Extreme quadriceps starting pain after 3-4 rest days

[lohmatik]

Hi everyone.

So happy to learn all the stories you had shared. I’m gonna try all advices and analyze each guess. I read all pages in hope to find a certain solution, but it looks like we should wait for some more time for that…

I’m 37 yo man from Russia (peaceful russian…).
172cm high and 78 kg. Before I started to ride road bike I was 95 kg. A ride often for 2 years now.

My first episode appeared last year in the beginning of September after 1,5 week of tempo ride session. I’ve made about 600 km. It was huge for me. Then I spent lazy 2 or 3 days at home and faced the pain somewhere in my hip muscles while I was going down the stares to metro station. I was so scared that I asked my girl to meet me and help to get home. The next day, the pain disappeared. I just forgot about the whole thing for a year.

Now I’m in the end (hopefully) of my second episode. It leasts already for 2 weeks. This season I started to participate in local races so I spent all summer maiking 300km per week. Accidentally I caught a cold and I was forced to stay at home for 3 days, mostly in my bed. After this pause, I got back to my bike and my current episode of pain had started. And it didn’t go away yet. Stretching helps for a short period… rolling hurts a lot.

So all the symptoms are like the most of yours, guys.

In winter, I don’t have this problems - probably, because I train smart, mixing with gym and Nordic skiing. But for the second summer in a row I do only cycling and leave everything else aside, so, I’m having this episodes in August/September.

I will try to implement more different training types in my life. It may be some kind of key.

I was doing CrossFit since 2014 and sometimes I got carried away with it, but I never faced those attacks.

Btw during my current episode I tried to spin through pain (when the pain was less obvious) and I reached success. I think it should be some effort around ftp, not just spin around. It works. But I want to understand the exact mechanism of this shi*…

Wish to solve this problem for all of us. Stay health and peace to all of you.

P.S. Please don’t forget shere your stories here. I read this pages for a week and now when I finished, I don’t now what to read next.

Sorry for my poor English

 

[RhabdomyolysisMaster]

Hi everyone.

So happy to learn all the stories you had shared. I’m gonna try all advices and analyze each guess. I read all pages in hope to find a certain solution, but it looks like we should wait for some more time for that…

I’m 37 yo man from Russia (peaceful russian…).
172cm high and 78 kg. Before I started to ride road bike I was 95 kg. A ride often for 2 years now.

My first episode appeared last year in the beginning of September after 1,5 week of tempo ride session. I’ve made about 600 km. It was huge for me. Then I spent lazy 2 or 3 days at home and faced the pain somewhere in my hip muscles while I was going down the stares to metro station. I was so scared that I asked my girl to meet me and help to get home. The next day, the pain disappeared. I just forgot about the whole thing for a year.

Now I’m in the end (hopefully) of my second episode. It leasts already for 2 weeks. This season I started to participate in local races so I spent all summer maiking 300km per week. Accidentally I caught a cold and I was forced to stay at home for 3 days, mostly in my bed. After this pause, I got back to my bike and my current episode of pain had started. And it didn’t go away yet. Stretching helps for a short period… rolling hurts a lot.

So all the symptoms are like the most of yours, guys.

In winter, I don’t have this problems - probably, because I train smart, mixing with gym and Nordic skiing. But for the second summer in a row I do only cycling and leave everything else aside, so, I’m having this episodes in August/September.

I will try to implement more different training types in my life. It may be some kind of key.

I was doing CrossFit since 2014 and sometimes I got carried away with it, but I never faced those attacks.

Btw during my current episode I tried to spin through pain (when the pain was less obvious) and I reached success. I think it should be some effort around ftp, not just spin around. It works. But I want to understand the exact mechanism of this shi*…

Wish to solve this problem for all of us. Stay health and peace to all of you.

P.S. Please don’t forget shere your stories here. I read this pages for a week and now when I finished, I don’t now what to read next.

Sorry for my poor English

Hey,
did you ever go to the hospital during one of your episodes (you did not mention it so I am curious), because if not I would highly recommend it, otherwise your kidneys could really suffer from this episodes. Even though I have not read a report in here, where someone got any kidney damage I would choose the save way. If not, remember to drink a lot of water to get the CK and other molecules out of your body. (During my episodes I drink 8-10 liters a day, I know this is not very healthy either but it flushes the CK out very efficiently and I test my blood regularly during the episode or I am already in the hospital. Find the way that suites the best for you because I would not recommend drinking that much.)

