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Extreme quadriceps starting pain after 3-4 rest days

Moderator: Tonton

21 Feb 2017 23:06

Hi Shayne. I watched that video and of the 3/4 symptoms mentioned I have only had the severe cramps. I've never had the second wind, fatigue when exercising or the red urine (the other symptoms). You mentioned you didn't have second wind. What about red urine (rhabdomyolysis?)? How did you get on with the dietitian also? Cheers Clarky
Clarky07920
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26 Feb 2017 07:51

My cramps do occur after rest days (I travel with work and exercise is not possible) If I consume carbs combined with no exercise during this period I will cramp,..sure as when returning to exercise .... the only possible escape from a week of cramps when returning to exercise is to avoid carbs during a period of "no exercise" . I dont have an answer but believe the reduction of carbs may contribute to escaping from the "hell" dealing with muscle cramps when returning to exercise
CFM
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05 Mar 2017 14:22

Shayne, I'm glad to hear you've got some sort of diagnosis, and I really look forward to hearing what the recommended dietary or other guidance is.

My first reaction after reading the list of McArdle's symptoms was similar to those above -- basically, no way. McArdle's is described as a genetic inability to process muscle glycogen. But many of us here are high functioning athletes with plenty of explosive power available without a warmup (ever show up to a cyclocross race with just enough time to get to the line?). And what many of us experience is entirely episodic; with a certain set of preconditions, like an unusual amount of rest, long-haul travel, or increased carb intake, and particular eccentric muscle activity (ie walking downhill), an episode occurs, which lasts for days until it clears up.

But the more I think about it, the more I think it's probably a mistake to try to find some holy grail of matching symptoms with a corresponding magic treatment. It seems clear that most of us are experiencing some sort of metabolic myopathy -- basically, with the right conditions, we go into rhabdomyolysis. It seems very likely there is a combination of genetic factors, specific body chemistry levels brought about through particular rest/dietary conditions, and physical triggers that makes a sort of perfect storm to initiate an episode. Maybe it doesn't match the exact set of symptoms that define McArdle's, but biology is always on a spectrum.
globecanvas
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09 Mar 2017 14:58

I think your probably right... I have given up looking for a cure/solution other than to reduce the level of training I do. Cycling was pretty much my life but it has helped me to prioritise a few things like family and work. Ironically I actually feel like I have a better balance now - I still enjoy cycling (although no longer racing) and I don't worry about having a couple of extra beers and gaining a couple of pounds! It's meant I've spent more times with the kids as well. I also bought a motocross bike which is a nice distraction ; )
Clarky07920
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29 Mar 2017 17:57

Wow, I'm a bit excited that I've finally found others having the same problem as me but at the same time a bit disappointed after reading all 11 pages that there seems to be no definitive answer to our problem.

I'm a competitive cyclist (USA Crit and Track) and like many others have stated I get the same 'stabbing' pains in my quads after intensive training blocks, usually only after resting for 1-3 days. Typical training week is ~ 12 hours 250miles on the high end which include 2 training crits, 1 active recover ride (~20-30miles), 1 solo temp ride (~30 miles) 1 race day which may consist of 2-3 races = 80-100minutes of racing.

The pain, just like everyone else, jumps around to different muscle groups in my quads, above the knee, hamstrings, glutes. It's a sharp stabbing pain, causing the muscles to feel like they are contracted and leaving my quads very soar afterwards.

I live on the third floor of my condo complex and have to take 4 flights of stairs. I can always tell when I'm about to have an attack when I walk down the stairs and about 30 seconds later the quads start to tingle and go into full spasm. Going upstairs is not problem, it's always the down part. I've been dealing with this problem for about 5 years now, it's very frustrating.

My only solution has been to get on the trainer/rollers and spin for 30 seconds to 1 minute, just about the time the quads start locking up but not full spasm, get off the bike and stretch deep. Rinse and repeat this for 1-2 hours for anywhere from 1-4 days until I'm to a point where I can ride again with only mild tightening. Once it's mild enough I seem to be able to ride through the initial tightness and I'm right back to having ZERO problems and 100% heath.

