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.

[thietkewebdulich]

I have noticed if I sit down on my ankles and lay backwards until my shoulders touch the ground the quads get the stretch they need.

[Chris__M]

The symptoms described in this chat group sounds very much like delayed-onset muscle soreness (DOMS).
Here's a couple of sites that describe what it is:
https://en.wikipedia.org/wiki/Delayed_onset_muscle_soreness
https://www.painscience.com/articles/delayed-onset-muscle-soreness.php

And most importantly, how it can be prevented:
http://m.ironman.com/triathlon-news/articles/2016/11/beachbody-muscle-soreness.aspx
http://main.poliquingroup.com/articlesmultimedia/articles/article/1079/nine_amazing_ways_to_reduce_post-workout_muscle_so.aspx

Chris

[jsk]

No, it's not DOMS. Not even remotely related, not one tiny bit.

[jjswift]

Count me as another victim of this syndrome. It is a condition so odd and apparently rare that this thread is absolutely the only reference to it I have been able to find anywhere.

Here are my particulars: If I take a few days off the bike after a period of frequent moderate-to-intense cycling, I can expect to eventually experience very sharp, localized muscle pain, mostly in my quads, but not always. And not the whole area, but localized spots within the muscles, with the pain coming on and dissipating in different spots at different times and with varying intensities, up to and including intensities that can prevent me from moving at all.

If the time off is 1 or 2 days, no problem. At about 3 days off, the pain will occur when I start pedaling again. Usually, if I can spin through it enough to get warm, it will eventually go away, or reduce to a manageable ache. If I'm off the bike for 5 days, I'll start having these pains even off the bike, just walking. For me, they never last more than a day or so.

If the training before the time off is more moderate, then the pain is reduced or never happens. Severity seems to be a function of how hard I was riding before the time off. The delay interval seems to be consistent, though, independent of the severity.

I first experienced this in my late 30s, during a period of frequent hard riding. I'm 60 now, and as I've gotten more serious about riding again over the last couple years, this problem has returned.

My best guess is that it is a by-product of the muscle repair process at the heart of exercise adaptation. It seems to happen at a certain phase of that process, but only if the area hasn't been 'worked' during the period between the damage and the repair. Maybe a doctor or physiologist can make something out of that.

Definitely doesn't seem like a nerve issue or a skeletal issue, or even an injury. It's really all happening in the muscle, and not in one spot.

Good to know I'm not alone. Someday someone will figure this out and our questions will be answered. In the meantime, the best practice seems to be: Don't stop riding.

-Tim

This post is a long way out of time but I also have actually taken some heart by all your posts. I have had this occur a number of times. On one or two occasions I was able to ease off and work my way into a ride, complete the rides but with some residual leg pain after the ride. Once or twice I have gotten off the bike, stretched and been able to continue. The key in all these cases was that I was able to ease up or get off the bike as soon as the pain started.

The pain is not in a particular muscle, I have had it start in the glut (one), in the quad. I have had in in both legs. As others have suggested it feels initially like a cramp but for me quickly moves to a stabbing pain where bending the leg (not pushing) is extremely painful. I also have issues in these circumstances walking down stairs.

I had the issue again today (Sunday) where I lined up for a 170 km ride and almost from the first rev started having stabbing pains. I struggled on for 7 kms and gave up. I had been training for this event quite intensely but had not been on the bike since Tuesday.....so exactly as everyone is reporting

I think someone mentioned not stopping. I think that is correct. More stretching and better recovery from intense training I hope is the answer.

Sympathies to all suffering. It is really annoying. Thanks for the above, I found the articles helpful.

Regards, Jeremy

[ERKN]

Wow, can't believe I found this post and that others experience the same issues. Here's my history:

-riding 15 years, some hard years, some easy. Never experienced pain like this before.
-43 y/o. Recently started riding more as I seem to be getting stronger with age, starting to race again.
-FTP = 4.35 watts/kg measured on trainer
-First experience with this extreme quad pain was 1.5 month ago when I took a one week break. After taking 3 days off, I was just sitting at my desk, stood up and zap, my right leg was completely hosed. The pain felt like my muscles were on fire. Hurt to stretch. Worried something was seriously wrong.
-After lots of stretching, it continued to hurt. The next day I was fine and did a mellow ride. About 30 minutes in it hit again and had to stop. Somehow after 10 minutes I was able to ride it out without too much pain. The next day I was back to normal, like nothing ever happened.
-The pain has returned during a 2 week business trip to Asia. I was actually ok in the first week with zero riding. At day 7 off the bike the pain hit in both legs at the same time, just walking around. I'm currently limping and can barely walk. The pain is about an 8/10 with 10 being a broken bone. I can barely make it down stairs and look rediculous limping around.
-I did a hard group ride before this trip. But I've done plenty of hard rides prior to traveling or taking time off before without issue.
-As I'm overseas right now, I'd be checking into an ER had this not happened before. I almost thought it was a blood clot the first time... the pain is just so severe and strange. The first time this only happened in my right leg. This second time it happened in my left leg, and the right followed about 15 minutes later.

This makes no sense. It's not a cramp or normal muscle soreness. It comes on hard and is debilitating. I'm going to re-read everyone's post to see if there are any other common causes than just "riding hard and taking 3+ days off". Is this an age thing? Fitness level? Flexibility issue?

[beejay1188]

Hi again,
I'm not back to give a cure, but maybe something that will help...

