Extreme quadriceps starting pain after 3-4 rest days

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Dec 31, 2020
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"Carnitine palmitoyltransferase 2 (CPT2) deficiency is a condition that prevents the body from using certain fats for energy, particularly during periods without food (fasting). There are three main types of CPT2 deficiency: a lethal neonatal form, a severe infantile hepatocardiomuscular form, and a myopathic form.[1] The neonatal and infantile forms are severe multisystemic diseases characterized by liver failure with hypoketotic hypoglycemia (extremely low levels of ketones (substances produced when fat cells break down in the blood) and low blood sugar), cardiomyopathy, seizures, and early death.

The myopathic form is characterized by exercise-induced muscle pain and weakness and occasional myoglobinuria (rust-colored urine indicating breakdown of muscle tissue).[2] Mutations in the CPT2 gene cause CPT2 deficiency. It is inherited in an autosomal recessive pattern.[1] Treatment is based on avoidance of prolonged fasting and a low-fat and high-carbohydrate diet.[3] "

I don't recall rust-coloured urine at any point with this and I would say that most of my episodes happen at times I'm very well fed rather than any fasted state (holidays, etc). So, I don't think this explains my issue but it could be a related thing for sure.
I agree that it's not an exact correlation as we all tend to experience an episode after a period of rest and not during exercise, AND during a fed state. That said, in my case, I had my first recent, acute episode on the 27th, after 48 hours off the bike and overeating carbs and treats and well, everything. I was feeling a bit better by the 31st and started a 5 day water fast (i like to do this once per year in off-season). The 'attacks' have been the worst I've experienced and triggered by the most simple movement (walking slowly more than 5 0 - 100 steps. It's definitely been the worst I've experienced in over a decade of dealing with this. I'm still in a fasted state at the moment but MAY end the fast later today if I'm convinced it will help.

Goal is to just keep chipping away and sharing results on here so we can all just get on with it.

I just ordered a fat bike yesterday for crying out loud!
 
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Dec 31, 2020
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Hi,

long time lurker of this thread, now I made an account. I had three episodes this year. All with elevated CK levels way above 9000. I also had three hospital stays were the checked me for everything (MRI, EMG, ENG, blood test, Ischaemic forearm test etc etc). Long story short, they couldn't find the cause.



You got it the wrong way round. The effect is the same (rhabdomyolysis - rapid breakdown of muscle fibre), but not the underlying cause. CPT-II deficiency is a very rare disease, so rare it's highly unlikely everyone here with these symptoms has it.
Her situation is not 100% consistent with ours, but it was close enough to warrant further consideration. Triggers for her don't seem to be the same, but also seemingly not 100% unrelated.

either way, I'm definitely going to do the CPT2 test just to rule it out. I see at least one other person on here has done it and it came back negative, but it's worth a shot anyways.
 
Jan 4, 2021
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Her situation is not 100% consistent with ours, but it was close enough to warrant further consideration. Triggers for her don't seem to be the same, but also seemingly not 100% unrelated.

either way, I'm definitely going to do the CPT2 test just to rule it out. I see at least one other person on here has done it and it came back negative, but it's worth a shot anyways.
Yes, I agree. If it comes back negative, you can at least rule it out.

As I said, the pain she is experiencing is the same we are experiencing. Rhabdomyolysisis a condition that can have multiple causes. When I was in the hospital they confirmed rhabdo (via CK levels and MRT) but couldn't find the cause. It happens for me exactly as it happened to so many others in the thread: longer break from cycling (for me 4 days) and going down steps triggering excruciating pain in quads. Next day everything seems in order until I take the steps again. Repeat for 7 days. I tried a high carb diet, I tried keto. Nothing helps, only cycling very regulary.

I haven't watched the documentary yet but I read that all her symptoms were manageable by a high carb, low fat diet. I find that very strange, normally cpt2 deficiency is not manageable that easily. There's a study that a high carb-low fat diet with additional substitution of a certain medium chain fatty acid can provide relief from attacks, but not the diet alone.