And to the spinning-through-thing I have experienced the same. If I start to cycle at the beginning of an episode, when I slowly start to feel the pain, it vanishes and goes away. Asked my doctor about it and he told me, that he thinks, that it is the same with muscle ache because there the pain also vanishes when you continue to train.

Get well soon and don't stop the grind

 

[lohmatik]

Hey,
did you ever go to the hospital during one of your episodes (you did not mention it so I am curious), because if not I would highly recommend it, otherwise your kidneys could really suffer from this episodes. Even though I have not read a report in here, where someone got any kidney damage I would choose the save way. If not, remember to drink a lot of water to get the CK and other molecules out of your body. (During my episodes I drink 8-10 liters a day, I know this is not very healthy either but it flushes the CK out very efficiently and I test my blood regularly during the episode or I am already in the hospital. Find the way that suites the best for you because I would not recommend drinking that much.)

And to the spinning-through-thing I have experienced the same. If I start to cycle at the beginning of an episode, when I slowly start to feel the pain, it vanishes and goes away. Asked my doctor about it and he told me, that he thinks, that it is the same with muscle ache because there the pain also vanishes when you continue to train.

Get well soon and don't stop the grind

Hey, thanks for answer)
Yes this time I checked blood parameters including CK level and it was normal. But my results was in different from yours values. 3,6 ng/ml when <5,2 is reference. May be I checked my blood too late. Not in the beginning of episode. Next time I’ll check right away. I’ll post here)

 

[lohmatik]

Guys i've just thought. if we are considering this episode as a chemical metabolic phenomenon why it's getting better when starting stretching? Ok, it is hurt and helps for short period but still. Looks like if it is metabolic you wouldn`t fix it by mechanical.
Just thoughts

 

[RhabdomyolysisMaster]

Hey fellow sufferers,
I have got an update from my case. I recently saw a human geneticist, who my doctor recommended to see, and showed him my genetic report. He looked at the report and my case and registered me as a participant for the MitoNet, they will now look at my DNA or mtDNA or both in more depth and do some more tests with it (I do not know what they are exactly doing, but the geneticist said they will test if my punctual mutation in my mtDNA really is the cause for my symptoms or something else.).

He said the whole procedure will take 1-2 years and then I will finally now the cause.

So for me there will (hopefully) be an answer soon.

 

[NaturallyDriven]

Hi all..

I just wanted to share that I haven't had any episodes in nearly 2 years. Last time was when I found this forum and also went to the hospital for the first time. I had been suffering them fairly regularly ) at least a few times per year) since 2009. All that I have focused on is limited sugar / carbs and staying hydrated. I was forced off training earlier this year for about 6 weeks and had no issues whatsoever. So for me, the obvious and simplest thing to do is limit binging / overeating carbs and sugar and also drinking plenty of fluids all the time. If nothing else, it definitely helps.

 

[Trifid]

It seems very common to me, since when you exercise the muscle does not hurt that same day, it hurts the following two days.



____
https://hhprocessors.com

This is why I haven't bothered going to the doctors with it as I know it will be dismissed as DOMS. I could cycle every day for a year and feel great every day, but just one day off and I'll be in pain and unable to walk. This isn't cramp from exercise, it is from a day of inactivity.

I did the festive 500 over Christmas, cycling a bit every day and also totalled 12 consecutive days of cycling . New years day was a planned rest day, despite feeling well rested. I get up in the night for a pee and upon returning to bed I get intense cramping in my leg that has returned this morning as I start walking around the house sorting breakfast. Just a few steps will trigger it and the pain will last hours afterwards. Likewise if I jump on a bike and do very light cycling, a normal warm up, my legs will cease up with intense cramp within 2 minutes.

