Bodyworks: Anterior Compartment Syndrome

How to recognise it, how to overcome it

Posted: 5 June 2000
by Patrick Milroy

The chances are that you are an oversupinator, and you’ll feel pain brought on by exercise in the area just outside the front of the tibia, although you may find it diffuse and hard to locate. It often follows excessive uphill running, in which the tibialis anterior muscle expands and may produce fluid which stretches the compartment sheath.

An experienced sports physician will locate the pain between the tibia and fibula and may sense increased pressure within the sheath. They will check to rule out the rare but very serious condition in which this pressure is high enough to block the bloodflow into the sheath, which could cause gangrene.

Medical investigations
In rare cases, you may have the pressure within the compartments of your leg measured. More commonly, x-rays and bone isotope scanning are needed to ensure the diagnosis is correct. For resistant and recurrent cases, you’ll need biomechanical evaluation on a treadmill.

What else could it be?
Your pain could alternatively be caused by stress fractures (again!) or tibial periositis (see below). It could also come from muscle tears or tenosynovitis, where inflamed muscles within a sheath rub roughly against each other.

RICE to the letter. Ice to restrict fluid formation and elevation for damage should be complemented by aspirin or ibuprofen in one of its forms to minimise inflammation.

Medical treatment
Along with other first aid, active electrotherapy by a physiotherapist will speed recovery. In rare cases, you may need an operation to open the sheath and release the pressure within the compartment, especially in the acute obstructed case.

Can you run through it?
Attempting to run through it without understanding the causes can only prolong the agony.

Recovery time
Treat it appropriately and four weeks should see full recovery, although this may be hastened and recurrence prevented if doctor, coach and athlete can work together to eliminate the causes. After recovery, changes in training should be gradual.

Previous article
Bodyworks: Baker's Cyst
Next article
Bodyworks: Ankle Pain

compartment syndrome

Discuss this article

i have been running for a few years now and only seem to suffer with my calfs,sometimes its the left only then both then the right,it can happen at any time or distance. i have manadged to complete 2 londons and quite a few halfs,where possible i complete apropriate training sheduals my shoes are changed at approx 500miles and am told iam a nuteral runner ,perhaps being stocky framed ! may have a connection. i would be greatfull for any imput or exprience please !
Posted: 28/12/2002 at 20:04

Is 500 miles too far for a pair of shoes, I tend to get closer to three hundred.

perhaps some new stretches??? Not much help I know, but good luck mate.
Posted: 28/12/2002 at 20:12

When you say you suffer with your calves, what happens as this will determine what should be done. I'm no medic and will leave that to others but have suffered from calf injuries.
The advice above seems sound and 500 miles does seem rather optimistic for running shoes. A first port of call to a good specialist running shop to get your shoes sorted out and find out what type you need for your running style might be the answer.
Hope this helps
Posted: 29/12/2002 at 13:24

thanks for the replies ,a local running has done a video gate check and told me my running style/type was nuteral so shoes perchased are of the neuteral veriaty .They seem to so many to choose from ,when you find a pair you like you go back and guess what sorry no longer make those try these the shoes own tread mill .Still thankyuo for yuor reply and have a great new year.
Posted: 29/12/2002 at 21:23

i would like advice for a problem that i have when running. my calves seem to burn ( both legs) and the pressure is unbearable. the pain eases off when i stretch off but returns after a few minutes running! any help please?
Posted: 22/09/2003 at 18:01

I get the same problem and some times the day after a good run I get tenderness running up the outside of bothe legs starting just above the ankle. It feels as though it is muscular and needs stretching. Does anyone know a good stretch for that area? I get the feeling that my problem goes back to the days when I used to do a lot of running in Army boots. I am probably paying the price now as I imagine so are a lot of other ex squadies.
Posted: 01/04/2006 at 10:00

i was seeing a chiropractor for whiplash at the same time as running and i mentioned an occasional tight calf problem. he clicked things about - said a knee wasn't in the right place (may from an old rugby injury) With a recent tightness- knee was fine but bones out of place in an ankle after a turn - clicked back into place and calves better
Posted: 01/04/2006 at 10:36

i have just started running so I am running and walking (running for 60 secs, then walking for 3 mins) and trying to build it up so I can run a 5K (not asking for much am I!!) the problem is I can only seem to run for 60 secs and then walk and when I come to run again my calves really hurt, the pain is down the inside of my calves and I have been told its not shinsplints, is there such a thing as not being able to run!!!!!!
Posted: 26/04/2006 at 16:50

How could your knee not be "in the right place"?
Did it mysteriously appear in your arm? Or in Nottingham?
Do I need a new subscription to "How to speak Chiropractor?"
Posted: 26/04/2006 at 16:58

Hi All

Does anyone have a problem where you feel like a pinching sensation in areas of your leg? not a big area just little areas?
Posted: 04/05/2006 at 21:38

I suffer badly from compartments, often it prevents me from running for more then 3k. Up hill and faster speeds sub 5.30 k are a nightmare.However I have been experimenting with taken Ibuprofen and Asprin and have had no major problems on my last 3 runs over a hilly course climbing 120m over 10 k in about 60 /65 minutes.
I take 400mg of Ibuprofen 30 minutes before a run 400mg 4 hours before the second Ibuprofen and 300mg of Asprin 1 hour after my 1st Ibuprofen (75mg anteric asprin may suffice). I have been looking for years to get the right combination combined with very frequent strectching of the calf and the occasional massage this may help. Please give me your feed back. However before you untertake this course please check that the drugs will not make any other existing condition you have worse.
Posted: 10/01/2007 at 16:51


I desperately need advice,i`ve been running for only 3 months and really enjoy it and i`m looking forward to doing the Norwich Half marathon in November.However about a month ago i got this pain in the back of my legs whilst running one day and decided to have a rest for a week.However the following week after another 8 mile run a couple of days later i got a pain in my foot,and its been sore for a couple of weeks but the pains gone to the back of my legs now.

Its getting a little bit easier and i dont know if i`m getting a bit frustrated,but when i run i get this pulsating pain in the back of my leg which is preventing me from running far.Can anyone help?



Posted: 08/10/2008 at 09:56

Get yourself to a physio.
Posted: 08/10/2008 at 13:12

Have you got the right running shoes Matt? If they're the wrong sort for you your legs will start to complain as you up the distance.
Posted: 08/10/2008 at 23:14

Do lots of stretching before and after runs.  Mix it up with other low impact CV sports.  Have two sets of running shoes.  Do some yoga.  Basically mix it up to improve all muscles.  I've had a few injuries and had to pull out of a few races, but there's always more races!  The above combination seems to have worked well for me for the past year or so.
Posted: 24/11/2009 at 13:38

I recently posted some information about the success we've been having coaching runners to adapt their running form to releive the pain of Anterior Compartment Syndrome.

Hope it helps...

Posted: 05/07/2013 at 00:15

I have recently started feeling problems in just above the fibulas on my lower leg and I'm not sure if this is the problem. Having looked at some things I think the actual muscle is the fibularis brevis. I recently ran the London Marathon and the first time I ran after the Marathon, I felt a bit of a twinge in this area. It was about ten days after the marathon. After that every time I ran it was there again but it went away. Now it's got worse but no one seems to know exactly what it is. It's not tendonitis or shin splints. Is it anterior compartment syndrome as it seems the closest or is it likely to be something else, like a different type of tendonitis 

Posted: 11/06/2014 at 09:31

We'd love you to add a comment! Please login or take half a minute to register as a free member

Smart Coach
Free, fully-personalized training plans, designed to suit your racing goals and your lifestyle.