Edit: watching the documentary right now. I dunno, this seems strange. Why did noone before think about CPT-2 deficiency. If you Google rhabdomyolysis or even myopathy it comes up. Even if the US healthcare system is as *** as I heard it is and the doctors couldn't help her, by doing private research it should have popped up.
Also I wish I could walk as well as she can when I have one of my bouts lol
 
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Dec 31, 2020
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Yes, I agree. If it comes back negative, you can at least rule it out.

As I said, the pain she is experiencing is the same we are experiencing. Rhabdomyolysisis a condition that can have multiple causes. When I was in the hospital they confirmed rhabdo (via CK levels and MRT) but couldn't find the cause. It happens for me exactly as it happened to so many others in the thread: longer break from cycling (for me 4 days) and going down steps triggering excruciating pain in quads. Next day everything seems in order until I take the steps again. Repeat for 7 days. I tried a high carb diet, I tried keto. Nothing helps, only cycling very regulary.

I haven't watched the documentary yet but I read that all her symptoms were manageable by a high carb, low fat diet. I find that very strange, normally cpt2 deficiency is not manageable that easily. There's a study that a high carb-low fat diet with additional substitution of a certain medium chain fatty acid can provide relief from attacks, but not the diet alone.

Edit: watching the documentary right now. I dunno, this seems strange. Why did noone before think about CPT-2 deficiency. If you Google rhabdomyolysis or even myopathy it comes up. Even if the US healthcare system is as *** as I heard it is and the doctors couldn't help her, by doing private research it should have popped up.
Also I wish I could walk as well as she can when I have one of my bouts lol
Strange indeed. There was one person here that was tested for CPT2 and came back negative.

What got me considering it was that I'm currently on a prolonged fast (since Dec 31) and so should be burning pretty much exclusively fat.. At the same time, this is the worst I've had it (recurrent bouts within a ~10 day period). When I was in hospital this past weekend with Rhabdo, I told them I was fasting and they didn't seem to think it was any issue. THAT said, I have followed a LCHF / Keto diet in the past and had no issues... It's always been the rest periods, like everyone else here. If it were classic CPT2 I'd have had plenty of issues DURING workouts while on keto or fasted. I just can't help but think it's somehow related and would like to rule it out, along with some others.
 
Jan 4, 2021
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Strange indeed. There was one person here that was tested for CPT2 and came back negative.

What got me considering it was that I'm currently on a prolonged fast (since Dec 31) and so should be burning pretty much exclusively fat.. At the same time, this is the worst I've had it (recurrent bouts within a ~10 day period). When I was in hospital this past weekend with Rhabdo, I told them I was fasting and they didn't seem to think it was any issue. THAT said, I have followed a LCHF / Keto diet in the past and had no issues... It's always been the rest periods, like everyone else here. If it were classic CPT2 I'd have had plenty of issues DURING workouts while on keto or fasted. I just can't help but think it's somehow related and would like to rule it out, along with some others.
I did all the things which should trigger an cpt2 deficiency attack and never had a problem. I did 23/1 fasting or omad for half a year. Never felt better in my life, energy levels were through the roof. Unfortunately it's very hard to maintain if you try to be somewhat sociable. I did very strict keto, below 20g net carbs for months, felt great, but I really like (healthy) carbs, especially fruits.


All doctors I spoke to think it's a metabolic disorder, just not one they know yet.
 
Dec 31, 2020
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I did all the things which should trigger an cpt2 deficiency attack and never had a problem. I did 23/1 fasting or omad for half a year. Never felt better in my life, energy levels were through the roof. Unfortunately it's very hard to maintain if you try to be somewhat sociable. I did very strict keto, below 20g net carbs for months, felt great, but I really like (healthy) carbs, especially fruits.


All doctors I spoke to think it's a metabolic disorder, just not one they know yet.
Sounds like we are like minded..... I'll certainly update this thread if I find anything promising in the coming weeks / months.
 
Dec 31, 2020
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Do any of us have dark coloured urine during an episode? I never do.

what’s the quickest way you found to get back into exercise? I remember someone mentioning to just work through an episode and you can get over it. I’ve done this in the past but I’m not sure it’s smart now that I’m aware of the CK / Rhabdo connection. At a little over 1 week since the first recent episode and I’ve had symptoms / narrowly avoided episodes / full blown episodes since then, by simply walking (flat) or even just putting out the trash. I am at a loss this time around and it’s driving me insane.
 
