Compartment syndrome
Compartment syndrome occurs when pressure increases within a closed muscle compartment and affects blood flow and the function of muscles and nerves. Acute compartment syndrome can develop after a fracture or significant injury and is a medical emergency. Chronic or exertional compartment syndrome develops during repeated physical activity and typically improves when the activity stops.
In exertional compartment syndrome, early symptoms may include localized pressure, tightness, aching or discomfort in the lower leg that develops after a certain duration or intensity of running. Symptoms typically decrease after the activity stops.
Acute compartment syndrome is caused by rapidly increasing swelling or bleeding within a closed muscle compartment. It can occur after fractures, severe crush or soft-tissue injuries, or other significant tissue damage. A bandage or cast that is too tight can also contribute.
Exertional compartment syndrome
- •Repeated running or other exercise that increases pressure within the muscle compartment
- •Symptoms that recur at a particular level of activity
- •Pain, pressure or tightness that develops during exercise
- •Symptoms typically decrease after the activity is stopped
Acute compartment syndrome cannot always be prevented because it often occurs as a consequence of an injury. In recurrent exertional symptoms, it is important to identify and modify the activity or loading pattern that triggers the symptoms.
- •Increase running and other training loads gradually
- •Avoid sudden large increases in training volume or intensity
- •Take recurrent exercise-related pain, tightness or numbness seriously
- •Seek medical assessment for recurrent symptoms that limit training or matches
- •After an injury, be alert to excessively tight bandages or other external compression
Stop or reduce the activity that provokes the symptoms. Do not immediately return to the same level of loading if symptoms recur. Medical assessment should be considered for recurrent symptoms to determine the cause.
Load modification
Identify the type and amount of loading that triggers symptoms and temporarily reduce it.
Goals
Reduce or eliminate exercise-related symptoms.
Progression criteria
Daily activities and light exercise can be performed without recurrence of symptoms.
Progressive loading
Gradually reintroduce running and other loading while maintaining or improving strength and function in the lower leg.
Goals
Increase tolerance to physical activity without provoking recurrent symptoms.
Progression criteria
Progressively increasing loading can be completed without recurrent pressure, pain or neurological symptoms.
Football-specific loading
Gradually reintroduce running, acceleration, sprinting, jumping and changes of direction.
Goals
Tolerate the loading demands of football training and matches.
Progression criteria
Full football-specific loading can be completed without recurrence of the previous symptoms.
- Can walk and jog without symptoms
- Can complete progressively increasing running loads without recurrent symptoms
- Can accelerate, sprint, jump and change direction without symptoms
- Can perform football-specific activities without recurrent pressure or pain
- Has a plan for continued load progression and follow-up if symptoms recur
The information in the Injury Center is for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare professional for diagnosis and treatment.
Compartment syndrome
Compartment syndrome occurs when pressure increases within a closed muscle compartment and affects blood flow and the function of muscles and nerves. Acute compartment syndrome can develop after a fracture or significant injury and is a medical emergency. Chronic or exertional compartment syndrome develops during repeated physical activity and typically improves when the activity stops.
Mild — Varies depending on the cause. Symptoms triggered by exertion may improve after adjusting training, but recurring issues require investigation to determine the appropriate treatment.
Symptoms
In exertional compartment syndrome, early symptoms may include localized pressure, tightness, aching or discomfort in the lower leg that develops after a certain duration or intensity of running. Symptoms typically decrease after the activity stops.
Acute Treatment
Stop or reduce the activity that provokes the symptoms. Do not immediately return to the same level of loading if symptoms recur. Medical assessment should be considered for recurrent symptoms to determine the cause.
Rehabilitation
Identify the type and amount of loading that triggers symptoms and temporarily reduce it.
Goals
Reduce or eliminate exercise-related symptoms.
Progression criteria
Daily activities and light exercise can be performed without recurrence of symptoms.
Gradually reintroduce running and other loading while maintaining or improving strength and function in the lower leg.
Goals
Increase tolerance to physical activity without provoking recurrent symptoms.
Progression criteria
Progressively increasing loading can be completed without recurrent pressure, pain or neurological symptoms.
Gradually reintroduce running, acceleration, sprinting, jumping and changes of direction.
Goals
Tolerate the loading demands of football training and matches.
Progression criteria
Full football-specific loading can be completed without recurrence of the previous symptoms.
