Extreme quadriceps starting pain after 3-4 rest days

[Wandering_Aengus]

Just adding my name to the list of people who have had this issue.

I had my ~5th episode on Saturday. Consistently the very same cause and symptoms as everyone else, a touch of flu/COVID this week so a few days off from my triathlon training plan. Went for a run on Saturday that started with a fairly steep downhill and I felt it coming on immediately. Managed to run for 10km at Z2 with a 5 minute Z4 interval before I had to stop. Hobbled the 2km home over the course of an hour or so.

I have a race in ~2 weeks so a little desperate to make this episode one of the ones I recover from quickly. After reading some posts on here I decided to jump on my indoor trainer later that evening and slowly worked up from very easy Z1 to Z2 over the course of an hour, backing off when I felt it coming on again. I also stopped a couple of times for some downward facing dog. By the end of the hour I felt like I had "flushed out" most of the bad feeling from my legs.

The next day I had a very hard 3.5 hour ride with a 30 minute run off the back of it. Legs felt a little "tingly" for the first hour of the ride but fine by the end. The run went without issues so i'm hoping this episode is over for now. Swim yesterday and a brick workout this evening so that will be another test I guess.

I have mentioned this issue to a Doctor at a very well regarded sports medicine reserach facility at a Univesity. He was as baffled by it as everyone else here and didn't have any real answers.

After reading this thread I did get a blood test a few days after one of my episodes started and my CK levels were really really elevated - left me wondering what they were like when the episode started. A little scary.

I do not take creatine so that is not a factor for me.

I like the idea of getting some sort of record of peoples symptoms and experiences - with the optimistic idea that it might entice someone with the right clinicial background to look in to it further.

Would others be willing to fill in a Google Form or similar to try and get some more clean data as per the few replies above, but in a slightly more structured fashion?

 

[Getting Old Sucks]

I like the idea of getting some sort of record of peoples symptoms and experiences - with the optimistic idea that it might entice someone with the right clinicial background to look in to it further.
Would others be willing to fill in a Google Form or similar to try and get some more clean data as per the few replies above, but in a slightly more structured fashion?

Hi there Aengus,
are you volunteering to prepare a form for a questionnaire to be uploaded / exchanged on the internet?
Something like "Click on the link, fill it, submit it"?
If this is the case I'm ok with filling it and support the initiative. Using usernames we shouldn't incur in any privacy problem I suppose. For a starter you can get the list in my previous posts dated November 4th. Then integrate with some more information you believe could be relevant.
Thanks!

 

[MickW753]

Hi all,

A bit late to the party having stumbled upon this out of sheer desperation and having lost faith with yet another physio that sent me away with another "mobility" program.

I suffered with my first episode of this back in Nov 2017, literally 2-3 days into a family holiday out in Tenerfie and whilst walking down numerous flights of steps/stairs and hills from out apartment up on the hillside overlooking the sea, down to sea level (quite a difference in elevation).

Typical symptoms of a dull ache in the outer (IT band area) of the thighs/quads, which built rapidly with any further movement into an extreme burning sensation that made my legs feel like they were going to explode. Walking backwards seemed no problem, even walking and running uphill was no real issue either (figured it was just a recruitment of different muscles).

This lasted for a good few days and only really eased with 1000mg of brufen and paracetamol too.

Prior to flying out from the UK to Tenerife, I'd smashed out nearly 500km on my watt bike (generally morning and evening sessions), over the course of maybe 8-9 days.

Since then I've had numerous repeats of this, which only seem to appear if i take more than 2 rest days from cycling (tend to average 150-250 miles per week) I know that this is going to flare up so am always anxious about trying to plan things so I can stay active and normally I just try to aim for one rest day.

Having had a good trawl of everything in here the information/relationship with carbs connection has been interesting as my most recent episode (current) has been due to an enforced rest situation due to flu or covid, I pedalled on the Friday morning and then started to feel ill later in the day, far too ill to even contemplate training on the Saturday or Sunday I was always without appetite and ate and drank very little over the weekend, Monday morning feeling a little better and anxious about whether or not my legs would flare up I attempted to ride on Zwift but lasted less than 5 minutes, I tried again on the Tuesday morning and lasted maybe 10 minutes, fast forward to Saturday (today) and I managed 30 minutes before the pain kicked in and I stopped.

I've not been particularly bad with the carbs in between as I'm pretty weight conscious too and all my morning rides are done on a pint of water and a cup of coffee with only a protein yoghurt after it, even my evening meal is generally protein based (so I know I'm not overdoing the carbs when this happens).