Been to my primary DR, chiropractor , PT, massage, nothing works. After reading some of the posts here seems like the only thing left to do is muscle biopsy but I really cant be on crutches for a week and off the bike for 6 weeks in the middle of race season.

Like everyone else here, cycling is life, it's so frustrating to be sidelined while watching all of my friends racing and training and all I can do is sit and watch. Try to tell anyone whats wrong with you and you get the same generic, "Well you're not stretching enough", "You need to eat more potassium and hydrate", "Foam roller and compression". NONE of these things work to solve the problem, I've been there, done that, got the Tee Shirt.

Anyway as I said I'm glad to have found this thread and will keep an eye out for any real solutions. Thank you to everyone that has contributed a story here, it's nice to know I'm not the only one out there with this disorder.
Last edited by SB23 on 29 Mar 2017 18:13, edited 1 time in total.
SB23
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29 Mar 2017 18:08

Welcome SB23. How often you you have these episodes? You might be a more susceptible than others if you have to walk down a lot of stairs every day, as eccentric muscle loading seems like a common trigger. Have you ever tried loading up on NSAIDs when you feel an attack coming on, as per this comment?

viewtopic.php?p=2061501#p2061501 (oops fixed the link)
Last edited by globecanvas on 29 Mar 2017 18:26, edited 1 time in total.
globecanvas
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29 Mar 2017 18:20

Welcome, SB23. I apologize for being MIA for a bit, I was waiting for everything to come back before I posted again...It is not McArdles disease, or Tarui's disease and they are now unsure if it is a metabolic disorder / glycogen storage disease. The kicker is, they are unsure if they have enough usable material (muscle) to perform further tests on! The level of frustration has reach an entirely new level, which I didn't think was possible. smh

Now, we are essentially back to square one and I need to see if they can do any more tests on my tissues. I do not want to go through / pay for another surgery, that is for certain.
Shayne_G
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Re:

29 Mar 2017 18:24

globecanvas wrote:Welcome SB23. How often you you have these episodes? You might be a more susceptible than others if you have to walk down a lot of stairs every day, as eccentric muscle loading seems like a common trigger. Have you ever tried loading up on NSAIDs when you feel an attack coming on, as per this comment? viewtopic.php?p=2061501


I get these episodes about 3-4 times a year seemingly for no reason. As you said, i walk down stairs everyday multiple times a day but only have these problems a few times a year, usually when the training volume goes up for race season.

I've not tried NSAIDs due to my chronic kidney disease, I tend to stay away from things that make my kidney work any harder then they have too. I have elevated elevated creatinine levels (1.50 mg/dl Creatinine, 21 mg/dl BUN). My doc seems to think this is "normal" as I have very large legs (typical track sprinter build) thus a lot of tissue breakdown which causes my kidney to work overtime, been monitoring my Bloodwork for a 5-7 years and the number remains about the same.

I may consider trying the NSAIDs just to see if there is any change in my condition, I'm pretty desperate to get back to training I've got some big races in April and I need that fitness!
SB23
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Re: Extreme quadriceps starting pain after 3-4 rest days

07 Apr 2017 12:22

I've just had these symptoms and spent last night in hospital on an IV. My CK was over 10000 when tested on Tuesday morning. I had pain Thu/Fri last week which worsened on Sat & Sun. I rode 3 times the weekend before but not in the week. It was warmer than it had been for a while that weekend and I was probably dehydrated.

My diagnosis was this https://en.m.wikipedia.org/wiki/Exertional_rhabdomyolysis .

There's further info here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031324/#!po=72.9167
When I was discharged my CK had dropped to circa 6000 overnight after fluids to flush my kidneys and I have a retest early next week to check progress.

