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Chronic Exertional Compartment Syndrome of the lower leg (CECS) N083

Last amended 
22 November 2023


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Changes from Previous Instruments:

SOP Bulletin 239.pdf

Brief description:

Chronic exertional compartment syndrome of the lower leg is a condition characterised by exercise induced pain in the legs due to muscle swelling. There is an increased pressure within the muscle compartments, which is a group of muscles, nerves and blood vessels surounded by a tough membrane (fascia) that does not stretch easily.  Activities such as running can result in increased pressure in a compartment and impaired blood flow, producing pain in the calf or shin.

Confirming the diagnosis

This diagnosis is usually based on characteristic clinical presentation and intracompartmental pressure testing. If intracompartmental pressure testing is not performed, either the Medial Tibial Stress Syndrome (Shin Splints) SoP should be considered or no diagnosis should be established. X-rays, bone scans and MRIs or MRAs may also be ordered by treating clinicians to rule out other possible diagnoses. 

The relevant medical specialists include Orthopaedic Surgeons and Sport Medicine Physicians.

Additional diagnoses covered by SOP
  • Exercise- induced compartment syndrome
  • Posterior compartment syndrome (chronic)
Conditions not covered by SOP
  • Acute compartment syndrome #
  • Atherosclerotic peripheral vascular disease*
  • Compartment syndrome of other parts of the body – upper arm, forearm, hand, thigh, and foot#
  • Iliotibial band syndrome*
  • Myelopathy# or lower limb radiculopathy #
  • Nerve entrapments (sural or superficial peroneal) #
  • Periostitis#
  • Stress fracture of the tibia or the fibula* - Fracture SOP
  • Bursitis or tendinopathy of the flexor or extensor tendons of the lower leg and ankle - #  or  * - Posterior Tibialis Tendinopathy SOP or Achilles Tendinopathy and bursitis SOP
  • Popliteal artery entrapment syndrome * - Popliteal entrapment syndrome SOP
  • Vascular insufficiency * - Chronic venous insufficiency of the lowr limb and varicose veins of the lower limb 

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Clinical onset will date from when there was a presentation of characteristic symptoms involving exercise- induced pain and tightness in the calf or shin, typically resolving or reduced with rest. Chronic exertional compartment syndrome of the lower leg can resolve completely and redevelop at a later date.  If there has been a substantial symptom free period (e.g. > 1 year) between episodes then a new symptom episode is likely to represent a new clinical onset.  An underlying propensity to develop the condition with activity may be present but there is no evidence of residual pathology between episodes.  

Clinical worsening

Many cases of chronic exertional compartment syndrome of the lower leg will respond to conservative treatment (e.g. rest, modification of activities, physiotherapy, and orthotics). Surgery may be required in severe cases.  Acute compartment syndrome, requiring emergency surgery, is a separate condition that is not covered by the SOP and it does not represent a worsening of chronic exertional compartment syndrome of the lower leg.