The rhabdo is a bit of a concern (although I've never experienced the dark pee or any of the other symptons other than the pain pushing me to the point where I thought I was about to pass out on a few occasions), as I've first hand experience of dealing with someone who suffered a near fatal rhabdo episode which left Doctors stumped, so I can see why this seems to be very "niche" and so many physios and a couple of GP's that I have seen have been less than useful in their ideas of what is going on with my legs.

As I have a confirmed (through MRI) bit of an issue with some degenerative vertebrae and minor bulging of discs in my lumbar region, all the physios I have spoken to have automatically jumped at this being neuropathy related, something that I've always had my doubts about given the coincidental timing of each episode when i take a few days off the bike.

 

[Reno sushi king]

I really like hearing everyone's experience with this condition. Makes me feel better about it, and, in the initial phases I thought it was so serious that I had something major medically going on and that the end could be near.

But make no mistakes about it, I think it can be seriously damaging to muscles and kidneys because those who have gotten tested show super high creatinine levels which is also connected with rhabdo although a different kind than text book examples. Nerve pain may also be connected to elevated creatinine levels. Creatinine is a waste product created when creatine is broken down in muscle tissue. Bottom line cease activity, pretty sure that's what the pain is trying to say.

And in hearing everyone's tales, I experimented on myself during the Thanksgiving day holiday. I was previously convinced that it was all spinal related, inflammation, etc. My reason because I could always stretch out my spine doing the upward dog (or cobra pose) and symptoms would dissipate, sometimes completely, although it could be a mixed bag. Anyhow, I went on vacation and never took a break from biking to see what would happen with a mix of over eating carbs, fats, alcohol, bad sleep, bad beds, 7+ hour car rides, etc.

As you may guess I was never more hung over, inflamed, dehydrated, sore lower back from a crappy bed, and sitting on my ass forever with a long drive both coming and going. In the past this would have brought on symptoms but this time I either jumped on an old rusty bike or a hotel gym stationary bike and pedaled for a good hour daily through the festivities.

Nothing ever happened, so I'm changing my mind and agree that it has to do with a succession of rest days. Maybe just as simple as racing horse syndrome. Our bodies don't like rest. So don't rest, but cycle often, and easy sessions worked for me.

 

[sisu]

Hi everyone,

Thought to write in since I read all the posts this summer and came to see if there are any updates and since the conversation is still going...

About me:
29-year-old Caucasian female. Former runner turned triathlete at 25 years old. Ran at D1/international level, now racing 70.3s at elite level.

My symptoms began in the summer of 2020: I'd have maybe 3-5 times/year these very extreme "cramps" in my glutes, quads or hamstrings and it seems like they would only come AFTER I had:

1. Taken a rest day
2. Traveled (=rested)
3. Got sick (=rested)
4. Tapered "too much" for a race (=rested)
and this year mainly 5. Taken a day off from biking.

The pains would start during the first session I do after I resume training, and sometimes it would take anywhere from 5 to even up to 30min into the session until I "seize up". The frequency of my symptoms in 2020-2023 was sporadic and I didn't really think of it much, just thought it was some "odd" quality of mine. I could usually get over the symptoms in 1-2 days and usually worked through them by stopping and stretching out and rinsing and repeating that process until I was able to complete the whole session...

In 2022, I did about an hour indoor ride on Christmas Eve morning, then rested the night and on Christmas Day as I had just completed a solid training block and on Boxing Day started getting the cramps in my glutes and hamstrings. I kept getting the cramps for 4-5 days in different locations between my hips and knees (have never had them in my upper body or below knees) and then I finally decided to get some blood values checked in case my sodium, magnesium, calcium etc. were off and causing this "cramping". (I just want to point out here that these "cramps" are NOT like any regular cramps one might get from being dehydrated... they are way more intense muscle pain... literally feels like the muscle fibers are rupturing). The next day I had an okay swim with only minimal symptoms and once I finished I saw someone had tried to call me twice from an odd number. I called back and it was the lab asking me how I was doing and saying I should go to the hospital because my creatine kinase (CK) was 12,000 U/I (reference values are where I'm from up to 210 U/I). I went to the hospital and was diagnosed with "rhabdo" and was on an IV for a couple hours and my values halved. I also had elevated liver enzymes. My pee was never dark and I felt generally okay besides the cramps and resulting ache in the muscles. I didn't think it was rhabdo. I have heard that I'd feel HORRENDOUS and seek for medical attention if I was actually having rhabdo. I had thought it was just that my electrolytes were off.

