The following case report describes a collegiate athlete with long-standing unilateral lower extremity exertional pain and associated vague neuropathic symptoms initially diagnosed as Chronic Exertional Compartment Syndrome (CECS). After surgical intervention failed to resolve these symptoms, the athlete presented to our group for further evaluation and was diagnosed with a less common etiology of pain masquerading as CECS. This article includes a less invasive ultrasound guided treatment which was successfully performed resulting in a favorable outcome. In summary, this case discusses the importance of a thorough diagnostic workup in athletes with Exertional Leg Pain (ELP) as well as utilizing less invasive interventions in a step-wise fashion.