This is something I've been suffering with for 10 years, ever since getting a bike as an adult, I never had a problem as a child. Back then I was only doing the odd day here or there and would then cease all cycling when the problem started and it would take a week or two to stop completely. Now I understand the triggers better, I push through it with more cycling, the best cure seems to be an hour of intense cycling as soon as I feel the start of the cramp starting, enough to feel some actual DOMS and then continue with a normal cycle every day. I could be unable to walk 50m in the morning, do an intense cycle and then be able to walk for miles straight after pain free.

 

[NaturallyDriven]

This is why I haven't bothered going to the doctors with it as I know it will be dismissed as DOMS. I could cycle every day for a year and feel great every day, but just one day off and I'll be in pain and unable to walk. This isn't cramp from exercise, it is from a day of inactivity.

I did the festive 500 over Christmas, cycling a bit every day and also totalled 12 consecutive days of cycling . New years day was a planned rest day, despite feeling well rested. I get up in the night for a pee and upon returning to bed I get intense cramping in my leg that has returned this morning as I start walking around the house sorting breakfast. Just a few steps will trigger it and the pain will last hours afterwards. Likewise if I jump on a bike and do very light cycling, a normal warm up, my legs will cease up with intense cramp within 2 minutes.

This is something I've been suffering with for 10 years, ever since getting a bike as an adult, I never had a problem as a child. Back then I was only doing the odd day here or there and would then cease all cycling when the problem started and it would take a week or two to stop completely. Now I understand the triggers better, I push through it with more cycling, the best cure seems to be an hour of intense cycling as soon as I feel the start of the cramp starting, enough to feel some actual DOMS and then continue with a normal cycle every day. I could be unable to walk 50m in the morning, do an intense cycle and then be able to walk for miles straight after pain free.

Sorry to hear you've had a recent episode of this. It was 2 years ago as of a couple weeks ago that I had my last major flare up / episode. For me, it was often around holidays when I'd be off the bike a bit more and imbibing in some alcohol and sweets. I can tell you that the BIGGEST thing for me is, when not training every day, to be adequately hydrated and to limit sugar. Doing this has kept me issue free for a long time. For me it was usually triggered with some sort of downhill walking or walking down stairs. Another thing is that I'm sure your CK levels spike during this and can cause damage to the kidneys if not addressed ASAP.

congrats on your festive 500! Was it on Zwift?

 

[Trifid]

Sorry to hear you've had a recent episode of this. It was 2 years ago as of a couple weeks ago that I had my last major flare up / episode. For me, it was often around holidays when I'd be off the bike a bit more and imbibing in some alcohol and sweets. I can tell you that the BIGGEST thing for me is, when not training every day, to be adequately hydrated and to limit sugar. Doing this has kept me issue free for a long time. For me it was usually triggered with some sort of downhill walking or walking down stairs. Another thing is that I'm sure your CK levels spike during this and can cause damage to the kidneys if not addressed ASAP.

congrats on your festive 500! Was it on Zwift?

I'm skiing in 2 weeks time and am very concerned about it. Currently I can't be off the bike for much more then 24 hours without having problems. I'm desperately hoping that if I cycle before leaving for the airport that I can make it through to the slopes the next day and build up enough fatigue skiing to keep the issue at bay.

I don't consume a lot of sugar (but plenty of carbs through bread, pasta, potatoes). I don't drink alcohol at home any more and keep things moderate when drinking out on rare occasions. I drink plenty of liquids and my pee has never been dark.

I've been thinking about getting a private blood test for CK levels after a couple of days of rest and presenting it to the doctor, the only thing stopping me is I'm not sure I can face the pain and fighting through it to get back to normal. Or otherwise just writing a letter to my GP in the hope that they will keep a open mind reading through it. But I don't have the best experience with medical professionals.

Yes, a Zwift Festive 500, so not quite as much volume as the real thing but I stopped cycling in less ideal conditions after a nasty crash a couple of years back.

 

[suvowner]

this is an interesting thread, I have not read every single response in detail but my take away is that there is still no unifying definitive diagnosis.

fyi I am a physician, I do emg/ncv testing, I have corresponded with Katie Compton some years ago, I have 23andme genetic data from chip V3 (960,000 snps and V5 640,000 snps and no hits for a genetic mitochondrial defect to explain these symptoms and I have found no definite unifying answer/diagnosis.

most mitochondrial diseases have no treatment anyway, so it seems likely a futile effort, and mitochondrial disease is very unlikely in a patient who can otherwise reach a very high level of fitness.