Fast forward to this year, I had the cramps occasionally and I started thinking it was related to biking volume/intensity, as I seemed to get them more often after more biking (like after a training camp, where I'd ride ~15h/wk vs. my typical 10ish). I also would get them after days where I had only done a swim, so I thought I had to either bike or run every day to keep them away. But then, I was in a traffic accident this spring where I got hit by a car when I was biking. I broke my collarbone but was able to start biking quite soon after. I did about couple of weeks of pretty solid indoor rides until I was able to start easy run/walks and did one of those in the morning and then rested until the next day. The next day, I went for another run/walk and the symptoms hit me HARD. The next two weeks, I was unable to train at all. I could not leave my house. If I tried to go for an easy walk or walk a couple hundred meters to the post office, I'd seize up so bad that I'd have to limp back home in tears. I was stuck at home for two weeks. It was very depressing and scary. Like going from training hard and being fit to not even being able to leave the house?! Then I discovered this forum and read through all the posts. Someone recommended trying tabatas on the bike if you feel the symptoms coming. I had tried resting, easy walks, stretching... everything for two weeks because people kept telling me I was just overtrained and my body needed rest. Then I saw this and I was like "F it, let's try". I did 20min of 10sec all out/20sec easy without warm up. IT WORKED. I was able to break the two-week cycle with this. I managed to resume normal training by doing those sessions for 3ish days.

However, I have had more of these episodes this year than ever before and I believe they are related to an autoimmune reaction that is due to either physical or mental stress. Training and traveling are stressors for your body, and when you rest after your body thinks it's "ok to get sick". Just think about the times when you have had a lot of stress at work or school and then the vacation comes and you get sick. You fought it off until it was okay to take the time to rest. I think that's why I can do big training blocks (keep pushing and suppressing the immune system) and then when I rest afterwards my body goes crazy ("we are safe now to rest"). I think I have had a lot of physical and emotional trauma after my accident this spring and that made my symptoms worse. There's been an ongoing legal process related to the event and that has been stressing me out even though it's now been almost 8 months since and that has caused anxiety, sleeping problems and these muscle symptoms. A good thing is that my symptoms are finally taken seriously and I have got some testing done, here's what I know:

1. My baseline CK values are elevated. I haven't had any measurements within the normal ranges. I got a test done this week and it was still 242 U/I even though I have been otherwise asymptomatic for about 3 weeks now.
2. My liver enzymes (AST, ALAT) are often elevated too and always elevated if I have higher CK.
3. I got an MRI done for the my quads and they saw some abnormal "signal" in the vastus lateralis
4. I got an ENMG done and they saw some abnormal neural activity that might be an indicator of a myopathy.

My neurologist thinks that it might be some very rare yet mild case of myopathy. I have a muscle biopsy next Wednesday (Dec 18). It's been about a six months' process to get to this point but I am really hoping they can finally figure it out and "fix" me. I have tried some supplements like coQ10 and regular Magnesium, but I don't think they have really helped. I'm sick of being afraid of traveling and being "allergic" to restdays. I recently took a two-week off-season, where I still kept active every day but biked waaaaay less. I noticed that during the first week my muscles felt very odd and there were times where I thought I was going to cramp up but then I didn't. During the second week I no longer had these sensations. The weird thing is that I have only had these symptoms since I began biking more when I switched to triathlon. I have also had the symptoms triggered by walking downhill/downstairs.

I don't know if this helps anyone but I just thought to pitch in with my story. I can update you after the biopsy if they find anything because I understand the struggle and frustration you are all going through and if I could help even just a one person that'd be super awesome.x

 

[Getting Old Sucks]

Hi everyone,

Thought to write in since I read all the posts this summer and came to see if there are any updates and since the conversation is still going...

About me:
29-year-old Caucasian female. Former runner turned triathlete at 25 years old. Ran at D1/international level, now racing 70.3s at elite level.

My symptoms began in the summer of 2020: I'd have maybe 3-5 times/year these very extreme "cramps" in my glutes, quads or hamstrings and it seems like they would only come AFTER I had:

1. Taken a rest day
2. Traveled (=rested)
3. Got sick (=rested)
4. Tapered "too much" for a race (=rested)
and this year mainly 5. Taken a day off from biking.

The pains would start during the first session I do after I resume training, and sometimes it would take anywhere from 5 to even up to 30min into the session until I "seize up". The frequency of my symptoms in 2020-2023 was sporadic and I didn't really think of it much, just thought it was some "odd" quality of mine. I could usually get over the symptoms in 1-2 days and usually worked through them by stopping and stretching out and rinsing and repeating that process until I was able to complete the whole session...

