Compartment syndrome occurs when the intramuscular pressure (IMP) within an enclosed muscle compartment increases to the point where it restricts the blood flow to the region and thereby causes pain and impaired muscle function. The acute form, acute compartment syndrome (ACS), is a limb-threatening condition where the increase in IMP is caused by an injury or loss of circulation, and acute surgical treatment is essential to avoid irreversible injuries. In the chronic form, chronic exertional compartment syndrome (CECS), the increase in IMP due to activity induced muscle expansion leads to pain during exercise but reversal of symptoms at rest. In patients with CECS, the compartments of the lower leg are the most commonly involved. The anterior compartment is predominantly affected; isolated anterior CECS represents more than 60% of lower-leg CECS. Young athletes, especially runners and soccer players, are over-represented among CECS patients. The diagnosis of CECS is based on the patient’s history, clinical examination, and post-exercise measurement of IMP. The most widely used IMP criteria for CECS are based on the Pedowitz diagnostic criteria: cut-off values are set at ≥ 30 mmHg at 1-min post-exercise, or ≥ 20 mmHg at 5 min post-exercise. The gold standard treatment for CECS is fasciotomy of the compartment(s) involved. Common differential diagnoses of exercise-induced lower leg pain are medial tibial stress syndrome, popliteal artery entrapment syndrome, stress fractures, and nerve entrapment syndromes.