Are you routinely experiencing painful swelling in your legs when running? If so, you may be dealing with chronic exertional compartment syndrome (CECS), a condition that often presents with symptoms of tightness, cramping, and swelling during exercise. While it’s easy to brush off as typical soreness, CECS can become progressively worse until it forces you to stop your activity altogether.
If you’re like me, you’ve probably brushed it off at first—thinking the tightness, cramping, and swelling were just part of pushing yourself hard. After all, a little pain is normal when you’re training, right? But when that pain doesn’t subside, and instead intensifies until it forces you to stop, that’s when it starts becoming something you can’t ignore. I remember how frustrating it was, feeling like my body was betraying me in the middle of what should have been routine runs or even just walking.
I’m here to tell you that if you’re feeling this, you might be dealing with chronic exertional compartment syndrome (CECS), a condition I know all too well. CECS occurs when the pressure inside your muscle compartments builds up during exercise, restricting blood flow and causing pain. It’s not just an inconvenience; left unmanaged, it can derail your training completely.
The good news? There’s a way forward. With early recognition, a few smart adjustments, and the right approach to training and recovery, you can keep active, maintain your fitness, and—hopefully—return to doing what you love without the crippling pain that CECS brings.
Let’s dive into what CECS looks like, how I dealt with it, and how you can manage it to stay on top of your game.
Identifying CECS Symptoms
If you’re experiencing painful, swelling-like tightness in your legs, especially when running, walking, or performing high-impact activities, it’s easy to brush it off as normal soreness or overuse. I made that mistake early on, figuring it was just a matter of pushing through. But there’s a point when you can’t just “push through” anymore.
In my case, it started as a dull ache in my lower legs that would build into a feeling of tightness—like my muscles were about to burst out of my skin. At first, it only flared up after long runs. Then it started hitting earlier, sometimes within the first mile. Walking up a hill or even walking briskly on flat ground would trigger it. The sensation wasn’t just uncomfortable; it was painful.
And that’s the tricky part—these symptoms can easily be mistaken for muscle fatigue or simple overtraining. But with CECS, it’s different. It feels like the muscle is swollen and can’t release the tension, like your skin is trying to contain something that keeps expanding. You might even experience a burning sensation, numbness, or cramping that won’t go away until you completely stop what you’re doing and rest for a while.
When I was experiencing the worst of these symptoms, it was while I was attending Navy SEAL training. Ultimately, I was medically dropped from training due to injuries to my back, so the CECS wasn’t diagnosed for a couple of years. Once I was cleared from my back injuries and attempted training again, I immediately felt those all-too-familiar painful pumps in my lower leg muscles. Before, I had felt lots of pain in the shins and was convinced the pain was more likely shin splints or stress fractures, so I continued to push on. Now that I wasn’t in training, I could consider the possibility that it might be something else.
What finally tipped me off that this wasn’t normal soreness was the consistency of the symptoms. They appeared every time I exerted myself and vanished almost as soon as I stopped moving. I discussed this with my medical provider, and he had me read an article in a medical journal on this condition. The symptoms fit my situation perfectly. These symptoms are the hallmark of CECS: pain during exercise, relief after stopping. Of course, there would be further testing, which we’ll get to later.
It took me longer than it should have to recognize these symptoms for what they were. But once I did, it was a relief knowing that I could take some action and get professional help. If this sounds familiar, don’t wait to address it. The sooner you recognize CECS for what it is, the sooner you can start managing it properly. Maybe it’s not CECS, but regardless, it’s good to seek help.
Initial Adjustments to Training Routine
After recognizing the consistent symptoms during exercise, I knew it wasn’t something I could keep ignoring. The pain wasn’t going away, so I moved forward with additional testing to confirm the diagnosis. If you’re not familiar with the testing for chronic exertional compartment syndrome (CECS), it’s not exactly a pleasant experience. I had large needles inserted into my legs before and after running to measure the pressure in my muscle compartments. Sure enough, the results were clear—CECS.
At that point, I had to make a decision. I opted to have surgery on the worst of the two legs, hoping it would alleviate the symptoms enough to let me get back to some form of normal activity. Unfortunately, while the surgery reduced the symptoms, I still tested positive for CECS afterward. That’s when the reality hit me: I was informed I wouldn’t be fit for most military activities, and any hopes of returning to Navy SEAL training were out of the question. It was a tough blow, especially after putting so much into that path.
