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Extreme quadriceps starting pain after 3-4 rest days

Moderator: King Boonen

25 Oct 2014 21:17

Best of luck, my friend, I hope you are
back racing next year as planned.
Team GB 2016: victoRIOus, happy and gloRIOus
User avatar oldcrank
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28 Oct 2014 23:16

After a successful 60 minute indoor ride yesterday, i rode outside today. MISTAKE. After 4 miles i pushed a little up a rise and the burn switched on in my right IT band area. I backed off and turned for home. By the time i got home, my left and right quads were screaming, just above the knee. My right leg is extremely sore.

Back to square one, again. Into the third week with this, a week longer than any previous episode.
waynepovey
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Re: Extreme quadriceps starting pain after 3-4 rest days

24 Apr 2015 16:33

I'm way late to this string and it appears that the interest has wained. Probably because it's depressing to talk about.

Anyway, like others have said, I'm just glad to learn I'm not alone. With that said this phenominon is so depressing every time it occurs I wish a MD or physiologist would join the forum and provide a definitive solution/answer for all of us. Not to mention, when I come home crying and crawling in the door my wife typically starts in, which is a hole other bummer.

In response to possible remedies, one thing I have found that can work is wrapping my legs very tightly. It doesn't always work but often does. When the pain begins to manifest itself as has been described throughout this thread, when my legs are wrapped very tight I can often make it through the initial pain signal that absent any wrapping typically becomes debilitating. I do this for 3, 4, 5 or 6 days and I can take the leg wraps off and I'm usually good to start punishing myself in earnest again absent the wraps.

Good luck to all and to all a good bike!

Best
parfore
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11 May 2015 13:05

Another sufferer here. Again, this is almost the only reference to this condition anywhere that I have been able to find. I too am at my wits end, after 16 years of suffering this intermittent pain in my quads and glutes.

I have had two biopsies and no end of tests at a muscle specialist hospital in London with no prognosis. The tests have revealed sky high creatine kinase levels during attacks. The episodes of pain last from a couple of days up to 17 days and I'm now into my 16th day of it, having gone for a ride yesterday thinking I was OK, only to have to be 'rescued' a couple of miles from home.

As others have noted, walking is also hard when it's bad, especially downhill (and steps). I have not been able to link episodes with diet and had my worst ever attack in February during a month off the grog, so I can probably rule out alcohol (though excess would no doubt not help!). My quads feel like a knife is being pushed into them during attacks, and then feel sore and incredibly 'tired' (tender) for 24 hours afterwards. I have no external signs at all (swelling etc).

The current attack began a week or so afer a 70 mile ride (long for me) and does seem to be linked to delayed onset pain after long rides.

Anyway, although thoroughly depressed by this, at long last I have found somewhere where others seem to have a similar issue. I only hope someone can come up with a suggestion.

I have been prescribed co-enzyme Q10 - said to assist muscle function (though I don't notice much improvement) and I drink cherry juice as I have read it is a good anti-oxidant. Other than that, I'm pretty much out of ideas.

The only other site I have seen reference to this problem is here: http://translate.google.com/translate?u=http%3A//www.feltet.dk/forum/read.php%3F22%2C233909&hl=en&langpair=auto|en&tbb=1&ie=UTF-8
It's a Danish site (translated) with some ideas that may help some. Some suggested excercises too. There are mentions of carbs too there which is interesting. The caviat is of course we may well all have different conditions which just happen to manifest themselves in a similar way, so always be cautious before trying any treatment.
gloworm558
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Re: Extreme quadriceps starting pain after 3-4 rest days

24 May 2015 13:18

Hello from my vacation along the Amalfi Coast. I can't believe but, I'm currently experiencing this situation. I cycle in the U.S. anywhere from 3 to 5 times per week. I decided to take a vacation and not cycle. Fast forward five days into my vacation we decided to go hike uphill one hour to ruins. Everything was splendid until it was time to descend. The pain in the front upper region of my quads was unbearable. I couldn't decend the hill like a normal human. I actually found it easier to walk down backwards. Talk about embarrassing. Each day I've been healing more and more. Crazy to think rest is a key ingredient to this injury. Makes zero sense.
BMooreFit
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24 May 2015 13:34

