Chronic exertional compartment syndrome in martial arts

UPDATE: Here’s a follow-up article I did two years after writing this.

Last week,  I received an email from somebody who follows my Youtube Channel. He asked why I wasn’t regularly uploading videos like I used to in the past. That’s a good question and it deserves an answer:

I don’t like making crappy videos in which my performance sucks.

The next question would then be: why would my performance suck?

The answer to that one is something I debated if I would explain it or not. On the one hand, my personal life and health is nobody’s business but my own. I also don’t feel like sharing everything that goes on in my life with the entire world. I believe I already give more than enough access to my thoughts and life experiences. Finally, I don’t like people who whine each time they get a little bit injured and would rather not be seen as one of those.

On the other hand, I very much hate the macho-attitude that is rampant in martial arts and combat sports. You know what I mean; the guys who pretend like they can take everything that comes their way, they’re never hurt, they cannot be beaten, etc. I loathe that kind of immature showboating because it is both stupid and pointless. Fighting hurts. If you train to fight and/or fight a lot, you’ll get hurt regularly. If you’re unlucky, you’ll get injured and if you really push it, you’ll get chronic injuries. Pretending that this doesn’t happen is one of the biggest lies macho martial artists perpetrate.

A second aspect is the years I lived with pain and had no cure for it. If by sharing my story I can spare just one person going through that same ordeal, then it’ll be worth it.

Here goes.



A bit over two years ago, I felt like crap. I was tired, weak and always in pain, in particular in my back and legs. Then all of a sudden the symptoms got worse and it felt like I had aged ten years in a month. So  I went to my MD and he did a basic examination. Not much to be found except that I scored zero on the patellar reflex test. Meaning, he hit me with the hammer and nothing happened. My legs didn’t even twitch. Then started a long downward spiral that lasted until a few weeks ago…


The quest for answers

My MD sent me to the hospital for a series of scans and blood work tests. Turns out I have low vitamin D, but that couldn’t explain the pain in my back and legs. The MRI showed two bulging discs in my spine, but the neurosurgeon said that couldn’t cause the pain in my legs, only that in my back. First thing was to fix those discs, which meant physical therapy and no heavy training with impacts anymore. So I cut way back on some of my favorite training and stopped all heavy bag work. Over the course of about four months, my back slowly got better (today it’s pretty much fine.) But my legs still hurt, more and more in fact, so I kept on looking for answers. In total, I visited:

  • Three professors, leaders in their field.
  • Several specialists in sports medicine.
  • Several physical therapists, each specialized in different therapies.

I also took tons of supplements one doctor prescribed, changed my diet, made a bunch of other life changes. I did even more tests and got to hear I might have MS, cancer and a host of other illnesses you really don’t want to hear about at my age… So far, none of those have turned out to be true, but there was never a clear diagnosis either and my legs kept on getting worse.

At that point, I was feeling pretty down and frustrated. After a year and a half of getting nowhere and paying a small fortune on doctors and therapies, I wasn’t any closer to getting my health back. In the mean time the pain was getting so bad I could hardly train anymore, let alone work with clients. After training almost every day for the last thirty years, being unable to train began to wear me down mentally with each passing day. What was worse, people started telling me I was imagining things and the pain was in my head. Simply because of the fact that the whole thing was going on for so long and the doctors couldn’t find what was going on, they decided I was making it all up. So I stopped talking about it altogether.


The change

Around March, I started working with a well-known physical therapist here in Belgium. He specializes in helping athletes with injuries and is a big name here. He was the head of the medical staff for our national soccer team and has treated tons of international athletes, so I was hopeful. Fast forward several months, a bunch of money and my symptoms had only gotten worse. One of them was a misalignment of my feet with my shinbone and it was what worried me the most for long term joint damage. When I told my therapist things were getting worse, she didn’t have much to say. When I asked when I could expect my feet to be back to normal, her response was “It’s too late for that.”


When I asked why she hadn’t told me that to begin with, there was silence. I stayed calm and polite, picked up my stuff and left. I plan to never return.

