Chronic Exertional Compartment Syndrome

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Chronic Exertional Compartment Syndrome

Chronic exertional compartment syndrome (CECS) is a condition that causes pain in a muscle compartment, usually in the lower leg, during exercise. The pain arises due to increased pressure within the compartment as the muscles swell during activity. This buildup of pressure restricts blood flow and compresses nerves, causing pain, tension, and weakness.

What causes CECS?

The exact cause of CECS is not fully understood, but several factors may contribute:

Anatomical factors: Tight fascia (connective tissue) surrounding the muscle compartment may limit its ability to expand and accommodate swelling during exercise.
Overuse: Engaging in activities that repeatedly stress compartment muscles, such as running, jumping, or dancing, can contribute to CECS.
Muscle Imbalances: Weak or unbalanced muscles can place additional strain on the involved compartment.
Previous injuries: Injuries such as leg cramps or compartment syndrome can increase the risk of developing CECS.

Signs and symptoms of CECS

Pain: The main symptom is pain that develops in a specific muscle compartment, usually the anterior compartment of the lower leg, during exercise. The pain typically:

It begins gradually during activity and worsens with continued exertion.
It improves with rest or reducing activity.
It may be accompanied by a feeling of tightness, cramping, or burning.
In some cases, people may experience numbness or tingling in the affected area, especially in severe cases.
Affected muscles may feel weak, especially at the end of the activity or the next day.

Diagnosis of CECS

Medical history and physical exam: The doctor will ask about your symptoms, activity level, and any history of injuries. They will also perform a physical exam to evaluate tenderness, swelling, and weakness in the affected compartment.
Sphygmomanometer test: This non-invasive test uses a blood pressure cuff to indirectly assess pressure changes within the compartment after exercise. While not definitive, it may provide preliminary information.
Imaging tests: X-rays or MRIs may be used to rule out other causes of pain and evaluate any anatomical abnormalities.
Intracompartmental pressure testing: It is considered the gold standard for diagnosing CECS. It consists of inserting a needle into the muscle compartment to directly measure the pressure before, during and after exercise.

Predisposing factors for CECS

While anyone can develop CECS, certain factors can increase the risk:

Participation in certain sports: Runners, dancers, and people who participate in activities that involve repetitive jumping or strenuous leg movements are at increased risk.

Participation in certain sports: Runners, dancers, and people who participate in activities that involve repetitive jumping or strenuous leg movements are at increased risk.

Footwear: Improper footwear that does not provide adequate support can contribute to abnormal mechanics and strain in the lower leg.

Previous leg injuries: People with a history of leg cramps, stress fractures, or compartment syndrome are more susceptible to CECS.

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Treatment options of CECS

There are several treatment options available for CECS, depending on the severity of symptoms and individual factors:

Non-surgical treatment

Modification of rest and activity: Initially it may be necessary to avoid activities that cause pain, followed by a gradual return to exercise with appropriate guidance.

Ice therapy: Applying ice packs to the affected area after activity can help reduce swelling and pain.

Stretching and strengthening exercises: Stretching the calf muscles and strengthening the muscles around the ankle joint can improve flexibility and support, reducing strain on the compartment.

Orthotics: Custom orthotics can help improve foot mechanics and relieve pressure on the compartment.

Pain medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can control pain.

Surgical treatment

Fasciotomy: In severe cases where non-surgical approaches fail to provide adequate relief, surgery may be considered. Fasciotomy involves releasing the tight fascia surrounding the compartment.

Recovery Time for CECS

The recovery time for CECS varies depending on the severity of the condition and the chosen treatment approach.
Non-surgical treatment might take several weeks or months to see noticeable improvement.
Recovery after surgery typically involves physical therapy and can take several months to regain full strength and function.
It’s crucial to remember that adhering to the treatment plan and a gradual return to activities under proper guidance are essential for optimal recovery and preventing future complications.

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