Member Case Study: Muscle Cramps on the Shins

author : AMSSM

comments : 0

What you're describing sounds very much like chronic exertional compartment syndrome. This can cause pain and numbness like you're describing.

Question from Tribrz

When I run I get muscle cramps on the front outer portion of my shins. You can visibly see the muscles cramping and it looks like I have two small welts on each of my shins. They seem to be in the area of anterior shin splints, but I have not heard shin splints described as muscle cramps.

I used to be able to run through it, but the cramps seem to be getting worse; they burn badly, and don't go away during the run like they used to. When this is occurring, my feet seem to be harder to flex at the ankle and start curling in so that I don't lift my foot as high and seem to trip more when I trail run.

Is this a form of shin splints? Do compression wraps help?

Answer from Thad Barkdull, MAJ, MC

Member AMSSM

What you're describing sounds very much like chronic exertional compartment syndrome. The muscles in the lower leg are surrounded by a tough, fibrous tissue called fascia. The fascia does not expand very well, and for some people, when there is too much blood flow into the muscles (i.e. during exercise), the increased volume within the compartment of fascia compresses the muscle, nerves and blood vessels. This can cause pain and numbness like you're describing; the compression of the nerves passing through can often make it difficult to lift, or "dorsiflex" your foot, resulting in a condition we call "foot drop," and the "welts" you've observed may be the result of small herniations or defects in the fascia, where the muscle is bulging out during activity.

This condition may affect any one of four (some doctors think five) compartments found in the lower leg, but the outer front area you're describing is by far the most common area to be affected. There are also compartments in the thigh and the arms, though compartment syndromes in these locations are much less common.

Chronic exertional compartment syndrome can be diagnosed by measuring the pressure within this compartment before and immediately after exercise. A trained physician will place a needle into this compartment and measure the pressure. He will then have you run on a treadmill until you develop your symptoms, and then re-measure the pressures. Large changes in the pressure or above a certain level are diagnostic for the condition.

The symptoms are usually transient, resolving within 30-60 minutes of stopping exercise. Occasionally, with stretching and physical therapy, the fascia can be stretched more to accommodate the larger volume, but in some cases, a surgical procedure called a fasciotomy is recommended. Cuts are made into the fascia to allow for more "breathing" room for the muscles. One study reported about a 90% success rate with this procedure in eliminating or significantly reducing symptoms, with a return to running in about three weeks.

I would recommend that you check with your doctor. If it does appear that your compartment pressures are elevated with activity, your physician can make sure that there are no biomechanical problems (like overpronation) which are making you more prone to the problem, and initiate a rehabilitation program to try and fix the problem. If that doesn't work, referral to an orthopedic surgeon who is experienced in performing this procedure is your best bet for a return to pain free running.

Thad Barkdull, MAJ, MC
Director, Sports Medicine

Family Medicine Department, Tripler Army Medical Center
 Honolulu, Hawaii
 "He koa na 'alapa a pau" (Every Warrior an Athlete)

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date: April 14, 2008