Understanding compartment syndrome - A Guide for Athletes and Defence Personnel
As a clinician working with athletes and defence personnel, I’ve seen firsthand how frustrating and limiting compartment syndrome can be. Whether you're a runner, soldier, or just someone trying to get back to pain-free movement, the mystery and misinformation around this condition can delay recovery and lead to unnecessary worry.
Let’s break it down — clearly, practically, and with some science to back it up.
What Is Compartment Syndrome?
Compartment syndrome occurs when pressure builds up within a muscle compartment — the group of muscles, nerves, and blood vessels surrounded by fascia. This pressure can reduce blood flow, impair nerve function, and lead to pain, numbness, and weakness.
There are two main types:
Acute Compartment Syndrome (ACS): A medical emergency, usually after trauma (e.g. fracture, crush injury). Requires immediate surgical intervention (fasciotomy).
Chronic Exertional Compartment Syndrome (CECS): A reversible, exercise-induced increase in pressure. Typically seen in runners, military personnel, and load-bearing athletes.
In this blog, we’ll focus on chronic exertional cases — the ones I most commonly manage in clinic.
Anatomy Recap: The Lower Leg Compartments
There are four compartments in the lower leg:
Anterior – Houses the tibialis anterior, extensor hallucis longus, and extensor digitorum. Pain often on the front of the shin.
Lateral – Peroneals. Pain or pressure on the outside of the lower leg.
Deep Posterior – Flexor muscles and tibial nerve. Pain deep behind the shin.
Superficial Posterior – Gastrocnemius, soleus. Less commonly involved.
CECS typically affects the anterior compartment, especially in runners and military personnel during loaded marches.
How It Presents
Common complaints I hear include:
“My shins feel like they’re going to explode when I run.”
“I lose sensation or feel pins and needles in my feet.”
“The pain builds after 10–15 minutes of running, then eases off when I stop.”
Unlike shin splints or stress fractures, CECS pain is consistent and predictable in onset and relief.
Diagnosis
Diagnosis is typically clinical, with a detailed history and physical exam. If needed, pressure testing pre- and post-exercise can confirm it. Imaging like MRI or ultrasound may rule out other causes but don’t diagnose CECS directly.
If you're in defence or sport and undergoing work-up, talk to your provider about whether a compartment pressure test is appropriate.
Can You Train Through It?
This is the #1 question I get. The answer: sometimes — but it depends.
Conservative rehab is often trialled before surgery and can be highly effective, especially if the pressure increases are mild to moderate.
Sample Rehab Program (Modified from Styf, 1989 & Turnipseed, 2002)
Here’s a phased example we might use:
Phase 1: Load Reduction + Tissue Health
Cross-training (bike, deep water running)
Neural mobility (e.g., tibial nerve glides)
Calf and tibialis anterior soft tissue release
Breathwork to downregulate central sensitivity
Phase 2: Capacity Rebuild
Isometric holds (e.g., dorsiflexion wall holds)
Calf raises (bent and straight knee)
Walking drills in boots or packs (graded exposure)
Phase 3: Return to Impact
Jump rope progressions
Tempo running intervals (start 1:1 walk:run)
Loaded marches (gradually increasing weight/distance)
Phase 4: Performance Rebuild
Sprint mechanics
Hills + change of direction
Sport-specific drills or ruck training
Every program is individualized, but that’s a typical framework we adapt to your pain, goals, and lifestyle.
When Is Surgery Needed?
If conservative rehab fails (and we’ve given it a proper shot), fasciotomy is the surgical option. The outcomes for CECS fasciotomy are generally good — especially in younger, athletic populations.
But even post-op, rehab is key. You’ll need to rebuild strength and mobility in the affected compartments and gradually return to running or load-bearing tasks.
Common Questions
1. Is this the same as shin splints?
No. Shin splints (medial tibial stress syndrome) are from bone stress. CECS is pressure in the muscle compartment.
2. Can I still join the military / play sport?
Yes — many return successfully. But early diagnosis and a clear plan are crucial.
3. Will it just go away if I rest?
Probably not. Unlike DOMS or overtraining, CECS doesn’t just “settle.” It’s load-specific and often recurs unless addressed.
Final Thoughts
If you're dealing with leg pain during running, marching, or training, and it's affecting your performance — don’t push through blindly. CECS is real, it’s manageable, and recovery is possible. The key is an accurate diagnosis and a structured approach to rehab.
Whether you're preparing for deployment, a marathon, or just want to walk pain-free again, there's a pathway back — and it doesn’t always require surgery.
If you’re dealing with these symptoms, feel free to reach out. I’m always happy to discuss next steps and tailor a plan that works for you.
Stay strong, stay smart.
— Dan
Sports Clinician & Rehab Coach
Scope Sports Injury & Exercise Clinic
Ipswich, QLD
Want help with a rehab plan? Book an assessment or send us a message to get started.
References
Turnipseed WD. "Chronic compartment syndrome: diagnosis and management." Surg Clin North Am. 2002.
Styf JR. "The role of exercise-induced intramuscular pressure in the pathophysiology of chronic compartment syndrome." Am J Sports Med. 1989.
Pedowitz RA et al. "Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg." Am J Sports Med. 1990
