It’s one week to the Jersey City Marathon, and I haven’t run pain-free since March 28. Last week, I had no idea what was happening. This week, I think I know. It doesn’t really change how all of this has felt, which is wildly frustrating and at times pretty depressing. I’ve been trying to maintain a neutral attitude, but the best I have been able to do most of the time is aloof. My normal pre-race worries about weather forecasts and sleep quality feel so far away right now.
I think I was right about compartment syndrome. At first, I had to doubt it because I’ve run so many miles over so many years for this to suddenly show up now, fifteen years after my surgeries. It didn’t make sense. What changed?
The change is that I started taking creatine about two months ago. After hearing a lot about it online, it seemed like a no-brainer, no-risk supplement that might have some small benefit to my training. For many people, it is! Keeping your muscles chock full of extra phosphates to power the ATP cycle is like keeping a battery fully charged. The creatine sales pitch is you can train harder and recover better with full batteries, and maybe even think clearer—brain cells use ATP too. You might carry a little more water weight, but even that might have benefits for keeping your body hydrated during prolonged activity—I saw some discussion about this but couldn’t find a paper on it in my limited research. Ask your doctor if creatine is right for you!
I should have. At least, I should have tested it outside of a critical training block first.
With my history of compartment syndrome, that extra water weight is adding volume where I can’t bear it. My fully charged batteries look more like an overcharged battery: bloated and threatening to explode. I have a feeling this is why I haven’t been able to run the past two weeks. After weeks of supplementing, my muscles must have finally hit their limit. I’m running on a pair of Samsung Galaxy Note 7s.
Once I made the connection, I went online and confirmed that yes, creatine supplementation increases intracompartmental pressure in the lower legs, yes, it can do so enough to show signs of compartment syndrome, and yes, other people have anecdotally experienced this same issue. Shit.
The good news is I shouldn’t need surgery to fix this—I caused it by taking creatine, and I can stop it by stopping creatine. I actually had a sneaky suspicion the creatine could be causing problems at least a week ago, so I already stopped taking it.
The bad news is that creatine stores can take a long time to return to baseline, on the order of 4 to 6 weeks. My only hope is that I don’t need a full return to baseline to run without pain—I’ll only be about two and a half weeks removed by race day—and that I haven’t done additional damage by trying to run on it in the meantime.
So how do I get myself running again? I’ve been working with a few physical therapists on this, and we’re tackling it from a variety of angles:
- First, we want to encourage my muscles to let go of their creatine stores. I’m staying active on the exercise bike to maintain my fitness until the race, but any activity has the added benefit of draining my bloated batteries just a little bit. We’re also using compression to encourage fluid exchange in my legs, and I’m staying hydrated so I can readily pass anything my muscles leak out.
- Second, we want to improve the function of my soleus so it’s not so quickly overwhelmed by the demands of running. I’m doing seated calf raises most days, with weight, to strengthen the muscle. I’m also stretching and foam rolling to stay loose.
- Finally, we want to support my soleus with other muscles as best we can. This week I’m starting new exercises to activate my glutes and hamstrings.
I’ll be going for another test run on Wednesday to see how much all of this has been helping.
So far, I’ve noticed a slight improvement in symptoms from run to run, but progress has been slow. It doesn’t feel like I’m going to be ready by race day. At the same time, this is a problem that is likely going to get better suddenly, all at once—as soon as the pressure drops enough in my lower leg, I won’t feel any pain at all. That could happen at any moment. I have to hold out hope, keep my fears at bay—compartmentalize, if you will—and keep preparing like I’m going to race on Sunday. I have to try.

