Movement used to be as easy as “5-6-7-8” for Thea Dumans-Ranum—and it was also her whole life. Every day, from right after school until well past the sun had set, she eagerly danced her heart out in a myriad of dance classes. She trained until she would drop. And then she did, literally.
Compartment syndrome took her legs out from under her. Now every step counts.
For Dumans-Ranum, a sophomore at Carlmont High School who has spent years immersed in dance, compartment syndrome is more than just a medical condition. It is a challenge to her identity as an athlete. But Dumans-Ranum’s story is just one of many— it reflects the numerous lives around the world silently suffering from Compartment Syndrome every day.
Sore muscles
Acute compartment syndrome affects about 34,400 people in the United States annually, especially those who engage in repetitive, high-intensity activities.
However, there is another, more rare branch of this condition. Chronic exertional compartment syndrome (CECS) affects a smaller number of people. Unlike acute compartment syndrome, which disappears after treatment, CECS persists for many years. Patients experience both periods of elevated symptoms and times when the condition is unnoticeable.
“I’ve seen CECS mostly in the legs and the calf region. It can happen in the upper thigh, the arms, but most commonly, the lower leg,” said Laurel Mines, a physical therapist and mental performance coach who runs Bay Laurel Athletics, a physical therapy center in the Bay Area.
For Dumans-Ranum, it started so gradually that it was hardly perceptible.
“At first, it only hurt with big moves such as jetés, or hard leaps. I just thought it was sore muscles, but I was naive,” Dumans-Ranum said.
In most cases, the fleeting nature of CECS can cause it to seem like sore muscles. This is because the pain from CECS will subside with rest and disappear when the affected muscle is not being exerted.
However, during exercise, CECS symptoms can flare up intensely. Muscle compartments — muscles or groups of muscles surrounded by a fascia (a thin membrane surrounding muscles) — can swell up to 20% of their original size and cause more than just pain. According to a paper by Penn Highlands Healthcare System, this swelling can even impede movement for individuals.
“The condition develops slowly over time, which can be associated with exercise training errors. If you keep exercising, you continue to cause more inflammation within the compartment, making it more painful, and in turn, may shrink the muscles,” said Dr. Danielle Conway Littlehale, a physical therapist at Agile Physical Therapy.
As time passed, the pain and swelling began to creep earlier and earlier into Dumans-Ranum’s dance routines. What was once a minor nuisance after dance rehearsals became an issue that affected the quality of her dance.
It also didn’t help that Dumans-Ranum trained for hours each day. CECS, which usually lies dormant for most people outside of strenuous activity, began to limit her mobility outside of dance. She would spend up to 30 minutes massaging her calves to mitigate the pain.
“I remember when it first started, my mom bought me this expensive massage gun,” Dumans-Ranum said. “We tried every at-home remedy probably on the planet, but nothing helped.”
Every day that she pushed through the pain, dancing became harder. At one point, she couldn’t even do leaps anymore. But still, she continued dancing, chalking her injury up to lack of willpower and sore muscles. Numb, tingling feet and sharp stabbing pain in her calf became commonplace.
This experience is not an isolated one. Up to 11% of NCAA Division I student-athletes report that they experience burnout from pushing themselves when they shouldn’t. However, this number is estimated to be far greater than reported.
According to Prairie Orthopaedic & Plastic Surgery, 54% of student-athletes reported playing with an injury, which can be very dangerous and lead to the progression and development of new and existing conditions. Athletes with previous injuries, particularly chronic ones, report feeling a reduced sense of accomplishment in their sport.
Returning to a sport after an injury can be a very disorienting experience, especially because those around the injured athlete have progressed while the athlete is making up for lost time. This may discourage athletes from taking breaks in the first place.
“I was thinking, ‘What if I have to move down a level? What will this do for my progress?’ I only had three more years left before I graduated, and I didn’t want to miss any of them,” Dumans-Ranum said.
Then, one day, in the middle of a turn, Dumans-Ranum’s legs buckled, and she fell to the floor. At first, she thought she had tripped over her feet, but nothing happened as she tried to get up. Her left calf muscle was completely paralyzed.
“That might have been the scariest moment of my life. There are no words to describe the feeling of something vital, like movement, being taken away from you,” Dumans-Ranum said.
Her superficial peroneal nerve (SPN), which controls the foot, had been pinched, leading to temporary paralysis. The immense swelling and the time she had left the condition untreated culminated in her muscles temporarily shutting down. This is a late-stage symptom and indicates a severe progression of the condition.
“That’s when I knew something was seriously wrong. Your muscles don’t just give out, especially for someone as strong as a dancer,” Dumans-Ranum said.
