Sports-medicine diagnostics · Patient guide
Compartment pressure testing, the diagnostic test for chronic exertional compartment syndrome.
Intracompartmental pressure measurement is the diagnostic test for chronic exertional compartment syndrome (CECS) — most commonly of the lower leg. Pressures are recorded before and after treadmill exercise using a Stryker needle system.
Why patients choose us
- 01
The right hands
We route you to a sports-medicine consultant experienced in intracompartmental pressure testing — the person doing the needle work also interprets it against the Pedowitz criteria.
- 02
Often answers same-day
Pre- and post-exercise readings can be discussed immediately, with a written report to your referring specialist to follow.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — including whether to test at all — is impartial and costs you nothing.
Key facts
The six things to know about compartment pressure testing.
The short version: what the test is, when it is indicated, and how the result changes the plan.
- 01
Definition
Needle-based intracompartmental pressure measurement recorded before and after provocative exercise.
- 02
Gold-standard test
The diagnostic test for chronic exertional compartment syndrome (CECS).
- 03
Pedowitz criteria
Standardised pressure thresholds applied at rest, 1 minute and 5 minutes post-exercise.
- 04
Not the acute variant
Acute compartment syndrome is a surgical emergency — pressure testing is for the chronic exertional form.
- 05
Guides fasciotomy referral
A positive test is the trigger for a considered fasciotomy discussion.
- 06
Complements MRI and gait
Sits alongside MRI and gait analysis to build the full picture — it does not replace them.
The problem
Exertional leg pain that never quite gets diagnosed.
Chronic exertional compartment syndrome is repeatable, reproducible and often bilateral — and it is still missed for months. Pressure testing is the objective answer when the history fits.
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Pain that comes on with running
Reproducible tightness or pain at a predictable distance, that settles with rest.
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Bilateral, hard-to-pin-down leg pain
Symptoms in both legs that have defied physio, orthotics and imaging so far.
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Considering fasciotomy?
A confirmed diagnosis with pressure testing is the usual pre-requisite for that conversation.
Preparation and journey
From referral to report — what happens, in order.
Seven steps, from the sports-medicine consultation to the written report your specialist can act on.
Phase 1 · Before
Consultation first
Phase 2 · On the day
Needle, exercise, repeat
Phase 3 · After
Interpretation and report
- 01
Before
Sports-medicine consultation
Consultant history and examination first — pressure testing is only booked when the clinical picture fits CECS.
- 02
On the day
Ultrasound-guided needle placement
A Stryker needle is placed into the target compartment under ultrasound guidance for accuracy and comfort.
- 03
On the day
Baseline pressure recorded
Resting intracompartmental pressure is measured before any exercise.
- 04
On the day
Treadmill or provocative exercise
You run or perform the activity that reproduces your symptoms, until the pain is representative.
- 05
On the day
Repeat pressure at 1 and 5 minutes
Post-exercise readings are taken at 1 minute and 5 minutes — the two time points that define the Pedowitz criteria.
- 06
After
Pedowitz criteria applied
Findings are interpreted against validated thresholds to confirm or exclude chronic exertional compartment syndrome.
- 07
After
Written report to your specialist
A formal report goes to the referring sports-medicine or orthopaedic consultant with a clear next step.
What it shows
What compartment pressure testing actually reports.
A precise, narrow answer: three pressures per compartment, interpreted against the Pedowitz criteria.
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Baseline intracompartmental pressure
Resting pressure in the target compartment, before any exercise.
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Post-exercise pressure at 1 minute
The first Pedowitz time point — the earliest post-exertion reading.
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Post-exercise pressure at 5 minutes
The second Pedowitz time point — pressures that fail to normalise support the diagnosis.
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Anterior, lateral, deep-posterior compartments
The three compartments most commonly involved in lower-leg CECS.
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Chronic exertional compartment syndrome
Confirmed when the Pedowitz criteria are met on the recorded readings.
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Bilateral disease pattern
CECS is often bilateral — both legs are typically considered on the same visit.
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Compartment fascial hypertrophy on MRI
A supportive MRI finding when cross-sectional imaging is done alongside.
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Red flag: acute compartment syndrome — pain out of proportion — surgical emergency
Sudden, severe, disproportionate limb pain after trauma or exertion is a 999 / A&E problem, not a private appointment.
Next steps
Treatment options after a positive test.
Conservative first, then targeted — the sequence a sports-medicine consultant will usually follow.
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Activity modification
The first-line step — modifying volume, intensity or surface to keep you moving while symptoms are worked up.
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Gait retraining (forefoot strike)
A forefoot-strike pattern has evidence for reducing anterior-compartment pressures in selected runners.
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Physiotherapy and stretching
Structured physio, calf and fascial mobility work as a conservative trial before any injection or surgery.
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Botulinum toxin injections
Specialist ultrasound-guided botulinum toxin into affected compartments — used in selected cases as an alternative to surgery.
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Fasciotomy of affected compartments
Surgical release of the affected compartments — the definitive option for confirmed refractory CECS.
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Sports-medicine follow-up
Consultant-led follow-up to sequence conservative, injection and surgical options in the right order.
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Return-to-sport protocol
A staged loading plan after intervention — running distance, intensity and terrain progressed in defined steps.
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Repeat testing after intervention
Repeat pressure testing when clinically indicated, to confirm the response after surgery or botulinum toxin.
