Can You Run with Anterior Compartment Syndrome?

If you feel pain in the front of your shins while running, and it seems to predictably get more painful after a certain point in every run, you may be suffering from Anterior Compartment Syndrome (ACS). The question: is it safe to continue to run with Anterior Compartment Syndrome?

You do not have to stop running if you have Anterior Compartment Syndrome. However, in many cases it may be too painful for you to want to run. If you do want to persist with running, taking walking breaks will help you to run for longer without pain.

Taking frequent walking breaks during your runs will allow the muscles that are overworking, swelling, and causing the increase in pressure, to relax a little before the next bout of running.

This video offers some more essential advice when it comes to running with Anterior Compartment Syndrome:

Essential Running Injury Prevention Workouts >>
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What is Anterior Compartment Syndrome?

Anterior Compartment Syndrome (ACS) is a relatively common running injury that afflicts the anterior tibial compartment (the front of your shin). It is a form is Chronic Exertional Compartment Syndrome (CECS).

In ACS, pressure builds up inside this anterior compartment. The reason for this increase in intracompartmental pressure is still unclear amongst researchers, but one suggested mechanism is the increase in muscle volume (by up to 20%) in exercising muscles of the lower leg.

This pressure can lead to pain and swelling as it compresses blood vessels, nerves and other structures within the anterior compartment.

Symptoms of Anterior Compartment Syndrome

The symptoms of Anterior Compartment Syndrome can include:

  • intense localised pain in the shin region, potentially tracking down into the foot.
    tenderness of the shin region.
  • a feeling of tightness in the muscles of the lower leg.
  • a feeling of weakness in the muscles of the lower leg.
  • a tingling or burning sensation.
  • numbness can also be present in cases where nerves are being compressed.

The anterior shin pain usually sets in predictably after a certain period of running or even walking, and will normally ease within a day of stopping exercise.

Anterior Compartment Syndrome Explained

Treatment for Anterior Compartment Syndrome

Once you have been diagnosed with Anterior Compartment Syndrome, treatment options are unfortunately fairly limited. Typically surgery will be discussed fairly quickly.

A surgical procedure known as a fasciotomy involves cutting the fascia of the anterior compartment of the lower leg, to allow more space for the expanding tissues to use when you exercise, reducing the pressure in the anterior compartment.

However, it has also been reported (and I have also experienced myself) that making changes to your running gait can be very effective in taking the strain off the muscles (such as tibialis anterior) that often get overused and contribute to the increased pressure in ACS.

When it comes to running technique, all the runners I have treated for Anterior Compartment Syndrome, all of them have come to me as heel striking runners.

As I described in this previous article about changing running technique to conquer Anterior Compartment Syndrome, gradually changing your running form over time, and transitioning from a heel striking running form to become more of a midfoot or forefoot runner will help to reduce your symptoms – in many cases even fix the issue.

Just bear in mind that in changing to a midfoot or forefoot running style, you will be placing more demand on your calf muscles and achilles tendon. To avoid trading one type of injury for another, be sure to follow a structured training plan like this free Return to Running Plan.

Can You Run With Anterior Compartment Syndrome?

Are Compression Socks Good for Anterior Compartment Syndrome?

Simply put, no. Given that Anterior Compartment Syndrome is caused by the increased pressure within the lower leg, adding more pressure to the region through compression is more likely to make your symptoms worse, rather than helping to ease your pain.

Essential Running Injury Prevention Workouts >>
Free Download [PDF]

Does Massage Help Anterior Compartment Syndrome?

Sports massage after exercise can help to return the muscles and other soft tissues of the lower leg to their resting state, reduce pressure within the anterior compartment, and to improve recovery in general.

Regular sports massage has been known to help delay the onset of Anterior Compartment Syndrome symptoms during a run, but certainly isn’t a cure to the problem.

If you do find sports massage to be helpful, every case is different after all, you may want to look into regularly doing some self-massage work on your shins and lower legs with a foam roller or tennis ball.

This video has some techniques for you to try:

Which Running Shoes for Anterior Compartment Syndrome?

When it comes to selecting running shoes to help you recover from Anterior Compartment Syndrome, the need for extra support or cushioning isn’t as important is it often is for injuries like Shin Splints or Runner’s Knee.

In fact the best option in most cases is to look for a shoe that will facilitate your transition away from a heel striking running technique, to a forefoot or midfoot running gait.

Lightweight running shoes with a lower heel-to-toe drop like a Saucony Kinvara (4mm drop) will make it a little easier for you to change your running form in this way. Just be sure to take my earlier advice… change your running form gradually!

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Posted on June 20th, 2021