She was rushed to the hospital, leg elevated in the backseat, with tears in her eyes—not from the pain, but from the fear that her life would be drastically different.
Slow burn: diagnosing chronic exertional compartment syndrome
Dumans-Ranum’s visit to the hospital was neither quick nor efficient. While the paralysis had since faded, it was still necessary to figure out its cause. What started off as an urgent care visit quickly transformed into an arduous journey spanning months, and many days spent consulting different orthopedic and sports medicine doctors.
At first, they thought she was faking it due to the fact that she had been overtraining in dance. They assumed it was fatigue and sent her home with painkillers and ice packs.
“I knew there was something wrong. I was frustrated, and the doctors were frustrated. We were all just grasping at straws,” Dumans-Ranum said.
Later, she was told it she had pulled a muscle and then danced on it, and a muscle spasm enhanced by her existing injury took her out. Her doctors recommended rest and physical therapy.
12 million patients around the United States receive a misdiagnosis every year and share Dumans-Ranum’s frustrations because these misdiagnoses can lead to serious consequences.
“I don’t get how you dismiss someone in so much pain,” Dumans-Ranum said. “It’s their job to help me, and they didn’t even try to do it.”
Dumans-Ranum felt frustrated but also afraid of developing something more serious if she wasn’t diagnosed properly.
Misdiagnosis for CECS can be very high due to its elusive nature. The incidence rate for the condition widely varies from 10% to 64%. This means that in every given year. The non-specific term “shin splints” is often used by patients to cover the umbrella of symptoms associated with CECS and can be mistaken for this condition.
“I could see it flying under the radar and being misdiagnosed. When an athlete sees their medical provider, rest is one of the first things mentioned, so doctors may help alleviate symptoms of CECS without properly diagnosing their patient,” Conway Littlehale said while recalling her patient’s experiences with CECS.
Over a period of six months, Dumans-Ranum was in and out of the doctor’s office, growing increasingly desperate for a diagnosis. After a month, when a muscle strain should have long resolved itself, the next misdiagnosis came. The doctors thought she had varicose veins, a condition where veins are enlarged and look twisted upon themselves due to weakened blood vessels letting blood pool and lowering blood pressure. Still, Dumans-Ranum knew that this was not the right diagnosis.
“Finally, I saw something really off. There was a slight, almost unnoticeable bulge in my calf muscle; I had developed a hernia, which is when the muscle bulges out of the fascia. We immediately called my doctor and scheduled an appointment,” Dumans-Ranum said.
After six months of uncertainty, she finally had her diagnosis. Now, Dumans-Ranum would have to begin her battle with treating CECS.
A risky way out
The existing treatments for CECS are very limited. Mitigation strategies include rest, alternating foot-striking patterns, and taping the affected area, while the three main treatment paths are botox, physical therapy, and surgery.
“When the doctor laid out the treatments to me, that’s when I grasped the severity of my situation,” Dumans-Ranum said. “Each treatment was a journey of its own, and there was no easy fix.”
The surgical treatment option, specifically a fasciotomy, is a procedure where incisions are made in the fascia around the affected muscle to allow space for the muscle to expand and relieve pressure. These incisions can be very large and, in some cases, run down almost the entirety of the calf. This makes recovery for such a large area very prolonged and painful.
The eventual scars that accompany this surgery can be equally large and noticeable, discouraging many patients from pursuing surgery as a treatment option.
Aesthetics aside, even more concerns about the surgery stem from the long list of adverse outcomes.
“Surgery can relieve pressure in the compartment, but it doesn’t guarantee success,” Dumans-Ranum said. “The doctors warned me the surgery wasn’t always effective, and there’s a risk of nerve damage or infection.”
One narrative review at Qassim University in Saudi Arabia put the number of patients who experience unfavorable complications as high as 38%. Hematomas — internal bleeding — could affect up to 22.5% of patients. Up to 18.5% of patients could experience nerve damage, and 2.7% may experience deep vein thrombosis (blood clots in veins deep inside the body). Muscle tissue death is another possibility. Due to all these complications or when symptoms recur, up to one in ten patients need an additional revision fasciotomy.
“I had surgery on Nov. 8, 2023, and we did all compartments, both legs at the same time,” said Traci Leaumont, who was diagnosed with CECS while in college playing ultimate frisbee for her school.
She shares her story with CECS on TikTok and is one of the few influencers discussing the rare condition.
“And then I got a complication in my right leg after surgery, so I didn’t walk for 25 days and couldn’t drive for 40,” Leaumont said.
