Extreme quadriceps starting pain after 3-4 rest days

[h35mm]

Hi guys,

This is a great discussion and I won’t be the first to say that I’m glad I’m not the only one experiencing this oddity.

To contribute my story

Riding background
I’ve been riding for approximately 4 years (periods of hiatus for a few months)
I generally commute to work every day, approximately 40-45 kms per day
Weekends rides, my local loops will varying, from a 50-60 to 120 kms

I’ve had three attacks this year

Jan
Was in Bright, Victoria for a short away trip with the fiancée. During one of our hikes, as we started to descend down Mount Buffalo, I started to experience pain in my left leg, particularly around my upper thigh quad region. The more I stepped down, the pain continue to exacerbate to the point it was debilitating I had stop for a few minutes, I had to endure it until I got to the base (slowlest decent in my entire lol).

It felt like somebody was stabbing my leg and it was incredibly difficult to flex, bend and stretch. After that experience I avoided any further hikes/climbs for the rest of the trip.

March
Morning commute, about a few minutes into the ride my left thigh/quad started to seize up, the continuous pedalling made it worse to the point I could only pedal with the my right leg and then had to eventually get off the bike.

Similar symptoms as first attack
Stabbing/burning sensation around the quad, not localized it changes time to time above knee, outer or inner thigh.
As a result I was unable to walk, I was limping to take the weight impact off my leg for a few days.

I visited the physio, and he concluded I may have mild quad strain and muscle weakness. He suggested/recommended leg strength conditioning workouts, i.e. squats, leg curls and lunges and use a foam roller. About a week later the issues went away.

Present
So as of Monday morning, I experienced a similar attack as above, leg seized up becoming too painful to cycle and walk.
Going for a walk, both my quads flare up in pain, the pain seems to circulate around my quads. It can be above the knee, outer or inner thigh and sometimes just below my hips.

I end up limping around by trying to not put too much weight on my left leg (it’s more problematic than my right)

Sitting down or standing for a few minutes the pain will go away, but as soon as I start moving the quads flare up in pain again.

The situation hasn’t improved since Monday and if I squeeze my quads, I can feel they’re quite tender/sore.

I have a physio appointment booked tomorrow. So I'll see how I go and share any feedback with you all.

[trkstr]

Just checking in. Since my last post, have gone through 2 bouts (currently 2 days into the 2nd bout). Was interesting in that i seem to have been able to delay the onset this time.
Usually, these bouts are triggered after i do a period of commuting Monday - Wednesday, then the bouts are triggered Sunday/Monday. However, there was one week when it didn't trigger. i was more physically active that weekend and so was able to do the commutes again the following Monday - Wednesday with no troubles. Did the same commutes again Saturday - Monday (again, same distance), so was expecting a bout starting Thursday/Friday, except i rode on Wednesday and was off the bike Thursday - Sunday and was fine until Monday morning. Walked a bit and did a lot of physical stuff (just not riding). Then took a real slack day on Sunday with the feet up sitting on the couch and i realised that may be a point of similarity between when i get my bouts. All the bouts (like many have stated) are preceded by a period off rest. More specifically, i'm talking about my posture during this rest phase. For this current bout, I was sitting on the couch with the feet on a footstool, legs stretched out in front of me.

Sitting with the feet up in this position has the quads in a shortened, non contracted state. So wondered if (somehow) the recovery process sets my quads in this shortened state but then when i start using it again, it's tearing (like a wound that clotted over on a flexible part of the body that then, flexed and opened the wound again, sorry for the imagery....) and that it's this new tearing that might be what this issue we all have might be?

I think i've ruled out nutrition as a cause and go back to thinking about the muscular recovery process. Certainly, a poor diet would definitely not help with the recovery process. So my next steps are to focus on my recovery after each ride, actually go for recovery rides and am strongly considering buying an indoor trainer so i can get in a quick 10 min spin at the minimum every day to stretch out those muscles.

Thoughts?

[beejay1188]

Hi all,

I'm another newbie to join this list of poor souls..

I'm not going to go into a long winded spiel as youve all stated symptoms ive got..

Painful quads, always after a decent week (at least) of riding and then a few days off..

several months ago, I was always of the belief that if I got the symptoms one day, then the next time I rode I'd be right...

And this was the case until the last couple of times.

The latest (im in the middle of one now) has lasted a week already. I was able to limp out about 12kms on the trainer (Zwift) tonight but it was a real limp. Any harder than about 1.5 w/kg and up came the pain.

I'm hoping that someone will come up with an answer to this so I'll be following you guys closely.

Thank you so much for starting this thread..as a lot have already said, there is nothing else I can find on google that describes the symptoms so perfectly...

I plan on taking this whole thread to my GP/Physio/Specialist..

