Compartment syndrome - what is this common running injury?

There are two types of Compartment syndrome: acute or chronic.

Acute compartment syndrome is extremely serious and will need urgent medical attention. It is usually caused by a severe injury and is a medical emergency. It can lead to muscle death and damage if not treated quickly.


Chronic compartment syndrome is not an emergency and is usually caused by over training or over exertion. This type of compartment syndrome is also known as exertional.


Where does compartment syndrome occur?

Compartments are basically areas of muscle, tissue and blood vessels which are surrounded by fascia. Fascia is a thin sheath of fibrous tissue surrounding the muscle. From an anatomical perspective they can occur in a lot of places:

  • Hand: 10 different compartments
  • Wrist: 6 different compartments
  • Forearm: 4 compartments
  • Lower Leg: 3 simple compartment zones

We will focus on the leg as it is most important from a running perspective. The three main compartments are: Anterior, Lateral and Posterior. Within each of the segments many muscles can be affected, namely around the tibialis posterior, fibula, peroneal nerve and the tibilais anterior.

Why does compartment syndrome arise?

Elliot & Johnstone (2003) describe that acute compartment syndrome of the lower leg usually arises after a direct trauma. In most cases, the ACS (Acute Compartment syndrome) is seen with a fracture of the lower leg. About 40% of all compartment syndromes originate after a lower leg fracture.  It is also mentioned that 30% of all acute cases can come from a tibial plateau fracture.

In the journal of Bone & Joint Surgery, McQueen (2010) states: A prompt diagnosis is necessary to minimise the risk in a predominantly young and active population of potentially devastating long-term complications such as muscle necrosis, contractures, neurological deficits, fracture non-union, infection, chronic pain, and in the worst cases amputation and even death.

This reiterates the notion that acute compartment syndrome is a serious injury that needs to be addressed quickly and thoroughly.

CCS (chronic compartment syndrome) usually arises from over exertion and increased myofascial pressures in the lower leg. It is a term given to describe reoccurring pains in the leg as suggested by Franca (1993)et al. Therefore, any form of intense physical activity can set off this issue.

In treatment of acute compartment syndrome, a ‘Fasciotomy can be a safe, effective, and economical treatment for acute & chronic compartment syndrome’ Don et al (2009). A fasciotomy is the process by which the fascia is cut to relieve the pressure on the muscle.

In most chronic cases, orthotics and physical therapy can help to relieve symptoms. In end stage cases surgery may be elected as a solution anyway.


  • Elliott KG, Johnstone AJ, J, Diagnosing acute compartment syndrome.
    Bone Joint Surg Br. 2003, 1985(5):625-32.
  • Detmer, DE, Sharpe, K, Sufit, RL, Girdley, FM. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. 1985;13:162-170.
  • McQueen MM. Acute compartment syndrome. In: Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P 3rd, eds. Rockwood and Green’s Fractures in Adults. Seventh ed. Philadelphia: Lippincott Williams & Wilkins, 2010:689-708.


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