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. I will continue to do this stretch to see if this solves the issue.
BMooreFit
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Re: Extreme quadriceps starting pain after 3-4 rest days

04 Jun 2015 05:23

I have had this no and off for the last 3 depressing years. I've spent a fortune on physios and had 2 MRI's. The pattern is always the same. A heavy block of training, hitting some form, a day off more than usual and then BAM, it strikes. I've tried all of the above and the only thing that seems to sort it is rest. I've given up finding a cause and just accept that 3 times or so a year I face 2 weeks off at a time.

My final port of call was going to be a visit to a rheumatologist but seems that people have already been there.

Maybe one day we will all find out.
pheonix026
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Re: Extreme quadriceps starting pain after 3-4 rest days

05 Jul 2015 17:58

I have also suffered with this for quite a few years and have seen a number of specialists to try and diagnose the issue, all to no avail. However, over time I think I have worked out the cause and while I don't know of a cure I can manage the issue. The symptoms are exactly as described: it only come on when I have been doing a lot of cycling and have rested for 3 days or more; the pain is always in my quads but it moves around them; it takes up to 2 weeks to clear up and when the pain comes in it is very severe and can make even walking difficult; it seems to be triggered especially when walking down stairs/down hill but it can be cycling gently or just walking on the flat; once I can exercise fairly hard the issue resolves itself until I next rest.

I think the issue is to do with excess glycogen build up in the muscles. This would be consistent with the causes and the "cure". I now try not to take a rest of more than 2 days and if I feel that the problem may be coming on I try and cycle hard for at least 30 mins which does resolve the problem. I have even done this with pain killers so I can cycle through the pain and again once I have been cycling a while the problem seems to go away. I can feel that my legs aren't right before I get a severe bout of pain so that helps me manage it.

I would love to know why it is so painful and what is the exact cause but I am happy that I can manage the problem particularly if I have a big event/race coming up. I am pretty sure my self diagnosis is not far from the mark but if any one knows how I could get this tested more thoroughly I would be very grateful.
garywyatt
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07 Jul 2015 21:22

I've had this for 10 years. Finally went to the ER after a particularly painful week. Spent 24 hours in the hospital on an IV. Sorry to say it is recurrent rhabdomyolysis. Could be dangerous if not properly managed - treatment being hydration.

The pain is caused by the muscle breaking down and releasing myoglobin. Myoglobin can cause renal failure. Hydration helps dilute the myoglobin and prevent injury, but does not mitigate the pain. The relevant test is for creatine kinase (CK) in blood and can be performed in the ER, though a rheumatologist is probably more appropriate. The test should be performed early on during your painful episode, otherwise your CK levels will drop and the test will be useless.

My symptoms have been identical to those described above. The pain and duration of episodes reflect the length and intensity of each workout. Like clockwork, the pain begins 2-3 days after cycling and is often triggered by walking down (though not up) stairs. If I keep cycling every day or so, I'm fine. My first and longest episode followed a 2500 mile trip and lasted one month, though it typically disappears in a day or so - less if I resume riding. My current episode began a week and a half ago. The location of the pain often varies, from my rear-end at times, to the outside, inside, front or rear of my thighs. It often terminates on the top of my calves. Keeping the leg outstretched and relaxed, and waiting, is the only way to relieve the pain. Stretching, NSAIDs, etc have no measurable effect. I've recently discovered (while on a very long and painful flight) that torquing the leg inward while resting also helps. I've had some luck with cross training. The more I jog, the less likely it seems I am to have an attack.

