I assume you are talking about your calf right? I’m not too familiar with posterior but I had what my doctor called “exercise induced compartment syndrome.”

It was on the outside, I guess you would call it anterior and lateral compartments.

For me, it would only bother me a little while walking, but when I tried to run I could only make it about 5 minutes before my leg got so tight and my foot was in extreme pain, then went numb.
For example, before I had this issue I would do about a 30 minute 5k. With this issue I tried a 5k with my buddy and it took about 50 minutes.
I tried physical therapy, acupuncture with stim, untrasound, and a few other useless things.

I was ready for the surgery before I even went to see the surgeon.
The way he explained it was that nothing that I tried would have ever worked. He said the facia in the muscle won’t stretch to allow my muscles to swell while exercising. So it had to be cut.



He went in through a roughly 4” incision and cut the facia pretty much down to my ankle and almost up to my knee.

I was on crutches for maybe 3 days, mainly to keep pressure off the incision and avoid a bleed.

By the end of the week I was out walking the dog.

And two weeks later I was able to start running again.

The first few runs were painful but in a good way, hard to explain.

It’s been two years and I’m so glad I had the surgery.
I hope this helps in some way and I didn’t give you some long winded waste of time. If you have any questions don’t hesitate.

For years I struggled with the same thing but it took me two years to get a correct diagnosis. For years, my run pace was stuck at 8+ min/miles. My warmup would actually be faster than the rest of my run. I also had horrific numbness and pain in my feet during races. After getting the surgery my zone 2 pace dropped by about a minute immediately. It felt like magic. Even if only one of your compartments is registering high pressure I would highly advise getting all compartments released. My doc said that you are just wasting your time if you only release one compartment because it is extremely likely that the others will start acting up once you recover and can push harder. My doc, who was very conservative in her treatment plans, also said that there is no literature that supports anything other than surgery for compartment syndrome. Last year I had both legs done, right first and left second. I was walking within three days, easy spinning in four, and running in about two weeks. I would highly recommend buying some great compression socks for post-surgery. If you keep the swelling down, the recovery is a breeze. If you let it get too swollen its a nightmare. I'd also recommend a vacuum boot (made for swimming with a cast) so that you can shower without any concern.

I didnt have the deep posterior released, but I had (have) compartment syndrome in the lateral and anterior compartments in both legs, and the deep posterior in my left leg. Had the release done for the anterior and lateral on both legs and was told that it would relieve some pressure in the dp of my left leg. Sadly, not only did it not release the pressure in the DP, but the surgery failed all together and the symptoms came back a year after the surgery, and pressure tests revealed the compartment syndrome was just as bad as it was pre-surgery. All that said, I have met several people who have had the compartment release surgery and have had it be very successful!

I had a similar experience to the other two posters above. I spent about 4-5 years of pain incurred in my lower leg while running in my late teens and early twenties. I visited a countless number of physiotherapists and sports injury specialists who all failed to correctly diagnose or treat the problem. Eventually I saw a consultant who diagnosed compartment syndrome within 5 minutes of seeing him. Diagnosis was confirmed through monitoring the pressure within my lower leg. I had anterior and posterior compartements released on both legs at the same time. It made recovery a little more difficult but effectively reduced the overall time until I could return to normal exercise. I have incissions about 4 inches long on the front of each shin. I did incur some complications following surgery as I developed a haemotoma in the right leg. I spent 2-3 weeks unable to walk then began rehab and was back to normal exercise after 6-8 weeks. This was done about 12 years ago so surgical procedures may well have improved since then leading to shorter recorvery times. Following rehab, I had some pain in the lower leg when running which was probably more a result of the surgery and haemotoma, but this quickly settled down after a couple of months. I now have no pain whatsoever when running and no issues related to the surgery. If the diagnosis is proven then I can't recommend the surgery enough.

Hey Powerbar Junkie
How did you have the chronic posterior compartment syndrome diagnosed?

The research on chronic exertional compartment syndrome has been primarily focused on the anterior compartment, not the deep posterior compartment. Really it is the only one that has had normative data reported. Unfortunately, there is not a consensus that chronic exertional compartment syndrome is best treated by surgery. Even the measurement of the compartment can be heavily influenced on where the catheter tip is placed- so even published literature on the topic is limited.
I have had more than 20 patients who underwent surgery via fasciotomy to release the compartment with no relief of symptoms. Prior to surgery, these patients had pressure testing and failed conservative treatment (however this is misleading because I do not believe the functional driver of their symptoms was ever treated). I have probably 10-15 patients per year that have symptoms that could be 'exertional' compartment syndrome and in most cases we can treat it conservatively.

