Acute compartment syndrome subsequent to high velocity trauma and motor vehicle accidents causing fractures and significant soft trauma in the extremities has been reported in the literature. Compartment syndrome also has been reported to occur after prolonged decubitus position while in the lithotomy position in gynecological patients as well in arthroscopic patients. This case report presents a new and different presentation of acute compartment syndrome. A 39-year-old woman presented with severe pain in her right calf after falling off of a sofa. The patient most likely caused extensive compression of the leg compartments by her body weight and position. This case report is a good example of the high level of suspicion that an orthopedists needs to have when a patient presents to the emergency room with severe pain of an extremity after what may initially be considered to be insignificant trauma.