Extreme quadriceps starting pain after 3-4 rest days

[NaturallyDriven]

Hi all... I'm 'enjoying' reading the continued experiences and details of the events leading up to the episode. I feel our shared experiences help narrow underlying causes / triggers, as 'officially medically undiagnosed' as we are. I've been back, training as hard as ever (up to 15 hours or so on trainer) and have had no issues. I haven't had a day off, and have no intentions to do so anytime soon. I had blood work done a few weeks ago for electrolytes and Acyl Carnitine.. electrolytes are fine and still waiting on the other results. My doctor also referred me to a geneticist for further testing, so we'll see if that bears any fruit.

No rest
Hydration
Reduced refined sugars
Stretching / rolling
Staying active on 'off days'

That seems to be the recipe.

 

[budegan]

I've not checked in on here for some time, but as I believe is the case for many other followers of this thread, it's the first place I come to as soon as the issue becomes relevant to me again.

It's interesting to see that there have been several new members to this horrible club since I was last here, and although I'm sorry to hear of anyone else suffering with this, it is somewhat reassuring knowing that I'm not alone!

Anyway just FYI - having avoided an episode for almost 2.5 years (by literally never missing a day - I know: insane), I had a close call with one a couple of nights ago. I hadn't been on the bike for almost 36 hours (which I consider to be very much pushing it), and the previous day had eaten A TONNE of sugar - a real horrible binge (sugar is my weakness, it was a day of low motivation, and I succumbed).

I think I must have caught it in time because it reared its head but never fully kicked in, and was completely absent from my training ride this morning (12 hours later).

Anyway I am posting this as I suspect that for me (I appreciate we could all experience this slightly differently, and have different triggers) the combination of "too much" rest and the OTT amount of sugar was to blame.

I am confident that I could have got away with a bit (but not loads) more time off the bike, but combined with the sugar it was bad news.

(BTW I'm virtually teetotal so alcohol definitely isn't a factor for me on this one).

So that's my latest in this sorry tale.

Keep well everyone, and stay riding (as in my experience it's the only way to keep this - literal - pain at bay!).

 

[crampingafterest]

Hi another newbie here who is relieved to have found this forum.
I'm in the middle of my first full attack, on day 5 and still got stabbing pain but am finding that if I stop walking when the seizing of the quads set in, it does seem to be releasing quicker.
I have suffered mild attacks for the past 3 months when I started training for ironman, same as most people in week 3 of block plan the attack happens, alway after a rest day but I think an Easter weekend of binging seems to have made this attack a full blown unable to walk more than 10mins and also walking down stairs triggers the muscles seizing.
Couple of things I was wondering if other people have experienced though?
I never get muscle seizing in my glutes and hammies?
For years now I have always been able to tense my calves to the point they want to cramp out but they won't fully cramp out? (I assumed it was low magnesium and potassium so take hydration tablets, but not so sure if that is the only reason for it now)
Thank you also for all the ideas floating around, I just want to get through this attack (fingers crossed not long now), get back to training and moving forward avoid another full blown attack.

 

[budegan]

Hi Cramping.

Welcome to this s***ty club!

A day off + a tonne of chocolate Easter eggs would certainly do it for me. It's SO ANNOYING!!!

Personally I have somewhat vaguely felt it in my glutes a couple of times, but nothing like the quads where it's consistently and intensely focused.

Hopefully you've only got a few more days and you'll be out of it, and you'll be smashing your way towards the Ironman again.

Best of luck. Of course if you happen upon a miracle treatment then post up!

 

[NaturallyDriven]

Hi another newbie here who is relieved to have found this forum.
I'm in the middle of my first full attack, on day 5 and still got stabbing pain but am finding that if I stop walking when the seizing of the quads set in, it does seem to be releasing quicker.
I have suffered mild attacks for the past 3 months when I started training for ironman, same as most people in week 3 of block plan the attack happens, alway after a rest day but I think an Easter weekend of binging seems to have made this attack a full blown unable to walk more than 10mins and also walking down stairs triggers the muscles seizing.
Couple of things I was wondering if other people have experienced though?
I never get muscle seizing in my glutes and hammies?
For years now I have always been able to tense my calves to the point they want to cramp out but they won't fully cramp out? (I assumed it was low magnesium and potassium so take hydration tablets, but not so sure if that is the only reason for it now)
Thank you also for all the ideas floating around, I just want to get through this attack (fingers crossed not long now), get back to training and moving forward avoid another full blown attack.

indeed. Welcome to our club. Your situation sounds identical to mine and most others here. After more than a decade of trying to self diagnose, the answer is still ‘take minimal rest’. Definitely sugar and alcohol on those rest days exacerbates things. I was in hospital in early Jan for a fluid IV as a result of an acute episode. You should know that the end result is Rhabdomyolysis. If you are concerned, or have really dark urine, definitely go get you CK levels tested immediately. I’ve never got it in glutes / hams, only quads.

since Jan I’ve had a lot of blood work done, through my family physician (who is also a sports medicine doctor) and a geneticist to whom he referred me. The only ‘somewhat’ abnormal numbers were in carnitine and oxalates. Both likely diet related, and neither tooooo far out of range to be a real concern.

