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Running With Exertional Compartment Syndrome

By Charis Grey

If you’re a runner, exertional compartment syndrome, also known as chronic compartment syndrome, can really cramp your style. It is an uncommon, exercise related neuromuscular condition, but is sometimes confused with shin splints, a separate condition that runners often experience.

Exertional Compartment Syndrome

When you run, your leg muscles swell due to the infusion of blood. The muscles in your lower leg are separated into groupings called “compartments” which are covered by fascia, a tough connective tissue that keeps muscles and organs in their proper positions. For those with exertional compartment syndrome, problems result because the fascia isn’t very elastic; there's not enough room within the compartment for the muscle to expand. Muscle swelling puts pressure on the fascia -- and on all the structures within it including the blood vessels, muscles and nerves. Since the fascia doesn’t stretch, this pressure continues to build until the activity causing it stops. The pressure that builds during exertional compartment syndrome can disrupt the flow of blood to the muscles and nerve cells, which can lead to cell damage due to lack of oxygen and nutrient deprivation.


Anyone can develop chronic exertional compartment syndrome, but it is most common in those who participate in sports that involve repetitive motions such as running. Symptoms include pain and cramping, which occur during the exercise. The condition may also cause numbness, difficulty moving the foot and visibly bulging muscles.


To diagnose exertional compartment syndrome, your doctor must first rule out other conditions with similar symptoms such as tendonitis, nerve entrapment, vascular claudication or shin splints. Once these are ruled out, your doctor can then use a catheter to measure pressure levels in the muscle compartments before and after exercise. For a diagnosis of exertional compartment syndrome, your intracompartmental tissue pressure must measure at least 15 mm Hg before exercising, 30 mm Hg one minute after exercising, or 20 mm Hg five minutes after exercising, according to the “Bulletin of the NYU Hospital for Joint Diseases.”


The only surefire way to eliminate exertional compartment syndrome without surgery is to stop the activity that causes it. For a dedicated runner, that’s not a satisfying option. An operation called a fasciotomy treats exertional compartment syndrome by slitting the fascia and allowing the compartment's contents to expand while you're running. Before opting for surgery, however, most runners try less radical therapies, such as using orthotic shoe inserts, physical therapy, massage or anti-inflammatory medication. If you run on hard surfaces, switching to a dirt path or other soft surface may help relieve symptoms, notes the American Academy of Orthopedic Surgeons.

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