Compartment Syndrome


Article by A. Clarke, S. Armfield

What is Compartment Syndrome?

compartment syndrome

Compartment syndrome, also known as recurrent or chronic exertional compartment syndrome (CECS), is a condition that affects the lower leg. Your lower leg is divided up into four or five compartments with different muscles, nerves, blood vessels and tendons running through these compartments. 

The compartment is surrounded by fascia, which helps to improve the efficiency of contraction and divide the muscle from surrounding tissue. Sometimes the pressure within one or more of these compartments increases to the point that the muscle, blood vessel or nerves are compressed. This can cause pain and loss of function. It is often found in runners as a result of the high repetitive loads that occur with running. 

What Causes Compartment Syndrome?

Compartment syndrome can become evident with an increase in activity or training. As we use our muscles there is a build-up of waste product and an increase in blood flow to the muscle. This causes the muscle volume to increase by between 8-20%, which results in increased pressure within the muscle compartment. There may also be an increase in the resting size of the muscle as a result of training. These changes are normal, with increased pressures reducing within 5 minutes of ceasing exercise.

Compartment syndrome seems to develop as a result of different anatomy.

  • In some people, there is an extra ‘fifth’ compartment deep in the lower leg, with an extra sheath of fascia extending up the leg. The further the sheath extends, the greater the risk of compartment syndrome.
  • The fascia becomes fibrotic, or thickened, as a result of a chronic inflammatory process or surgery. This leads to the fascia becoming less flexible.

In either case, pressure increases to a greater degree and takes longer to reduce post-exercise. The extra internal pressure in the compartment means that there is reduced blood flow to the muscle, and reduced oxygen for the muscle tissue. We think that the pain is due to a lack of oxygen supply. This is called ischaemic pain.

What are the Symptoms of Compartment Syndrome?

Tightness, burning, pressure, cramping and/or pain in the lower leg every time you exercise, most commonly around the calf and shin region. The pain commonly occurs in both legs.

The onset of these symptoms occurs at predictable intervals (for instance, 4 minutes into every run). Depending on which compartments are affected, you may also experience sudden fatigue on the top of your foot or ankle, numbness in the webbing near your big toe, or even drop foot (this is quite uncommon). Sometimes there may be lumps or bumps in the tissue due to small hernias.

How is Compartment Syndrome Diagnosed?

It can be difficult to diagnose compartment syndrome as the pain in your leg could be caused by a number of other problems such as tendonitis, stress fracture or a condition called periostitis. Exertional compartment syndrome is usually diagnosed clinically by what causes the pain and its predictable nature. At rest you have no pain but when you exercise the pain comes on and this usually happens after a set period of time. If you continue to exercise the pain gets worse but is usually completely relieved with rest.

Compartment syndrome can also be diagnosed with the use of a needle inserted into the compartment attached to a pressure monitor. If the difference between the resting pressure and the pressure measured immediately after exercise is too high then this is a positive test for exertional compartment syndrome.

Compartment Syndrome Treatment

PHASE I - Pain Relief. Minimise Swelling & Injury Protection

Managing your pain. Pain is the main reason that you seek treatment. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.

Your physiotherapist will use an array of treatment tools to reduce your pain and any chronic inflammatory disorder. These may include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage and temporary use of a mobility aid (eg orthotics) to off-load the injured structures. They will advise you on any necessary modification of training, or complete rest in severe cases.

PHASE II - Restoring Normal ROM & Posture

There is often a biomechanical fault leading to the increased load. Your physiotherapist will look to restore your normal joint range of motion, muscle length, neural tissue mobility, resting muscle tension, and fascial tissue flexibility.

Treatment may include joint mobilisation and alignment techniques, massage, muscle stretches and neurodynamic exercises, plus acupuncture, trigger point therapy or dry needling. Your physiotherapist is an expert in the techniques that will work best for you.

PHASE III - Restore Normal Muscle Control & Strength

Researchers have found different muscle firing patterns in runners with exercise-related leg pain. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best exercises for you specific to your needs.

PhysioWorks has developed a “Foot Stability Program” to assist their patients in regaining normal muscle control. Please ask your physio for their advice.

PHASE IV - Restoring Full Function

During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their bodies that will determine what specific treatment goals you need to achieve. For some, it is simply to run around the block. Others may wish to run a marathon.

Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.

PHASE V - Preventing a Recurrence

Injuries and the pain associated does have a tendency to return. Insufficient rehabilitation is thought to be one reason for this.

In addition to your muscle control, your physiotherapist will assess your biomechanics and start correcting any defects. It may be as simple as providing you with some foot orthotics to address any biomechanical faults in the legs or feet. Your physiotherapist will guide you on this.

What Results Can You Expect?

The advice that your physiotherapist gives you in conjunction with some ‘hands-on’ therapy can work to reduce your symptoms very well. Unfortunately, there are a number of people that do not respond as well as we would like, usually as a result of their underlying anatomy. If we are not seeing the desired improvements you may be referred to a sports doctor, podiatrist or orthopaedic surgeon.


Surgery is only considered if a conservative programme has failed and you want to keep exercising. The surgery involves cutting the fascia that surrounds the muscle to allow for muscle volume increase. In some cases, surgical release is essential and urgent!

Other Treatment Options

Specific Interventions eg Injection

Cortisone and other injected substances are usually not successful and are not recommended.


Many patients find that soft tissue massage therapy is beneficial to assist your pain relief, muscle relaxation and swelling reduction. Please ask your physiotherapist if you would benefit from massage.


Acupuncture can be helpful for the relief of your pain. If you are interested in trying some acupuncture, many of our therapists are trained in acupuncture. Please ask for their advice.


Carrying excessive body weight can predispose you to injury or pain.

Recommended Brace or Product

Self-massage tools can help to reduce muscle tightness, increase tissue flexibility and provide pain relief. These include foam rollers and spikey balls.

Shin Splints

More Advice

If you have any concerns or have some specific questions regarding your condition, please ask your physiotherapist or doctor.

Call PhysioWorks

Book Online

Common Treatments for Compartment Syndrome

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • What to do after a Muscle Strain or Ligament Sprain?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Scapular Stabilisation Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Walking Boot
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Kinesiology Tape
  • Neurodynamics
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Related Injuries

    General Information

    Achilles Injuries

    Calf Pain

    Shin Pain

    Muscle Injuries

    Systemic Conditions

    Neurological Conditions

    FAQs about Compartment Syndrome

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Barefoot Running: Your MUST READ Guide to the Pro's and Con's.
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Can You Prevent a Future Leg Injury?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • Runners: How to Reduce Your Knee Stress
  • What are Growing Pains?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Call PhysioWorks

    Book Online

    Share this page

    Last updated 11-Oct-2019 03:53 PM

    Receive Special Offers and the Latest Injury Information

    Enter Details Below to Signup:

    Receive Special Offers and the Latest Injury Information

    Enter Details Below to Signup:

    PhysioWorks does not endorse companies or products who choose to advertise on this website. Advertising revenue supports the free access to our educational content and its updates. Check out the links below for more specific health information from your trusted PhysioWorks team.

    Share this page