HighlightsWe present a rare case of exertional paravertebral lumbar compartment syndrome that was initially misdiagnosed as ureteric colic.Exertional lumbar paravertebral compartment syndrome typically present with intractable lumbar back pain 6–12 h following lumbar specific exercise.There is currently no consensus on management with both conservative and surgical techniques used and case reports the only standard for comparison.Long term back pain is more likely in patients managed conservatively.