We tried physical therapy and compression therapy to see if I could manage the condition, but the recommendation was pretty straightforward—avoid any activities that triggered the symptoms. It was hard to accept, but at that point, I made the decision to leave the Navy at the end of my contract.
In the years that followed, I found that lifting weights was one of the few activities I could do without triggering CECS. Running, cycling, and even walking long distances brought the symptoms back, so I had to be cautious. Weightlifting became my go-to form of exercise, allowing me to stay active and build strength without dealing with the painful swelling and tightness that came with other activities.
But now, I’ve reached a point where I’m ready to push the boundaries a bit. I want to explore other activities that can improve my overall health and help me maintain a leaner body weight. The challenge is finding what works without triggering the symptoms—something I’m still navigating.
Overview of CECS
Chronic Exertional Compartment Syndrome (CECS) is not the kind of condition that’s easy to spot right away, and trust me, it can feel like one of those “invisible” injuries. It’s easy to brush it off as overtraining or shin splints in the beginning, but what separates CECS from typical soreness is the buildup of pressure inside the muscle compartments.
Here’s what happens: each muscle group in your legs (or arms, in some cases) is surrounded by a layer of tissue called fascia. When you exercise, the muscles expand, but the fascia doesn’t stretch much, causing pressure to build up inside those compartments. This pressure restricts blood flow and compresses nerves, resulting in pain, swelling, tightness, or even numbness.
For me, the pain would always hit during activity and disappear quickly after I stopped. I was dealing with symptoms for quite a while without realizing what they were. I thought it was just part of the grind—part of pushing harder in training. But CECS isn’t something you can push through, and if you try, it only gets worse. That’s what makes it so frustrating; it’s not a muscle you can stretch out or strengthen. The problem is with the structure of your fascia, and there’s no amount of grit that will make that pressure go away.
Diagnosing CECS involves testing the compartment pressure before and after exercise, and for many of us, it leads to a choice—do you attempt surgery or try to manage it conservatively? In my case, surgery helped, but it wasn’t a perfect fix. Some people find long-term relief through surgery, while others, like me, have to adapt to living with the condition.
Whether you’re just recognizing the symptoms or have been dealing with it for a while, the key takeaway is this: CECS doesn’t just go away on its own. You need to take action, whether that’s through modifying your activity, seeking treatment, or trying out new methods of managing the condition.
Consulting Medical Specialists
When the symptoms of chronic exertional compartment syndrome (CECS) become too severe to ignore, seeking the right medical advice is crucial. You might feel that you’re just pushing through soreness or overtraining, but once the signs become persistent, consulting a sports medicine specialist or a doctor familiar with CECS is essential for an accurate diagnosis.
The diagnostic process for CECS typically involves compartment pressure testing, which measures the pressure within your muscle compartments both at rest and after exercise. This can feel invasive, but it’s the gold standard for confirming the condition and ruling out other potential issues like shin splints or stress fractures. Once confirmed, you’ll be faced with important decisions about treatment.
From there, you’ll likely discuss your options with your specialist—ranging from conservative management to surgical intervention. Many people, including myself, initially explore non-surgical methods, such as physical therapy, compression therapy, or modifying activities to manage symptoms. However, each case is unique, and some patients find that surgical options like fasciotomy are necessary to achieve long-term relief.
What I learned through this process is that CECS isn’t something you can simply push through. The sooner you get professional help, the sooner you can make informed choices about how to adjust your training and lifestyle to manage the condition. While my own diagnosis led to tough decisions about my future, including the end of my military aspirations, it also gave me clarity and the chance to explore new ways of staying active.
If you suspect you’re dealing with CECS, consulting a specialist will provide the guidance needed to navigate your next steps, whether that’s surgical intervention or adapting your training in a way that works for you. There’s no one-size-fits-all approach, but having a clear diagnosis will help you make the best decision for your long-term health.
Pivoting Training While Managing CECS
After surgery and the realization that I would not be able to return to the Navy SEAL program, I had to pivot my training to accommodate chronic exertional compartment syndrome (CECS). For a long time, it felt like my options were limited. Running, cycling, and even extended walking triggered the painful swelling and tightness in my legs. But I wasn’t willing to give up on staying fit.
What I found over time was that lifting weights became my main form of exercise. It was one of the few activities that didn’t trigger the painful symptoms of CECS. I could control the pace, intensity, and amount of rest between sets, which gave my legs enough recovery time to avoid that pressure buildup. Lifting has allowed me to maintain my strength and stay active, even if my endurance activities were severely limited.
