Exertional compartment syndrome has been described and implicated in pain syndromes involving several fascial compartments. This entity is classically characterized in the legs, feet and forearms of athletes. We describe a case of acute, severe exertional compartment syndrome of the paraspinal muscles in a young and healthy male ultimately resulting in significant rhabdomyolysis and acute kidney injury. The rarity of the syndrome has prevented the establishment of specific guidelines for management; therefore, we will discuss this case in the context of similar previously reported cases, contrasting the various treatment approaches and outcomes described in previous reports. This discussion outlines a syndrome not commonly considered in the differential diagnosis of back pain.