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Extreme quadriceps starting pain after 3-4 rest days

Moderator: King Boonen

Re: Extreme quadriceps starting pain after 3-4 rest days

29 Nov 2018 12:03

[quote="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.[/quote]

This is 100% me. A couple of months ago I came perilously close to an "attack" after 48 hours off the bike, but managed to just about keep it at bay by getting on the bike just in time (I could feel the "acid" (or whatever) rising but it never went nuclear); otherwise I've managed to keep it completely at bay by real careful management. It can be an incredible inconvenience though, especially with holidays, and thankfully my missus is a saint.


[quote="One the of the things that popped up on mine: "susceptibility to malignant hyperthermia (MHS) You may be at higher risk for a bad response to anesthetics."[/quote]

I'd be interested in giving this a go, just to help test your hypothesis. Which test did you do? The Health and Ancestry Svs or just the Health one?

Then was there any cost for the further analysis?
budegan
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Re: Extreme quadriceps starting pain after 3-4 rest days

08 Feb 2019 17:50

[quote="I'd be interested in giving this a go, just to help test your hypothesis. Which test did you do? The Health and Ancestry Svs or just the Health one?

Then was there any cost for the further analysis?[/quote]


I used 23andMe. You don't need to pay for the health report. You can just by the ancestry test and then download your raw file (a huge test file with your full DNA sequence). Running that raw file through promethease.com cost $12. I'll be interested to hear your results. Thanks!
barnes21bb
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Re: Extreme quadriceps starting pain after 3-4 rest days

12 Mar 2019 16:49

Drewza101 wrote:
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


I've got this StabbyLeg / LegAIDS problem, have had a few bouts over the years. Normally in reasonably heavy training that suddenly stops, often for a holiday that involves flights and/or lots of boozing, although I know other people who are non-drinkers that get it.

It's an interesting theory and I'm excited to try low-carb holidays to see if it makes any difference, but why does the problem only seem to happen to quadriceps if it's a whole-body muscle glycogen enzyme? Also, how come running up the stairs doesn't trigger the issue but gingerly walking down stairs will? That does seem to match the theory.
User avatar firsthippy
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Re: Extreme quadriceps starting pain after 3-4 rest days

14 Mar 2019 18:28

barnes21bb wrote:To test my hypothesis, is there anyone on this forum that has had DNA testing done? I know 23andME and Ancestry.com will let you download the raw data. It would interesting to see if anyone else on this forum comes back as MHS positive.

Interesting theory. I ran my 23andMe results through promothease, and when I search the report for malignant hyperthermia all the results that come up are green/good in my case.
jsk
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Re: Extreme quadriceps starting pain after 3-4 rest days

07 Jun 2019 21:19

Drewza101 wrote: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!!


Hello All
Finally have got around to posting after dipping in and out of this forum over a few years. I'm posting to let you know what has worked for me in managing this, and to point newcomers to some of the posts that I've found most useful. This is the only forum I've found that disucsses this in any detail, yet, asking around, it seems it is not uncommon.

First to be clear, I'm talking about what I think most are referring to here, covered in detail in earlier posts. In brief: debilitating muscle spasms/seizing up throughout quads, typcially occuring after periods of rest (e.g. especially 'extreme' rest when travelling) and often triggered by eccentric excercise. Extreme pain; can lock up legs entirely so cannot bend knees; not typical cramps (magnesium supplement no help); certainly not DOMS; those who've had it measured report high levels of CK; muscle damage and pain can persist for days after an event.

I strongly recommend taking the time to trawl though the many posts here. I've found useful posts by Drewza101, BJ1188, Shayne_G (who had a lot of meidical invetigations), to name a few. What Drewza101 says aligns with my experience; i.e. this appears to be a problem with over-storage of glycogen in muscles (perhaps that same as 'tying up' in horses: https://ker.com/equinews/managing-tying-up-in-horses/ ?)

My last episode followed 2 days rest (driving) after consistent period of cycle commuting (low mileage <120 km/wk), eating junk, then going for a run, not warmed up (attempting to keep up with my too-fit sister). I could barely walk for 10 days, and any stepping down trigger new attacks. I eventually broke out of it, following advice of some earlier posters, by:

1. Taking high doses of anti-inflammatories (Ibuprofen 800 mg, four times daily), starting two days before excercising again (3, below).
2. Fasting over three days (attempting to deplete glycogen stores): Day 1 some fat and protein, nil, repeat nil, carbohydrates. Days 2 - 3 nil food.
3. Jumping on bike and, with no warm up, cycling at maximum sustainable effort up hill for as long as I could endure, then spin to recover and repeat for about 20 minutes. Continued with 30 min hard riding on the flat. Then solid short daily rides until back to normal.
4. Weeping for joy (almost).

How to manage it? Again, what Drewza101 says. Key seems to be to maintain some degree of glycogen depletion (I find a low carb healthy fat diet highly beneficial, but not sure yet if it helps ith this).

Stopping cycling works, long-term: Last year, prior to a 4-week trek in Nepal, fearful of being incapacitated there, I stopped cycling and, a few months before the trip, eased into long walks, starting on the flat, then some easy runs for. At first, I experienced leg cramps even on descents, but gradually these eased (avoiding striding out on descents helps) and was able to do the trek with no problems at all.

Never stopping cycling also works. i.e. I find never having more than 2 days off seems to help. Trouble is, the more cycling fit I am, the more prone I am to this.

I'm working on trying to build both cycling and running fitness to see if that helps/gives me an alternative if I cannot cyle. I find that, currently, even when cycling regularly, eccentric quad excercise (e.g. running downhill) tends to trigger it. Anyone have experience with this?

What does not work: Gently easing into exercise doesn't help me - I got it after an 18 km barely trying ride - I'm guessing because this does not deplete glycogen. Massage seems to trigger it, not relieve it. In earlier days, I tried magnesium supplmentation which made no difference (which makes sense if it's a glycogen over-storage problem).

My brother, also a cyclist, suffers from identical symptoms. There may be a genetic predisposition?

I hope this is helpful.
MDSanders
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