In 2022, I did about an hour indoor ride on Christmas Eve morning, then rested the night and on Christmas Day as I had just completed a solid training block and on Boxing Day started getting the cramps in my glutes and hamstrings. I kept getting the cramps for 4-5 days in different locations between my hips and knees (have never had them in my upper body or below knees) and then I finally decided to get some blood values checked in case my sodium, magnesium, calcium etc. were off and causing this "cramping". (I just want to point out here that these "cramps" are NOT like any regular cramps one might get from being dehydrated... they are way more intense muscle pain... literally feels like the muscle fibers are rupturing). The next day I had an okay swim with only minimal symptoms and once I finished I saw someone had tried to call me twice from an odd number. I called back and it was the lab asking me how I was doing and saying I should go to the hospital because my creatine kinase (CK) was 12,000 U/I (reference values are where I'm from up to 210 U/I). I went to the hospital and was diagnosed with "rhabdo" and was on an IV for a couple hours and my values halved. I also had elevated liver enzymes. My pee was never dark and I felt generally okay besides the cramps and resulting ache in the muscles. I didn't think it was rhabdo. I have heard that I'd feel HORRENDOUS and seek for medical attention if I was actually having rhabdo. I had thought it was just that my electrolytes were off.

Fast forward to this year, I had the cramps occasionally and I started thinking it was related to biking volume/intensity, as I seemed to get them more often after more biking (like after a training camp, where I'd ride ~15h/wk vs. my typical 10ish). I also would get them after days where I had only done a swim, so I thought I had to either bike or run every day to keep them away. But then, I was in a traffic accident this spring where I got hit by a car when I was biking. I broke my collarbone but was able to start biking quite soon after. I did about couple of weeks of pretty solid indoor rides until I was able to start easy run/walks and did one of those in the morning and then rested until the next day. The next day, I went for another run/walk and the symptoms hit me HARD. The next two weeks, I was unable to train at all. I could not leave my house. If I tried to go for an easy walk or walk a couple hundred meters to the post office, I'd seize up so bad that I'd have to limp back home in tears. I was stuck at home for two weeks. It was very depressing and scary. Like going from training hard and being fit to not even being able to leave the house?! Then I discovered this forum and read through all the posts. Someone recommended trying tabatas on the bike if you feel the symptoms coming. I had tried resting, easy walks, stretching... everything for two weeks because people kept telling me I was just overtrained and my body needed rest. Then I saw this and I was like "F it, let's try". I did 20min of 10sec all out/20sec easy without warm up. IT WORKED. I was able to break the two-week cycle with this. I managed to resume normal training by doing those sessions for 3ish days.

However, I have had more of these episodes this year than ever before and I believe they are related to an autoimmune reaction that is due to either physical or mental stress. Training and traveling are stressors for your body, and when you rest after your body thinks it's "ok to get sick". Just think about the times when you have had a lot of stress at work or school and then the vacation comes and you get sick. You fought it off until it was okay to take the time to rest. I think that's why I can do big training blocks (keep pushing and suppressing the immune system) and then when I rest afterwards my body goes crazy ("we are safe now to rest"). I think I have had a lot of physical and emotional trauma after my accident this spring and that made my symptoms worse. There's been an ongoing legal process related to the event and that has been stressing me out even though it's now been almost 8 months since and that has caused anxiety, sleeping problems and these muscle symptoms. A good thing is that my symptoms are finally taken seriously and I have got some testing done, here's what I know:

1. My baseline CK values are elevated. I haven't had any measurements within the normal ranges. I got a test done this week and it was still 242 U/I even though I have been otherwise asymptomatic for about 3 weeks now.
2. My liver enzymes (AST, ALAT) are often elevated too and always elevated if I have higher CK.
3. I got an MRI done for the my quads and they saw some abnormal "signal" in the vastus lateralis
4. I got an ENMG done and they saw some abnormal neural activity that might be an indicator of a myopathy.

My neurologist thinks that it might be some very rare yet mild case of myopathy. I have a muscle biopsy next Wednesday (Dec 18). It's been about a six months' process to get to this point but I am really hoping they can finally figure it out and "fix" me. I have tried some supplements like coQ10 and regular Magnesium, but I don't think they have really helped. I'm sick of being afraid of traveling and being "allergic" to restdays. I recently took a two-week off-season, where I still kept active every day but biked waaaaay less. I noticed that during the first week my muscles felt very odd and there were times where I thought I was going to cramp up but then I didn't. During the second week I no longer had these sensations. The weird thing is that I have only had these symptoms since I began biking more when I switched to triathlon. I have also had the symptoms triggered by walking downhill/downstairs.

