Chronic Exertional Compartment Syndrome – what is it and can physio help?

In our last blog we looked at a common diagnosis for pain in the shin area; shin splints. However that’s often a diagnosis used to describe a variety of problems and another one we see fairly often is Chronic Exertional Compartment Syndrome or CECS.

Do you have CECS?

In simple terms, CECS manifests itself as tightness in the lower leg muscles responsible for bringing your toes and ankles up towards you – the anterior compartment to give it the full name.

If you start running and feel pain after just a few minutes then this could well be CECS – something that also eases off within just a few minutes of stopping. It can also be felt when walking and for some people it happens more walking than running.

Other symptoms may include a dead leg or weak feeling when trying to bend your toes up (dorsiflex) or even a slight tingling in the toes.

What causes CECS?

Imagine the anterior compartment of the lower leg like a thick potato sack with your muscles as four balloons – as the muscles start to work and blood rushes into them, they expand. The sack  is much less pliable which means as the balloons expand the bag does not, increasing the pressure on the balloons.

Compression of the muscles can be uncomfortable and can build over time. There are also nerves in the same compartment, and it’s the pressure on these nerves that can lead to the dead feeling in the foot and/or the tingling or numbness in the toes, similar to how your arm can go tingly and numb if you lie on it for too long.

What’s the answer?

Foam rolling can relieve some of the pressure on the muscles and nerves – it doesn’t loosen the ‘sack’ a great deal but it can help. Take a look at this video to see the right technique.

Strengthening is something we’re a big advocate of – and focusing on the ‘kinetic chain’ can treat many of the causes of CECS. The muscles on the front of the leg can be overloaded as a result of reduced strength or control further up – sometimes the cause isn’t in the same place as the symptoms. Split squats are a particularly good exercise for strengthening all the way from the core to the feet – it’s an exercise we recommend for many injuries as, when done correctly and introduced at the right time, they really are an excellent way of getting different muscles and joints working well together.

While doing these exercises we’d recommend cutting back on your volume of exercise – particularly if you’re building up to something and training 4+ times per week. In this case changing to cross-training or other strengthening work can help build fitness while still resting the legs.


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