I think most likely what is happening is the fact that cycling only loads the muscle in a concentric fashion, and the muscle is adapting to the concentric loading of the cycling motion, at the expense of the muscles ability to tolerate eccentric loading, such as running or walking downhill. this intolerance of eccentric loading is the only unifying pattern I have and seems to hold true for most of the posts I have read in this forum.

now without getting to far into the weeds of muscle physiology, you can review actin/myosin and the mechanism of how they work together for muscle contraction and relaxation at the level of the sarcomere, interestingly an ATP is required to release the myosin head, maybe this is related or not. the lack of ATP to release the myosin head is what causes "rigor mortis".

so lets say there is some discovered genetic defect, how likely is it there will be a treatment to fix it, I think extremely unlikely, so all your left with is supportive measures, different training, etc.

one option is to quit cycling, I did for a couple of years and no symptoms ever. if you want to keep cycling, the most effective strategy I have found is to be sure and give the cycling muscles some eccentric loading, before a rest period. the easiest way to do this is lunges, sometimes just your body weight is sufficient, if not you may need dumbbells of various weight as to increase the amount of eccentric load. with some trial and error you should be able to figure how much lunging or even squats you have to and how often to minimize a flare during or preceding a rest period. it might be daily, every other or every 3. depending on how quickly your symptoms come on, you may have to lunge after your last ride, or maybe you can wait a few days.


I think there is one area of genetics that might give some insight, which is that for alpha-actin-3. from 23andme I am TT, which means I don't make the protein, this protein is more common in elite power athletes, and it is involved in sarcomere structure. So if there happened to be a high correlation for this protein genotype within this forum that would be interesting, but I won't be holding my breath, lol. around 20% of European ancestry has the TT, and it is present in fast twitch fibers. so if you had this genotype, and had a higher percentage of fast twitch fibers you might be more susceptible to the concentric only muscle stress of cycling. but there is a lot of might and maybe in that statement.

here is a link to a good article discussing this protein.
https://www.frontiersin.org/articles/10.3389/fphys.2017.01080/full

 

[Golden.]

this is an interesting thread, I have not read every single response in detail but my take away is that there is still no unifying definitive diagnosis.

fyi I am a physician, I do emg/ncv testing, I have corresponded with Katie Compton some years ago, I have 23andme genetic data from chip V3 (960,000 snps and V5 640,000 snps and no hits for a genetic mitochondrial defect to explain these symptoms and I have found no definite unifying answer/diagnosis.

most mitochondrial diseases have no treatment anyway, so it seems likely a futile effort, and mitochondrial disease is very unlikely in a patient who can otherwise reach a very high level of fitness.

I think most likely what is happening is the fact that cycling only loads the muscle in a concentric fashion, and the muscle is adapting to the concentric loading of the cycling motion, at the expense of the muscles ability to tolerate eccentric loading, such as running or walking downhill. this intolerance of eccentric loading is the only unifying pattern I have and seems to hold true for most of the posts I have read in this forum.

now without getting to far into the weeds of muscle physiology, you can review actin/myosin and the mechanism of how they work together for muscle contraction and relaxation at the level of the sarcomere, interestingly an ATP is required to release the myosin head, maybe this is related or not. the lack of ATP to release the myosin head is what causes "rigor mortis".

so lets say there is some discovered genetic defect, how likely is it there will be a treatment to fix it, I think extremely unlikely, so all your left with is supportive measures, different training, etc.

one option is to quit cycling, I did for a couple of years and no symptoms ever. if you want to keep cycling, the most effective strategy I have found is to be sure and give the cycling muscles some eccentric loading, before a rest period. the easiest way to do this is lunges, sometimes just your body weight is sufficient, if not you may need dumbbells of various weight as to increase the amount of eccentric load. with some trial and error you should be able to figure how much lunging or even squats you have to and how often to minimize a flare during or preceding a rest period. it might be daily, every other or every 3. depending on how quickly your symptoms come on, you may have to lunge after your last ride, or maybe you can wait a few days.


