Runners experience all manner of muscle pain and injury. From post-workout fatigue and soreness to more serious acute ailments, it can be difficult to decipher what's going on deep within muscle tissue. One of the more frequently overlooked causes of such discomfort in runners is chronic exertional compartment syndrome (CECS). Often experienced in the lower legs, it is commonly confused with diagnoses such as shin splints and tibial stress fractures.
Chronic exertional compartment syndrome occurs when the volume of the muscle increases during exercise, thanks to the increased blood flow prompted by exercise. While this is normal, discomfort occurs when the muscle size increases to the point that the fascial compartment wrapped around it becomes tight. The result is building pressure in the area, which can be painful.
Charlie Boeyink, a physical therapist and coach in Glendale, Arizona, says that diagnosis can be tricky because symptoms can occur in different parts of the leg. "If it is the posterior compartment, which involves the calf, it will likely be pain, cramping, tightness, swelling, and at times, numbness and tingling in the calf area," he explains. "If it is more the anterior compartment, these symptoms will be felt in the front and towards the outer shin."
Unlike other injuries such as shin splints, pain and numbness associated with compartment syndrome usually lingers long after exercise because of the pressure that has built up in the compartment as the muscle expanded. This is why it's important to stop running if you are experiencing these symptoms. Indeed, training errors are usually the cause of the problem in the first place.
"Bumping up mileage too quickly or adding interval or speed work before the soft tissues have adapted to base training are common culprits," says Boeyink. "Unfortunately there are also some folks who have an anatomical tendency for fascial restrictions that can lead to compression of a compartment."
In addition to rolling back training, there are a number of other measures you can take to treat CECS. Boeyink suggests: "Rest, gentle stretching, soft tissue mobilizations to free up fascial restrictions, and an assessment of any other biomechanical factors that may be contributing." Visiting a medical professional who knows runners is important in both diagnosis and treatment. Since this problem can go from bad to worse if left unchecked, it's important to consult an expert.
While rest and other rehab techniques work for some runners, others may end up needing a fasciotomy. A surgical procedure that involves cutting the fascia to relieve tension, it has a high success rate of relieving symptoms with no long-term damage. It is important to consider the severity of the problem, however, because there is some risk of nerve damage. Most of the time, however, a fasciotomy allows the runner to get back to running in a reasonable amount of time. In fact, research suggests that with proper diagnosis and rehabilitation, a runner could return to activity in 8 to 12 weeks after a fasciotomy and potentially as few as six weeks.
Regardless of the treatment plan, a runner affected by CECS should try to pinpoint any training errors that may have caused the issue to avoid reoccurrence. Whether it was a poor foundation of fitness or too much mileage and intensity, these elements of training can be easily tweaked. It may also be worth having an expert take a look at your running form. Some research has even shown that a conservative transition to forefoot running may assist in reducing symptoms associated with CECS.
In addition to figuring out what may have caused the problem in the first place, a runner should be cautious when beginning to run again. Since CECS generally requires full rest from running, you shouldn't return to regular training immediately.
"The treatment plan should include guidelines to return to running," says Boeyink. "For example, as the symptoms subside, pain-free walking is the goal, followed by a walk/run interval, and finally back to straight running with a gradual increase in mileage or time."
While this may sound tedious, a slow return will get you back to running faster than rushing back in and getting injured again. Post-injury patience is often difficult to harness, but it can make all the difference when it comes to your future running prospects. Although the rehab and return may feel painstaking, CECS is not a career-ending issue and the majority of runners who have received proper treatment will be back on their feet in no time.race.