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Extreme quadriceps starting pain after 3-4 rest days

Moderator: King Boonen

08 Mar 2016 12:06

I am going for a blood panel tomorrow morning and will fill everyone in with what it shows...
Shayne_G
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Re:

13 Mar 2016 07:59

Shayne_G wrote:I am going for a blood panel tomorrow morning and will fill everyone in with what it shows...


How'd the bloods go Shayne. ?
ScottyC1969
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13 Mar 2016 12:27

The blood came back with normal except for my liver function. The Bilirubin and AST levels were elevated which indicates Gilberts Syndrome. This is really nothing though and would not cause the cramping issue. My CK levels were elevated a bit too, but in the normal range for an athlete. The doctor is going to run some further tests on the liver and blood next week, but as of now no answer...
Shayne_G
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13 Mar 2016 16:06

It hurts
Last edited by Eltorovcb on 17 Mar 2016 19:29, edited 1 time in total.
Eltorovcb
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Re:

14 Mar 2016 19:41

Eltorovcb wrote:Hi guys, I've cycled for 7 years now after playing football at a good standard for 20 years and never suffering from this. I'm literally laid on the couch now in pain as I've been ill for 4 days, and just tried spinning the legs as have a cx race on Wednesday night and a TTT on Saturday, after 5 mins on the turbo the inevitable happened, severe pain in both quads to the point where had to stop, I had 3 days off 2 weeks previous and went on the turbo and caught it just in time, I haven't really done much cause of the weather so I think it's questionable that it's over training, I'm struggling to tense my muscles or stretch them cause you f the pain, it's so annoying as I was going really well and the season is just starting, I am dubious about wasting my money at a physio and going to the doctor I feel could be a waste of time going by what you guys have already tried?
This literally is the only forum I have ever found. HELP!!!!!

Hi! Welcome to the CN Forums.

I'm glad you found us and I'm sorry you are in such pain.

This thread has some wonderful information about other members previous and ongoing experiences with certain cycling related conditions. The people that post to this thread do so knowing that what they say may or may not be of help to others experiencing the same problems.

I say this because your comment has me concerned that your looking for medical advice on this subforum in lieu of seeking professional medical attention from a licensed practitioner. The information you read on this thread is not meant to be used as medical advice and is only to be used for informational purposes. Please see a physician if you need medical treatment.

Cheers!
User avatar Irondan
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Re:

14 Mar 2016 22:02

Shayne_G wrote:The blood came back with normal except for my liver function. The Bilirubin and AST levels were elevated which indicates Gilberts Syndrome. This is really nothing though and would not cause the cramping issue. My CK levels were elevated a bit too, but in the normal range for an athlete. The doctor is going to run some further tests on the liver and blood next week, but as of now no answer...



Cheers Shayne,
Pretty standard for everyone here I guess. Blood tests all normal. Looks like Gilberts Syndrome is nothing to worry about either. Sounds like a minor condition which is good news for you. Keep us posted if your doc performs a miracle and finds anything. I have just come out of a 2 week bout of it and am back on the bike thank god. Took 4 days off after a week long tour so knew it would come on. Never pleasant... The enforced rest is probably a blessing so won't rest more than 2 days as usual from now on as that's the only way to manage it thus far. Keep hunting for the answer. It's out there somewhere.... Even if we find out it can't be cured it would be good to know what it is.
ScottyC1969
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Re:

14 Mar 2016 22:17

Eltorovcb wrote:Hi guys, I've cycled for 7 years now after playing football at a good standard for 20 years and never suffering from this. I'm literally laid on the couch now in pain as I've been ill for 4 days, and just tried spinning the legs as have a cx race on Wednesday night and a TTT on Saturday, after 5 mins on the turbo the inevitable happened, severe pain in both quads to the point where had to stop, I had 3 days off 2 weeks previous and went on the turbo and caught it just in time, I haven't really done much cause of the weather so I think it's questionable that it's over training, I'm struggling to tense my muscles or stretch them cause you f the pain, it's so annoying as I was going really well and the season is just starting, I am dubious about wasting my money at a physio and going to the doctor I feel could be a waste of time going by what you guys have already tried?
This literally is the only forum I have ever found. HELP!!!!!