Dec 31, 2020
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I found this interesting..


For me, it could be compounding effects. Ie this most recent one. I trained fairly hard on Zwift on Christmas Day (93 minutes in avg Zone 3, 114 TSS).
I was on a bit of a rush and can’t remember how well I hydrated. I left shortly after finishing and cleaning up to drive to my inlaws (5 hours). I then drank alcohol (moderate) and ate for the next two days. Probably dehydrated. Then BOOM. It could have been the compounding effect of all of these things?

the fact that we all get it only in the working muscles is interesting. I’ve done bodybuilding, CrossFit, HIIT etc and never had issues in any other body part.

4. It can take three days to set in.
You might expect to know shortly after, or even during, a workout that something is wrong. But rhabdo usually peaks at 24 to 72 hours after a workout or injury, says Arora. Delayed-onset muscle soreness, or DOMS, is normal after a tough workout, and it can sometimes be hard to differentiate between DOMS and rhabdomyolysis, he says.
If you experience muscle pain or weakness in one muscle group that seems out of proportion to the workout, it could be rhabdo, says Arora. Swelling or a cramp-like sensation that won’t go away, especially in one muscle group, are other possible signs. If you’re sore all over, you’re probably OK, but it’s always better to err on the side of caution if you’re concerned, he says.
 
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Sorry for all the posts, just sharing as I go, and maybe something will resonate with the group.

The below is from https://n.neurology.org/content/82/10_Supplement/S36.005

The timing between exercise and the onset of symptoms of muscle injury differed between the two groups. In metabolic myopathy patients, symptoms of muscle injury occurred immediately and myoglobinuria within hours of exercise. Commonly, these patients also had a life-long history of exercise intolerance. In contrast, patients with exertional rhabdomyolysis not associated with a metabolic myopathy, had minimal symptoms immediately after exercise and developed muscle pain, swelling, and myoglobinuria 12-36 hours after exercise which typically involved unaccustomed eccentric muscle contractions.

Is this not familiar? Developing a period of time after the exercise, and triggered by eccentric muscle contractions (like walking downstairs or downhill).
 
Jan 4, 2021
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Do any of us have dark coloured urine during an episode? I never do.

what’s the quickest way you found to get back into exercise? I remember someone mentioning to just work through an episode and you can get over it. I’ve done this in the past but I’m not sure it’s smart now that I’m aware of the CK / Rhabdo connection. At a little over 1 week since the first recent episode and I’ve had symptoms / narrowly avoided episodes / full blown episodes since then, by simply walking (flat) or even just putting out the trash. I am at a loss this time around and it’s driving me insane.
I never had dark coloured urine. My doctors said that doing sport while in an episode is the worst thing you can do. You have to rest and hydrate (3 liters per day minimum). Working through an episode by doing exercise wouldn't even be possible for me, I can barely walk once it's triggered.


I found this interesting..


For me, it could be compounding effects. Ie this most recent one. I trained fairly hard on Zwift on Christmas Day (93 minutes in avg Zone 3, 114 TSS).
I was on a bit of a rush and can’t remember how well I hydrated. I left shortly after finishing and cleaning up to drive to my inlaws (5 hours). I then drank alcohol (moderate) and ate for the next two days. Probably dehydrated. Then BOOM. It could have been the compounding effect of all of these things?

the fact that we all get it only in the working muscles is interesting. I’ve done bodybuilding, CrossFit, HIIT etc and never had issues in any other body part.

4. It can take three days to set in.
You might expect to know shortly after, or even during, a workout that something is wrong. But rhabdo usually peaks at 24 to 72 hours after a workout or injury, says Arora. Delayed-onset muscle soreness, or DOMS, is normal after a tough workout, and it can sometimes be hard to differentiate between DOMS and rhabdomyolysis, he says.
If you experience muscle pain or weakness in one muscle group that seems out of proportion to the workout, it could be rhabdo, says Arora. Swelling or a cramp-like sensation that won’t go away, especially in one muscle group, are other possible signs. If you’re sore all over, you’re probably OK, but it’s always better to err on the side of caution if you’re concerned, he says.
Dehydration seems to play a certain role. My first episode also came on after drinking alcohol (something I do very rarely).

