Compartment syndrome presents a significant challenge for runners aiming to conquer endurance races like the Comrades Marathon. This condition, characterized by increased pressure within muscle compartments, can severely impact training and race-day performance if not managed effectively. 

Here’s a comprehensive exploration of compartment syndrome, its implications for runners, and strategies for effective management.

What is Compartment Syndrome?

Compartment syndrome occurs when the muscle compartment—a group of muscles, nerves, and blood vessels surrounded by tough fascia—becomes excessively tight. This tightness restricts blood flow to the muscles during exercise, leading to a buildup of pressure. As blood enters the compartment to provide oxygen and nutrients, the tight fascia prevents it from exiting efficiently. Consequently, pressure within the compartment rises, causing pain, numbness, and potential tissue damage.

Symptoms and Causes

Symptoms of compartment syndrome can vary but often include:

  • Pain: Initially mild, progressing to severe and unrelenting pain during exercise.
  • Numbness or tingling: Particularly in the affected muscle area or nearby regions.
  • Weakness: Difficulty moving the affected limb or loss of muscle function.
  • Swelling or tightness: Visible or palpable tightness in the affected muscle compartment.

The condition can stem from various causes, such as:

  • Edema (fluid buildup): Often due to prolonged sitting, traveling, or other factors causing fluid retention in the lower limbs.
  • Muscle growth: Rapid increase in muscle size without a corresponding enlargement of the surrounding fascia.
  • Anatomical factors: Some individuals may have naturally smaller compartments or thicker fascia, predisposing them to this condition.

Managing Compartment Syndrome

For runners like Terrence van Hinkle, managing compartment syndrome is crucial to continue training and prepare for events like the Comrades Marathon.

Related: Find Out Which Comrades Marathon Training Program You Should Be Following

Conservative Treatments

Initially, managing symptoms may involve rest, avoiding aggravating activities, and applying ice to reduce inflammation. Compression socks, used cautiously outside of exercise sessions, can help alleviate symptoms by promoting fluid drainage and reducing swelling.

Medical Interventions

In cases where conservative measures are inadequate, medical interventions may be necessary. These can range from physical therapy to surgical procedures aimed at releasing the fascial compartments and relieving pressure.

Training Adjustments

Navigating training with compartment syndrome requires careful consideration of exercise intensity and volume.

Low-Intensity Approach

Adjusting running pace and intensity to levels where symptoms are minimized can allow runners to continue training while managing the condition effectively. Gradual progression and monitoring of symptoms during exercise sessions are essential to prevent exacerbation.

Long-Term Planning

While short-term management strategies can provide relief, the long-term outlook often favors surgical intervention for persistent symptoms. Surgical release of the fascial compartments is typically effective in resolving symptoms and preventing future occurrences, enabling athletes to pursue their athletic goals without limitations.Compartment syndrome poses a unique challenge for runners preparing for endurance events. By understanding the symptoms, causes, and effective management strategies outlined above, athletes can navigate this condition proactively. Seeking guidance from healthcare professionals experienced in sports medicine is essential to develop personalized treatment plans and optimize training regimens.


With a passion for high performance sport – Lindsey Parry is one of South Africa’s most widely recognised coaches. Having led a team to the London, Rio and Tokyo Olympic Games as well as the Commonwealth Games in Edinburgh, the Gold Coast & Birmingham, and coached both triathletes and runners onto podiums of some of the world’s most illustrious races, Lindsey has a unique ability to understand what it takes to succeed at any level and thrives on coaching, motivating and inspiring others to do the same – whether it’s on the track, on stage or behind a mic.

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