Symptoms
◾Pain when flexing, stretching, or using the thigh muscles to move.
◾Muscle spasms
◾Swelling
◾Bruising on the front of thigh if blood vessels are broken.
◾Loss of leg strength.
◾Crackling sensation when you push your fingers on the injured area.

Initial Treatment
◾Rest, and avoid activities that require lower leg strength and power.
◾Apply ice or cold packs for 15-20 minutes, three to four times a day for the first 48-72 hours.
◾Apply moist heat after the first 48-72 hours for 15-20 minutes, three to four times a day.
◾Use an elastic wrap or bandage around the area to minimize swelling.
◾Use a pillow or cushion to elevate the affected leg as much as possible during the day and while sleeping at night.
◾Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain.

Comeback Strategy

Mild quad strains usually heal within 10 days. Moderate strains take 10 days to six weeks, and severe strains require three months or longer for recovery. Your return should be based on the absence of symptoms and the presence of normal leg strength and range of motion, not a certain number of days, weeks, or months. Use these tips to make a comeback:
◾Go through each movement required in your sport without pain before resuming normal training and competition.
◾Use heat on the area before an exercise session.
◾If running is part of your comeback program, don't run at full speed.
◾If you're running, avoid sudden stops until there are no symptoms and you have regained full strength and range of motion.
◾Cross-train in sports that don’t place a heavy demand on the quadriceps (upper body strength training, easy lap swimming, soft tossing a baseball, hitting off a tee, etc.).
◾Apply ice packs for 15-20 minutes after working out
ray j willings
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Re: Extreme quadriceps starting pain after 3-4 rest days

17 Mar 2016 19:27

Muscle shortening, get a foam roller and iron them quads out
Eltorovcb
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29 Mar 2016 11:49

Hi everyone,

I had another episode this Sunday while walking down the stairs in both quads. The pain was so severe that I thought I had compartment syndrome and went to the ER. ER doc cleared me for compartment syndrome, but my CK levels were >2500 and they admitted me for rhabdomyolysis. They tested me again yesterday and the CK levels were >6000. I am still here today (Tuesday) and basically just getting a ton of IV fluid pushed into me. Fortunately, I have no accompanying liver or kidney issues (and I never have with any previous episodes), but now at least I know what the deal is. I think this may have been precipitated by a viral infection on Wednesday, but no body at the hospital has been able to give me any answers or point me in a direction yet. Still more questions than answers unfortunately...
Shayne_G
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29 Mar 2016 17:12

I also just joined the forum in order to participate in this thread. I have experienced these episodes twice, most recently yesterday. It is spooky how exactly my experience matches the stories in the thread. Right down to wondering if I was experiencing DVT.

I race bicycles and train consistently. I very rarely take more than 2 days off the bike. I raced 2 weekends ago and felt great, then left the next day for a week's vacation with the family. Off the bike and minimal exercise all week. Mid-vacation, during an easy hike, experienced a lot of pain when walking downhill, had to hobble about a mile walking backwards. Felt OK for the rest of the week, snorkeled etc, no pain.

Long travel day Sunday, 12 hours of sitting. Monday went out for a ride and 10 minutes into warming up was hit with debilitating pain in both quads. Pain was sharpest on the upstroke. It took me an hour to pedal 2 miles back home. I felt as if somebody had beaten my legs with a stick, nearly throwing up levels of pain, couldn't think straight.

The affected muscles were different on the left and right. No muscle knotting, no visible signs of trauma, but the affected muscles were very sore to the touch.

I am particularly interested in the "muscles storing excess glycogen on rest days" theory (aka Monday Morning disease in horses). I will try a lower-carb diet on rest days. I will also try the suggestion to work through it with low-cadence, high torque pedaling.

It's a real catch-22 that the trigger is taking a number of rest days, because it feels risky to try to come back from the episode by not resting.
globecanvas
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Re:

29 Mar 2016 18:17

Shayne_G wrote:Hi everyone,

I had another episode this Sunday while walking down the stairs in both quads. The pain was so severe that I thought I had compartment syndrome and went to the ER. ER doc cleared me for compartment syndrome, but my CK levels were >2500 and they admitted me for rhabdomyolysis. They tested me again yesterday and the CK levels were >6000. I am still here today (Tuesday) and basically just getting a ton of IV fluid pushed into me. Fortunately, I have no accompanying liver or kidney issues (and I never have with any previous episodes), but now at least I know what the deal is. I think this may have been precipitated by a viral infection on Wednesday, but no body at the hospital has been able to give me any answers or point me in a direction yet. Still more questions than answers unfortunately...