Leaumont’s story illustrates the risks of the surgery. Still, it did improve her condition for a while, until she had a recurrence of symptoms.
“Things started to progress at the three-month mark. I started running again, and things were looking really good, and then some of the pain started coming back,” Leaumont said.
Dumans-Ranum considered the surgery but quickly dismissed the option. The surgery could be everything she dreamed of, but it could also end the possibility of returning to dance permanently.
“When I see people who have to retire because of an injury, sometimes challenges arise when they expect their bodies to do what they used to, but can’t anymore because of injury. That’s tough,” said Dr. Amie Haas, a licensed clinical psychologist and professor of psychology at Palo Alto University.
One article by Trifecta Therapeutics reported satisfaction rates of the surgery as low as 48%. Undergoing this surgery could be like betting one’s livelihood and ability to move on a coin toss.
Ultimately, Dumans-Ranum decided to work her way back to dance through physical therapy.
The long road to recovery
To manage CECS, physical therapists design specialized regimens consisting of stretching and soft tissue mobilization, deep pressure to relieve muscles, and strengthening exercises.
Dumans-Ranum started her physical therapy journey in October of 2023. Her sessions were tailored towards soft tissue exercises because of the severe progression of her condition. This included deep massages on the affected area and frequent foam rolling. She would also do various calf stretches, like ankle rolls and downward dogs.
“I really tried to believe that physical therapy would help me. I was doing everything, but my calves still hurt,” Dumans-Ranum said.
She would attend every appointment and spend almost half an hour every day completing the exercises her physical therapist assigned as homework. But as the months dragged on, the promised recovery kept being pushed farther and farther, and it seemed as if every time she got close to the finish line, it moved.
“I still could only dance in small spurts, which was negatively affecting my skills. I got frustrated once and doubled the amount of physical therapy exercises I was doing. That really backfired on me and set me back again,” Dumans-Ranum said.
Dumans-Ranum’s physical therapist introduced her to other exercises, such as gait training, which is a practice that alters weight distribution when walking and running. These techniques helped her function in her daily life, but did not improve her ability to dance.
CECS was also very unpredictable. For some time, she would experience symptom relief and feel like she was back to normal. Then she would exert herself, and be back to square one. She felt increasingly frustrated and fed up with physical therapy and began to rethink her treatment options.
“I haven’t worked with anyone with CECS, but a few colleagues have. They said physical therapy seemed not to be too successful, as they needed to go back to their medical doctor for a medical procedure,” Conway Littlehale said.
According to a cohort from a military rehabilitation center, only 65% of personnel with CECS were able to return to active duty without surgical methods.
Another article reported that only 25% of patients who chose non-surgical treatment were able to return to pre-symptomatic activity levels, compared to 77.4% for those who underwent a fasciotomy. While Physical Therapy may be the safer option, it often does not result in a full recovery.
Leaumont, who also went through physical therapy for CECS, shared many of Dumans-Ranum’s notions on the treatment option, which shows that from the perspective of many patients, physical therapy is often considered unsuccessful.
With this option exhausted, Dumans-Ranum decided to try the relatively new Botulinum Toxin A Botox injections next. This treatment is a long-duration, low-risk alternative to a fasciotomy, although long-term outcomes are currently unknown.
In May of 2024, Dumans-Ranum had her first Botox injection.
“At first, it felt a little bit like a miracle. Physical therapy was really slow and gradual, and with Botox, you can really notice it right after,” Dumans-Ranum said. “But my hopes were squashed again since it faded just a couple of weeks after the injection.”
Botox works by blocking the release of acetylcholine, a neurotransmitter responsible for muscle contractions. This reduces the overactivity of muscles and allows them to relax, thus decreasing pressure in the muscle compartment. The downside of this treatment is that it requires maintenance.
In one retrospective study by the Clinical Journal of Sports Medicine, almost 70% of athletes who received Botox were able to return to normal activity for their sport. However, 57% experienced a complete recurrence of CECS symptoms by five months.
For patients like Dumans-Ranum, who did suffer a recurrence of symptoms, Botox served as an unreliable stopgap to her issue rather than a definite fix.
“Botox can alleviate symptoms, but it doesn’t resolve the root cause, which is compartment pressure,” Conway Littlehale said. “It also should be paired with additional physical therapy, so it is not exactly a standalone treatment.”
Though Botox helped Dumans-Ranum temporarily, she ultimately decided against a second injection. Instead, she chose to continue physical therapy for the foreseeable future, hoping that it would start working sooner rather than later.
