Fire. That’s what chronic exertional compartment syndrome feels like. The fire eventually leads to strange kind of numbness where you can’t decide if your legs are actually about to fall off or if you just really want them to.
CECS, in a nutshell, as defined by the Mayo Clinic:
When you exercise, increased blood flow to working muscles expands them. If the connective tissue (fascia) that binds the muscle fibers in a compartment doesn’t also expand, pressure builds up in the compartment. Over time, the pressure cuts off some of the muscle’s blood supply.
So basically, the fascia ends up strangling the muscle itself. Hence a lot of burning, which eventually leads to numbness when the blood supply has finally been cut off completely. Sometimes you also get cramps and your legs can swell up. All very fun things.
Luckily CECS it isn’t something that follows you around 24/7. Honestly, I never even knew I had it until I started running a lot. I’d always had issues with riding in regular fillis stirrup irons, especially if my stirrups were short, but I brushed it off as some kind of flexibility issue. I would only get about 10 minutes into a ride before my lower legs and ankles were absolutely burning. The arrival of wide footbed irons was a major godsend for me and helped alleviate a lot of the pain. They’re an absolute necessity for me now.
What really brought this condition to light for me was several years ago when I was doing a lot of triathlons. It got so bad that I was to the point of being in pain pretty much all the time, so I finally went to a doctor. The first one had no clue, thought it was maybe shin splints or a blood clot, ordered an MRI which revealed nothing, and then finally sent me to a specialist. Within just a few minutes of talking to me he knew exactly what it was.
For riding by itself, CECS isn’t so bad. I feel it most when I’m jumping, or especially on cross country. A short stirrup combined with a lot of two point and weight in my heels will have my feet numb within about 5 minutes, with a whole lot of burning going on during that time. This is part of why you’ll often see my feet in more of a “home” position in the stirrups on XC. It helps alleviate some of the pain.
The bigger issue is running, especially if I’m running a lot when I’m also riding a lot. The two activities combined seem to be a little bit too much for my legs to take. Hot weather makes it even worse, and of course both of the half marathons I’ve done have been pretty excruciating. For my second one it happened to be almost 70 degrees that day and the entire last few miles were done with completely numb legs that ended up feeling like pure fire for days afterward. I generally have to cut my running activity way down in hot weather, and try not to ever run on days where I’m planning on riding in the jump saddle. Sometimes I have to break the ice packs out.
There really isn’t a whole lot you can do for CECS. The doctor said we could try a custom orthotic, to see if changing my biomechanics might help. Of course, those aren’t covered under my insurance and were quoted to me at $450 a pop. I asked him how often that actually helped (maybe half the time) and how much it helped reduce the symptoms (maybe 30-50%). Not really worth it to me. They mostly suggest that you cut out whatever activities cause it to flare up. If it gets particularly bad they can do a surgery that requires cutting the fascia and results in spending several weeks unable to use both feet. That’s a no for me.
So I try to manage it just by being smart about my activities, and planning my days carefully. Runs need to happen on dressage days or non-riding days, and the hotter the weather is, the shorter the run needs to be. For riding I tend to keep my stirrups a hole longer in my jump saddle until I’m actually jumping, and I do stick my feet further in the stirrups for long conditioning rides. I will probably always require a stirrup with a wide footbed, since for whatever reason it seems to help stabilize things and make everything more bearable. I will never have a particularly deep heel position. Whenever we stop for a break I often take my feet out of the stirrups and leg my legs hang to get some bloodflow back. Otherwise I just do what equestrians everywhere do all the time about all kinds of things… I just suck it up.