For me DOMS and Rhabdo is not hard to separate. These episodes are clearly not just DOMS.
For me a typical episode looks like this:

Day1: Excercise
Day2: mild muscle soreness from DOMS
Day3: normal muscle soreness from DOMS (more than Day 2)
Day4: mild muscle soreness from subsideing DOMS
Day5: no pain
Day 6 or 7: no pain when waking up, but Rhabdo in quads by going down the stairs (I live 4th floor): In the mornings when waking up and walking around my appartment I have no pains, but as soon as I go down a few stairs, extreme pain will flare up in my quads. This cycle repeats for 7-8 days until it abruptly stops. I can have the worst pain at day 13 and no pain at all at day 14.

Sorry for all the posts, just sharing as I go, and maybe something will resonate with the group.

The below is from https://n.neurology.org/content/82/10_Supplement/S36.005

The timing between exercise and the onset of symptoms of muscle injury differed between the two groups. In metabolic myopathy patients, symptoms of muscle injury occurred immediately and myoglobinuria within hours of exercise. Commonly, these patients also had a life-long history of exercise intolerance. In contrast, patients with exertional rhabdomyolysis not associated with a metabolic myopathy, had minimal symptoms immediately after exercise and developed muscle pain, swelling, and myoglobinuria 12-36 hours after exercise which typically involved unaccustomed eccentric muscle contractions.

Is this not familiar? Developing a period of time after the exercise, and triggered by eccentric muscle contractions (like walking downstairs or downhill).
I think the "eccentric" part correlates to the excercise itself, not to the trigger.
 
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Reactions: steviep
Dec 31, 2020
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Thanks Golden for the continued dialogue here..

I agree that exercising through it is a bad idea, and I'd agree that typically I'd say it'd be impossible, but in 2 of my acute episodes I've had no choice (sorta). Once was during a half Ironman, about 5km into a hilly ride. I could have turned around but chose not to. I figured I could always pull over at some point and have medical bring me back. It was excruciating, as we all know, and I was literally in tears for a while. But then it subsided completely and I just had the residual soreness. The second time was last summer. I decided to run the 16km to my office. 2km in I could feel it coming on so adjusted my cadence / speed... managed it for a couple more km and then full blown episode hit. I could have stopped and called my wife for a pick up, but kept on walking / jogging / running and it eventually subsided another 30 minutes later (again, just more sore than I'd typically be). During these times I had no idea about the Rhabdo connection so had I known I would have certainly stopped. That said, I didn't ever have dark urine and could train the following day pretty much as normal. I don't know about the rest of you guys but I've always been somewhat poor with hydrating during training / racing. On group rides, friends typically need to remind me, and on a 2 hour trainer ride I'd maybe go through 1 bottle, even though I have 2 - 3 on hand, and it's usually just water.

DOMS and Rhabdo are worlds apart, I agree, and the distinction is obvious. I feel I've lived half my adult life with some sort of DOMS, lol.

Your timeline is not unfamiliar, though for me it usually happens sooner than day 6 or 7. IE this time It was just shy of 3 days (Trained 25th AM and then happened 28th AM), then again 3 days later and again 2 days after that.

Hydration, alcohol, inactivity and maybe higher carb / sugar seem to be the consistent theme for most of us. That said, I've had this happen probably ~20 times or so now and under a variety of conditions...

I'd say 1/3 of the time in races (with a simple taper, no drinking, being diligent with diet) and 2/3 during vacation or work travel of some kind (both usually involving lots of sitting, lots of carbs, lots of drinking). Hiking, biking, running, walking downstairs, walking downhill... so many triggers.

At THIS point, I'm not convinced it's some sort of genetic myopathy and is indeed a form of exertional rhabdomyolysis.
 
Reactions: steviep
Jan 6, 2021
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Hi everyone. Just found this thread. Have only made it through page 3, but wow.

I first experienced this as a teenager around the year 2000 walking downhill. My dad experienced the same. We'd just started cycling at the time.

