What are the symptoms of chronic exertional compartment syndrome (CECS)?

Chronic exertional compartment syndrome is a difficult problem for runners and running athletes. It can keep them from training. In this Ask Dr. Geier video, I discuss this common problem and its usual symptoms.

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Salam Mulhem asks:
Hi Doc!
Have there been cases of CECS where the athlete hasn’t experienced numbness or tingling as part of their symptoms? Thanks, this site has been very, very helpful!

Chronic exertional compartment syndrome is an uncommon source of pain and disability in athletes. Most frequently, it causes leg pain in running athletes, but occasionally it is seen in the forearms of throwing athletes, such as pitchers.

Compartment syndrome occurs when the muscles of part of the body swell with activity. In runners, this muscle swelling occurs in part or all of the leg. This swelling causes discomfort or even severe pain while the athlete is running, but it usually gets better with rest. Over time, this swelling and pain increase to the point that it limits the runner’s ability to complete a training session. He or she will often notice, in addition to pain and swelling, numbness and tingling in the foot. As symptoms progress, the athlete might notice pain with activities of daily living, such as fast walking.

In the video, I discuss the symptoms of CECS as well as the treatments that can help the affected athlete.

Please remember, while I appreciate your questions, I cannot and will not offer specific medical advice by email, online, on my show, or in the comments at the end of these posts. My responses are meant to provide general medical information and education. Please consult your physician or health care provider for your specific medical concerns.

[DrDavidGeier]

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[indyskr]

Had symptoms of CECS for over a decade and had no clue what it was. I got told I wasn’t warming up properly or enough, that I was just dehydrated, or had some sort of vitamin deficiency. It wasn’t until last year when my lower legs basically completely locked up, that I knew this was something I needed to see a dr on. Long story short, I just had my anterior fasciotomy on both legs last Friday and I get my stitches out Wednesday, Sept 5th! The recovery, for me, has not been bad at all and, relatively speaking, pain free. If you’re dr recommends a fasciotomy, don’t be nervous! Mine went just fine and I think once the stitches come out, things will be just great!

[DragonThank]

Had it for 10 years. Started when I was 12. For years I could not walk 10minutes without pain. I had 2 surgeries in both shins. 1st cut was too small and it healed so a 2nd bigger cut had to be made in both shins. After that I just build up my training routine and changed my running strike to midfoot / forefoot. Stretching the shins is really important to prevent this injury to happen. Most people do not stretch their shins unfortunately....
2 years after the last surgery now and im able to walk 30km without a break, run 3km without pain in the shins!


Also I do train young boxers. I have had some boxers who started to experience the same pain as I had. Even one of my boxers had the pain for almost a year.
I told him to stretch his shins by sitting on the knees and heels while having his shoes on and holding the stretch for 2 minutes. I recommend doing this after every workout and in the evening before going to bed. Also I told him to look at his standing posture. He was pronating too much with both feet just like I did. I told him to think about the posture al the time he was standing and walking and to stop pronating too much.
He listened carefully and within a couple months his pain was gone.

Maybe some people here can learn from my experiences. I am happy to help anyone!

[goose]

I've never been able to run a mile due to calf pain. Basically my calfs feel like they are gonna explode. I'm 37 now and trying to get back into shape and still having the same issues I did as a teenager. Can only assume this is my problem

[patriknosreti]

Guys I just found out I have this. First I started to have problems 10 years ago when I was 15 years old. I can give you one big advice. Use warming gels before sport. It helped me a lot and I managed to play soccer for 10 years with slow warm up and use of gel. Before I couldnt play at all. Now it got worse and I will get it operated. But for some of you this can be a big help :)

[filukkasunivers]

i have not been diagnosed yet, but i think i might have this. it has been 7 years of pain, different kinds of meds, treatments, alternative stuff, doctors visits etc but the hospital system here in denmark is painfully slow. i used to dance, my body is my tool, i cant, run, sit, stand or anything for to long. i am a prisoner in my own home in my own body, i can´t go on adventures with my son, he does not even remember his mom without being in pain. i am so sad, im miserable, im not myself, im depressed, im in pain almost everyday and the few days i have little to no pain I feel so happy, hopeful and full of love. Im missing out on life. I try to keep that little hope inside my heart, even though i am heart broken over this condition i am in. Im loosing hope even though i swore i never would give up.

[MichaelThomas-ffkg]

I believe this is what I have. I have been to several specialist from a neurologist to a neurosurgeon to a podiatrist and finally another podiatrist who diagnosed me with this. It was very frustrating I would get a sharp intense pain in the peripheral nerve in my right foot, and no one could understand why. The only other symptom I would have is when I tried to work out the muscles will get really tight in the back of my calf. I've tried orthotics and physical therapy but it has not helped. The pain was so intense that I developed anxiety waiting for the next attack. I go back to my doctor tomorrow where I'm sure he'll recommend surgery. Thanks for explaining this.

[mr]

I got diagnosed the syndrome today. My doctor suggested that I take a break from the exercise that caused it. He also suggested that I get a better fit of shoes, as well as stretch out my calves.