It is also not true that no literature exists supporting other methods of treatment nor is the literature entirely supportive of surgical intervention. The most promising treatment at this point (in my opinion) is investigating possible overload of the muscle involved during the gait cycle. For example, the most commonly reported chronic exertional compartment syndrome is the anterior compartment. When monitoring the running pattern of these individuals, it is easy to note the increased dorsiflexion throughout the entire gait cycle. Even terminal stance into swing shows more than normal dorsiflexion (it is normal to see 25 to 35 deg of plantarflexion and these guys will have almost a neutral position). Couple this with the fact that the anterior tibialis is heavily involved during initial contact and loading response with runners (especially with a heel strike), it easy to see how this muscle can become overloaded and lead to the symptoms reported in compartment syndrome.

For your problem, I typically see the opposite presentation. So it is critical to know how you are diagnosed and what your running and walking pattern look like. If you have historically been a swimmer and use a forefoot or midfoot strike, exertional muscle pain is very common as well. The muscle spindle and golgi tendon organ are meant to balance the muscle activation but the interaction between the two disciplines can drive this problem

Finally, it is not surprising that walking is also problematic. Running gait can vary alot while 99% of humans use the same walking pattern. If you take big strides while walking, this will significantly load the posterior compartment. You are getting something like 1.3 times your bodyweight through the calf and like 90% of the maximal voluntary isometric contraction of the gastroc and soleus. You can test this hypothesis by pulling your toes up towards the shin while walking. I would do this for the entire day while walking. If it improves, then I would suggest your issue is not a compartment syndrome. A modified low taping can also confirm the diagnosis if the biomechnical overload is due to the posterior tibialis.

Let me know what you find out or if you have questions about what I talking about.

Totally concur with CraigAllenSmith. What you believe you have is exquisitely rare and very difficult to confirm. Did you actually have pressure testing in your calf? Typically compartment syndrome has to have an area of restriction. This can occur (still rare) anteriorly due to the tibia being a bony block. However, the calf is soft and and accommodate swelling and movement of tissues quite well without issue. I second the question, how were you diagnosed?

I am not a medical professional but here is my 2 cents. For years I had pain consistent with chronic exertional compartment syndrome in the Tibialis Anterior (sp?). I could not run for 1 minute without pain, numbness and toe drop. As a result, I went probably 10 years without running and just rode and swam instead.

When I wanted to get into triathlon I tried running again and the problem came back. I couldn't even complete the first workout of couch to 5k. I seriously contemplated going to a doctor with a view to surgery, however, my physiotherapist showed me some of the latest research on the topic that convinced me otherwise.

The research indicates that surgery has a level of short term success but has poor long term success. The research further provides that the testing protocols are inaccurate, perhaps somewhat meaningless? The physiotherapist that conducted the research instead proposed that what has traditionally been treated as chronic exertional compartment syndrome should instead be treated as a biomechanical overload injury.

With the assistance of my physiotherapist I began a rehabilitation program, treating the problem as a biomechanical overload injury as the research indicates. Began with single leg squats, calf raises, jumping rope and running on the spot. Starting off very easily and building up the load slowly over time. I then began a return to running. My first "run" was a few intervals of 30 seconds, very slow, walking in between. I had a goal of an olympic distance try 4 months down the track and, failing that, a sprint distance.

It took me about 3 months to build up to a 5k run and most of that time was run/walk intervals. From there I pushed things beyond what my physio recommended (bad patient) and went from 5k to 8.5k long run in just a couple of weeks before beginning a taper. I hit my goal of an olympic tri. 10km run, pain free, no walking. I definitelu wasn't breaking any course records (7:30ish per km) but I got there.

The other key to my success was understanding chronic pain and when it is safe to accept it.

This may not be the answer for your circumstances but don't believe that being cut open is your only option.

Were you a heel striker?

You had a good physio.

I think I am naturally a heel striker. I should have also mentioned I worked on developing a mid foot strike and fixing other gait issues as part of the process.

My physio is good. Pretty and she doesn't charge me anything. But if I don't follow her advise, I never hear the end of it.

CAS, I have had chronic issues with my calves, I have had soleus strains tears, recover and have gone through physical therapy, had ART, astym etc. I recently over the past 5 months of undergone eccentric calf exercises with a loaded bar. This has seemed to help while at same time I have been running on an alter G treadmill 1-2 times a week. Anytime I go run outside on a surface other than soft trails 20-30 minutes into the run my calves get super tight and full for several days after. I use compression device several times after each run. I have also noticed that I develop issues after a hard session on the bike, Im not able to run very far if Ive done intervals or a hard group ride as well for several days after.
This fullness and tightness has developed so many times its super frustrating, Been a runner since age of 14, currently 52. Almost ready to hang it up...where is your clinic?