I'm 35, male, and ride about 70 miles/ week. I'll stop cycling this year. My busy travel schedule punctuates my riding too much and the pain is becoming both unbearable and a nuisance. I hope to ride again in the future if things slow down. But the key seems to be riding everyday, and right now I can't do that. This forum has been a godsend for the past several years. It's one of two I've found that actually discuss this, and it's good to know I have company. Best of luck to everyone!
pasaglia
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14 Oct 2015 21:45

Hi All
You are not alone. I found the following forums about exactly this story:
http://forum.tour-magazin.de/showthread.php?44615-Muskelentz%FCndung
http://www.bikeforums.net/commuting/632008-quad-pain-hiking-down-hill-could-related-commuting-too-much.html

Hi guys

I am from switzerland, ambitious rider doing about 10k km per year, 45 years old and dealing with the problem for a long time. It comes up after 2-3 rest days from cycling. I have searched the the net a lot about this issue: there are other people dealing with this problem.

so far the cause for this is unknown. but basically it results in extremely high CK values (up to 20000 - normal 100-200). This means the muscle is terribly inflamed and temporarely damaged. why it only happens after restdays is a mystery.
there are several theories discusses:
-DOMS
-genetic defect which results in faulty glycogen processing (Mc Ardle Disease)
-simple over training

different people believe that it is related to nutrition. Others encounter it only after strong workouts. Many person have been to many doctors without any results. The symptoms can be as strong that you collapse completely or need to be hospitalized. if the CK values get over 20K it can be dangerous. the symptoms seem to weaken after years of training.

what do the people to deal with it:
- DO NEVER STOP CYCLING -> people bought ergometers to cycle at home when the weather is bad.
- changing nutrition (this is a philosophy)
- adapt the cycling workouts -> do not train too hard

when it starts there are different methods for resetting:
- if you encounter it during cycling which might be the case already after 1 rest day -> NEVER use high gears, take the strong gears !!! Apply high pressure and pedal slowly and GO OVER the pain - ride for another 45 mins . the next day you are fine.
- other people do not ride anymore at all when it started. they say the risk is too high to damage the muscle resulting in dangerously high CK values. with this method you have to stop for 1-2 weeks because the symptoms peak after 5-6 days. the CK values then go down rapidly again from 1 day to the other- another mystery.

I still did not find any solution to the problem but riding every day. this is not always possible. i try the strong gears after 2-3 rest days; this can be sometimes extremely painful but it works. after years of cycling i get the problem only once or twice a year - but hiking is no longer possible to me which is a pain too ...

I would be happy to know one day what is the cause of this disease, but probably not during my lifetime. Anyway it is good to know that you are not alone.

Cheers
coldizoard
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17 Dec 2015 01:02

I'm another sufferer of this bizarre condition. I’m 44 and I've probably had about a dozen episodes over the last 6 years since taking up cycling and each episode seems worse. Originally it was approx. 3-4 days of pain with 2 or 3 events each day. Last one was in August 2014, which was 7 days of agony with about 5/6 attacks each day. The other difference is the first attack of an episode would typically come about after about 10 minutes of walking, whereas the last time I was hit getting out of bed in the morning. My typical cycling pattern was 30k a day 5 days a week cycle commuter, with the occasional 40k Sunday ride. Consistent with others I can pretty much guarantee an episode if I take 4/5 days break, either for illness, snow or holiday. I'd tried various physios during the period to no success.

Again as with other posters the pain is always in quads, seems to start with a knife-like pain in a muscle which then radiates within that muscle. Intense pain lasts for approx. 30-45 minutes than then recedes, but that muscle then feels sensitive for a few hours afterwards. Meanwhile at an unspecified period the next attack will emerge, usually in the opposite leg but not necessarily mirroring the same quad. I had convinced myself until last time that the same muscle wouldn’t repeatedly hurt in any given episode, but that wasn’t the case last time. However, the specific spot on the muscle from which the pain started seemed different each time.

Once I’ve had an episode, if I don’t get back to regular riding I won’t get another one. I’ve had no episodes in the period since August 2014, but I’ve barely rode 100k in total since then.

On day 2 of that last event my GP ordered bloods and these picked up CK levels c.5-6000. Since then I've been referred through two hospitals and had the electrical tests referred to earlier in the thread, all drawn a blank.