While lifting weights has been working, I have started feeling like I’m missing out on other aspects of fitness—mainly cardiovascular health and maintaining a leaner body weight. So, now I’m at a point where I’m ready to start experimenting with other forms of activity, even knowing the limitations that CECS brings.
My approach now is focused on finding low-impact activities that don’t aggravate my symptoms. Swimming, for example, is something I’m exploring. It’s low-impact, keeps pressure off the legs, and still gives a good cardio workout. I’m also considering using stationary bikes at a low resistance setting, where I can control the intensity and avoid high-pressure buildup. The activity I’m most interested in seeing if I can progress in is walking—specifically rucking—though I’m fully aware this will be a slow progression. I also understand that, having nearly 100 lbs more muscle than the typical “rucker,” for the moment I can just take solace in the idea that I’m always carrying my ruck with me 24/7.
The key will be to find that balance between staying active and managing the condition. I’ve learned that while CECS might limit what I can do, it doesn’t have to stop me from doing anything. It’s all about adapting your training to fit your current abilities and exploring options that might work for you without pushing your body into pain.
For anyone dealing with CECS, I’d recommend experimenting with different forms of training—whether that’s swimming, rowing, or even elliptical training. The goal is to find exercises that help maintain your cardiovascular health and improve overall fitness, while still respecting the limitations that CECS imposes. It’s not about avoiding activity; it’s about finding what works. For me, it will no longer be about pushing through the pain to find my limitations, but rather training progressively and working in proximity to that limitation without doing further damage. In time, I believe I will be doing a great deal more activity.
Restorative Activities and Recovery Techniques
Managing chronic exertional compartment syndrome (CECS) isn’t just about adjusting your workouts—recovery plays a critical role. Over time, I’ve learned that balancing activity with recovery is essential to maintaining fitness while minimizing the onset of symptoms. You can’t ignore recovery, especially with a condition like CECS, where the body’s response to exercise can be unpredictable.
One of the most helpful tools for me has been massage therapy. Whether it’s through professional deep tissue massage, therapeutic massage, or self-care with massage guns, massage balls, and foam rollers, regularly working on the tight areas has made a noticeable difference. Mostly, it helps improve circulation and releases tension, and while the fascia is a very complex tissue that we still know very little about, these techniques definitely reduce the painful pressure that builds up. The use of body tempering, when I can get assistance with it, has been a huge help, though it’s not something I can do myself or something many people offer. For consistency and to be gentle on the pocketbook, my main go-to has to be something I can do myself anytime I start to feel that tightness coming on.
I’ve been learning a great deal about compression gear as a recovery method. There are plenty of studies to support using compression socks or sleeves, especially during and after activity, to help with circulation in the legs and the reduction of swelling. I plan to incorporate these into my training soon and will write more on the protocol I use and my response. Training clients often puts me on my feet for extended periods of time, and I hate that I need to sit down so much. I hope to get a good response from compression gear so that I can stay on my feet for longer periods of time.
While I haven’t used this method in years, I did find contrast therapy—alternating between heat and cold—to be very useful. This was mostly something I did after exercise, but there’s good data supporting its use before exercising as well. At the time, I used buckets of very hot water and buckets of ice. For convenience, I’d recommend using a heating pad to loosen up the muscles and increase blood flow. There are products specifically designed for the legs that provide heat, compression, and massage while you sit, and as I write this, I’m ordering one to try. I will start using this both before and after exercise. After workouts or long walks, applying cold therapy helps reduce inflammation and control any swelling that might come up. For many, the combination of heat and cold has been a simple but effective way to manage post-exercise recovery.
Hydration and nutrition are also essential. Staying hydrated helps maintain proper circulation, and I’ve noticed that when I’m dehydrated, my muscles cramp and swell more easily. In terms of nutrition, keeping up with electrolytes (especially magnesium) has helped me reduce cramping. Getting enough protein and healthy fats ensures my muscles are recovering properly, even if my cardio sessions are limited.
Recovery isn’t just about rest—it’s about actively managing the way your body responds to activity. These techniques, whether it’s massage, compression, or hydration, are all part of an approach that helps me stay as active as possible while keeping my symptoms in check. The more consistent I am with recovery, the more I can ensure my progression while avoiding much of that painful territory.
Gradual Return to Sport and Activity
After years of dealing with chronic exertional compartment syndrome (CECS) and figuring out what triggers my symptoms, I’ve learned that trying to jump back into full activity too quickly is a recipe for setbacks. Returning to any kind of endurance training or sport requires patience, experimentation, and, most importantly, a gradual approach.
