Published: December 18, 2025
A 13-year-old female presented with bilateral shin pain that began after she increased her gymnastics training from nine to 21 hours per week around nine months prior. Her right leg pain was worse than left. She was seen by an outside sports medicine specialist clinic in August of 2024 and treated with rest and physical therapy. About five months later, she returned to that clinic, and an MRI was ordered. She also was prescribed another course of physical therapy.
After another month, she complained that pain had progressively worsened and was now felt with walking. Her right leg pain was still worse than left. MRI images raised concerns for growth plate fracture, and the patient was referred to Norton Children’s Orthopedics of Louisville, affiliated with the UofL School of Medicine, for further workup.
After multiple rounds of physical therapy, the patient continued to experience significant, activity-limiting pain and remained unable to return to sports.
Her symptoms also did not improve with nonsteroidal anti-inflammatory drugs or rest, which usually would usually be seen with shin splints and stress fractures.
Exertional compartment pressure testing revealed abnormally elevated pressures following exercise, raising concern for an underlying exertional compartment syndrome.
Jennifer M. Brey, M.D.
Pediatric Sports Medicine Physician and Pediatric Orthopedic Surgeon
Norton Children’s Orthopedics of Louisville
Assistant Clinical Professor, PediatricsUofL School of Medicine
Kaitlin M. Zagami, PA-C
Physician Assistant
Affiliated with the UofL School of Medicine
Upon evaluation in the pediatric sports medicine office at Norton Children’s Orthopedics of Louisville, the patient’s legs were noted to be swollen after activities. The MRI was reviewed and felt to be normal, without evidence of growth plate injury. Testing was performed on her legs, which demonstrated an increase in the pressure within the muscle compartments after five minutes of exercise. This confirmed the diagnosis of exercise-induced compartment syndrome of both legs.
She was placed under general anesthesia and received Botox injections into both calf compartments as a minimally invasive treatment to reduce muscle pressure.
At her follow-up visit a year after symptom onset, the patient stated that the pain in her legs had resolved. She was able to rejoin gymnastics practice at full strength and was able to run a 5K with no pain.