Fast forward through multiple episodes and my physician told me to stop riding period as my CK levels were high and it could damage my kidneys, but I couldn't take that answer so took a trip to Vanderbilt Medical Center but by then the episodes had passed (it'd been about 8 days at that point) and no one could figure it out. I thought it was some acute type of exercise induced compartment syndrome as that was the only similar-sounding symptoms I could find.

Took up running at one point and started experiencing it in my chest muscles as well, which led to a new assortment of cardiac tests thinking it was heart issues. The dr. eventually said it must just be a muscular virus.

Anyway, I just did two big 12 hour weeks in a row (typically I do 6-8 hours) and I took three days off and boom, massive episodes, even just walking around the house.

I've found Icy Hot or some other topical heating lotion helps a lot after the first one or two episodes. It's how I've survived through a few races I've traveled to and felt the onset coming. As long as I stop at the first little niggle and apply it liberally and wait a few minutes, I've generally been able to get through it.

Looking forward to reading through the rest of the thread. Thanks so much for all the info. It's been two decades of utterly bizarre confusion.
 
Jan 6, 2021
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Fellow sufferer here and also very glad to have found this thread.
I found the pain sets in if I am off the trainer for 3-4 days.

Now here is a question for the rest of you.
Are you all riding road bikes or trainers? I ask because I don't have any issues when I ride my mountain bike. It only sets in once winter comes in and I move onto the trainer. Which has me wondering if it could be posture related as well?
This is just my speculation of course, I have no medical background or reference.
Indoor trainer seems to bring it on way less frequently than outdoor riding. I'd say 90% of my episodes occur outside in cool weather.

After a particularly hard block and rest, like what I'm experiencing now, even the training will bring it on, but I've had periods where I'd ride 30-40 minutes on the trainer for multiple days and then go outside and have it hit pretty hard.
 
Jan 2, 2021
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Indoor trainer seems to bring it on way less frequently than outdoor riding. I'd say 90% of my episodes occur outside in cool weather.

After a particularly hard block and rest, like what I'm experiencing now, even the training will bring it on, but I've had periods where I'd ride 30-40 minutes on the trainer for multiple days and then go outside and have it hit pretty hard.
But do you primarily ride road bikes vs MTB either outdoors or indoors?

I only ask because I ride MTB exclusively 8 months of the year and only have issues when I come indoors and start riding a road bike setup on the trainer. The trainer is the only time I ever am on a road bike, nothing against them, it's simply a preference. I may try to set up my MTB on the trainer to see if that changes things for me though the drive train won't have the same benefit.

To answer someone's question about dark urine during or around the time of an episode. I have never had dark urine even when my CK levels were as high as 23k. That seems to be consistent with this group.
 
Dec 31, 2020
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In the trainer vs outdoor debate, I'm not sure (in my case) it's makes any difference. I've trained outdoors in 30C+ and Sub Zero, without issue. I've put in ~15 hour weeks of pure indoor and no issue. Issues only arise when rested for a few days or more.

I'm not sure about the rest of you, but I COULD see a correlation with hydration. Generally, I'm poor with staying on top of hydration during training. Not to the point where I feel bad during a ride, but just not enough. And when I'm 'resting' or off for a few days there's a good chance I'm not hydrating enough either. In fact, this generally coincides with alcohol (dehydrating) consumption and increase carbohydrate consumption, further dehydrating me.
 
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Jan 2, 2021
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In the trainer vs outdoor debate, I'm not sure (in my case) it's makes any difference. I've trained outdoors in 30C+ and Sub Zero, without issue.
On road bikes or mountain bikes?
My question isn't about the indoors vs outdoors but instead about the body position difference between the two bikes.

I never have any issues while riding a mountain bike. It is only when I switch to the road bike that I have had the crippling pain and elevated CK ( between 7000 at the lowest and as high as 23000 ). At least this has been my experience so far.

Naturally I haven't done any specific testing to prove this and it could be the different cadance or other factors that make a difference. I'm simply looking for patterns.
 
Dec 31, 2020
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On road bikes or mountain bikes?
My question isn't about the indoors vs outdoors but instead about the body position difference between the two bikes.

