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What is Exertional Compartment Syndrome (ECS)?

Within different parts of the body, such as the lower leg and arm, muscles are compartmentalized into different sections. Each of these compartments is surrounded by a thick, stocking-like tissue called fascia. During normal exercise, blood flow to the muscles increases and the muscles expand, exerting a normal pressure on the fascia. Normally, this pressure and expansion is not problematic. In the case of exertional compartment syndrome, the muscle pressure increases more than normal and begins to push outward on the fascia.

Exertional compartment syndrome is characterized by exercise induced pain, numbness and tingling (paresthesia) and weakness, normally in the lower leg, that is relieved with rest. It often occurs in athletes who participate in sports with repetitive loading or excessive running, such as cross country/track, basketball, and soccer. In athletes who have exertional compartment syndrome, pain and symptoms normally occurs at a specific exercise distance, time interval or intensity level that they can pinpoint.


  • Normally results from repetitive microtrauma (i.e. excessive running, pounding, impact on the lower extremity)
  • Increased intramuscular pressure

Signs and Symptoms

  • Pain, commonly in the lower leg, elicited at a certain time point or intensity of training
    – Relieved with rest
  • Numbness and tingling (paresthesia)
  • Weakness of the muscles in the involved extremity
  • Increased intramuscular pressure reading of >30mmHG (measured clinically by physician)


Initial treatment of exertional compartment syndrome is often a period of rest and conservative treatment, focusing on rest from aggravating activity and stretching of the involved extremity. Unfortunately, in most cases of exertional compartment syndrome, symptoms generally return with the initiation of exercise. If conservative treatment fails, surgical intervention may be necessary if continued participation in sports is desired.

Surgery for exertional compartment syndrome is known as a fascial release or fasciotomy, where one or more compartments (fasica) of the lower leg are decompressed or “cut” to allow for muscle expansion in the hopes of reducing symptoms. The number of compartments that are released is a decision that is made by the orthopedic surgeon based on severity and location of symptoms as well as intramuscular pressure readings of all compartments. Outcomes following surgery are often successful and symptoms do not usually reoccur.

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