Our vetted London network
A small panel of clinicians, we picked them.
Sports-medicine consultants across London who do this test regularly. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every clinician in our network.
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Sports-medicine consultants with a specific interest in chronic exertional compartment syndrome
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Stryker needle system with ultrasound-guided placement
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Standardised pre- and post-exercise Pedowitz protocol
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Same-day discussion of findings, formal written report to your referring specialist
Red flags and mimics
When it isn’t a pressure-testing problem.
The situations where an elective pressure test is the wrong first move — and the mimics worth considering.
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Acute compartment syndrome
Sudden severe limb pain — often out of proportion to injury, with a tense, swollen compartment — is a surgical emergency, not an outpatient test.
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Post-op infection
Fever, spreading redness or wound discharge after fasciotomy needs urgent surgical review, not a repeat pressure test.
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Nerve injury (superficial peroneal)
New numbness or weakness in the foot after testing or surgery is reviewed by the operating team promptly.
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Failed fasciotomy
Persistent symptoms after surgical release warrant reassessment — repeat pressure testing may form part of that work-up.
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Bilateral disease
CECS is frequently bilateral; both legs are often tested and treated together where appropriate.
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Concomitant tibial stress fracture
Point-tender bony pain, night pain or worsening with weight-bearing warrants MRI to exclude a stress fracture before repeated testing.
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Post-traumatic compartment syndrome
Compartment syndrome after fracture or crush injury is a distinct surgical problem — not managed via elective pressure testing.
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Diabetic myonecrosis
A rare mimic in people with long-standing diabetes; suspected on MRI and managed medically, not surgically.
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Rhabdomyolysis
Severe muscle pain with dark urine after intense exercise needs urgent bloods and A&E review, not a scheduled pressure test.
Reading your report
A pressure-testing report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your doctor, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and sporting context
Your details, the presenting symptoms, sport or activity, and the specific question being asked of the test.
- 02 Technique
Compartments tested and exercise protocol
Which compartments were interrogated, the needle system used, and the exercise protocol that provoked symptoms.
- 03 Findings
Baseline, 1-minute and 5-minute pressures
The three recorded pressures per compartment, compared against Pedowitz thresholds.
- 04 Impression
The conclusion: read this first
Whether the Pedowitz criteria are met, on which side, and the concrete next step — read this first.
Recognised by major UK insurers
Cover depends on your policy and clinic; we confirm with your insurer before booking.
Frequently asked
Everything we get asked about compartment pressure testing.
Short answers on what the test is, how CECS is diagnosed, and when fasciotomy comes into it.
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What is compartment pressure testing?
A diagnostic test in which intracompartmental pressures are measured with a needle system — usually a Stryker — before and after provocative exercise. It is the diagnostic test for chronic exertional compartment syndrome (CECS), most commonly of the lower leg.
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How is chronic exertional compartment syndrome diagnosed?
By recording resting compartment pressure, exercising until symptoms are reproduced, then repeating the pressure at 1 minute and 5 minutes post-exercise. Findings are interpreted against the Pedowitz criteria — pressures that remain elevated support the diagnosis.
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What is the difference between acute and chronic compartment syndrome?
Acute compartment syndrome is a surgical emergency, usually after trauma, with severe pain out of proportion and a tense compartment — call 999 or attend A&E. Chronic exertional compartment syndrome is a repeatable exercise-induced pain pattern that fully settles with rest, and is the condition that pressure testing is designed to diagnose.
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Do I need a referral?
Yes — pressure testing sits inside a sports-medicine consultation. The clinical history and examination decide whether the test is indicated. We arrange the consultant appointment first.
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How soon can I run after the test?
The test itself is well tolerated. Most patients return to normal walking the same day and to gentle exercise within a few days. Any return-to-sport plan after a positive test is set by the sports-medicine consultant.
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When is fasciotomy the right next step?
When the Pedowitz criteria are met, symptoms are refractory to conservative measures, and quality of life or sporting participation is materially affected. The decision is a specialist one, not made by the test in isolation.
Sources
The guidance behind this page.
- British Association for Sport and Exercise Medicine (BASEM).
- NICE. Musculoskeletal conditions guidance.
- American Orthopaedic Society for Sports Medicine (AOSSM).
- Pedowitz RA et al. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.
Last reviewed 2026-07-30 · Next review 2027-07-30 · Reviewed by Pulse Atlas Editorial Board, .
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In practice, in London
Getting compartment pressure testing sorted in London, without the guesswork
With compartment pressure testing, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. Waiting lists on the NHS for compartment pressure testing vary widely by borough and by how the GP letter reads. Privately in London, we can normally offer a slot inside the same week, sometimes within 48 hours if there’s a cancellation. The difference isn’t clinical quality — the consultants are frequently the same faces you’d see on the NHS — it’s the calendar.
Once you’re in the private system for compartment pressure testing, the pace picks up noticeably. Consultant slots run to time, imaging is usually available in the same building or a short walk away, and the report comes back typed and detailed. It’s the coordination that tends to feel different — one person on the other end of the phone, not a switchboard. For compartment pressure testing specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
The value of going through a concierge for compartment pressure testing isn’t access — anyone with an insurer or a credit card can get a private appointment in London. The value is knowing which consultant reads this particular presentation best, which unit turns reports around fastest, and which pathway won’t hit a dead end if the findings point somewhere unexpected.