Chronic exertional compartment syndrome (CECS) commonly occurs in young adult runners. The mechanism of pain is unknown. CECS is a clinical diagnosis and is confirmed by intracompartmental pressure testing (IPT). The evidence-based guidance for IPT is sparse. Instead of Pedowitz et al's criteria we recommend one minute after pain triggered exercise IPT ≥ 36 mmHg as diagnostic value. At the moment fasciotomy is the treatment of choice for athletes who would like to maintain the same level of activity, but injection with botulinum toxin type A could be a new useful alternative.