Runner's Injuries: Anterior Compartment Syndrome

This article is by Islington's Angel Sports Injury and Physiotherapy Clinic's physiotherapist and looks at:

• anatomy of the lower leg
• signs and symptoms of anterior compartment syndrome
• diagnosis

Anterior compartment syndrome has to be considered when there is pain in the front of the shins. The location of the pain also can indicate a different injury called ‘shin splints’. This is a chronic condition and is the result of over training and is a very different condition from acute anterior compartment syndrome. Compartment Syndromes of the lower leg can be a medical emergency.

The lower leg contains two bones, the fibula which is the smaller bone on the outside of the lower leg that starts just below the level of the knee and extends downwards to form the outside ankle bone. The bigger leg bone is the tibia and this extends from the knee joint to form the medial anklebone.

Anterior compartment syndrome pain is located between the two bones and is due to the expansion of the major muscle in the area tibialis anterior, inside its inelastic fascial sheath. The action of this muscle is to dorsi flex and invert the foot and the muscle is used extensively in activities that repetitively dorsi flex and plantar flex the foot.

Activities such as running up and down hills can overuse the muscle. With an increase in blood and pressure inside the muscle, the muscle can’t expand anywhere due to the anatomical boundaries, laterally and medially are the tibia and fibula.

Signs and Symptoms of Anterior Compartment Syndrome

• Pain which gets to a crescendo type point, induced only by specific activity and often at a specific point in the workout
• Pain and tightness in the shin
• Decreased sensation on the top of the foot in the area above the second toe
• Weakness may be noted on toe extension and dorsiflexion of the foot
• Tingling into the toes
• Decreased dorsal pulse may be noted by a trained practitioner (Supplied by the anterior tibial artery)
• Symptoms disappear once activity ceases

The 5 Ps of Anterior Compartment Syndrome

1. Pain
2. Pallor
3. Paresthesia
4. Pulselessness
5. Paralysis (If not treated)

Tri-athletes and runners are particularly prone to this problem. In cycling the athlete will pull their pedals up with their feet which can tighten the muscles involved in the anterior compartment. In a triathlon once the swim and cycle leg is completed, the athlete will then embark on a pretty long and gruelling run which can induce the increasing pressure in the anterior compartment and lead to the crescendo pain in the shin.


If you are concerned about symptoms in your leg which sound similar to those mentioned above you need to seek a thorough assessment by a health professional.

A physiotherapist can perform a clinical assessment based on your injury history, and a sports physician can perform a compartment pressure test before and after a bout of physical activity in which the individual knows will bring on symptoms. It is a very tricky condition to manage, but imperative it is diagnosed correctly to prevent permanent damage and paralysis.

If you are a keen runner or suffer from any of the symptoms above don't let it go on for too long. Arrange an appointment with our physiotherapist in London at the Angel Sports Injury and Physiotherapy Clinic by clicking below.

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