Attention Runners: What you need to know about Exertional Compartment Syndrome

By Brad Gilden, PT, DPT, CSCS, CFMT

Do you experience pain in the front or back of your lower leg(s) when running?

Have you been told you have shin splints? Perhaps what you are experiencing is a condition called EXERTIONAL COMPARTMENT SYNDROME or ECS. ECS primarily affects athletes involved in repetitive weight bearing activities such as endurance running. It is characterized by increased pain in the lower leg region at progressively gets worse with running. Other symptoms may include burning, numbness/tingling, cramping, tightness or even foot drop. Symptoms will typically abate after 20-30 minutes after running. Have you have been told you have shin splints, but they aren’t improving, perhaps you need to seek an alternative opinion.

What causes ECS?

Each muscle in the body is encased by a fascial sheath that serves many functions including separating the muscle from its neighbors, absorbing shock, preventing the spread of infection, moving metabolizes for nutrition, and much more.

Fascia has a finite ability to stretch. In some cases, the muscle has hypertrophied (bulked up) to a point that puts pressure on the fascia.

With exercise, there is an increased demand for the muscles and they require additional oxygen to function. Increased blood flow to the muscle is required to deliver oxygen. This increase in blood flow causes the muscles to swell. (This is what causes the “pumped” look we get from working out).

In cases of ECS, the fascia is wound too tightly around the muscle and doesn’t have the capacity to stretch any further. As blood flow continues to increase with exercise, it leads to more swelling of the muscle which begins to compress against the fascia pushing on nerves and blood vessels in the respective compartment. This is what leads to pain, weakness and other symptoms.

Continued exercise causes greater swelling which is why symptoms continue to get worse with more exercise.

These symptoms sound familiar, how can I confirm I have ECS?

An orthopedist will take needle pressure measurements of each compartment following exercise to determine if your compartmental pressures are above normal. If they are, many physicians will recommend a surgery called a fasciotomy. This is where they cut a portion of the fascia to relieve pressure surrounding the muscle. Fortunately, there is an alternative to surgery, and that is seeking a FUNCTIONAL MANUAL PHYSICAL THERAPIST. We have had terrific success treating ECS conservatively with return to athletics without the need for surgery. Research data demonstrating our techniques and successes are pending.

What can (FMT) Functional Manual Therapy do for my ECS?

It has been hypothesized and demonstrated that ECS is caused by bio-mechanical faults in running mechanics that places increased demand on various muscle groups and compartments in the lower leg. A detailed bio-mechanical evaluation and running analysis by an FMT can isolated what mechanical or neuromuscular faults are present in your system. Specific techniques including soft tissue and joint functional mobilization will correct mechanical restrictions to the joints of the lower extremity restoring efficient movement to the system. Neuromuscular and motor control techniques are then applied to ensure proper muscle firing sequencing occurs. This may also include alteration of running technique and will definitely include an exercise program to reinforce proper movement mechanics and joint stabilization.

Should you have any questions or concerns that you may be experiencing ECS, contact a Functional Manual Physical Therapist to discuss your specific concerns.

Brad Gilden, PT, DPT, CSCS, CFMT

Brad Gilden has been practicing orthopedic & sports physical therapy since graduating from New York Medical College in 2000. He has worked in a variety of settings treating patients with various neurological, orthopedic and sports injuries. In 2004, he completed a clinical doctorate in upper quarter & hand therapy from Drexel University. He joined Elite Health Services as a managing partner and rehabilitation coordinator in 2005. FULL BIO »

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