I never have any issues while riding a mountain bike. It is only when I switch to the road bike that I have had the crippling pain and elevated CK ( between 7000 at the lowest and as high as 23000 ). At least this has been my experience so far.

Naturally I haven't done any specific testing to prove this and it could be the different cadance or other factors that make a difference. I'm simply looking for patterns.
I'm pure road / TT.. but it's happened from high volume (marathon training) running (completely upright).
 
Dec 31, 2020
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Officially BACK. 2 hours of solid effort on Zwift this morning and legs feel like nothing happened. Here’s to never taking a rest day again.
That said, I’m waiting on more blood work results and a referral to a geneticist.
 
Reactions: steviep and Brass
Jan 10, 2021
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Hi all,
Pleased to have been signposted to this thread by a fellow cyclist :)
I am 27yo female and have had this issue since I properly started cycling and running at the age of 21... Oh and as a typical student taking up drinking and partying at uni. My most painful memory is during a ironman 70.3 championship, where I had been advised to carb load, had a mild cold, a flight and tapered training for that week (which are some of my top causative factors). Got such bad cramp in my glutes and quads that I could barely get off my bike at 5km in the cycle (had made it thru the swim before fine)... sat on the side of the road sobbing lol... eventually got back on and endured the remaining 85km cycle and half marathon run in severe pain and just in front of the broom wagon (in hindsight not the best idea but wanted to complete as I had qualified agegroup for this!).

I am an equine vet/veterinarian/veterinary surgeon (realise in different nationalities vet refers to other things!) and horses not uncommonly (not super rare but always on differential diagnosis list for poor performance/lameness/stiffness) suffer from "tying up" also known as "monday morning diesase" (occurring after e.g. a racehorse training all week, doing a big race on the sunday and then having the monday off) NB, typically these horses are traditionally fed a high carb diet. Underlying issues vary, but I would carry out an AST and CK test at rest and following intense exercise. Basic management is reduced carbohydrate diet and managing exercise little and often. Full diagnosis usually reached following muscle biopsy, often horses may have an underlying polysaccharide storage myopathy. Full diagnosis, in horses, like humans can be tricky.

So, I diagnosed myself with "tying up". Well, its what I describe to my colleagues and friends, and at least I can now empathise with my equine patients! A few years ago, I went to the GP Dr, and had a resting CK which was normal but I had not been exercising much leading up to this nor had a recent episode (annoying felt I should have had a post exercise or post episode - 24hrs later) and they said to have an MRI of lower back to rule out some kind of spinal issue. I knew this was unlikely to be the case, but who am I to say, I am not a human Dr but a horse Dr o_O. It was normal. I had exams at the time so didn't pursue further.

I had put it on the shelf, but have had a week long episode following doing the Festive500, plus some extra runs and then stopping to overindulge without burning off sugars over new year and having one or two more alcoholic drinks than usual. A fellow cyclist friend got in touch, who suffers similar problems (he is probably on this thread!) and I am now pursuing a diagnosis.

A few things - my biggest triggers:
  • Fairly intensive training (no harder than friends doing similar things who don't suffer same issues, and no where near the level of a pro athlete) followed by rest
  • Having too many alcoholic drinks (especially if not being danced off)
  • Having too much sugar (in drinks, or foods) especially when resting
  • When my body is under more stress: a mild cold, on my period, a crash on the bike
  • Sitting down for long periods on a rest day or a flight often seems to be the worse thing (although usually after a cycling holiday for example)
  • Rest days - even after one rest day my muscles can complain (it doesn't have to be 3 or 4)
What helps:
  • Keeping training
  • Eating less refined sugars (did this for a month with success but also then did some partying and went down the drain) -I'm going to pursue a keto-esque style diet after I have done the testing and see if this works for a longer period.
  • Mildly, did find pickle juice?! sometimes distracted me from the episode (temporarily)
  • Generally gotta wait it out for the cramping to subside - I find running a much bigger trigger now so after a rest day I will cycle and then only run off the back of a cycle (didn't this week as wheel broken which was possible extra trigger!)
I have been in contact with the AGSD (UK) charity and have been asking them about diagnosis. With the pandemic hitting the UK hard I am going to do an at home CK finger *** test following an episode, so hopefully trigger referral with GP --> specialist regarding this issue.