I don't know if this helps anyone but I just thought to pitch in with my story. I can update you after the biopsy if they find anything because I understand the struggle and frustration you are all going through and if I could help even just a one person that'd be super awesome.x

Hey Sisu, welcome to our unfortunate club!
I totally feel you about the traffic accident you had as I had one myself in June this year (my fault, even though I have a lot to blame on that car driver I slammed into) and the psychological trauma ended up exceeding the physical one (a dislocated shoulder that I still cannot sleep onto and a neck whiplash also giving me a few trouble still). Combined with perception of unwillingly getting closer and closer to 50YO it made me feel like I'm not whole anymore. Depressing.
But let me ask you about creatine, do you (or did you) take that supplement?
For my case a lot of evidences point to that direction but it's also clear that for many others this is not a factor. Just curious to add another record to my little statistic.

And i know it's not much consolation but you're not alone in this.
Cheers!

🤞🏻🤞🏻

 

[sisu]

Hey Sisu, welcome to our unfortunate club!
I totally feel you about the traffic accident you had as I had one myself in June this year (my fault, even though I have a lot to blame on that car driver I slammed into) and the psychological trauma ended up exceeding the physical one (a dislocated shoulder that I still cannot sleep onto and a neck whiplash also giving me a few trouble still). Combined with perception of unwillingly getting closer and closer to 50YO it made me feel like I'm not whole anymore. Depressing.
But let me ask you about creatine, do you (or did you) take that supplement?
For my case a lot of evidences point to that direction but it's also clear that for many others this is not a factor. Just curious to add another record to my little statistic.

And i know it's not much consolation but you're not alone in this.
Cheers!

🤞🏻🤞🏻

Hey Sisu, welcome to our unfortunate club!
I totally feel you about the traffic accident you had as I had one myself in June this year (my fault, even though I have a lot to blame on that car driver I slammed into) and the psychological trauma ended up exceeding the physical one (a dislocated shoulder that I still cannot sleep onto and a neck whiplash also giving me a few trouble still). Combined with perception of unwillingly getting closer and closer to 50YO it made me feel like I'm not whole anymore. Depressing.
But let me ask you about creatine, do you (or did you) take that supplement?
For my case a lot of evidences point to that direction but it's also clear that for many others this is not a factor. Just curious to add another record to my little statistic.

And i know it's not much consolation but you're not alone in this.
Cheers!

🤞🏻🤞🏻

Hey!

Ugh sorry to hear about your accident. I know that feeling of not being able to sleep on the f*cked up shoulder Also, you are worthy and good at any age. I'm approaching a milestone birthday myself too and it has made me feel nervous too but it's okay! Just a different phase of the life.

Funny enough, I DID take creatine for a little bit around the time of my 2022 "rhabdo" (" " because I still don't fully buy in to that explanation as I never had dark urine and I didn't feel generally that horrible and had not done any extreme exercise... the doctors were gaslighting me to believe I had overdone my training but I had literally not done anything crazy and out of ordinary. I just biked a few hours more per week than usual due to having a running injury). My PT recommended creatine as there are some preliminary studies that suggest it might help with injury healing. I did it for about 4wks and then stopped when I got the bad symptoms as the doctors said I shouldn't take any supps so that my kidneys and liver won't be under more stress than what clearing out the CK and elevated liver enzymes cause. I also put on a few kilos of water weight as a result... But I have not taken it since then and I had these muscle symptoms both before and after so I am not convinced it could be the cause. But it can certainly dehydrate you so that could be a trigger for some. I also felt a bit weird tingling in my muscles during the time that was different from these muscle spasms/cramps.

I am just simply amazed by how many people are experiencing this same thing but it does make me feel slightly better to know I'm not crazy!! So many people have told me that I'm insane and this is just super weird (which it is) and it's been really hard to convince the medical professionals this is not a joke and that I'm 98% of the time fine and capable of doing insane physical things but that 2% when I'm crippled is really a problem when doing pro sports and that there's clearly something wrong with me... I'm nervous about my biopsy but also excited as I hope that could give some actual direction and maybe a name for these symptoms. It is maybe unlikely that everyone here has the same "rare myopathy" but maybe if they find anything in my muscle that could help the others to narrow down the possibilities a little bit.

 

[Reno sushi king]

I am just simply amazed by how many people are experiencing this same thing but it does make me feel slightly better to know I'm not crazy!! So many people have told me that I'm insane and this is just super weird (which it is) and it's been really hard to convince the medical professionals this is not a joke and that I'm 98% of the time fine and capable of doing insane physical things but that 2% when I'm crippled is really a problem when doing pro sports and that there's clearly something wrong with me... I'm nervous about my biopsy but also excited as I hope that could give some actual direction and maybe a name for these symptoms. It is maybe unlikely that everyone here has the same "rare myopathy" but maybe if they find anything in my muscle that could help the others to narrow down the possibilities a little bit

You got that right! When I sought medical help most doctors can't even follow my story. I'm actually grateful this syndrome comes and goes. Imagine what it would be like to have it the majority of the time. The feeling of being disabled is brutal. I too noticed it come on like crazy one time after being injured with a broken rib and lacerations. Anyhow, thanks for sharing, I found your take interesting regarding it being connected to stressors. Eventually this will be figured out and shared here.