[Derek76gib]

Mixed emotions going on here following all the posts that you guys have posted ,I am happy and sad at the same time. Reading up on the glycogen theory I can sort of match it to a liver problem I had in the past after collapsing from heat exsorrion in 2011. After that episode when I collapsed straight after that I started to get exactly the same symptoms as you guys amazing how similar not similar exactly the same symptoms as all of you guys. loved triathlon but was forced to stop running as flareups were much more frequent, after that I had to focus on the bike.. I have now stuck to swimming and cycling and flareups reduced by quite a bit, now a days I get three or four flareups a year which leaves me three weeks without being able to train.. I always thought before I read this thread that my problems came from my herniated disc's L3/L4 the femoral nerve exits between those two vertebrae's and if you follow the nerve roots they channel exactly to where the flareups demonstrate. Great to see that I am not alone but sad to see that there is not a cure or a conclusive diagnosis, I guess we shall have to grin and bear it every time we get an episode and Carry on training hard when we are clear .. safe riding and don't give up.

[trkstr]

Been a while since this thread has been posted to. Just wondering how everyone is going?

[budegan]

Funnily I have been thinking about dropping a post on here (but haven't wanted to jinx myself...here goes...).

It's been a year since my last episode, and I've concluded the absolute key (as reported up thread) has been to avoid more than a couple of consecutive days off.

At times that's been an absolute inconvenience (family, holidays, illness, work, travel), but I can vouch that it appears to be the way to keep the episodes at bay.

For clarity, I'm talking at least 45 mins minimum (generally an hour) at recovery / Z1 pace, generally on a turbo trainer; I have had the odd day where I've not done anything but have made sure it's just the one. Diet is generally good, but I have a very sweet tooth and have succumbed to sugar binges which haven't brought on an episode so long as I've kept riding (I don't think I've ever combined one of these with a day of no riding though).

I'll repeat, it can be a royal inconvenience. However I've returned to (very very modest level) amateur racing and have decided it's the price to pay to not have up to 2 weeks of enforced time off due to this condition.

Just wanted to get this out there as this thing is such a pain (literally) and I like that we have this little self-help community.

[trkstr]

I'm sorry to see another couple newcomers to this discussion thread. But, strength in numbers, yeah?

To everyone else who's continuing to battle this, soldier on, dear sir/madam, soldier on!

Had an interesting thing happen in the last couple days. I went out for a long-ish walk where the quads did flare up, as i had expected. Went for a higher intensity rides than usual (i suspect i bumped up the intensity too quickly) for 3 days, last ride on the day 3 days prior to the current bout. However, after gingerly walking home, i jumped on the trainer to test the legs as i have never actually tried to ride when this happens. And it seems i was able to ride with no problems! This seemed a bit contrary to what others have reported stating that they couldn't ride when a bout has started.
I should be on day 2 of the most recent bout but i managed to complete two 20km trips without many problems, going at average pace, for me.

This got me wondering about posture and bike fit, and whether how well we are fitted to our bikes would engage different muscles. Has anyone explored this?

[dcolvin]

I'm a 300km a week commuter, and suffer from the same symptoms as the rest of you triggered in the same conditions (historically, walking down stairs after the first ride following the weekend break). I figured out that taking ibuprofen as soon as possible after the symptoms started would stop the extreme pain, and although it was still uncomfortable up to 72 hours later, I could go about my business as normal. A blood test showed highly elevated CK levels, but this was normal because of my exercise intensity, frequency and duration (5 on, 2 off).

I sought help from a sports physio about 6 months ago, who after a few sessions, could trigger the attack by manipulating the muscles in my mid-thigh. He's not sure of the detail of what's going on, but indicated the ibuprofen worked because it reduced the swelling in the muscle group. He advised regularly and quite harshly working my Vastus Medialis muscle with a hard roller after every ride, I've not had a repeat.

Your mileage may vary, but I've gone from have pretty regular, debilitating attacks to zero - so far.

[Crosscountry]

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?

Hello all. I have just come out of hospital following a Rhabdo episode. I commute to work which is a c. 110 mile per week commute, i am 47 and at a good level of fitness. In my case i had been pushing hard, going as fast as I could and really using the daily commute as hard physical training. My own CK was 15k intially, rising to 22k before then dropping back towards a more normal level. Currently awaiting a neural consultant referral as the hospital were concerned about the delay between exercise and onset of symptoms, which in my case was c. 72 hours later. I also did not experience dark urine, and have subsequently read that this is not always present with Rhabdo. My legs are very weak now, struggling to walk to the end of the road, but early days and am expectign to regain full fitness. Thankfully seem to have avoided kidney damage, but a very frightening, painful and unpleasant experience. Everyone has their own threshold, and i will now be diong much more mild exercise, not try to race and really avoid pushing myself too hard to avoid another episode. Safe cycling to all. If you experience significant pain in hour quads, make sure to rehydrate alot and if the pain is prolonged, get a blood test to rule out rhabdo.