I think there is one area of genetics that might give some insight, which is that for alpha-actin-3. from 23andme I am TT, which means I don't make the protein, this protein is more common in elite power athletes, and it is involved in sarcomere structure. So if there happened to be a high correlation for this protein genotype within this forum that would be interesting, but I won't be holding my breath, lol. around 20% of European ancestry has the TT, and it is present in fast twitch fibers. so if you had this genotype, and had a higher percentage of fast twitch fibers you might be more susceptible to the concentric only muscle stress of cycling. but there is a lot of might and maybe in that statement.

here is a link to a good article discussing this protein.
https://www.frontiersin.org/articles/10.3389/fphys.2017.01080/full

But how does triggering an attack by increased carb intake factor into all of this? I agree with the idea that the lack of eccentric muscle contractions are the root cause, but for me carb intake does also play a huge role. I can easily trigger an attack by overdoing it on the carbs (like 2000 kcal+ of sugars) if I don't put in enough work on the bike.

 

[suvowner]

But how does triggering an attack by increased carb intake factor into all of this? I agree with the idea that the lack of eccentric muscle contractions are the root cause, but for me carb intake does also play a huge role. I can easily trigger an attack by overdoing it on the carbs (like 2000 kcal+ of sugars) if I don't put in enough work on the bike.

It probably modifies some inflammatory cytokines, maybe you have undiscovered insulin resistance and the sugar affects how the muscle can use/store glycogen , now if you could prove you are symptom free say on a strict ketogenic diet and proven to be in ketosis by way of blood ketone measurement that would be interesting, and maybe point to a larger role of mitochondrial function

 

[pasaglia]

Does anyone here have gout? I have had a full genetic workup to try an solve my rhabdo issue, including a biopsy of my quad and an analysis of mitochondrial electron transport. Everything has been negative for known defects.

But, I do have gout and started taking allopurinol a year ago. Concurrently I have not have much rhabdo. Correlation is not causation, but I thought I would share to see if anyone else has a similar story. I also found this .... https://europepmc.org/article/pmc/4255256

I am a white male, mid 40s. Based in NYC.

 

[shawnjames20]

Hi,
I have had a strange experience this week. I have been following my base training program for about 10 weeks with riding everyday including recovery rides etc.

Then for different reasons I had to take 4 days of from riding over the weekend. Then on Monday 20 minutes into my warm-up, I got extremely sore muscles in my left quadriceps. I had to stop, it was so painful.

Tuesday morning i tried to mount my bike again, but after 5 minutes, I got this extreme pain again and had to stop. Later I visited the chiropractor who thought it was a trapped nerve in the back, but she couldn't find anything, and it had no effect.

Wednesday morning I tried again, but same story. I couldn't even bike to work, which takes 5 minutes. I consulted my doctor who said it was over training, and that I should take 14 days off. I was/am a little skeptical because I have never heard of over training bringing on such severe pain. And I haven't experienced any of the symptoms related to it.

The pain is hard to describe but feel like acid in the legs that burn, and it doesn't go away. Here 24 hours after my short ride to the doctor, my legs are still sore. The pain only comes on when I bike or walk down the stairs, not up.

By accident I found this thread on a danish forum, translated into English here, and the OP basically explains the exact same story. Same symptoms with walking on stairs only biking a few km's etc. it reveals that quite a few people have experienced the same problems, without ever getting a proper diagnose.

Everyone describes how this has started after a few days of rest due to traveling and so on.

Anybody experienced anything like it, or can explain what might cause it. I can not find anything on the english-speaking web.

Your post is really helpful!

 

[carbong]

Glad to find people with the same symptoms as me. In fact, I found this article around 2014, but there was no meaningful progress at that time. At that time, I didn't pay attention to the post that said to pay attention to glycogen, but today I found out that it was a horse's Monday disease, and I thought it was worth a try. I have a solid solution for this one. my exact symptoms
1. I ride my bike in a competitive environment.
2. When I take a break, sometimes on the 2nd or unconditionally 3rd day, extreme pain comes .
3. If I do not ride a bicycle at all after the pain, the pain disappears after about 5 days and this symptom does not appear.

The solution is to get a prescription for Tramadol and when the pain is almost gone, quickly do strong training on a trainer. If you do this, the symptoms will go away in just a few hours.
Of course, it is best not to rest for more than two days.