 

[sisu]

You got that right! When I sought medical help most doctors can't even follow my story. I'm actually grateful this syndrome comes and goes. Imagine what it would be like to have it the majority of the time. The feeling of being disabled is brutal. I too noticed it come on like crazy one time after being injured with a broken rib and lacerations. Anyhow, thanks for sharing, I found your take interesting regarding it being connected to stressors. Eventually this will be figured out and shared here.

Hi!
Yes, exactly. But I think that's why my neurologist suggested it would be something more "rare" and "less serious" compared to many of the well-known myopathies, which typically have the symptoms occur all the time and particularly with any activity (and not like in our case when it is only triggered by time off). It would be impossible to train and compete. But it is kind of wild that one can function just fine if they keep pushing and rest is basically toxic.

 

[Reno sushi king]

Happy Holidays to all, and keep those legs spinning. Looking forward to a cure in 2025, figure we got to be close!

 

[Reno sushi king]

Had a little time today so I spoon-fed all 19 pages to ChatGPT (artificial intelligence) on the hopes what we've all gone through was already diagnosed elsewhere on the web. Hope no one takes offense, I think AI can be helpful with mysteries and especially when medical professionals just don't have the time to take in the full picture. Drumroll...

*** *** ***

After reviewing all 19 pages of the forum thread and considering the symptoms described, my professional opinion would be to approach this issue from a multi-faceted perspective, as it seems to be a complex and poorly understood condition with a combination of potential causes. Here's a summary of what seems most relevant:

1. Possible Neuromuscular or Metabolic Issues:​

• The pain seems to be triggered by a sudden return to activity after a period of rest, which suggests there may be an issue with muscle readiness, neuromuscular recovery, or metabolic dysfunction. This could involve impaired muscle recovery, possibly linked to an inability of muscles to efficiently clear waste products (like lactic acid) or a failure of the energy systems to reactivate properly after a period of rest. The fact that creatinine levels tend to be high in some cases, and that rhabdomyolysis (a muscle breakdown condition) has been mentioned in the thread, suggests a possible metabolic or cellular dysfunction that may need to be addressed. A metabolic disorder or dysfunction in muscle repair (perhaps involving the mitochondria or ATP production) could explain the delayed onset of pain after rest.

2. Muscle Imbalance and Biomechanical Factors:​

• The involvement of the quadriceps, glutes, and hip muscles after rest could suggest that muscular imbalances or spinal/pelvic misalignments play a role. Any abnormal biomechanical patterns or poor posture when riding, especially after rest, could lead to muscle strains or pain. This aligns with some forum discussions around possible pelvic misalignments or neural tension. For example, tightness or compensations in the hip flexors could lead to unnecessary strain on the quadriceps, resulting in pain or cramping once the muscles are re-engaged.

3. Spinal Health and Nerve Involvement:​

• There may be a link between the spine, specifically nerve root irritation or compression, and muscle function. Misalignments in the spine, such as subluxations, could create nerve compression that affects lower body musculature, especially during the activation of large muscle groups like the quadriceps after rest. This can result in a delayed response in muscle function and pain due to altered neural input. The idea of nerve-related issues contributing to muscle cramps or spasms after rest is plausible, especially since many of the pain episodes occur with activities like walking downhill, which can exacerbate spinal compression or pelvic tilt issues.

4. Lack of Warm-up and Sudden Activity:​

• Another factor is that lack of a proper warm-up after rest can contribute to excessive strain on muscles that have not yet activated properly. Some forum participants mentioned that they feel pain after resuming intense cycling, which could be due to insufficient warm-up or muscle activation. The body may struggle to transition back into higher intensity exercise after a period of reduced load, resulting in spasms or cramps in muscles that have deconditioned slightly.

5. Possible Hormonal or Inflammatory Factors:​

• Given that some individuals have been admitted to the ER and have high creatinine levels, there may be an underlying inflammatory or hormonal issue at play. Hormonal imbalances or inflammatory responses (even after relatively mild rest periods) might be exacerbating the situation. It's worth considering whether inflammation markers are affecting muscle recovery or leading to an abnormal pain response post-rest.