Hi Shayne
Hope all is ok and I'm sure it will be. Bet you're loving that hospital food... Did the episode come on after hard training or had you been resting for a few days? Weird how they diagnose rhabdo but then can't tell you much more. Hang in there mate.
ScottyC1969
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30 Mar 2016 18:23

I had the quad pain episode Monday as described 2 posts up. This morning I went to a sports PT who thought it was a classic overuse injury. I disagree with this diagnosis. The level of pain, the unfocused nature of it (different specific muscles in each quad), the unusual triggers (spinning easy after a rest week), it just doesn't make sense. I am a well trained athlete but I am not overtrained.

I tried riding again today, pushing a little harder from the beginning as somebody up-thread suggested, but I didn't make it 5 minutes from my house. I had to walk home. There was no question of pushing through the pain, when I got home I was afraid that bending my leg would rip the quad in half. I can understand how some sufferers have gone to the ER for fear of compartment syndrome or some other emergency. I can move around now but my legs feel sore and bruised, as if they were beaten with a pipe.

I feel that I can rule out a localized physical cause such as muscle pull, trapped nerve, etc. The pain is on both sides, and the specific affected muscles were different today than they were Monday.

I don't see any alternative now except to take yet more time off the bike. This is very disappointing to me as the racing season has just begun and this is usually my best time of the year.
globecanvas
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Re:

30 Mar 2016 20:43

globecanvas wrote:I had the quad pain episode Monday as described 2 posts up. This morning I went to a sports PT who thought it was a classic overuse injury. I disagree with this diagnosis. The level of pain, the unfocused nature of it (different specific muscles in each quad), the unusual triggers (spinning easy after a rest week), it just doesn't make sense. I am a well trained athlete but I am not overtrained.

I tried riding again today, pushing a little harder from the beginning as somebody up-thread suggested, but I didn't make it 5 minutes from my house. I had to walk home. There was no question of pushing through the pain, when I got home I was afraid that bending my leg would rip the quad in half. I can understand how some sufferers have gone to the ER for fear of compartment syndrome or some other emergency. I can move around now but my legs feel sore and bruised, as if they were beaten with a pipe.

I feel that I can rule out a localized physical cause such as muscle pull, trapped nerve, etc. The pain is on both sides, and the specific affected muscles were different today than they were Monday.

I don't see any alternative now except to take yet more time off the bike. This is very disappointing to me as the racing season has just begun and this is usually my best time of the year.



You're not alone and the episode you just described right down to walking home is not unfamiliar. Once it gets that bad I know from years of this that rest is the only cure. Then depending on how you feel trying some very light spinning on the indoor trainer. As the days pass you can hopefully go longer and increase the intensity. The foam roller 2-3 times a day can be helpful in the recovery/rest process too. Just thought I would share so you know there are others who know exactly how frustrating this can be. Hang in there. It will come right. Once it does don't stop riding...
ScottyC1969
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31 Mar 2016 09:59

Following my earlier post...

I could feel an 'attack' of this coming on the other day as I walked down stairs following my morning commute (usual 2 day rest syndrome!). I immediately stopped, went back upstairs to my desk, and took 800mg Ibuprofen (which is double the stated retail dosage but still within acceptable clinical guidelines). This was something my GP said to try next time I could feel it happening. I sat at my desk for about 45 minutes to give the drugs time to act and, surprisingly, this completely aborted the episode.

Why I think this matters is that I think I can discount the 'sitting for 45 minutes' as being the aborting factor, as I've tried immediate rest so many times in the past with no success. The key difference here was the large dosage of NSAIDs before the event really took hold.

