Chronic exertional compartment syndrome (CECS) is a condition in athletes (long-distance runners, basketball players, skiers, and soccer players) that can occur from repetitive loading or exertional activities. It is most common in the lower legs, but can also occur in any compartment of the extremities like in the forearms of motocross racers and other athletes.
CECS is characterized by exercise-induced pain that is relieved by rest. In some cases, weakness and paresthesia may accompany the pain.
The pathophysiology of CECS is not well understood. CECS may result from ischemic changes within the compartment; however, there are multiple theories and mechanisms.
Symptoms
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.
Causes
Chronic exertional compartment syndrome is caused by excessive pressure within an isolated segment of the muscle (a muscle compartment). Exercise increases the blood supply to working muscles, making them expand. If the connective tissue 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, the way a person moves, 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 surrounding a section of muscle, or high pressure within the veins.
Risk factors
Certain factors increase the risk of developing chronic exertional compartment syndrome, including age, type of exercise, overtraining and some drugs.
Complications
Chronic exertional compartment syndrome is not a life-threatening condition and usually doesn't cause any lasting or permanent damage if appropriate treatment is used. In cases when the person continues to exercise despite pain, the repeated exercise increases the compartment pressure and 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 sports. The pain may prevent a person from being an active athlete.
Treatment
Options to treat chronic exertional compartment syndrome include both conservative and surgical methods. However, conservative measures are typically only successful if the activity is drastically changed or stopped.
Pain medications, stretching or strengthening regimens, orthotics, massage, a break from exercise, or the use of different biomechanical techniques, such as changing how you land when you jog are recommended. However, these kinds of conservative options typically don't provide lasting benefit for solving the problem with chronic exertional compartment syndrome.
Surgery is the main treatment of chronic exertional compartment syndrome, and the most effective. It involves operating on the fascia, the inelastic tissue encasing each muscle compartment.
Although surgery is highly effective for most people, it is not without risk. Some of the complications of the surgery can include numbness and scarring, infection and permanent nerve damage.
Prevention
There are no self-care measures that will specifically help prevent chronic exertional compartment syndrome. But following basic sports and fitness guidelines can help protect health and safety during exercise:
- Stop if you're in pain,
- Warm up before starting exercise,
- Cool down when you're done exercising,
- Eat a healthy, balanced diet,
- Engage in a variety of physical activities,
- Drink a lot of water.