My Recommendations:​

• Spinal and Pelvic Health Assessment: A comprehensive evaluation from a chiropractor or physical therapist who specializes in spinal alignment, pelvic health, and neural tension might be beneficial. Identifying any misalignments or nerve involvement could reveal hidden causes.
• Muscle Activation and Warm-up Routine: Implementing a more structured and gradual warm-up routine before cycling could help. This would involve not only cardiovascular warm-ups but also dynamic stretching and muscle activation exercises to get the muscles primed for intense exercise.
• Metabolic Testing and Monitoring: Given the mention of high creatinine and rhabdomyolysis, working with a doctor to test metabolic functions, kidney health, and muscle enzymes may help uncover any hidden metabolic conditions that could affect muscle recovery.
• Reduced Rest and Active Recovery: Experimenting with active recovery (low-intensity cycling, swimming, or light walking) on rest days could potentially reduce the shock of suddenly re-engaging in intense cycling. This would help in maintaining a minimal level of muscle activity to prevent deconditioning.
• Nutritional Support: Since metabolic and muscular recovery may be involved, ensuring proper electrolyte balance (including potassium and magnesium) and adequate protein intake to support muscle repair might be helpful. Some cyclists on the forum mentioned using supplements like magnesium to manage cramps, which could be part of a larger nutritional strategy.

Ultimately, this condition seems complex, with potential contributions from musculoskeletal, neurological, and metabolic factors. The key would be a personalized approach, likely involving cross-disciplinary care from a healthcare team that includes a chiropractor, sports physician, physical therapist, and possibly a nutritionist.

 

[sisu]

Had a little time today so I spoon-fed all 19 pages to ChatGPT (artificial intelligence) on the hopes what we've all gone through was already diagnosed elsewhere on the web. Hope no one takes offense, I think AI can be helpful with mysteries and especially when medical professionals just don't have the time to take in the full picture. Drumroll...

*** *** ***

After reviewing all 19 pages of the forum thread and considering the symptoms described, my professional opinion would be to approach this issue from a multi-faceted perspective, as it seems to be a complex and poorly understood condition with a combination of potential causes. Here's a summary of what seems most relevant:

1. Possible Neuromuscular or Metabolic Issues:​

• The pain seems to be triggered by a sudden return to activity after a period of rest, which suggests there may be an issue with muscle readiness, neuromuscular recovery, or metabolic dysfunction. This could involve impaired muscle recovery, possibly linked to an inability of muscles to efficiently clear waste products (like lactic acid) or a failure of the energy systems to reactivate properly after a period of rest. The fact that creatinine levels tend to be high in some cases, and that rhabdomyolysis (a muscle breakdown condition) has been mentioned in the thread, suggests a possible metabolic or cellular dysfunction that may need to be addressed. A metabolic disorder or dysfunction in muscle repair (perhaps involving the mitochondria or ATP production) could explain the delayed onset of pain after rest.

2. Muscle Imbalance and Biomechanical Factors:​

• The involvement of the quadriceps, glutes, and hip muscles after rest could suggest that muscular imbalances or spinal/pelvic misalignments play a role. Any abnormal biomechanical patterns or poor posture when riding, especially after rest, could lead to muscle strains or pain. This aligns with some forum discussions around possible pelvic misalignments or neural tension. For example, tightness or compensations in the hip flexors could lead to unnecessary strain on the quadriceps, resulting in pain or cramping once the muscles are re-engaged.

3. Spinal Health and Nerve Involvement:​

• There may be a link between the spine, specifically nerve root irritation or compression, and muscle function. Misalignments in the spine, such as subluxations, could create nerve compression that affects lower body musculature, especially during the activation of large muscle groups like the quadriceps after rest. This can result in a delayed response in muscle function and pain due to altered neural input. The idea of nerve-related issues contributing to muscle cramps or spasms after rest is plausible, especially since many of the pain episodes occur with activities like walking downhill, which can exacerbate spinal compression or pelvic tilt issues.

4. Lack of Warm-up and Sudden Activity:​

• Another factor is that lack of a proper warm-up after rest can contribute to excessive strain on muscles that have not yet activated properly. Some forum participants mentioned that they feel pain after resuming intense cycling, which could be due to insufficient warm-up or muscle activation. The body may struggle to transition back into higher intensity exercise after a period of reduced load, resulting in spasms or cramps in muscles that have deconditioned slightly.

5. Possible Hormonal or Inflammatory Factors:​

• Given that some individuals have been admitted to the ER and have high creatinine levels, there may be an underlying inflammatory or hormonal issue at play. Hormonal imbalances or inflammatory responses (even after relatively mild rest periods) might be exacerbating the situation. It's worth considering whether inflammation markers are affecting muscle recovery or leading to an abnormal pain response post-rest.