I’m now with another consultant at a different hospital who is attempting a systematic diagnosis. He's secured new baseline CK tests, bloods and an MRI scan, and so the plan is to start cycling again. In a month or two I'll get another CK test whilst cycling regularly, then ahead of my next appointment I'll take 5-7 days off the bike, which will likely trigger an episode (can’t wait) which will allow him to observe the symptoms whilst it's happening. The blood tests are looking to rule out Muscular Dystrophies.

Will post updates with any more info.

Without a diagnosis there seems to be three options:
1. Don’t ride again
2. Never stop riding for more than 2 days
3. Deal with it when it happens.
I’d love a fourth.

coldizoard, I’m hopeful we will find an explanation in our lifetime! We all know the dangers of diagnosing over the internet but my son has an unrelated but ridiculously rare allergy (1:250000) which we managed to identify through internet searching, get referred to the only expert in the UK who quickly able to confirm with a simple blood test. It saved my son years of confusion and pain. Hopefully someone will crack this and share their insight.
sidpanda
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Re:

23 Dec 2015 21:40

kiwirider wrote:
What is your hip flexibility like? If I say "do an ilio-psoas stretch" do you know what I mean? And if you do, what does it feel like? What about if you do the Cobra yoga position - do you feel that pulling down the front of your abdomen?

I'm not anything medical, but I have had similar problems in the past - feelings like a massive build up of lactic acid, walking stairs making things worse, major pain when biking even short distances, etc, etc ...

For me the problem was massive tightening in the hip flexor muscles. They get a real pounding on the bike - and mine also got a good workout with skate skiing and skating over the winter. Then just to help them shorten up, I have a job that involves me sitting at a desk all day. Sitting on a plane for any length of time is also a good one for sparking this off - combination of the seated position and inability to move much when you are seated.

Two occasions that really set this off for me related to really big increases in mileage. A couple of years ago I had been doing very little riding - probably 150-200km/week - and then decided to try to ride 100km a day during a two week long "Bike to Work" promotion. By about day 10 I was in major pain.

The other occasion was last year when we moved to our current house. Mileage increased a bit from what it was before, but intensity increased markedly (my commute is about 40km each way of hilly roads).

What has fixed me is a lot of stretching. I'm talking general lower body and back stretching. Of course specific hip flexor stretching comes into play as well - check out this: http://www.markmcgrath.com.au/2011/06/hip-flexor-opening/
If you're super tight, you'll need to build up to this - either by having your rear leg flat on the ground or holding onto it behind you (like your would for a standing quad stretch) or just having your knee a bit out from the wall/shin at less than vertical.



This makes a lot of sense. Like most of you I ended up here googling the issue. It happened on my ride yesterday arvo after a two day break. I had to stop after 3km and try to walk it out. It was so bad I was seriously thinking of going back. I stuck it up by keeping the cadence high on low resistance to keep the blood flowing. It moved up to different parts of my legs then disappeared. From there on, once warm, I could press on hard, no issues what so ever but 30min before I was a sight for sore eyes. Never happened to me before. I tried to figure out what I did wrong and it dawned on me that I had been very slack with my stretching routine and again I sit on a computer desk 24/7 so all the stuff that was said resonate with me. So I second the advice here. Make sure you stretch for a good half hour after your ride, while you're still warm and sweaty. It should alleviate the issues. Nothing sinister such as nerves or clots. Just really tight and shortening muscles over time.
multiweb
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29 Feb 2016 05:39

I'm another one.... 17 years of it. Have had every test under the sun. MRI, Arteriogram. Massages, Chiropractors, X Rays. Have seen every doctor and health expert out there I've spent tens of thousands of dollars. Same symptoms. Usually after a hard bout of training and a rest of 2-3 days then bam. If I can get through the first 15 mins of the ride then I am away again but if not its 2-3 weeks off the bike. Walking downstairs is excruciating after 6 steps when its at its peak. Even walking on the flat can be a killer. I would love an Option 4 also. Keep posting though people. Its a relief to know I'm not alone or insane...
ScottyC1969
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29 Feb 2016 06:35

