Exercise-induced Pain & Cramping in Your Lower Leg

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Published on January 27, 2017

Exercise-induced Pain & Cramping in Your Lower Leg

By: Jamie Edwards, MD & Ryan Schrader PA, ATC

If you're an athlete you may have experienced exercise-induced pain and cramping in your lower leg.Almost all healthy, active, young individuals participating in vigorous activity have experienced some sort of cramping and/or pain in their lower legs around the calf muscles. This pain, cramping, and numbness or tingling is known as exertion compartment syndrome. It is more common in athletes who participate in activities with repetitive impact, such as running. This typically results in an inability for these individuals to improve or maintain their sports performance.

What Causes Exertion Compartment Syndrome?

The cause of exertion compartment syndrome is unclear, but thought to occur from some form of a connective tissue disorder of the casings around the four muscle compartments of the calf. This disorder affects the elasticity of this tissue making it more rigid. With the tissue around the muscle groups unable to expand, the muscle compartment pressure rises as arterial blood pumps in delivering nutrients and oxygen to the muscle during exercise. This results in veins collapsing in the muscle compartment which prevents blood to leave. Symptoms begin to develop and worsen as the muscle compartment pressure rises with continued exercise. Once symptoms are intolerable, the activity ceases resulting in a decrease in compartment pressure with rest.

How is Exertion Compartment Syndrome Diagnosed?

The gold standard for diagnosing exertion compartment syndrome is compartment pressure testing. Saline is injected into the affected muscle compartments and pressure is measured both at rest as well as after exertion.

What is the Recommended Treatment for Exertion Compartment Syndrome?

If the patient is willing to reduce the amount of aggravating activity, symptoms will generally subside. However, it is common for them to recur as soon as the aggravating activity is resumed. Initially, cross-training should be encouraged, including other treatment options like physical therapy, massage and changing improper training mechanics. When these fail to alleviate symptoms, surgical fasciotomy is considered which involves cutting into the affected muscle compartment casings to open and thereby release the pressure. Surgery is often very effective in returning most of those affected back to their activity.