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Compartment Syndrome: The Often Overlooked Cause Of Lower Leg Pain

Compartment Syndrome: The Often Overlooked Cause Of Lower Leg Pain
Compartment Syndrome A Frequently Overlooked Cause Of Lower Leg Pain

Compartment Syndrome A Potential Cause Of Lower Leg Pain

Athletes particularly running athletes may 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 to shin splints. Chronic exertional compartment syndrome is a frequently missed condition causing lower leg pain in athletes.

What Is Chronic Exertional Compartment Syndrome?

Chronic exertional compartment syndrome, frequently referred to as just “compartment syndrome” for short is a condition where the connective tissue (fascia) covering of a muscle group becomes excessively stiff. When exercising or with activity muscles require additional blood flow and will swell, when this occurs the connective tissue will need to stretch to accommodate the swelling. However if the connective tissue is stiff then the muscles in this compartment become constricted which in turn causes the blood supply to the area to be compromised creating what could be described as a tiredness, heaviness, discomfort or pain sensation in the area.

What Is The Cause Of Compartment Syndrome?

The stiffening of the fascia around the muscle group causing lower leg pain due to compartment syndrome could be due to trauma, ageing or genetics. Clues towards a diagnosis of compartment syndrome is often indicated in what the athlete describes. Different to a shin splint type pain which commonly will be painful on warm up and initial activity but then disappear only to return following activity (and sometimes remain for quite an extended period). An individual suffering with compartment syndrome will typically be painless for the first 5-10 minutes of their activity before the onset of pain which slowly worsens and can be described as a crescendo type pain, where the pain may become severe enough to make them stop their activity. This pain however unlike shin splits typically subsides very quickly following activity with rest.

What Tests Can Be Done For Chronic Exertional Compartment Syndrome?

Typically at rest there are very few if any signs that indicate a diagnosis of compartment syndrome, however following exercise the individual may have increased tension through the affected compartment on palpation of the area. Worth noting is that chronic exertional compartment syndrome usually causes lower leg pain on both sides of the body.
Investigations such has MRI, X-ray and bone scans can help mostly in excluding stress fractures and shin splints. Specifically the test for compartment syndrome is a compartment pressure test which involves the pre and post exercise procedure of putting a needle attached to a pressure gauge into the affected compartment and assessing the pressure rating relative to clinical norms, with a positive test being a rise in pressure from the accepted normal.

Failure of conservative treatment to resolve symptoms (this typically being physiotherapy or podiatry focused at loosening the stiff connective tissue and correcting biomechanics) may result in surgery being a viable and recommended option. The surgery in this case for lower leg pain from compartment syndrome is typically a procedure to release the fascia 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 Compartment Syndrome: The Often Overlooked Cause Of Lower Leg Pain should consult his or her general practitioner, physiotherapist, sports medicine specialist, orthopaedic surgeon or otherwise appropriately skilled practitioner.

Hayden Latimer is the founder of and principle physiotherapist at Sydney Physio Clinic. Since graduating from Otago University, Dunedin, New Zealand he’s gained wide experience practicing across the globe for over 15 years and is now extremely knowledgeable in helping people reduce discomfort and restore function and mobility.


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