The truth is, with CECS, there’s no “one-size-fits-all” plan for getting back to the activities you enjoy. For me, the focus is on finding low-impact ways to challenge my body without pushing it to the point of pain. I’ve started by incorporating short-duration, low-intensity activities that allow me to test my limits while respecting the boundaries set by CECS. I’m also allowing for intervals, meaning I’ll stop walking for a moment to allow the circulation time to catch up.
If I want to start working on walking or rucking, I do it incrementally. I’ll begin with a short walk, and as long as there’s no pain, I can gradually increase the time or distance—usually by no more than 10% a week—while always paying attention to how my legs respond. If I feel the familiar signs of CECS—tightness, swelling, or pain—I might take a step back, reduce the intensity, and give myself more recovery time before trying again. I’m taking detailed notes to track my response to any and all changes.
I’ve also found it helpful to build in rest days between these activities, even if the session felt easy. Rest is critical to avoid overloading the muscle compartments, especially when you’re working toward higher-impact or endurance-based activities. By alternating between low-impact cardio and strength training, I can keep my body active without risking the pain that comes with pushing too far.
In addition to this gradual approach, I’ve become more mindful about listening to my body. Pushing through pain used to be my default, especially coming from a military training background. But with CECS, that mindset doesn’t work. Instead, I’ve learned to work up to my limits without crossing into the danger zone. This doesn’t mean avoiding hard work—it means being smart about how and when to push.
For anyone managing CECS, the path back to sport or high-intensity activity requires experimentation and patience. Start small, build gradually, and focus on how your body responds. It’s not about rushing to get back to where you were; it’s about progressively increasing your activity in a way that keeps you moving forward without taking steps back. Even if I’m never as good as I once was, I will take comfort in being the best I can be.
Long-Term Management of CECS
Living with chronic exertional compartment syndrome (CECS) isn’t something that can be fixed overnight. I’ve come to terms with the fact that long-term management of this condition will require a strong commitment to smart training, recovery, and self-awareness. It’s not about completely eliminating the condition—at least, not in my case—but about finding ways to keep it under control while still leading the active life I want.
I know I’ve said it already, but one of the most important lessons I’ve learned is that balance is key to long-term success. It’s easy to want to push yourself back to full capacity. If that was all that was needed, believe me when I say not too many are willing to work as hard as I will. But with CECS, that approach is more likely to lead to setbacks than progress. For me, it has to be about balancing the things that give me the challenge I’m after with being realistic about my limitations. So far, I’ve found that pacing my activity, allowing for recovery, and rotating between different types of workouts has been effective in preventing flare-ups.
Consistency in recovery practices is also crucial. Whether it’s massage, compression, or contrast therapy, making recovery a regular part of my routine has been just as important as the workouts themselves. I’ve learned that neglecting recovery for even a short period can quickly lead to symptoms resurfacing. So, I prioritize recovery with the same level of importance as my workouts.
Another major factor in managing CECS over the long term is adaptability. Some days, my body feels capable of more; other days, I have to dial it back. The key is being flexible and adjusting based on how I’m feeling that day. I don’t treat every day as an opportunity to push my limits anymore—instead, I focus on sustainable progress over time.
Staying engaged in different forms of training has helped keep things interesting and manageable. Lifting heavy ass weights remains a core part of my routine, but incorporating low-impact cardio like swimming and experimenting with activities like walking and rucking has allowed me to maintain a well-rounded fitness regimen without triggering my symptoms.
Finally, the biggest change in my mindset has been learning to accept that it’s okay if I’m not where I used to be physically. It’s natural to want to compare yourself to what you could do in the past, but for those of us managing a condition like CECS, progress looks different. It’s about staying consistent, making adjustments when necessary, and finding satisfaction in being as strong and healthy as possible, given the circumstances.
Long-term management of CECS is an ongoing process, but with the right approach, it doesn’t have to hold you back from staying active and fit. It’s all about playing the long game, making sustainable adjustments, and recognizing that managing your condition is just as important as your training itself.
Looking to Additional Ways to Modify Training Approach
For those of us managing chronic exertional compartment syndrome (CECS), the idea of modifying our training approach can feel limiting, but it’s where true progress begins. While weightlifting and low-impact activities have been central to my routine, there are always additional strategies worth exploring. Recently, a case study caught my attention and provided hope for further adaptations.