This is for a specific scenario:
- You've had time off bike (lets say 5 days)
- You're about to jump on in the "hope" that you don't feel the pain

Ok, so jump on and start pedalling as per normal warm up..

As soon as you feel a small niggle (you all know what i mean - DON'T wait, this has to happen AS SOON as you feel it), up you're wattage dramatically - to well over threshold.

(to give you an idea, i warm up at around 1.5-2.0 w/kg. I would start riding around 4-5 w/kg.)

Pain should go away for a short period, but you will still probably start feeling the pain again.

As soon as you do - 'stop pedalling completely/dont move pedals/stand up on pedals' and coast for about 20 seconds.

Then straight back into interval type sprint at above threshold. stop/stand again if you feel pain.

Keep repeating this...

You'll tire out, but ive found it stops me from getting the pain. You can usually do a normal(ish) ride after that

Next day you'll be completely OK again..

Let me know if you try this and it works.

REALLY bad warm up i know but hey, if it works.....

[Chrisp65]

Hi.

Not having read all post´s, similar might have been posted before ?

I also have had problems with quads cramping badly after few days off my bike, so I started searching the web for possible solutions, and fell over an answer from someone named Steve Hogg to a person asking about quad cramps, which solved it for me;

If the main focus of the cramping is down the centreline of the quads and above the knee it is reasonably certain that you are sitting too far forward and too high.
Cramping in the centre of the quads is usually the rectus femoris which is the only quad the crosses the hip joint making it a hip flexor as well. The cramping above the knee usually indicates overextension which is common when people sit too far forward

After lowering my saddle 5mm and moving it 7mm backwards, I have not had any quad cramps since.


Maybe this could help others too..

[Chrisp65]

Hi.

Not having read all post´s, similar might have been posted before ?

I also have had problems with quads cramping badly after few days off my bike, so I started searching the web for possible solutions, and fell over an answer from someone named Steve Hogg to a person asking about quad cramps, which solved it for me;

If the main focus of the cramping is down the centreline of the quads and above the knee it is reasonably certain that you are sitting too far forward and too high.
Cramping in the centre of the quads is usually the rectus femoris which is the only quad the crosses the hip joint making it a hip flexor as well. The cramping above the knee usually indicates overextension which is common when people sit too far forward

After lowering my saddle 5mm and moving it 7mm backwards, I have not had any quad cramps since.


Maybe this could help others too..

EDIT:
It´s stil same saddle height for me (when measure "BB->middle of saddle"), I just ended up with more setback which felt like there´s less load on Quads and engaging hamstrings more...

[ScottyC1969]

Hi again,
I'm not back to give a cure, but maybe something that will help...

This is for a specific scenario:
- You've had time off bike (lets say 5 days)
- You're about to jump on in the "hope" that you don't feel the pain

Ok, so jump on and start pedalling as per normal warm up..

As soon as you feel a small niggle (you all know what i mean - DON'T wait, this has to happen AS SOON as you feel it), up you're wattage dramatically - to well over threshold.

(to give you an idea, i warm up at around 1.5-2.0 w/kg. I would start riding around 4-5 w/kg.)

Pain should go away for a short period, but you will still probably start feeling the pain again.

As soon as you do - 'stop pedalling completely/dont move pedals/stand up on pedals' and coast for about 20 seconds.

Then straight back into interval type sprint at above threshold. stop/stand again if you feel pain.

Keep repeating this...

You'll tire out, but ive found it stops me from getting the pain. You can usually do a normal(ish) ride after that

Next day you'll be completely OK again..

Let me know if you try this and it works.

REALLY bad warm up i know but hey, if it works.....

Thanks for the suggestion. Will give it a go amongst the other things I use.
I have also found instead of double dosing on painkillers etc I use a standard dose along with a high quality Curcumin supplement which is a proven natural anti inflammatory. Really works for me when I feel an attack coming on. I take them together about half an hour or an hour before I ride. FYI I use these https://naturespurest.co.nz/shop/longvida-optimised-curcumin.aspx

Cheers

[TOHolm]

Hi again,
I'm not back to give a cure, but maybe something that will help...

This is for a specific scenario:
- You've had time off bike (lets say 5 days)
- You're about to jump on in the "hope" that you don't feel the pain

Ok, so jump on and start pedalling as per normal warm up..

As soon as you feel a small niggle (you all know what i mean - DON'T wait, this has to happen AS SOON as you feel it), up you're wattage dramatically - to well over threshold.

(to give you an idea, i warm up at around 1.5-2.0 w/kg. I would start riding around 4-5 w/kg.)

Pain should go away for a short period, but you will still probably start feeling the pain again.

As soon as you do - 'stop pedalling completely/dont move pedals/stand up on pedals' and coast for about 20 seconds.

Then straight back into interval type sprint at above threshold. stop/stand again if you feel pain.

Keep repeating this...

You'll tire out, but ive found it stops me from getting the pain. You can usually do a normal(ish) ride after that

Next day you'll be completely OK again..

Let me know if you try this and it works.

REALLY bad warm up i know but hey, if it works.....

This works perfectly. I usually get the pain in both legs when I walk downhill (several days after my last ride). When the pain sets in, I get on my bike and ride the steepest hills I can find, full power. I do this several times and it hurts as hell, but the next day all pain is gone and I'm good. But the best way to avoid the pain for me is to only rest one day. So if I have a resting-week on my trainingplan, I still go out every day and ride Zone 1 for an hour. I always stay in hotels that have a stationary bike. This is just how I have learnt to live with this problem.