Lower Leg Pain, It Could Be Compartment Syndrome?

Compartment Syndrome Is A Potential Cause Of Lower Leg Pain

Athletes and particularly running athletes commonly experience lower leg pain. In fact only knee pain is a more common complaint in runners. There are many potential causes of lower leg pain, anything from stress fractures, tenosynovitis, tendinopathy to shin splints. Chronic exertional compartment syndrome is a frequently missed cause of lower leg pain in athletes.

What Is Chronic Exertional Compartment Syndrome?

Chronic exertional compartment syndrome, frequently referred to as simply “compartment syndrome” is a condition where the fascia, a connective tissue encasing a muscle group becomes excessively stiff. With activity and exercise your muscles require additional blood flow, this additional blood flow to the muscle will cause it to “swell”. When the muscle becomes enlarged with the increased blood the connective tissue compartment surrounding the muscle must give/stretch to accommodate the change in the resulting muscle size. However, if the connective tissue is “stiff” then the muscles in this compartment become constricted as the fascia doesn’t “give” which in turn can cause the blood supply to the area to be compromised creating what could be described as a cramping, tiredness, heaviness uncomfortable sensation in the muscle compartment.

What Causes Compartment Syndrome?

The “stiffening” of the fascia around the muscle group causing lower leg pain can occur as a result of trauma, ageing or genetics. Clues towards making a diagnosis of compartment syndrome is often indicated in what the athlete describes more than physical assessment. Lower leg pain as a result of compartment syndrome differs to shin splint pain which classically is painful on warm up and initial activity, but then subsides throughout the activity only to return again shortly after exercise for a variable duration depending on severity. Whereas an individual suffering with compartment syndrome will typically be painless for the first minutes of exercise before the onset of any cramping, tiredness, heaviness or pain. Symptoms which then gradually worsen in what is  described as a crescendo type pain. Ultimately the symptoms will frequently become severe enough to force the individual to cease activity prematurely. However, unlike shin splits these symptoms typically subside quickly with rest rather than return and remain present for an extended period with a classic shin splint.

What Investigations Are Performed To Diagnose Compartment Syndrome As A Cause Of Lower Leg Pain?

Typically at rest there are very few if any signs that would indicate a diagnosis of compartment syndrome. However, following exercise the individual may have increased tension with palpation  through the affected compartment. Worth noting is that chronic exertional compartment syndrome usually causes lower leg pain on both sides of the body (bilateral), this is the case with regard to shin splints, whereas other causes of lower leg pain like stress fracture and tendinopathy are quite commonly unilateral in their presentation.
Investigations such has MRI, X-ray and bone scans can help mostly in what they exclude, not through their capacity to confirm a diagnosis of compartment syndrome. These investigations can be useful to exclude other causes of lower leg pain like stress fractures, tenosynovitis and shin splints. The “gold standard” test for diagnosing and confirming compartment syndrome is a “compartment pressure test”. This investigation involves a pre and post exercise component, where the procedure of inserting a needle attached to a pressure gauge into the affected compartment is performed. Then assessing the pressure rating relative to normal standards, where a “positive” test result confirming the diagnosis will be a rise in pressure from the accepted norms.

Treatment For Lower Leg Pain From Compartment Syndrome

Failure for conservative treatment to resolve symptoms may result in surgery being the viable and recommended option. Conservative options include physiotherapy or podiatry often focused at loosening the stiff connective tissue, load management and altering biomechanics or activity technique. The surgery employed for lower leg pain resulting from compartment syndrome is typically a procedure to release the fascia (called a fasciotomy) of the affected compartment.

Disclaimer: This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific medical advice or assistance on Lower Leg Pain, It Could Be Compartment Syndrome? should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopaedic surgeon or otherwise appropriately skilled practitioner.