Differential Diagnosis of Exertional Leg Pain:
Periostalgia ('Shin Splints')
Medial Tibial Stress Syndrome
Exertional Compartment Syndrome
Exertional Compartment Syndrome (ECS):
A clinical condition where an athlete experiences reproducible exercise induced lower leg pain
that begins at a consistent time with activity and is relieved with cessation of exercise. There
may be numbness, tingling, and weakness.
Exact cause is unknown though is felt to be secondary to excessive pressure within the
compartments of the leg leading to reduced blood flow.
Diagnosis is made by measuring pressures within the leg pre and post exercise. Pressures
normally rise with exercise but should return to baseline with in 5 minutes after cessation of
running. In ECS, pressures remain elevated for a prolonged length of time. In rare cases, an
acute form may occur where emergency surgical release is required.
Treatment consists of modification of activity, addressing training error, orthotic and
footwear evaluation, biomechanical evaluation, massage and myofascial release, and core and
extremity strengthening. Fasciotomy (surgical release of the compartments) is sometimes
required with success rates of 50 - 80%.
Your skin is numbed with lidocaine. A manometer, as imaged above measuring the anterior
compartment, is inserted four separate times into your leg. You will then run until symptoms
are brought on, with testing repeated 5 minutes after stopping your activity.
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