University of Oregon

Department of Human Physiology Graduate Studies in Athletic Training and Sports Medicine

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Chronic Exertional Compartment Syndrome

Colin Wallace MS, ATC

Athletes participating in sports involving repetitive motion are prone to a variety of overuse injuries. Medial tibial stress syndrome (MTSS), stress fractures, plantar fasciitis, strains, and sprains are all example of injuries that can occur to any repetitive strain athlete.1 One condition, which should not be overlooked when assessing the lower limb in any endurance athlete, is chronic exertional compartment syndrome (CECS). The leg is normally divided into four distinct myofascial compartments: anterior, lateral, superficial posterior, and deep posterior.2 A fifth compartment may exist containing the tibialis posterior muscle alone.3 CECS can occur in any of these compartments, however, it is more prevalent in the anterior, which accounts for up to 70% of cases.4 CECS is characterized by reduced capillary blood flow caused by an increase in pressure within a closed fascial space. If left untreated it may lead to tissue hypoxia and possibly cell death.5 Proper muscular function is also prohibited which leads to weakness in the affected compartment.6 The onset of CECS is gradual; resulting from microtrauma caused by repetitive loading during exercise, such as in long-distance running, soccer, and military training, and is more common in younger athletes.7, 8 Signs and symptoms include increased pain in the affected compartment; pain and weakness when a passive stretch is applied to the muscles of the affected compartment; hypoesthesia, or a reduced sense of touch or sensation caused by compressed nerves in the affected compartment; red, shiny skin over the affected compartment; and possible bulging of the tissues in the affected compartment.4 The pain experienced with CECS begins shortly after exercise has commenced, and ceases when activity is stopped. The involvement of nervous tissue in CECS makes the diagnosis all that much more important, as neurological damage can be permanent if this condition worsens.

Normal compartmental pressure is between 0 – 10 mmHg. For the diagnosis of CECS, compartmental pressure of ≥15mmHg before exercise, ≥30mmHg after 1 minute of exercise, or prolonged pressure of ≥20mmHg after 5 or more minutes of rest after the completion of exercise, must be observed.1, 5, 7, 9, 10 Three common devices used to test for CECS include the Stryker Intracompartmental Pressure Monitor System, an Arterial Line Manometer, and the Whiteside apparatus.11 Much of the research on CECS involves the Stryker Intracompartmental Pressure Monitor system, likely because it is the only hand-held monitor on the market. It is also quick to set up and involves disposable components for quick transition and measurements.