Acute Exercise-Induced Compartment Syndrome Following High-Load Resistance Training in a Powerlifter: A Case Report

Acute compartment syndrome (ACS) is a surgical emergency most commonly associated with trauma. A less common variant, acute exercise-induced compartment syndrome (AEICS), occurs without direct injury and is rarely seen in strength athletes. We report a case of a 50-year-old male powerlifter who developed AEICS of the right lower leg following an 815-lb squat. He presented with delayed onset right calf pain, weakness, and creatine kinase (CK) elevation exceeding 93,000 IU/L. Despite an emergent four-compartment fasciotomy, he sustained a persistent right foot drop. This case highlights the diagnostic challenge of AEICS in nontraumatic settings, the potential role of anabolic steroids as a predisposing factor, and the importance of timely recognition and decompression to prevent permanent neurologic deficits.