[AnAlaskaHomestead]

I got it in my forearm and ignored the pain. Ended up in the emergency room and had 75% of my #5 muscle die. After a week in the hospital and a couple of months of not using my right arm life began to become normal again.

[mary-udwp]

I was diagnosed with exertional compartment syndrome after an initial misdiagnosis. After a month or so of training and getting up to a 3 mile base run and long weekend runs, I would go out to run and literally be stopped in my tracks. I had severe foot drop in my left foot. Then after about 45 minutes the symptoms went away.
I went to an orthopedic doctor and told him I thought I might have exertional compartment syndrome. He said no, he didn't really see that, it was rare, and he didn't do the pressure tests for it. He said I was just training wrong.
For four years, I tried everything. Changing my running technique. Different shoes like zero rise. Massage. Foam rolling. Very slow warm-up before running. Still, every year the exact same thing happened. It stinks when you enjoy running and then go out for a run and 8 minutes in have to stop.
So I went to another doctor and got the pressure tests. Anything above 30 after exercise was considered exertional compartment syndrome. After just walking to the table, the pressure in my lateral compartment was 31 and anterior was 29.
The dr said hop on the treadmill. So I ran about ten minutes and hopped off before the symptoms were even close to how bad they could get. The pressure in my anterior compartment was 96 and lateral was 76.
I ended up getting surgery on both my lower legs, even though my left leg was worse. I can run now without the symptoms and I am really happy about that. I find running very therapeutic.
If you have exertional compartment syndrome, you can't train it away. Forefoot running won't fix it. Surgery fixed it. I had pretty much constant tingling in my left foot before surgery and that's gone. I had some complications after surgery with my nerve in my right leg and had to get physical therapy, but it's like 98 percent better now.
If you think you have exertional compartment syndrome, get a pressure test. The competent Dr told me it isn't rare, but I was some of the highest pressures he had ever measured. Don't keep suffering if you love running.

[mladymocha]

This will be a long one, but here in 2000, I worked for a Canadian courier company for 8 years, walking 8-9 hours a day at my own pace, WITHOUT ANY LEG ISSUES WHAT SO EVER. In 2008 I left that job to join the military. During the first two weeks of the 14 weeks of basic training, I started to get excruciating pain in my lower legs. I would get up early every morning to wrap my legs and take Advil prior to our early morning PT (physical training). I am 5'1" (being short, while someone taller is setting the marching pace, caused me to have to continually take longer strides in order to keep up, otherwise I would have messed up the stride for the others marching behind me.) Just imagine someone 5'1" and someone 5'11" standing side by side, then both taking 5 steps. The taller persons stride will land them significantly further ahead than the stride of myself. Imagine having to stretch out my stride for each and every steps for 14weeks. The pain was unbearable. However the one thing I learned in Basic Training is to 'Push through the pain" and that is what I did. Never realizing the damage I was causing.

Once basic was over, I was posted, my pain subsided as I was not having to march everywhere. My pain would start again when I had to run during PT, but I chalked it up to shin splints. For the next 10 months I was doing OJT (on job training) while waiting for my trade training to start. I very quickly started to feel the recognizable pain again once on my trade course, because again we were having to march everywhere we went. (I started to notice the onset of pain was starting earlier then it had in the past) Again I pushed through the pain. Marching everywhere, PT every morning, 10 more months of this until graduation and finally living a normal life with my trade qualifications course complete. There is a 13km Ruck Sack March that we had to do in our course, (same in basic, I did the one in basic, miraculously), in Full Fighting Order. Full gear, helmet, 55lbs ruck sack on our back while carrying our weapon. We would regularly do the work up training for this Ruck sack march. Some days we would range from doing 2km, 4kms, 6kms etc. I always started out at the front to "set the pace",
however the Sgt walking with us was the one setting the real pace, as we were training to complete this march by a certain time limit, sooo that means I always had to fall back because the pace he kept was too fast for me. The pain was unbelievable. The pattern began to develop, I would start off with the other guys, but I was never able to go as quickly or as far as them. They would carry on way up ahead of me, and I would be marching alone, at a significantly lower pace. They would disappear around the bend off in the distance, and then I would see them heading back in my the had already reached the turnaround point, while I was still marching towards the turn point. I would eventually be back with them when I just turned around once they reached me. Remember these were just the work up Rucks. I was medically excused from the actual 13km RuckSack March.  Through out my 11 yr military career this pattern reemerged. The pain would start within the first 5 minutes of marching, running, stair climbing, going uphill etc.