Wouldn't it be great if there could be a research study on this cohort of cyclists/athletes in general suffering with similar issues. This has probably been raised before! I wonder how we can raise interest with a research faculty in this area. I am involved in a fair bit of research myself (albeit equine), and I am very keen on evidence-based approaches!

Thanks and take care all :)
 
Jan 18, 2021
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I have read though the many pages on here but not all; the list is long. I am a 43, a weight lifter as well as a cyclist or a cyclist as well as a weight lifter. I get consistent muscle cramps after taking just a single day off. It doesn't matter if I am riding with a high or lower TSS (training stress score), and both volume and intensity will vary. One day off = muscle cramps. It will happen in my quads the most, but it also happens in larger muscle groups, like my latissimus dorsi if I try to train back after a rest day. The first time it happened to me was on a cool morning hike about 10 years ago. I went up just fine but on the way down, complete quad lockup... I had to wait and slowly try to walk it out. I was worried that I would be stuck at the top for most of the day. I always hike with poles in my pack for safety; even after hours, putting as much weight on the poles as I could, it was the only way I could get down very slowly.

It happened again today. For training right now, I lift 6 days a week. Each muscle group twice a week and I commute to work by bike. So an hour a day on the bike at an avg HR 125. My lifting sessions have been light too. No soreness from any of the lifting. Barely fatigue in the large muscles the following day. Typically when my cramps happen, it is from a true rest day where I spend all day lying around such as reading or watching TV (being off my feet). I rarely take a rest day (recovery rides instead).

Is there a diet correlation? Hard to tell. My diet does change during these days, but not dramatically. Like many on this forum, I have played with various diets. Typically, I am percentage balanced (PRO, CHO, FAT equal amounts unless I had a really high caloric expenditure). With the exception of caffeine, I am drug free. This includes alcohol. I do drink less water during rest days, which is natural since I am not sweating. All blood work within normal ranges.

Some other things to note is the decline in my ability to train so I cannot not train as hard as years past yet this is still an issue. My doctors like to blame hard training and that I am getting older. Really? I'm 43 not 93. Doctors can be so frustrating so I feel all of you with the same experiences. I also have some "idiopathic" issues which include skin itching before starting to sweat, not always consistent. I can barely stay awake in the middle of the day even after treatment for sleep apnea (so now I have idiopathic narcolepsy). Underlying conditions could be the reason I have muscle "cramping" issues 24 hours off instead of 3-4 days off like many of you.

Like some on this forum, sadly, my only option is to never have a sedentary day off. If I take a day off the bike or the gym, I must still be doing a lot on my feet still. Be it cooking, cleaning, shopping, etc. Best of luck to everyone looking for their answer.
 
Jan 2, 2021
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Update (if anyone is interested);
Jan 10 - 30 minute easy spin on the trainer with my MTB mounted on it. Followed by a couple days off. No other training, just normal life and walking the dog.
Jan 13 another 30 minute easy spin on the trainer again with MTB. No other cycling or training after, just regular walks with my dog.
Today ( Jan18 ) 5 days later, just starting out on an easy walk with the dog, the cramping and pain set into my right thigh/quad.

So I think this clearly puts an end to my theory about it being related to the riding position.
 
Jan 1, 2021
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Update(after 13 days without pain):
I've been cycling regularly (but lightly) last week since last event, took weekend off.
Monday morning at work, lots of pain, short walk at the office.
I'm here wondering how painful my walk to the car will be.
I'll have to cycle everyday to be fine.
 
Jan 2, 2021
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Be careful during the drive home. I have had those episodes while in the car in traffic and had to pull over out of fear of not being able to stop.
 
Jan 1, 2021
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Hi there, thanks for your answer Brass.
another update:
I just pedaled through the pain!
I was in a lot of pain on my way home.
When I arrived I stood for a few minutes until the pain subsided then I took my bike and went for a ride.
I pedaled very slowly and without applying too much pressure, after 5 minutes I didn't feel any pain
I just got back from a ride and I feel great.
I don't know if I was right or wrong doing this but not being in pain comforts me.
 
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