Find a hill that's about 1-3 km long. Not too steep. 4-7%. Stay out of the saddle.... Don't sit... and push a decent gear at roughly 70 rpm. You want your legs to start filling with lactate and your heart to be pumping a bit. Go at 80% -90% effort. Keep going as long as you can. You will probably feel the "cramping " trying to come on. If it's not a full blown attack you are suffering from you can hopefully ride through it and flush your legs out and get going. The key is to stay out of the saddle. Sounds like the opposite of what you want to do I know. Yes it may hurt a bit but hopefully not to the point you have to stop with that hideous knife like pain. The pain should hopefully subside. If you can then carry on riding for a good 90mins at least. Once you get this ride out of the way you should hopefully be back in the game.....until the next time. It's about the only thing that often works for me if an episode is starting before it spirals to a full blown attack where I need 2-3 weeks off. Just thought I would share. If it helps anyone get back on the bike from this ****** ailment then great.
ScottyC1969
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05 Mar 2016 03:31

Same here...I have been cycling for years and am always struck with the same symptoms previously described after 2+ days of rest. Question: Does anyone here supplement with beta-alanine, creatine, and/or GPLC? I have been reading that supplementing with beta-alanine will decrease the amount of taurine in muscles which will lead to cramping. This is because beta-alanine and taurine use the same uptake system.

The whole rhabdo thing has me worried...I think I may get my CK levels checked to rule it out.
Shayne_G
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Re: Extreme quadriceps starting pain after 3-4 rest days

05 Mar 2016 15:42

Created an account just to add a 'me too' to this list. I've got reasonable Google skills, but this is the only forum I've found that talks in any detail about this "disorder".

A lot of what already has been described is the same for me. When not travelling for work, I commute 4-5 times a week on my road bike, 32km each way, a 64km round trip. That's about 40 miles in old money. On average, I've covered 10,000km per year for the past 2 years. I've been physically fit pretty much all my life, and have always had strong legs - but never had anything like this before.

The same trigger points for me as others have mentioned, though it's never happened as I've been riding. The trigger day for me is Monday after 2 days rest Sat-Sun. I'll cycle to work, shower, and then as soon as I walk DOWN the stairs, one thigh, then almost immediately the other, will erupt in the most unbearable pain right in the middle of my quads. There's no cramp per se as the quad tissues are soft, but the pain is extreme and I'm barely able to walk. The core pain lasts for a minimum of 24 hours, but the episode takes at least 72 hours from start to end. I've tried: magnesium, potassium, multivits, overhyrdating, overprotein-ing (is that a thing?), squats, stretches, NSAIDS (both topical and oral), salting, starving, no booze, too much booze (!).

Nothing works. Muscle roller is semi-useful but isn't getting to the core of the pain.

This is unpredictable from an episodic perspective, sometimes I'll have 2 events a month, other times I'l go for a few months with nothing. I've had perhaps 12-14 episodes over the past few years.

Like others, I've also had blood tests, as I'd read about the potentially dangerous effects of rhabdomyolysis. My CK levels were 6-7x elevated above acceptable levels, however my reasonably well informed doctor said that raised CK levels are normal in athletes. She had no idea what could be causing the leg pain but suggested it could be a combination of factors including biochemical and muscular.

I'm reassured that there are others like you suffering the same thing, so I know I'm not dying (even though it feels like it when it's happening, I initially though I had a DVT!), but it's also sad to hear that so many of you are also suffering.

If anyone gets to the bottom of this, please do let this thread know.

Safe riding.
DC, London, UK.
dcolvin
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Re:

05 Mar 2016 19:47

Shayne_G wrote:Same here...I have been cycling for years and am always struck with the same symptoms previously described after 2+ days of rest. Question: Does anyone here supplement with beta-alanine, creatine, and/or GPLC? I have been reading that supplementing with beta-alanine will decrease the amount of taurine in muscles which will lead to cramping. This is because beta-alanine and taurine use the same uptake system.