I haven’t had a day off training since I got back into it and I’ve been 100% fine. Crazy that we can go as hard and long as we want, we just can’t rest.

 

[crampingafterest]

indeed. Welcome to our club. Your situation sounds identical to mine and most others here. After more than a decade of trying to self diagnose, the answer is still ‘take minimal rest’. Definitely sugar and alcohol on those rest days exacerbates things. I was in hospital in early Jan for a fluid IV as a result of an acute episode. You should know that the end result is Rhabdomyolysis. If you are concerned, or have really dark urine, definitely go get you CK levels tested immediately. I’ve never got it in glutes / hams, only quads.

since Jan I’ve had a lot of blood work done, through my family physician (who is also a sports medicine doctor) and a geneticist to whom he referred me. The only ‘somewhat’ abnormal numbers were in carnitine and oxalates. Both likely diet related, and neither tooooo far out of range to be a real concern.

I haven’t had a day off training since I got back into it and I’ve been 100% fine. Crazy that we can go as hard and long as we want, we just can’t rest.

 

[crampingafterest]

It is crazy that we can't rest, I've spoken to people in my Tri group and coach etc and everyone has just looked at me like I'm nuts.

I haven't been to the doctors as at present it seems to be improving, I swam today (open water 8 degrees lol) and had minimal seizing of the quads and calves which is a massive improvement from Wednesday, where I spent 20 mins having siezed legs.

I am monitoring my urine though, as

 

[combatman]

Hello everybody!
I have the exact same problem. After 3-4 rest days I will develop an extreme pain in the quads when trying to exercise. If I'm unlucky the symptoms worsens to the point I'm almost unable to walk. Just bending the legs are painful.

I believe it is a form of chronic exertional compartment syndrome. During normal conditions, when you train regularly, everything is fine. But when you're resting, glycogen builds up in the muscles, drawing in fluids and making the muscles swell a bit. Carb loading basically. Usually this is not a problem, but if your muscle fascia compartments restrict the swelling, pressure builds up instead. If the compartment pressure is higher than your diastolic blood pressure you will develop ischemia and severe pain. The ischemia may then lead to rhabdomyolysis and even more swelling.

My way to handle this is:

1. Training regularly
2. Stretching the quads after each workout (hopefully making the compartments adjust)
3. Being careful with carbs when I'm forced to rest

If this conservative treatment doesn't work there's always surgery. But I want to avoid that.

 

[SAL9000]

Hello, all!

I similarly registered just to post in this thread.

I'm also afflicted in my quads, with the two notable characteristics - the pain is not cramping, spasms or strain (it's just pain) and it's almost always triggered, when the TBD conditions were ripe, by walking downhill (like after a hike) or by riding on the flat after a big climb, always in the first 10-20 minutes of a ride.

I could write extensively on my experience, but in short, in the past I've been diagnosed with both compartment syndrome and rhabdo. The doctors said the later was essentially unheard of due to cycling but that's what they went with anyway. They recommended hydratation, supplements, and beinging mindful of recovery. I would still average 1-2 bouts a year however.

Welp, I'm here again after a bout, but the preceeding volumes of riding the last month have been ~25-50% my usual so extreme exercise (rhabdo) can't be it. I love my carbs, and spent the three days prior to this (easy) ride on the couch no doubt engorging my muscles with glycogen and fluid (dat WFH!).

I'm going to take the oft-mentioned advice ITT of taking it easy on carbs, under the general guise of a compartment syndrome problem. Not a doctor of course, but some of these responses (esp. by combatman just above) simply make more sense to me.

Would be fantastic to finally nail this . I often go on rides I have to drive hours to get to, and sometimes with a crew. Though this issue has never upset such a ride, it would be exceedingly unfortunate if it did.

 

[budegan]

Hey Sal. So are your bouts not triggered by time off the bike (as in 1+ rest days)?

 

[SAL9000]

Hey Sal. So are your bouts not triggered by time off the bike (as in 1+ rest days)?

AFAIK, that was not a common characteristic of previous bouts, but then again they weren't too memorable as they always happened in late August/early September, after 4-5 months of riding 8-10 hours/week, so I just went with the rhabdo diagnosis. This last bout happening in May is new and has me 99% convinced that it's not rhabdo as previous diagnosed.

I also ski, but do so only 1-2 days a week at most during the season - meaning, I'd easily have 5-6 days of virtually zero activity and then significant activity for a day (equivalent to a fairly strenuous ride) and never had a bout in all those years of skiing. It's only tied to consistent strenuous activity 4-6 days/week for quite a length of time (in my case, hiking many years ago, and riding in recent years).

Could be that previous bouts were indeed preceeded by a number of days of inactivity and I simply never connected the dots because of the rhabdo diagnosis. This time I am connecting such dots (compartment syndrome) and will go with the recommendation to lay off the carbs as I'm a bit desperate. Riding is a huge part of my life and getting taken out this early in the season is not good at all. I should say I'm a man in my late 40s, so age may have something to do with this new phenomenon of early onset (fascia not as "flexible" maybe?).