The study involved a 34-year-old female athlete who, like many of us, struggled with leg pain, tightness, and numbness during running. After being diagnosed with CECS, she was presented with the option of fasciotomy surgery, but instead, she chose a more conservative route—gait retraining. Over a 6-week program, she modified her running mechanics by shifting from a heel-strike to a forefoot or midfoot strike, shortening her stride, and increasing her cadence.
Remarkably, by the end of the program, she was able to run 3 miles without any CECS symptoms and, even more significantly, her post-exercise compartment pressure dropped from 67 mm Hg to 45 mm Hg. While still elevated, the pressure was low enough to avoid surgery, and she was able to continue her running without further complications.
This study highlights an important takeaway for anyone dealing with CECS—modifying your movement patterns can make a significant difference. Whether through changes in running gait, cadence, or even the type of terrain you train on, adjusting the way you move may open doors to activities you thought were off-limits.
For me, it’s a reminder that there are always ways to refine my approach, whether through gait retraining or experimenting with low-impact cardio and interval work. The key is being open to new methods, tracking progress, and continuing to adapt as necessary. If a gait retraining program could bring such success for a long-time sufferer of CECS, it’s certainly worth considering for anyone looking to push the limits of what’s possible with this condition.
Conclusion
Living with chronic exertional compartment syndrome (CECS) has been a journey of adaptation, patience, and self-awareness. While I accept that I have this condition, I refuse to be defined by how others live with it. In fact, I fully intend to push the boundaries of what most people consider possible with CECS. However, I understand that this won’t happen through brute effort, but rather through a careful and thoughtful training approach. For anyone managing this condition, the key takeaway from this article should be that while CECS can be limiting, it doesn’t have to be the end of your active lifestyle. Create your own plan for managing activity with CECS—one that embraces experimentation and a willingness to approach training differently so that you can continue to move forward.
Success comes not from ignoring the symptoms or trying to push through them, but from finding that balance between challenging yourself and respecting your current limits. It’s about being mindful of your body’s signals and understanding that progress may look different than it used to. But progress is still progress.
Recovery is your ally and a crucial weapon in fighting this condition. Fight the good fight with consistent use of techniques like massage, compression, and contrast therapy, and keep the symptoms under control. While I might not be able to engage in high-impact endurance activities like I once did, I can still lift heavy and do other low-impact activities, proving that there’s more than one way to stay fit and healthy.
If you’re facing CECS, know that while it may change the way you train, it doesn’t have to stop you from achieving your fitness goals. The road to long-term management involves patience, adaptability, and an ongoing commitment to recovery. It’s not just about pushing harder—it’s about working smarter.
In the end, I’ve accepted that while I may not be able to do all the things I once could, I can still do plenty. And the most important thing is that I’m still moving forward, still working on being the best version of myself, given the circumstances.
So, whether you’re newly diagnosed or have been managing CECS for a while, remember that the journey doesn’t have to stop here. With the right approach, you can continue to stay active, maintain your fitness, and lead a fulfilling, healthy life.
References:
Allison, A. K., Ishikawa, K. L., Gerber, J. P., & Dewing, C. (2023). Chronic exertional compartment syndrome resolved with running gait retraining: A case report. Journal of Athletic Training, 58(4), 345–348.
Tucker, A. K. (2021). Chronic exertional compartment syndrome of the leg: Steps to a “quiet” stride. Current Sports Medicine Reports, 20(3), 108–114.
Helmhout, P. H., Diebal, A. R., van der Kaaden, L., & Wolfhagen, H. A. (2015). Conservative treatment for exertional compartment syndrome in the lower leg: A case series. International Journal of Sports Physical Therapy, 10(1), 85–94
Reinking, M. F., & Hayes, A. M. (2013). Intrinsic factors associated with exercise-related lower leg pain: A review of current literature. Journal of Athletic Training, 48(5), 654-662.
Diebal, A. R., Gregory, R., Alitz, C., & Gerber, J. P. (2011). Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. The American Journal of Sports Medicine, 40(5), 1060–1067.
Pedowitz, R. A., Hargens, A. R., Mubarak, S. J., & Gershuni, D. H. (1990). Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. The American Journal of Sports Medicine, 18(1), 35–40.
Waryasz, G. R., & McDermott, A. Y. (2008). Chronic leg pain in athletes: A guide for differential diagnosis, evaluation, and treatment. Sports Health, 4(2), 125-132.
EXERCISE