The whole rhabdo thing has me worried...I think I may get my CK levels checked to rule it out.



Hi
It's not caused by any of those and it's not just normal cramping so don't stress. I would probably discontinue the creatine though. I've read it's not ideal if CK levels are already elevated. Ive used them all and the "issue" is the same with or without them.
ScottyC1969
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05 Mar 2016 19:55

Not saying we are all horses... but I'm sure whatever is going on is strongly linked to " tying up" in horses
Also called " Monday morning disease" amongst other things. A few links for people to read that you may find useful. A lot of similarities.

http://www.aaep.org/info/horse-health?publication=782

https://en.m.wikipedia.org/wiki/Equine_exertional_rhabdomyolysis
ScottyC1969
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05 Mar 2016 21:23

Thanks for the vote of confidence, ScottyC. My urine has not been discolored and is always clear to a pale yellow, so I did not think it was rhabdo, just wanted to be sure. Sorry if that was TMI...

So it looks like there can be multiple causes of this idiopathic issue including:

1. Rhabdolysis (Rhabdo) - This doesn't sound like we all have this though as no one has said their urine was dark and, as ScottyC pointed out, it is normal for athletes to have elevated CK levels anyways.
2. Femoral nerve entrapment - Maybe? We do spend a ton of time in a hunched position and I know for sure that my iliopsoas can become tighter after a few days rest. Plus, I tend to sit more when I am resting which will further shorten the muscle. Has anyone tried stretching this with any signs of relief? I am also curious if the inguinal ligament has anything to do with this.
3. External iliac artery endofibrosis - Similar method of action to femoral nerve entrapment and this has been seen numerous times in professional cycling. This one seems like a maybe, especially because the majority of us seem to be riding >10 hours a week and have done so for many years.
4. Genetic defect in which muscles store excess glycogen during rest days. This has also been seen in horses. Has anyone modified their diet to limit their carb intake on their rest day to see if this makes any difference? Or had a muscle biopsy done to see their glycogen levels on a rest day?

What makes the most sense though? Not to try and pigeon hole everyone, but I want to start somewhere and attack this.

The "cures" seem to be few and far between with the only one I have seen being to never rest more than 1 day which seems to concur with everyone else's observations on this thread.
Shayne_G
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Re:

08 Mar 2016 06:49

Shayne_G wrote:Thanks for the vote of confidence, ScottyC. My urine has not been discolored and is always clear to a pale yellow, so I did not think it was rhabdo, just wanted to be sure. Sorry if that was TMI...

So it looks like there can be multiple causes of this idiopathic issue including:

1. Rhabdolysis (Rhabdo) - This doesn't sound like we all have this though as no one has said their urine was dark and, as ScottyC pointed out, it is normal for athletes to have elevated CK levels anyways.
2. Femoral nerve entrapment - Maybe? We do spend a ton of time in a hunched position and I know for sure that my iliopsoas can become tighter after a few days rest. Plus, I tend to sit more when I am resting which will further shorten the muscle. Has anyone tried stretching this with any signs of relief? I am also curious if the inguinal ligament has anything to do with this.
3. External iliac artery endofibrosis - Similar method of action to femoral nerve entrapment and this has been seen numerous times in professional cycling. This one seems like a maybe, especially because the majority of us seem to be riding >10 hours a week and have done so for many years.
4. Genetic defect in which muscles store excess glycogen during rest days. This has also been seen in horses. Has anyone modified their diet to limit their carb intake on their rest day to see if this makes any difference? Or had a muscle biopsy done to see their glycogen levels on a rest day?

What makes the most sense though? Not to try and pigeon hole everyone, but I want to start somewhere and attack this.

The "cures" seem to be few and far between with the only one I have seen being to never rest more than 1 day which seems to concur with everyone else's observations on this thread.




I'm more inclined to think something along the lines of number 4.
Have had a full arteriogram in operating theatre and all arteries etc were perfect. Have also had extensive massage ( painful) and stretching on psoas with no joy.
It's a mystery alrite.
ScottyC1969
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