 

[Daniel Seo]

I'm glad to find these threads with the same symptoms as me.

I am a 33 years old Korean and it has been about 3 years since I had this symptom. It happened after 3 months of riding the bike for the first time.

I have exactly the same symptoms, and it happens every month.
I have no problem going up the stairs, but when I go down the stairs, I feel extreme pain and heat in my quadriceps, as if stabbing my quad with a knife.

Through the threads written here, I found out that Katie Compton has the same symptoms, and she seems to have confirmed the cause with the MTHFR genetic test. So I'm going to do the same MTHFR test.

In the meantime, I found an episode of a person experiencing the same symptoms on YouTube, and he seems to have identified the cause of this pain as uric acid. So, in addition to the MTHFR gene test, I am also trying to measure the uric acid level. After testing I will share the results in this thread.

Have any of you had your uric acid levels tested?

 

[OldBoyBiker]

I'm glad to find these threads with the same symptoms as me.

I am a 33 years old Korean and it has been about 3 years since I had this symptom. It happened after 3 months of riding the bike for the first time.

I have exactly the same symptoms, and it happens every month.
I have no problem going up the stairs, but when I go down the stairs, I feel extreme pain and heat in my quadriceps, as if stabbing my quad with a knife.

Through the threads written here, I found out that Katie Compton has the same symptoms, and she seems to have confirmed the cause with the MTHFR genetic test. So I'm going to do the same MTHFR test.

In the meantime, I found an episode of a person experiencing the same symptoms on YouTube, and he seems to have identified the cause of this pain as uric acid. So, in addition to the MTHFR gene test, I am also trying to measure the uric acid level. After testing I will share the results in this thread.

Have any of you had your uric acid levels testedu

 

[OldBoyBiker]

I had biopsy. The biopsy show my muscles have difficulty absorbing glycogen.
I had genetic testing - this didn't find anything.

High uric acid is the main cause of gout. (A previous reply mentioned they have gout.)
I get gout too. I am taking Allopurinol also but this pain started years before the Allopurinol.

There might be some link.

 

[Daniel Seo]

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!!

 

[Daniel Seo]

I had biopsy. The biopsy show my muscles have difficulty absorbing glycogen.
I had genetic testing - this didn't find anything.

High uric acid is the main cause of gout. (A previous reply mentioned they have gout.)
I get gout too. I am taking Allopurinol also but this pain started years before the Allopurinol.

There might be some link.

I'm not sure why that hypothesis(Drewza101) was buried, but I think it's the hypothesis that most effectively explains the symptoms we have that pain after 3 days rest, especially after high exercise load, only in the quadriceps, slight swelling of the quadriceps before the attack, etc.

Also, I think it has a lot to do with carbo-loading(glycogen loading) that bodybuilders and marathoners do.

I'll check it more about this mechanism and post it in this thread.

 

[Daniel Seo]

Does anyone eating something while riding a bike? I don't eat anything while riding my bike. In a recent episode, I rode my bike for 80 km for 3 hours and didn't eat anything, and the next day it attacked me. I think we should all be wary of depleting muscle glycogen.

 

[suvowner]

I think this article is definitely worth a read, for those of you in the UK attempting to correspond with the author might be useful, particularly the section
"Alpha‐actinin‐3 R577X polymorphism and the initial phase of exercise‐induced muscle damage", on page 1598.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983298/pdf/421_2016_Article_3411.pdf

in short the cause is most likely multifactorial, I still don't buy mitochondrial disease as the most likely etiology, nor do I think everyone in this forum will have the same etiology, some or several combinations of polymorphisms in mitochondrial respiration or skeletal muscle cytoskeletal elements likely combine to create variable susceptibility to this phenomena.

the poster "Shayne G" went the farthest in trying to find an answer, which included a large muscle biopsy, and per post#207, no definitive evidence of a metabolic or glycogen storage disease. he even tried strict keto for 3 months with no change. Katie Compton has the same issue, and she is a world class cycling endurance athlete, I just don't see how someone could reach that level of fitness and endurance performance with a mitochondrial disease.

the one unifying pattern is intolerance to eccentric loading of the cycling muscles after 1-5 days of rest, especially high speed such as running downhill. The best low speed eccentric load I know of is a heavy/slow squat or a lunge with dumbbells. if you are going to be forced off the bike, then experiment with doing squats at the gym with as much weight as you can do for about 10-12 reps 3-5 sets or lunges with dumbbells 10-12 reps 3-5 sets 1-5 days before your time off, and depending on your degree of suspectibility to this you may need to squat or lunge every 1-5 days during your time off the bike.