Whilst the plural of anecdote isn't data, this was the first and only time I've managed to effectively stop this happening. If you are tolerant of ibuprofen, then it might be worth giving this a shot as soon as you feel the tension in your quads rising. I'm unsure how effective this will be once the attack as fully started.
dcolvin
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Re: Extreme quadriceps starting pain after 3-4 rest days

02 Apr 2016 11:29

Hi all
I've had a number of episodes of this issue and have been working with my coach (Phd with focus on sports science and genetics) and some sports doctors, and have come up with a hypothesis as to what is going on:

Onset of the condition in my case:
- relatively high training / racing load
- 3-4 days of inactive rest
- normal / increased carb and sugar intake during the training load, and importantly no moderation /and often an increase in carb and sugar intake immediately during the rest period (ie pigging out a bit post a stage race / big block, or at least not reducing intake during this period)

Manifestation
- pain as described above, in quads, calves, hammies, abductors, glutes.
- importantly the fact that during an episode the pain moves around (anterior, posterior, right leg, left leg) indicates that this is not a nerve/skeletal issue
- significantly increased CK levels indicating some for or myopathy
- CRP levels normal indicating that it isn't an autoimmune issue

Hypothesis
- the issue is an enzyme related issue in the muscles specifically related to the production of glycogen synthase.
- glycogen synthase is the enzyme which is responsible for converting glucose into glycogen for storage in muscle cells.
- in a "normal" person, during high load, levels of glycogen synthase increases in order to store fuel to meet the increased requirement for energy for the body. When exercise load decreases, the body automatically regulates the level of this enzyme as the body's need for stored glycogen reduces.
- the theory that we are working with is that in my case, the body is not regulating this enzyme level, and so the body is continuing to convert glucose into glycogen and packing it into the muscle cells.
- the problem is twofold in that firstly exercise has stopped and so the glycogen is not being used (but continues to be stored) and sugar and carb intake has not reduced (and often increased) so there is excess in the body and it is being stored.
- the theory is that the muscle cells get overloaded with glycogen and when exercise is introduced, the cells literally tear as a result of being overloaded.
- this accounts for the pain felt, as well as the increased CK levels.
- the hypothesis is that this is a genetic issue and there isn't a "cure" as such

Prevention and treatment
- active rest as opposed to inactive rest has been effective in preventing onset (ie. 90 minute low intensity sessions with not more than a day of inactive periods).
- significant reduction of carb and sugar intake as the rest period starts
- during the most recent episode I went into a LCHF (virtually carb free) diet and within 2 days had no more pain
- during the episodes, multiple, short (10-20min) sessions until onset of pain, with aim of stimulating metabolism and effectively burning off glycogen
- once pain had subsided, introduced low intensity IMTG rides for the first few sessions.
- use of ibuprofen to assist with inflammation in Muscles and for pain during the episode
- increase water intake to assist kidneys with CK load

As I said, this is a theory that the guys i am working with have come up with and it seems to make sense and be working for me. I'm sharing it with you simply because I know the frustration and the pain associated. If (and hopefully we don't have another episode given our prevention strategy) we have another episode, we will need to do a muscle biopsy to test the theory - obviously invasive so would prefer to avoid!!

Once again, this is a theory - hopefully it helps!!
Drewza101
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02 Apr 2016 15:02

Drewza, perfect explanation! This is the theory I am currently going with as well. I have been doing some research on McArdle disease and Tarui's disease which seem to align with the symptoms described by everyone.

I like your prevention and treatment especially. I will do 3-4 rides/day when I have a flare that may last only 20-30 minutes before I cramp initially, but like you said over the course of a few days the rides will gradually get longer and the intensity will increase as the excess glycogen burns off and levels normalize.

So, you have been able to relegate the symptoms entirely with carbohydrate modification during your rest days? If so, do we all just change our diets to low carb/high fat and see what happens? There have been some recent studies done on the ketogenic diet that seem promising.

I am going to see a nephrologist this Wednesday and will be requesting a muscle biopsy (to see the level of glycogen in them) as well as a genetic test to see if I have any mutations that would signify CPT II deficiency, McArdle disease, or Tarui's disease. I will let everyone know when I get the results back.

-Shayne
Shayne_G
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02 Apr 2016 17:47

I'm 10 days into the current episode. It's ongoing and deeply frustrating. Yesterday I felt much improved; this morning the pain exploded in a brand new quad muscle while I was walking to the car. It's infuriating how the particular muscle being affected seems to change from day to day. 2 weeks ago I was racing, now I can't even walk to the car.

