Chronic Exertional Compartment Syndrome (CECS)

Causes & Risk Factors for CECS

The cause of chronic exertional compartment syndrome isn't completely understood. However, many orthopedic experts believe it’s caused by increased pressure in a muscle compartment. During exercise, the muscles receive additional blood flow causing them to expand. Normally, the fascia will also expand. In people with CECS, the fascia remains tight, causing pressure, pain and weakness.

Exercise trigger’s the body’s release of chemicals called metabolites. In people with CECS, these chemicals build up in the muscles, compressing the nerves and causing muscle fatigue and pain.

CECS can occur at any age but is most common in endurance athletes under the age of 30. Additional risk factors include:

• Poor exercise mechanics
• Excessive training and repetitive, high-impact activities like running
• Creatine supplements, which may increase muscle swelling

Symptoms of Chronic Exertional Compartment Syndrome

The most common symptoms of CECS include:

• Muscle pain and cramping during exercise that progressively worsens
• Swelling, numbness or weakness in the affected limb
• Herniation of affected muscles (rare)

The symptoms of CECS will usually become less intense or disappear within 15 minutes of stopping movement. However, the length of time needed for recovery may increase if the condition is not diagnosed and treated.

How is CECS Diagnosed?

Your doctor will take a complete medical and lifestyle history and perform a physical exam to rule out other more common exercise-related conditions like shin splints or stress fractures. Because the symptoms of CECS only occur during exercise, your doctor may have you perform certain exercises (like running on a treadmill) until symptoms occur before examining you. If CECS is suspected, your doctor may order imaging tests, including:

• MRI to evaluate the structure of the affected muscles and measure fluid volumes.
• Near infrared spectroscopy (NIRS) – a noninvasive test to measure blood oxygen levels in the affected muscles.

If your medical history and other tests strongly suggest CECS, a more invasive test called compartment pressure testing may be performed. This test inserts a catheter into the muscle before and after exercise to take measurements and is the gold standard for diagnosing chronic exertional compartment syndrome

Conservative Treatments for CECS

In most cases, conservative treatment and rest will relieve symptoms. However, this relief is usually only temporary and symptoms will return once normal activities and exercise are resumed. Temporary measures for symptom relief may include:

• Nonsteroidal anti-inflammatory medications (NSAIDs) like ibuprofen
• Massage and stretching
• Physical therapy and improved body mechanics
• Custom orthotic shoe inserts
• Switching to low-impact exercises such as cycling or swimming

If these conservative measures don’t provide effective symptom relief and if returning to your sports of choice is important to you, surgery may be an option.

Surgical Treatment of Chronic Exertional Compartment Syndrome

A surgical procedure called fasciotomy is the most effective and lasting treatment for CECS. This procedure involves creating an opening in the fascia surrounding the affected muscle compartment(s) to relieve the pressure. In most cases, fasciotomy can be performed through small incisions which may reduce recovery time and allow you to return to your regular activities sooner.

Although surgery is effective for most people, some may experience complications including infection, nerve damage, numbness, weakness, bruising and scarring. Talk to your orthopedic specialist about the pros and cons of this procedure.