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Chronic exertional compartment syndrome

Chronic exertional compartment syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes even disability in affected muscles of your legs or arms.

Anyone can develop chronic exertional compartment syndrome, but it's more common in athletes who participate in sports that involve repetitive impact exercise, such as running and fast walking. Chronic exertional compartment syndrome is sometimes called chronic compartment syndrome or exercise-induced compartment syndrome.

If conservative treatment doesn't help with chronic exertional compartment syndrome, your doctor may recommend surgery. Surgery is successful for many people,  allowing you — whether you're a recreational or serious athlete — to return to your sport.

Symptoms Causes Risk factors Complications Prevention

The pain and other symptoms associated with chronic exertional compartment syndrome may be characterized by:

  • Aching, burning or cramping pain in the affected limb — usually the lower leg
  • Tightness in the affected limb
  • Numbness or tingling in the affected limb
  • Weakness of the affected limb
  • Foot drop, in severe cases, if nerves in your legs are affected
  • Occasionally, swelling or bulging as a result of a muscle hernia

Pain due to chronic exertional compartment syndrome typically follows this pattern:

  • Begins soon after you start exercising the affected limb
  • Progressively worsens as long as you exercise
  • Stops within 30 minutes after the affected limb comes to rest
  • Over time, may begin to persist longer after exercise, possibly lingering for a day or two

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

When to see a doctor

If you experience unusual pain, swelling, weakness, loss of sensation, or soreness related to exercise or sports activities, talk to your doctor immediately, because these symptoms may be associated with conditions that require emergency medical treatment. Don't try to exercise through the pain, as that may lead to permanent muscle or nerve damage — and jeopardize continued participation in your favorite sports.

Sometimes chronic exertional compartment syndrome is mistaken for shin splints, a more common cause of leg pain in young people who do lots of vigorous weight-bearing activity, such as running. If you think you have shin splints but they don't get better with self-care, talk to your doctor.

Excessive pressure within an isolated segment of muscle (a muscle compartment) causes chronic exertional compartment syndrome. Exercise increases the blood supply to working muscles, making them expand. If the connective tissue (fascia) that holds the muscle fibers together in a compartment doesn't also expand, pressure builds up in the compartment. Over time, the pressure cuts off some of the muscle's blood supply, leading to chronic exertional compartment syndrome.

Some experts suggest that biomechanics — how you move — may have a role in causing chronic exertional compartment syndrome. Other causes may include having enlarged muscles, an especially thick or inelastic band of tissue (fascia) surrounding a section of muscle, or high pressure within your veins (venous hypertension).

Certain factors increase your risk of developing chronic exertional compartment syndrome, including:

  • Age. Although people of any age can develop chronic exertional compartment syndrome, the condition is most common in athletes under 30.
  • Type of exercise. Exercise that involves repetitive impact activity — such as running or fast walking — increases your risk of developing the condition.
  • Overtraining. Working out too intensely or too frequently also can raise your risk of chronic exertional compartment syndrome.
  • Certain drugs. Taking anabolic steroids or the supplement creatine may increase the water content and mass of a muscle segment, contributing to the development of chronic exertional compartment syndrome.

Chronic exertional compartment syndrome isn't a life-threatening condition and usually doesn't cause any lasting or permanent damage if you seek appropriate treatment. However, if you continue to exercise despite pain, the repeated increases in compartment pressure can lead to permanent numbness or weakness in affected muscles.

Perhaps the worst complication of untreated chronic exertional compartment syndrome is its impact on participation in your favorite sports. The pain may prevent you from being active.

There aren't any self-care measures that will specifically help prevent chronic exertional compartment syndrome. But following basic sports and fitness guidelines can help protect your health and safety during exercise:

  • Warm up before starting exercise.
  • Cool down when you're done exercising.
  • Stop if you're in pain.
  • Check with your doctor before starting a new exercise program if you have any health issues.
  • Eat a healthy, balanced diet.
  • Stay hydrated.
  • Engage in a variety of physical activities.
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