Drewza101, thanks for the summary. I have been limiting carb intake but I will try more extreme limitation. I will also try short, easy exercise sessions, though my last 2 rides have lasted less than 5 minutes.

Once I'm through this episode I will never, ever take more than 2 days off in a row. I just hope I can actually get through it.
Last edited by globecanvas on 03 Apr 2016 12:00, edited 1 time in total.
globecanvas
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03 Apr 2016 08:40

Shane G
I have managed to completely eliminate symptoms - from being unable to do more than 15 min up until Thursday night, I have managed to do 10 hours of pretty easy riding in the last 3 days. Whether this is attributable to going off carbs and sugar altogether (which I did on Tuesday) or to the body starting to regulate enzyme levels isn't clear, but all I cam say is that I've gone from having serious pain to all systems go in a short space of time

In terms of whether a LCHF diet makes sense permanently, I'm not an expert but don't believe that a low carb diet makes sense for endurance athletes. My view is that a balanced diet makes more sense - and the theory is not that the body can't deal with carbs, it's that it cannot regulate glycogen storage in rest. I typically do 15,000 to 20,000km per year and happily eat carbs (focused on more complex carbs like sweet potatoe, butternut etc as opposed to sugars or quick carbs) and don't have any issues until I go into inactive rest.

Globecanvas - good luck, I know how frustrating it is. Maybe give what I've described a bash.
Drewza101
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05 Apr 2016 16:01

17 days ago: Raced, felt great.

16 days ago: Started a week long vacation.

14 days ago: Hiking easy on vacation with the family, moderate to severe quad pain walking downhill. Had to walk about a mile down a steep rocky slope backwards. I was dehydrated at the time (in the tropics, didn't quite bring enough water). Assumed it was cramps and didn't think too much of it.

13 and 12 days ago: 15 minute uphill run each day, tempo pace. Some quad discomfort but assumed it was residual from the cramp episode.

9 days ago: Long travel day returning home.

8 days ago: First time on the bike since the race (9 days earlier). 5 minutes in spinning easy, severe/maximum quad pain. Stopped, stretched out, pressed on, became practically incapacitated. Took an hour to pedal about a mile back home.

6 days ago: Tried riding again, this time starting with a climb and pushing a bit, following a recommendation from this thread. Disaster. Lasted less than 5 minutes, practically incapacitated, had to walk home.

3 days ago: While walking about 30 feet downhill in my yard, another pain episode but only in one particular muscle in one leg. Pain lasted about 4 hours. Starting that day, cut out carbs completely following another recommendation in this thread.

1 day ago: Took advil and tried pedaling on the trainer. Moderate pain for first 5 minutes, and a lot of anxiety trying to guess if this was just residual soreness or another severe pain episode about to spiral out of control. Legs settled down after that. Pedaled for 45 minutes including 20 minutes of low tempo. Felt weak but OK, could have gone longer/harder but decided to quit while I was ahead.

Today: No advil, 45 minutes on the trainer, 20 minutes of high tempo, felt weak but just about normal. Still a bit of residual soreness in the legs but totally manageable.


All together, it's been 14 days from the first pain episode. I'm feeling quite optimistic now, a bit out of shape but no longer broken. I have no idea if cutting out carbs is correlated with finally getting through this, but I'll assume it is, and in the future I plan to cut carbs any time I need to take more than a day off the bike. I am pretty sure cutting out carbs is contributing to feeling weak on the bike, but that's to be expected.

I missed 2 races because of this problem and will probably skip one this weekend that I had been targeting, but if that's the only damage to my season from this experience, I'll count myself lucky.

Drewza101, thanks again for your summary and recommendations.
globecanvas
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20 Apr 2016 11:17

One last post on this for now. The first pain episode was 4 weeks ago today, the worst of it was 3 weeks ago. I was off the bike completely for 2.5 weeks, and have been back to normal training for 2 weeks. I raced last night and it went fine, it was as if the pain episodes and layoff had never occurred. I'm back on a normal diet as well.

Hopefully I can prevent a recurrence by light exercise on rest days and diet management when the training workload decreases.
globecanvas
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