 

[Vl4d4s]

Hi all,

Greeting from Lithuania! I found this thread April 2023 when I had the same "attack" on my quads. I am cycling for ~4 years now, I train ~10-15/h week, my FTP is ~4.7-4.8W/kg. I train all year round, no off-season breaks. So far I had these seizures 4 times. Only after 3rd time I found this thread. First 2 times I had to wait for ~3 weeks without cycling to be able to get on the bike again. All the symptoms and circumstances match this thread 110% (2-3 off bike, knife-like pain in quads after going down the stairs or just climbing down).

After 3rd "attack" on my quads I found this thread and one tip helped me. I just had a 4th "attack" (I was sick for 3 days hence I didn't train), it helped immediately as well.

I highly recommend it for other as well.

When pain starts, try to sit down and relax. Slowly bend the legs and when you can fully bend them stand up and slowly start doing squats. For me it takes ~4 sessions of 50 squats to tire my legs. Then I am able to get on the bike and pedal. I do 30-60min really hard session (80-100% of my FTP) and it's solved! I still feel some pain in my muscles for 1-2 days but it does not disturb to cycle at all.

Please let us all know in the thread below if this works for you as well, I hope this will make others try this technique as well!

Best Wishes,
Vladas

 

[AlexLovesSpeed]

You know I did have this happen only once after what was a bigger ride for me at the time (roughly 40 miles). It scared me to the point I stayed off the bike for over a week but it ended quickly. Despite going beyond that distance and speed its not happened again knock on wood. I assumed it had to do with me pushing too hard

 

[gregsipes]

I'm posting this hoping it will help someone else. I'm not a MD or in any related field but I had the same problem and it took me almost 2 years to figure it out. I ride and train 15-20 hours per week and lift 2-3 days per week with an RPE of 8 or 9. I normally ride 6-7 days per week, following a polarized training plan with a mix of hard interval session, long endurance days, and some active recovery sessions as needed. In January, I put 108 hours on the bike and felt completely fine, maybe just a little fatigued. However, when I finally do take a rest day, there's probably around a 50% chance that when I get back on the bike, I can't even turn the pedals without extreme pain in my quads. If I take 2 days off, there's closer to a 75% chance this will happen, and 3 or more days, its 100% chance. The pain can happen in either leg and in any of the 4 muscles in either quad. I tried diet changes, supplements including calcium, daily stretching and core work, but nothing seemed to help. One more important detail to mention, I am software developer so I spend long hours at my desk daily (this is actually what got me into cycling to begin with).

As the season is about to start, my training was going great and my numbers were looking better than ever, then I found myself back in the cycle of pain and off the bike after spending a few days in the hospital for the birth of my son. As the days started to pass, I was resting but it seemed like my condition was getting worse, not better. After more and more searching, I finally found an article from the Cleveland Clinic that was my "ah ha" moment. Many cyclists and runners have IT band problems but that didn't seem like it was my problem because the more I rode the better I felt. However, this article also mentions that many people also experience IT band issues from sitting at a desk with your knees bent for hours at a time. After reading that, I thought about it, and every time I take a rest day, its a work day, so therefore I sit all day, eat dinner, then wind down with the family and go to bed. After 3 days of a cycle like this, its no wonder I couldn't get back on the bike for a workout. I remember Pogi's coach saying that on rest days you want to do as little as possible, but I was even doing that wrong. To test my theory, I decided to spend an entire day off the bike but on my feet doing stuff around the house. The following day, I went for a ride and my legs still had some soreness but the pain was gone. As of this writing, I think I'm back on track and my season isn't going to wasted after all. I really hope this helps someone else. Here's a link to the Cleveland Clinic article some possible things you can do to help: https://health.clevelandclinic.org/it-band-stretches-and-treatments-to-relieve-knee-and-hip-pain