before and after exercise.
Treatment
There are two treatments usually used to treat chronic exertional compartment syndrome. For example, nonsurgical and surgical. In most cases, nonsurgical treatment is effective only if you significantly reduce or stop activity that causes the disease.
Nonsurgical Treatments
First, doctors may prescribe some pain medicines, physical therapy, orthotics (athletic shoe inserts), massage, or take a break from exercise. Sometimes, changing how you land your foot may help ease the symptoms. Unfortunately, nonsurgical options usually do not provide long-term relief.
In some cases, CECS is treated with injection of botulinum toxin A (also called Botox).
Surgical Treatments
The most effective treatment for people with CECS is considered a surgery (fasciotomy) that involves a cut in the inflexible tissue of the affected muscle compartments. As a result, it helps reduce pressure and relieve pain. In some cases, fasciotomy is performed through multiple small incisions. In such cases, patients recover faster and return to regular sport.
While it is effective, fasciotomy, like other surgeries, carries multiple risks. For example, permanent nerve damage, numbness, weakness, bruising, scarring, infection, and bleeding.
Frequently Asked Questions
What is the most effective treatment for people with chronic exertional compartment syndrome?
People get pain relief and may return to physical activity with a surgery called fasciotomy. Some people may effectively treat the condition with nonsurgical options (such as medicines, massage, and others).
How long does exertional compartment syndrome take to heal?
Usually, the complete recovery from CECS takes 3-4 months. The healing time depends on the cause of the disease.
What can be mistaken for compartment syndrome?
There are multiple health conditions that cause pain, and they occur more commonly than chronic exertional compartment syndrome. For example:
- Shin splints
- Stress fractures
- Tendonitis
- Soft tissue sarcomas
- Neurovascular entrapments
This article does not contain all possible conditions that can be mistaken for CECS. Ask your healthcare provider if you have any other questions.