I was angry at hearing they’d been wasting my time but also became even more determined to find a solution. The one good thing I had gotten out of that place was the number of a sports-traumatologist with experience treating athletes. So of I went to see him. It took him less than five minutes to make a preliminary diagnosis: Chronic exertional compartment syndrome

In short, this means that when you exercise, your muscles expand as they get filled with blood. The connective tissue that is wrapped around them sometimes (they don’t know why) ends up not expanding enough and the pressure inside the muscle increases. When the condition worsens, muscles and nerves start getting “strangled” and atrophy. Then other muscles take up the slack and your movement patterns start getting messed up. Give it some more time and you start hurting in other places because of that. I was in that latest stage.

It took another bunch of MRIs and X-rays, along with a special test (warning: graphic) to make sure, but the results were conclusive: I had CECS. The only option was a fasciotomy on all compartments in my lower legs. So about a month ago, I woke up in a hospital bed and saw this when I looked down:

Chronic exertional compartment syndrome in martial-arts

A few hours after surgery.

Two weeks ago the stitches came out and all was fine. I came home, bent down a bit to take my shoes off and hear a sound like cloth tearing. The result was this:

Chronic exertional compartment syndrome in martial arts

Back to the hospital to get stitched up again…

Right now, all is reasonably well. I’m working with clients and am doing my rehab like a good boy and the therapist is confident I’ll get back to normal. But it will take more time to get all those atrophied muscles back in shape, realign my joints and fix the bad movement patterns. Until that’s done, I’m not allowed to do intense training. If I don’t train hard, I won’t be able to perform well for videos. And that’s why I haven’t made a lot of videos for my Youtube channel in the last few years, nor will I do more until I feel I can do a good job.



There are many conclusions you can draw out of all this and I leave you to do just that. I do want to point out a few things :

  • CECS is a difficult condition to diagnose. It is often missed by doctors, as was the case with me. The symptoms are similar to those of other conditions and it takes specific tests to determine it.
  • Medicine is not an exact science. I went to tons of specialists with fancy titles and none of them found what was wrong with me. The body is not a machine, you can’t just take a look and fix it right away.
  • Don’t give up. I won’t lie, I had a rough couple years going through all this. It was frustrating and depressing all in one. But what turned it around for me was getting pissed off when that therapist told me I should give up on hoping for things to get better.

I searched online for references of chronic exertional compartment syndrome in martial arts and didn’t find any. I doubt I’m the first martial artist to get this, but it appears to be rare. So if you ever start getting lots of pain in your legs and they can’t find the problem, ask your doctor if CECS could be the cause. Can’t hurt asking…

As always, good luck in your training.

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  1. Thanks for posting this. I think it’s hugely valuable for all of us to realize that we need to look after ourselves, and that part of that is learning how to listen to our bodies.
    None of us is getting any younger. None of us. And I for one fully intend to try to be as mobile as possible for as long as possible if I have any say in the matter.

    Your point about medical professionals is also very important. They don’t know everything. We ALL bear a responsibility to research, test, and assess, all information, drugs and treatments, and never ignore our experiences inside our own bodies just because a doctor tells you it cannot be so.
    There is nothing to be lost by persevering. The body has a huge ability to heal., once the true problem has been identified.
    Good luck with you recovery.
    All the best,

  2. Hugh Wallace says

    Thanks for sharing Wim and I hope you get better soon.

    This was really interesting to read. I’ve heard of the syndrome because it came up in the sports massage training I did in the summer so I’m surprised nobody you saw considered it. Just goes to show that all ‘experts’ are really only scratching the surface of knowledge. A timely reminder for the likes of me who wants, one day, to be such an expert!

    All the best,


    • I’ve been told by numerous eople that it’s easy to overlook or mistake for something else. But I’m no MD so I can’t comment on that part. I can say that it pissed me off royally to lose several years of having a functional body because of it. But such is life…

  3. Jeffrey Behiels says

    CECS is very common in top end motorsports as well, it’s known as ‘arm pump’. Several top notch MotoGP riders get surgery all the time for it.
    Not very relevant to martial arts, just thought this might be interesting for you.

  4. Hello there. I know it’s been a couple of years since you have posted about this, but I was diagnosed with this syndrome this past September after experiencing symptoms for five straight years. It nearly effected my military career, but fortunately I was able to push through and had great leadership that kept fighting for me.

