Understanding is the first step to gaining an upper hand
Chronic Exertional Compartment Syndrome (CECS)
Chronic Exertional Compartment Syndrome(CECS) is a condition most commonly seen in runners and athletes. It's caused by an increase in pressure in a "compartment" or group of muscles, blood vessels, and nerves that are surrounded by a tough membrane(the fascia). This increased pressure reduces blood flow, causing pain, numbness, and potentially muscle damage.
It's called "exertional" because symptoms usually occur during or after exercising, often at a consistent point in a workout. Symptoms typically subside after stopping the activity, although if the condition is severe or left untreated, symptoms might persist even at rest.
Important note: Chronic exertional compartment syndrome is different than Acute Compartment Syndrome (ACS) which occurs after a major trauma causing an acute increase in pressure within a compartment and is a surgical emergency. CECS is a chronic overuse syndrome which changes the nature of the fascia to set the stage for symptoms.
Symptoms
The symptoms of Chronic Exertional Compartment Syndrome (CECS) usually begin during or immediately after exercise and may include:
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Aching, burning, or cramping pain in the affected limb (most often the lower leg)
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Tightness or fullness in the affected limb
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Numbness or tingling
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Foot drop in severe cases (if the nerves controlling foot movements are affected)
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Weakness or difficulty moving the affected limb
These symptoms typically improve with rest. However, as the condition progresses, the symptoms may begin to interfere with the individual's ability to exercise or participate in their sport. In severe cases, symptoms may persist even at rest. As always, if one suspects they have this condition, they should seek medical attention.
Specialist
An orthopedic surgeon or a sports medicine specialist would be the best to consult about this condition.
Diagnostics
Diagnosis typically involves measuring the pressures within the muscle compartment, and additional tests may include X-rays, MRIs, or ultrasound. Here are some tests to diagnose exertional compartment syndrome:
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History and Physical Examination: A careful history of the symptoms and physical examination is often the first step. The doctor will ask about the exercise habits, what triggers the symptoms, and how long they last. They will also look for any signs of swelling, tenderness, or abnormal muscle firmness, and fascial defects.
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Intracompartmental Pressure Testing: This is the most definitive test for diagnosing compartment syndrome. A needle attached to a pressure gauge is inserted into the muscle compartment to measure the pressure before, during, and after exercise. Elevated pressures, particularly post-exercise, may indicate compartment syndrome. It's worth noting that this test can be painful and is often done under local anesthesia.
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Imaging Tests: While imaging tests like MRI or ultrasound can't directly diagnose exertional compartment syndrome, they may be used to rule out other potential causes of leg pain such as stress fractures or tendinitis.
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Near-Infrared Spectroscopy (NIRS): Some research has suggested that NIRS, a non-invasive method of measuring tissue oxygenation, might be helpful in diagnosing compartment syndrome. However, this technique is still under investigation and not yet widely used.
Treatments
Consider
The primary treatment for Compartment Syndrome is physical therapy to address gait imbalance and stabilizer weakness. If physical therapy does not improve symptoms, surgical intervention is the next step. Physical therapy is a critical part of the post-surgical recovery and return to sport.
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Fasciotomy: a surgical procedure that is typically performed to treat compartment syndrome. Compartment syndrome is a condition characterized by increased pressure within a muscle compartment - a section of the body that contains muscles, blood vessels, and nerves. This increased pressure can compromise blood flow and cause pain to the tissues within the compartment.During a fasciotomy, the surgeon makes an incision in the skin and the fascia, which is the tough connective tissue that surrounds the muscle compartments. This relieves the pressure within the compartment, allowing blood to flow more freely and preventing or mitigating tissue damage.
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Botox (Botulinum toxin) injections: explored as a potential treatment for Chronic Exertional Compartment Syndrome (CECS). Botox works by blocking the nerve signals that cause muscle contraction, thereby potentially reducing the increase in pressure within the muscle compartment that occurs with exercise. Research on this treatment option is relatively limited and the results have been mixed. Some studies suggest that Botox may be beneficial in treating CECS, while others indicate that it may not be as effective as traditional treatments like fasciotomy surgery. It's important to note that the use of Botox in treating CECS is not a commonly accepted practice and is generally considered experimental. It may also carry risks, including muscle weakness and other side effects.
Diagnosis should involve orthopedic surgeons, sports medicine specialists, and sometimes vascular surgeons, as it is crucial to rule out other conditions such as Popliteal Artery Entrapment Syndrome that may present with similar symptoms. Click here for more information.
Questions
When consulting with your physician about your pain, diagnosis and treatment path, asking questions is an important element of making an informed decision. Click here for some suggested questions.
Information
The information of this site is limited and intended to provide an overview of the chronic exertional lower leg conditions which can cause pain and functional limitations. Click here for more information on Chronic Exertional Compartment Syndrome (CECS).