 

[steviep]

Sal hpw was your compartment syndrome diagnosed?From your history or by actual measurement of your compartment pressures?

The compartment sydrome diagnosis doesn't ring true for me... the thigh has 2 compartments, both of which are massive and can take a lot of extra swelling- unlike the lower leg, the commonest site of chronic compartment syndromes, which has 4 and so these are indvidually a lot smaller and can handle a lot less swelling. The lower leg version comes on quickly with exercise and so the phenomenon we are describing where it seems particularly related to several days of of not cycling, and also the 'second-wind' phenomenon, where if some people manage to cycle through it it goes away, doesn't match up. And why would walking downhill cause more swelling than walking uphill? We're missing an important piece of the puzzle! I def agree with you that I think glycogen is important somehow.

I've been doing lots of squats on non-cycling days and feel this has maybe put off my symptoms? But difficult to say how much of this has been psychological/down to other factors, when the longest has been 4 days. I'm doing ironman training so can't take any more time off cycling than that, but will test this all the way through after my race in October and report back.

 

[steviep]

https://www.england.nhs.uk/wp-content/uploads/2018/08/Rare-and-Inherited-Disease-Eligibility-Criteria-November-2020-21.pdf

I got re-enthused for sorting this out and found (for those of us in the UK, see link p212) the NHS eligibility criteria for testing for glycogen storage disorders. We fall under the heading of the second paragraph 1 (did they mean para 2?), "glycogen accumulation in the relevant tissue", section b. "Evidence of muscle involvement: myalgia OR rhabdomyolysis OR muscle weakness".
The test has to be requested by Cardiology/Clinical Genetics/Hepatology/Metabolic Medicine/Neurology; I don't know how enthused my GP would be to refer me to one of those specialties just for that, especially given the paragraph
"Referrals for testing will be triaged by the Genomic Laboratory; testing should be targeted at those where a genetic or genomic diagnosis will guide management for the proband or family"
... and I don't think a positive would alter management much!

To save myself the hassle I'll investigate a private test, as it's just a PCR panel I shouldn't think it would be too much

 

[SAL9000]

Compartment syndrome was diagnosed via blood tests and doctors' opinions. I'm not a pro athlete so they did not recommend the pressure test. It just seems a more likely cause than rhabdo in hindsight. The doctors have all said I probably have some sort of genetic predisposition for it all, and that there was no cure.

The effects of glycogen storage disease seem to be both chronic and severe - I've never had any of those issues - have always been healthy. Either way I'm gonna listen to the experience of soooo many ITT and see where low(er) carb takes me.

 

[SAL9000]

After the last episode (that precipitated my involvement ITT) I took ~9 days off and limited to significant extent carb intake, and today duplicated the same ride as last week that triggered "the burn." Sure enough, I triggered "the burn" after walking down hill ~50 feet after the first climb.

I took the advice to immediately get back on the bike and climb. I was expecting even more pain (so this was previously unimaginable) but amazingly, it was same and lo and behold after just about a minute of climbing the pain was ~50%. I finished the short climb, descended a bit, climbed a bit more, and repeated, and after ~15 minutes pain was 10-20%. The pain was so much better in fact I finished the ~2 hour ride (with ~2,000 feet of climbing, so not a easy ride, though I did go slow).

Over the course of the ride the pain slowly subsided to ~0%. A couple of interesting notes: When at the top of the pedal stroke (i.e.., knee bent) I would get ~50% pain but if I held it there for a few seconds it went away. After a few times of doing this that stopped as well. Also, when straightening the leg and flexing as hard as I could I'd get ~25% pain (but of course one does not ride a bike like this).

By the time I got home pain was gone and even the hard flex would only get me maybe 10%. After a few hours of just lounging around all returned to normal. The next day (yesterday) I repeated the ride at a moderate pace and could not trigger "the burn" despite trying multiple times (i.e., hopping off the bike multiple times to walk down an incline ~50 feet). Today I went on an ever harder ride (2 hours and even more climbing) and felt great.

Reading and thinking again, I have to think that I can't be causing significant, shall we say, "mechanical" problems/damage (compartment syndrome, rhabdo, as I had been diagnosed in the past) as I never ever get the pain during extreme exercise nor when at rest - it's the eccentric loading immediately following. Plus, the low volume of riding the last ~6 weeks simply can't point to such problems/damage. The how and why of exertion solving the problem is a complete unknown to me. I have to think any sort of glycogen processing problem would have been chronic, severe and full-body. Also, ALL previous bouts hit both quads simultaneously but this time it was the left leg the first ride and the right leg the second ride.

So, still mostly a mystery, but I'm at least one step closer knowing that immediate exertion (though a fair amount of it - it's not quick) fixes the issue.

 

[Golden.]

Did anyone ever have an episode despite riding every day? I was having mini episodes the last week which I could ride out but today I got hit very hard and had to stop riding after 1km. I've been riding every single day for at least one hour, but had the occasional recovery ride thrown in (around half of my 267FTP). I'm wondering if maybe those recovery rides are too easy and if I should up them to say 200watt. Recovery wouldn't be great, but everything is better than being off the bike for 7+ days.