    I have been considering joining a martial arts class for some time now and I have not gotten the surgery…and do not plan to. I am 35 years old, just landed a new job and can not afford to take the time off to heal and rehab. I was also told that it wasn’t a guaranteed fix.

    I’m writing to see who else you have spoken to about this syndrome, and if the person did suffer from it and wanted to continue training, what style of martial arts would be best for them?

    Thank you.

    • There are different treatments, depending on severity. The best thing you can do is to find a surgeon who actually has plenty of experience with the procedure. Because the condition is relatively rare and easily mistaken for other issues. So they interpret things differntly than MDs who have never treated it.
      I’ve talked to a few other people and they all had surgery. All of them were extremely glad they did it, as am I. IIRC, they did karate or another Japanese style. As far as I know, there is no best style. Either you fix the problem or you don’t and your body continues to degrade. It’s been 3.5 years since my surgery and I’m still rehabbing to fix everything that slowly broke due to CECS.
      IMHO, I would follow this up very closely.

  5. Jim Costa says

    I am glad I found this site as it helps explain some of my issues with CECS. I had the surgery done on both legs after I couldn’t walk for more than 10minutes without pain in both calves. I do suggest one at a time as it took a good 30 days to get to be able to use it again without a cane. Doing both was an option but my surgeon wisely talked me out of it. Now I still have the issue with my forearms and will start to go through the process of getting the pressure test before I can go ahead with the surgery. As far as I am aware, there is no other alternative to relieve the pressure in your muscle groups without the surgery. The incisions are only about 2 inches a piece now due to advances in the surgery but you want someone with experience doing it. I suggest a doctor who practices in sports medicine, because it happens alot with runners who have breaks that cause compartment syndrome. I must say that since the last surgery, both my legs work fine again and I can walk without pain. I was up and walking in 2 weeks with a cane and mostly mobile after 30 days.

    • In my case, it needed to be done both legs at a time because of all the muscle atrophy and other problems; time was a factor. It’s bee n3.5 years since surgery and I’m still rehabbing, finally closing in on normal function again. So never give up on rehab, it’s worth it.
      I walked out of the hospital the day after surgery. Painkillers were obviously a blessing. :-) But a week later, I was already working again, giving a lecture. So it all depends on the long-term damage CECS did before surgery and how your body adapted.
      Check with your doctor before using it, but this saved my life: It revitalized the fascia and was the only thing that helped with the pain (other than medication, which I didn’t want to take for a prolonged period.) I tried all sorts of other massagers, but none were strong enough for me. The Vyper is perfect.
      Good luck with your recovery.

  6. I was diagnosed yesterday. I’ve had shin/ leg pain as far back as I can remember with walking or running and I never knew why. As an adult, I assumed it was severe shin splints. I saw my orthopedic surgeon yesterday for something completely unrelated and finally remembered to mention the shin pain. He asked me a few questions and said that it was not shin splints, but chronic exertional compartment syndrome!

    I, like you, have been suffering from foot pain for years. I’ve seen 6 doctors, countless Physical Therapist, tried all sorts of medications, shoe inserts, shoe types, braces, cast, x rays, MRI’s, and no answers. I saw that you said you were having foot pain as well. Did your doctor say that it was from the compartment syndrome? I’m seriously thinking that this is also the cause of my foot pain!

    I’m not having surgery at this time, because I’m also dealing with Radial Tunnel Syndrome and Tennis Elbow in my left arm. I had the right one done about 2 years ago. I can’t be down to one limb, as I am a full time school owner/instructor (Tang Soo Do).

    I’m curious as to what type of foot pain you were experiencing and how your recovery has been since it’s been several years since this was written?

    • I have permanent damage so my case may not apply to you. I also can’t distinguish the pain in my feet from arthritis I had beforehand already. So it was a constant mix of different kinds of pain. That said: due to the CECS, my ankles dislocated and my foot arches eventually collapsed. In the end, I couldn’t walk for more than a minute. You might have the same thing going on if you’ve had it for a while. I would seriously reconsider the surgery. The problems tend to work their way through your body, all the way to the head, accumulating damage along the way.

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