Coping with a chronic condition
According to a review by Ohio University in Athens, around half of all NCAA D1 athletes also have some kind of chronic injury. While Dumans-Ranum’s condition may be rare, the situation she finds herself in is not. Many other athletes have been put out of their passions by chronic conditions with no quick fix and have to work many hours every day to regain the level of motion they once possessed.
“I feel like I’m a mile behind where I should be. Sometimes my legs start hurting towards the end of the school day just from walking between classes, and it’s really humbling,” Dumans-Ranum said. “I still hold out hope for a miracle recovery, but it’s hard. ”
Leaumont, who had a fasciotomy in mid-2023, has still not returned to her sport because of a recurrence of symptoms in her right leg. She and her doctors believe that since she was not able to move due to her complications for a couple of weeks, scar tissue formed over the fascia and is now causing more problems. CECS has incapacitated her for almost a year now, while her ultimate frisbee teammates continue to progress and grow.
“This year, my team qualified for regionals and placed higher, and it was really hard to just sit and watch it happen and not be a part of it,” Leaumont said.
Many athletes who end up developing CECS often start young and train very intensively, such as Dumans-Ranum, who started dance at six years of age, or Leaumont, who played ultimate frisbee at the college level for her university. Having put so much effort and time into a sport, redefining one’s self-image completely separate from that sport can be challenging.
“If what you love to do is all you do, it can be tough, because your identity may be so connected to your passion,” Haas said.
Haas believes passion is something that can be transferred into something else that’s meaningful to an individual. Once other meaningful activities are identified, the key is to rechannel work ethic and passion, and hopefully find a renewed sense of purpose somewhere along the way.
“That kind of flexibility in thinking is important in life, in whatever you do. I view sports as a foundation, a way to learn important things like self-efficacy, hard work, and humility,” Haas said. “Those skills are important in whatever you do, and can shift to new dreams and goals that may be even better than the ones you had in your prior sport.”
Dumans-Ranum is trying to do just that — find other hobbies that spark excitement and interest.
“I’m trying to branch out past dance. I still practice as much as my body lets me, but I’ve taken up art, and I’m getting more involved in leadership at school and other places,” Dumans-Ranum said. “I still miss dance, but it’s opened up a world of possibilities for me. It’s given me time to think about who I am without dance.
However, many athletes find that redefining themselves can be difficult. For example, Leaumont’s other interests were all physical, like running and swimming, and she couldn’t avoid the loss of most of those activities because CECS affected all of her movement.
That being said, redefining an individual’s identity does not mean they have to let go of their sport and passion entirely. Haas believes that one’s connection to their activity can be redefined in different ways that can still uphold their sense of self.
“One coping strategy may be to problem solve to see how the skills they learned in their activity can be translated to something else. For example, a dancer may not be able to dance themself, but could be an excellent choreographer or dance teacher,” Haas said.
For all athletes struggling with CECS or another chronic condition, it is important to seek out help because without it, thoughts can spiral out of control.
“I felt really alone and confused with myself when it all first started,” Dumans-Ranum said. “I want to raise awareness of that and make sure others know that they are not alone in what they’re feeling.”
Though CECS is rare, if someone with the condition looks for help, they will find a community full of resources and support. From social media influencers like Leaumont sharing their stories online to psychologists such as Haas and other professionals who can assist CECS patients emotionally, mentally, and physically, help is available to those who look for it.
“A key to maintaining good mental health, even when you’re injured, is to recognize when you’re struggling and not be afraid to ask for help,” Haas said.
Looking to the future
Dumans-Ranum hopes to be nearing the end of her journey with CECS. She plans to go through with the fasciotomy surgery sometime in the spring of 2025. While the procedure can be risky, those who have successful surgeries typically go on to make a full recovery and eventually return to their sport at pre-CECS levels.
“I feel like I’m at a low point in my dance career right now, and I’m giving this one last shot,” Dumans-Ranum said.
The risk of recurrence does exist, but many, including Dumans-Ranum, deem it a calculated risk for reaping the potential benefits of a fasciotomy.
While dance is still front and center in Dumans-Ranum’s heart, she is taking multiple new steps towards her future. Whether that is a forward step in her recovery through surgery or a tentative step into different areas of interest to define herself without dance, she is sure that when she comes out on the other end, her sense of identity and ability to overcome hardship will be better for it.
“It’s been a rough time, really rough. But ultimately CECS has had one good virtue — how it changed my worldview,” Dumans-Ranum said. “Would I go back to before all this if I could? In a heartbeat. But would I choose to forget all the knowledge, self-reflection, and personal growth that going through CECS gave me? No, definitely not.”