Return to Play
- ☐ Can walk and jog without symptoms
- ☐ Can complete progressively increasing running loads without recurrent symptoms
- ☐ Can accelerate, sprint, jump and change direction without symptoms
- ☐ Can perform football-specific activities without recurrent pressure or pain
- ☐ Has a plan for continued load progression and follow-up if symptoms recur
Moderate — It varies depending on the underlying cause and treatment. In cases of exertional compartment syndrome, the return to activity may take weeks or longer, especially if surgical treatment is required.
Symptoms
Clear pain, pressure or tightness in the lower leg that recurs during running or other exercise and limits performance. Tingling, numbness or temporary weakness may occur with exertional symptoms.
Acute Treatment
Stop the activity that provokes the symptoms and avoid trying to train through recurrent pain or neurological symptoms. Recurrent symptoms should be medically assessed because several other conditions can cause similar symptoms.
Rehabilitation
Recurrent or clearly limiting symptoms should be assessed to determine the cause before full loading is resumed.
Goals
Determine whether the symptoms are consistent with compartment syndrome or another injury or condition.
Progression criteria
Medical assessment has been completed and an appropriate treatment or rehabilitation plan has been established.
Loading is gradually increased according to an individual plan while symptoms are monitored during and after activity.
Goals
Restore function and load tolerance without recurrence of symptoms.
Progression criteria
Increasing running and training loads are tolerated without recurrent pain, pressure or neurological symptoms.
Gradual return to acceleration, sprinting, jumping, changes of direction and full training.
Goals
Tolerate the repeated and high-intensity demands of football without recurrent symptoms.
Progression criteria
Full football training can be completed without clear symptom increase during or after the session.
Return to Play
- ☐ The cause of recurrent symptoms has been medically assessed
- ☐ Full running and high-intensity loading are tolerated
- ☐ Sprinting, jumping and changes of direction can be performed without symptoms
- ☐ No recurrent numbness, tingling or weakness occurs during loading
- ☐ Full training can be completed without clear worsening afterwards
Severe — This varies significantly depending on the cause, how quickly the condition was treated, and any associated nerve or muscle damage. In cases of acute compartment syndrome, rehabilitation can take several months.
Symptoms
Acute compartment syndrome can cause rapidly increasing and severe pain, often with marked tightness or swelling in the affected area. Pain may become significantly worse when the affected muscle group is stretched. Tingling, numbness, weakness or reduced movement may occur and are serious signs.
Acute Treatment
Stop the activity and seek emergency medical care immediately if acute compartment syndrome is suspected. This is not an injury that should be managed with continued training or watchful rehabilitation. Acute treatment may require surgery to release pressure within the muscle compartment.
Rehabilitation
Acute compartment syndrome requires immediate medical assessment and may require fasciotomy to release the pressure.
Goals
Release the pressure and prevent permanent damage to muscles and nerves.
Progression criteria
Acute treatment has been completed and medical follow-up has established that rehabilitation can begin.
Rehabilitation focuses on restoring mobility, strength, nerve and muscle function and progressively increasing loading according to an individual medical plan.
Goals
Restore normal or sufficient function in the affected body part.
Progression criteria
Mobility, strength and load tolerance improve according to the rehabilitation plan and higher loading is tolerated.
Running, acceleration, sprinting, jumping and changes of direction are gradually reintroduced following medical assessment.
Goals
Restore sufficient capacity for full football loading.
Progression criteria
All relevant football activities can be completed with adequate function and without significant symptoms.
Return to Play
- ☐ Medical follow-up supports return to sport
- ☐ Mobility and strength have been sufficiently restored
- ☐ Neurological function is adequate for the demands of the sport
- ☐ Running, sprinting, jumping and changes of direction can be performed without significant symptoms
- ☐ Full football training can be completed without clear worsening
When to Seek Medical Care
Suspected acute compartment syndrome should be treated as a medical emergency. Rapidly increasing severe pain, particularly together with tightness, swelling or pain on passive stretching, requires immediate assessment.
- Sudden or rapidly increasing severe pain
- Pain that is disproportionate to the original injury
- Markedly increased pain when the affected muscle group is stretched
- Pronounced tightness or firmness in the affected area
- Tingling, numbness or altered sensation
- Increasing weakness or difficulty moving the affected body part
- Rapidly increasing swelling after an injury
References
- Compartment syndrome — NHS (https://www.nhs.uk/conditions/compartment-syndrome/)
- Acute Compartment Syndrome – Patient Information — Royal National Orthopaedic Hospital (https://www.rnoh.nhs.uk/patients-and-visitors/patient-information-guides/acute-compartment-syndrome)