I was not diagnosed until 2011. After merely 2 minutes, (YES 2 MINS)on the treadmill, the pressure test showed the pressure in my legs were at 95!!!! I was told that I was the most severe case she had ever seen. In 2012(Jan & May) I had 2 fasceotomy surgeries, and believed I was healed. WRONG!!! My symptoms started to rear their ugly head again in Sept 2013 (16 months later). I was devastated. Ironically I was on another course (luckily no marching) when the symptoms started which meant I would have to again "Push Through the Pain", until the course was over, before anything could be done. Oh and did I mention, immediately after the course (June 2014), I would be posted to a different base? Causing more delays, oh and just to add salt to my already open wounds, let's get you on yet ANOTHER course 9 months (April 2015)after the move shall we??? Of course this course shall take place PRIOR to my next fasceotomy surgery! Oh and btw, this particular course will require you to MARCH 6.5km each day got the next month!!!! The very first day marching this time, I was not even able to control my legs properly. Everyone following behind me was completely out of step because they were trying to follow my pace, which I was not even able to set due to not having control of my own legs. I am truly surprised they let me stay to complete the course, I shoulder have been RTU'd (returned to unit). My surgery wasn't until Oct 2015, 2yrs after the symptoms resurfaced.

I have had 3 fasceotomy surgeries in total, and NONE of them worked. 2016 I was posted again to BC, and at this posting, my unit liked to climb mountains for their PT. Needless to say, at this point I was no longer participating in Unit PT. I did PT at my own pace. I had medical limitations and if I came off of that I would have to climb a fridge mountain. I could barely climb the stairs without pulling myself up by the railing. I also was issued a medical parking pass to park beside the building, otherwise I would have had to park at the base of a hill, walk up the hill and back down the other side, before even reaching the main gate of the base, and then another 8 minutes to the building I worked in. So I arrived at a new posting, had a parking pass, while everyone else had to park and walk. Great way to start at a new place. I tried to refuse the pass, but my doctor insisted, saying not to worry what others thought. That in 5 years I would not be working with them anymore, but if I didn't pay attention to the pain in my legs, the onset of pain would be much shorter. She was absolutely right.

The toll on my legs was getting worse, and as my doctor had predicted, my "distance from point A to point B prior to pain commencing" was significantly shortening. My condition was getting worse, and would never change. Being in the military was no longer something I could continue. By 2017 my doctor put me on half days, the paperwork was started for my medical release from the military and by 2019 I was released.

I am on long term disability currently, luckily I will be paid at leased until May 2021, but most likely at that point switch over to permanent disability. I have a handicap placard for my car, I have a cane with me for when the walking hurts too much. When in a store, and ask where something is, I no longer try and keep up with the employee that is quickly walking ahead of me to take me to the item I asked about. I pay attention to the fact that I can not walk as fast as that. I do not walk on uneven ground, up hills or take the stairs if avoidable. I even have difficulty crouching down to clean the litter box, because when I stand up, the blood rushes back to my calves and the pain is unbearable. My legs feel weak and I have actually wobbled and almost fallen over.

This condition, robbed me of so much, my employment, prevented me from being able to exercise properly, my ability to spend time doing things that I love with my family, and even has prevented me from playing with my grand babies the way I should be able to. My husband and I went to Costa Rica to the Hot Springs, but I had difficulty walking through them because of the uneven volcanic floor of the springs. Not to mention I was unable to walk along the beach due to the instability of the sand. I have lost so much more than just my job. I am only 52.

I hope my story has not discouraged others, but I just wanted to share. Hopefully others will have a more positive experience than I have had. Thank you for reading, it was long I know, but it is this was my it was long too. 🙏🏽

[nishanish]

Thank you for a simple, yet clear explanation.

[jordanfortenberry]

I have this and it is one of the worst pains and I’m only 14

[kee]

Aren't there any NON SURGICAL solutions or treatments ?

[jdougy]

I have seen multiple doctors, including a specialist, and all have refused to give me a compartment pressure test, and went with their opinions which were wrong (stress fractures) but i got X-rays that proved otherwise.

[dorronski]

Cheers, I was fine for years then a year ago, what you described started to happen just walking and hiking, then the thigh muscle gets real tiered, so affected my hip, I thought stretching would help but doesn't.

[jdougy]

Dr. David Geier, thank you for the video. I've had these exact symptoms for 3 months now at the same milage without fail. This condition is the only thing holding me back from joining the military and I need the procedure to fix it. Can you recommend anyone around Oakland County, MI who has handled this before?

[tluangtea]

Both the muscles of my shins are like this for almost 3 years. I went to therapista and doctors but to no avail. I'm not sure if it's CECS or Chronic Shin splints. Please help🤧

[edhowardjr]

I think this may be what I have. Im in my 40's now but played football and worked out for many years until about five years ago I have been unable to run for more than 7 or 8 minutes. My lower left leg becomes really stiff and feels like a flipper (i.e. floppy). There is usually a really intense pain along the front of my leg. I am literally unable to run anywhere past 8 to 10 mins without intense pain in my left leg. I went to a podiatrist a while back who said that I had a muscle imbalance in my leg. He told me that my calf muscles were too big and tight and were putting strain on the front part of my leg. I did the exercises he recommended but they did not help. I only get this pain when I run . The pain does not occur cycling or on the elliptical.

[NN-nehm]

Do you think forefoot running can cure this problem?