I still have some mild symptoms and stiffness but nothing like the weekend. I did try and ride at the weekend but like lots have commented only rode a few 100 meters and pretty much had to walk home. No doubt attempting to ride probably made matters worse.

If this accurate it is muscle damage which takes longer than DOMS to appear and the up to 5 days aligns with the amount of time it took my pain to start and the period many are seeing as 'not riding time's before problems start.

There isn't a solution once it starts it seems except treating the elevated CK levels to remove it from the body and protect the kidneys. The main thing appears to be managing things to prevent an issue in the first place.

Also interesting:
http://www.athleteinme.com/ArticleView.aspx?id=241

http://watchfit.com/general-health/injury/effects-of-rhabdomyolysis/

http://bmjopensem.bmj.com/content/2/1/e000151

One of the things I'm unclear on is why the pain happens in the same place at the same time most of the time - as though the legs are connected somehow?
jb001e9634
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Re: Extreme quadriceps starting pain after 3-4 rest days

18 Apr 2017 18:25

Hey everyone -

Just checking in and seeing if anyone has any new ideas or made any progress...

I am right back to square 1 again and being referred out to other specialists since I have exhausted my current ones. I had a faux episode after taking 2 days of light spinning and had that initial tightening and "full" feeling in the legs once I resumed training again. Now, 4 days later, I rode 135 miles yesterday without any issues, this is still so perplexing!
Shayne_G
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21 Apr 2017 10:41

Well, I just recovered from a full blown attack..Five days of pain until I was able to work through it. I was active on the bike and had maintained a strict LCHF diet. I then had to travel interstate which meant 2 days no riding and attendance at a wedding. At the wedding I consumed LC foods but digressed and ate potatoes, the only hi carb food for many weeks.... not many, .... after this meal is when the full blown attack occurred. The 5 days I mentioned of pain and suffering was after this meal.... I'm still trying to find answers to this condition
CFM
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Re: Extreme quadriceps starting pain after 3-4 rest days

21 Apr 2017 13:09

jb001e9634 wrote:One of the things I'm unclear on is why the pain happens in the same place at the same time most of the time - as though the legs are connected somehow?


To me this is the signal of rhabdo type episode rather than a severe cramp -- that it occurs in multiple muscles, in both legs, at the same time.

I just got back from a week in the tropics on vacation with the family, the exact same situation that triggered the most severe episode I've ever had, last year. Long-haul travel, a week off of regular training, potential for dehydration, eating poorly/too much, alcohol, and sporadic eccentric-muscle exercise. I was paranoid of having another episode so I pre-dosed on nsaids prior to the first day of exertion during the vacation (hiking in the jungle) and tried to drink as much water as possible. The hike included climbing a Mayan pyramid which seemed like the perfect setup for a nightmare episode, walking down hundreds of steep steps after hiking a few miles in the heat. I climbed down backwards and very slowly. The day after flying back, I did a regular/hard bike training day without pre-dosing on nsaids. No episode, no trouble.

It's all circumstantial and maybe it's correlation without causation, but I haven't had a full blown episode in a year now. A few times (maybe 4 times during the year) I would pre-dose nsaids prior to potentially triggering activity, and once I double-dosed after feeling an episode coming on.
globecanvas
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Re: Extreme quadriceps starting pain after 3-4 rest days

22 Apr 2017 14:53

+1 on that. I took a normal dose of NSAIDs (ibuprofen) the last time I felt an episode coming on and that seemed to relegate the symptoms and allow me to workout as normal. After a couple days of working out, I was over the hump again and back to baseline.

Since all my metabolic tests came back as negative, I am going to stop pursuing that road. My new theory is that something is occurring during the healing process of the tissues. I am unsure if we just develop too much inflammation during this process (which would make sense why the NSAID works so well), or if there is a hormonal imbalance somewhere. I am still waiting on the genetic testing, but may seek advice from an endocrinologist in the meantime...
Shayne_G
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