Exertional Compartment Syndrome

Signs and Treatment of This Condition

Exercise-induced compartment syndrome, also called exertional compartment syndrome and chronic compartment syndrome, is a condition that causes muscle pain and difficulty performing athletic activities due to increased pressure in the muscle compartment. People with this condition typically experience pain after a period of high-intensity activity or exercise that is quickly relieved by rest. The pain from exercise-induced compartment syndrome can be quite severe, and it often limits an individual's activity level.

Group of adults jogging in a grass field
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Exercise-induced compartment syndrome is different from acute compartment syndrome, a surgical emergency. Typically, acute compartment syndrome is the result of a traumatic injury causing a similar increase in compartment pressures. In this situation, the pressure cannot be controlled easily, and a delay in treatment can lead to permanent muscle and tissue damage. In people with chronic compartment syndrome, the pressure is relieved by stopping exercise activity, and the symptoms will spontaneously improve. While treatment may be pursued, including surgery, this is generally not considered an emergency.

Causes of Exercise-Induced Compartment Syndrome

Exercise-induced compartment syndrome is due to a pressure build-up within the muscles. Muscles are enclosed within a tight tissue called fascia. This fascia wraps around and contains the muscle. Normally, the fascia has enough extra room to allow the muscle to function without a problem.

When activity levels are increased, blood flow to a muscle increases and the size of the muscle increases. During strenuous activity, the volume and weight of a muscle can increase by about 20% in size. This is a result of the muscle fibers swelling during these periods of strenuous activity. In most people, the fascia allows sufficient room to accommodate this increase in muscle size during exercise. However, in patients with exercise-induced compartment syndrome, the fascia is too tight, and it constricts the muscle during these episodes of strenuous activity.

The most common location of exercise-induced compartment syndrome is the leg, in particular around the shin bone. Symptoms are often seen in runners and cross-country skiers. Compartment syndrome can also occur in the thigh (common in weightlifters and cyclists), forearm (rowers and motocross riders), and other muscle compartments of the body.

Pain With Compartment Syndrome

As the muscle expands and becomes constricted by the fascia, blood flow to the muscle is interrupted. When blood flow to a muscle is interrupted, pain can occur. In severe cases, the lack of blood flow can cause ischemia—the same phenomenon as a heart attack. When this occurs in the heart muscle, chest pain is the result; when it occurs in the leg, leg pain is the result.

Before you begin to worry, ischemia of the heart and exercise-induced compartment syndrome are very different! Furthermore, relief of exercise-induced compartment syndrome is usually very easy—simply stop exertion of the muscle.

Symptoms of Exercise-Induced Compartment Syndrome

The most common symptom is pain during activity that is quickly relieved with rest. Patients may notice a tingling or numbness due to a lack of blood flow to the nerves that pass through the compartment. Often when the symptoms are present, the area over the muscles of the affected compartment feels very tight.

Diagnosis is made by measuring the pressure within the muscles of the affected compartment. Usually, pressure measurement is made at rest, and then the patient performs some activity (such as a quick run) until the pain is present. A repeat measurement is then made and the pressure change is compared. In normal patients, the pressure difference between rest and activity is small. Patients with exercise-induced compartment syndrome will have a dramatic increase in pressure readings when symptoms are present after exercise.

Several other conditions need to be considered. Exercise-induced compartment syndrome is uncommon, and it is much more likely that leg pain (the most frequent area for exercise-induced compartment syndrome) is being caused by one of the following conditions:

Treatment of Exertional Compartment Syndrome

A period of rest may be attempted, as well as avoiding any activities that cause the symptoms. However, if the diagnosis of exercise-induced compartment syndrome is clear and the symptoms persist, surgery may be needed.

The surgery involves releasing (cutting) the tight fascia, called a fasciotomy. An incision is made over the affected area. Next, the surgeon cuts the tight tissue that surrounds the muscle. The major risk of this surgery is cutting the small nerves that provide sensation to the extremity. Usually, the surgeon can identify the nerves and avoid them, but it is still possible to damage the nerves.

A Word From Verywell

Exercise-induced compartment syndrome can be a frustrating problem. Without an easy test to diagnose this condition, many people struggle to find relief from their symptoms. Usually, relief can only come from one of two methods: modifying activities to prevent the muscles from having to work excessively, or a surgical procedure that allows more room for the muscles.

Modifying activities can be difficult for athletes who require high-intensity activity in order to compete at the highest levels of their sport. In these situations, surgical solutions are typically the most effective treatment. However, there are some recent breakthroughs in treatment through gait and running retraining that may also be effective.

Frequently Asked Questions

  • Which muscles are affected by exertional compartment syndrome?

    Any muscle can be affected by exertional compartment syndrome, but it most frequently affects the leg. Other muscles located in the arms, legs, and feet can also be affected. These muscle compartments are involved in repetitive movements, especially during sports or physical activities such as kayaking, rowing, swimming, or running.

  • Can you prevent exertional compartment syndrome?

    There are two ways to prevent exertional compartment syndrome: avoid or alter exercises that trigger pain and receive surgery. For example, if running on concrete causes symptoms to occur, running on other surfaces or performing low-impact exercises may help. Nonsurgical treatments such as anti-inflammatory medications, shoe inserts, and physical therapy are not always effective for preventing symptoms, but it may be worth mentioning these to your healthcare provider.

  • How do you test for exercise-induced compartment syndrome?

    You can test for exercise-induced compartment syndrome by visiting a doctor. They will perform a physical examination to rule out other possible causes; for example, the doctor may check for tendonitis by applying pressure to the tendons. They might also check compartment pressure before and after exercise to see first-hand how you are affected.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Buerba RA, Fretes NF, Devana SK, Beck JJ. Chronic exertional compartment syndrome: current management strategies. Open Access J Sports Med. 2019;10:71–79. doi:10.2147/OAJSM.S168368

  2. Joyner MJ, Casey DP. Regulation of increased blood flow (hyperemia) to muscles during exercise: a hierarchy of competing physiological needsPhysiol Rev. 2015;95(2):549–601. doi:10.1152/physrev.00035.2013

  3. Chandwani D, Varacallo M. Exertional Compartment Syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing,

  4. Zimmermann WO, Hutchinson MR, Berg RVD, Hoencamp R, Backx FJG, Bakker EWP. Conservative treatment of anterior chronic exertional compartment syndrome in the military, with a mid-term follow-upBMJ Open Sport & Exercise Medicine. 2019;5(1). doi:10.1136/bmjsem-2019-000532

  5. American Academy of Orthopaedic Surgeons. OrthoInfo. Compartment Syndrome.

Additional Reading

By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.