My Recommendations:​

• Spinal and Pelvic Health Assessment: A comprehensive evaluation from a chiropractor or physical therapist who specializes in spinal alignment, pelvic health, and neural tension might be beneficial. Identifying any misalignments or nerve involvement could reveal hidden causes.
• Muscle Activation and Warm-up Routine: Implementing a more structured and gradual warm-up routine before cycling could help. This would involve not only cardiovascular warm-ups but also dynamic stretching and muscle activation exercises to get the muscles primed for intense exercise.
• Metabolic Testing and Monitoring: Given the mention of high creatinine and rhabdomyolysis, working with a doctor to test metabolic functions, kidney health, and muscle enzymes may help uncover any hidden metabolic conditions that could affect muscle recovery.
• Reduced Rest and Active Recovery: Experimenting with active recovery (low-intensity cycling, swimming, or light walking) on rest days could potentially reduce the shock of suddenly re-engaging in intense cycling. This would help in maintaining a minimal level of muscle activity to prevent deconditioning.
• Nutritional Support: Since metabolic and muscular recovery may be involved, ensuring proper electrolyte balance (including potassium and magnesium) and adequate protein intake to support muscle repair might be helpful. Some cyclists on the forum mentioned using supplements like magnesium to manage cramps, which could be part of a larger nutritional strategy.

Ultimately, this condition seems complex, with potential contributions from musculoskeletal, neurological, and metabolic factors. The key would be a personalized approach, likely involving cross-disciplinary care from a healthcare team that includes a chiropractor, sports physician, physical therapist, and possibly a nutritionist.

Hi,

Thanks for doing all this work. I had my muscle biopsy 11 days ago and here's a short(ish) update:

Well first off, haven't got any results back yet. They said it might take 2-4 weeks depending on what tests they run with the samples + the Holidays, so I'm not expecting to hear anything for at least another 10-14 days. The biopsy went well and was way less painful than I thought. However, the recovery has been a lot longer. I was initially advertised that it'd be a simple procedure and I'd have a stitch or two for 3-4 days... Then I got told that the stitches would stay in for 5-7 days and I'd have to avoid strenuous exercise for the first 24h... But after the procedure was done, the doctor said I'd have to have the stitches in for 10-14 days AND not do pretty much any activity that involves the legs during that time... UH??? I consulted my friend who is a doctor and he asked around his doctor friends and they recommended to take it easy for a week and then can start aerobic cycling and running during the second week. I followed this suggestion and did a couple attempts of indoor rowing and cycling with one leg (that was silly and desperate lol). I hadn't had any cramps for 3 weeks before the biopsy and training was going super well, which made me question the necessity of the procedure (I was nervous and getting cold feet), but after the procedure I got cramps in my right glute during these single leg activities -- i.e. only in the leg that was working. I finally started biking again this Wednesday, a week after the procedure, and I got the WORST cramps of my life in both glutes. However, I decided to keep pushing through them as from the past experience I knew it seems to help if I force myself through the cramps during the first day they come. I had to take a couple of breaks during the ride and ride again later but on Thursday I didn't have any muscle issues besides tenderness from the previous day. The sad thing is that this triumph was short lived as on Friday night I noticed my wound had opened up a bit more and my dr friend recommended me to take it super easy this weekend (i.e. no bike or run) so that I could possibly get the stitches out on Monday and also minimize the risk of infection.... Now I'm just worried about having to fight against the cramps again as it was so painful.

I think it's important to acknowledge that it is very unlikely that all of us in this forum have some rare genetic disorder and that cramps and rhabdomyolysis can have different causes. However, after reading your ChatGPT summary, I thought to comment those 5 points:

1. Possible Neuromuscular or Metabolic Issues:​

• The pain seems to be triggered by a sudden return to activity after a period of rest, which suggests there may be an issue with muscle readiness, neuromuscular recovery, or metabolic dysfunction. This could involve impaired muscle recovery, possibly linked to an inability of muscles to efficiently clear waste products (like lactic acid) or a failure of the energy systems to reactivate properly after a period of rest. The fact that creatinine levels tend to be high in some cases, and that rhabdomyolysis (a muscle breakdown condition) has been mentioned in the thread, suggests a possible metabolic or cellular dysfunction that may need to be addressed. A metabolic disorder or dysfunction in muscle repair (perhaps involving the mitochondria or ATP production) could explain the delayed onset of pain after rest.

Lactic acid (actually it's lactate, but that's irrelevant in this) is cleared from the systems within an hour after exercise no matter what, so it's very unlikely that this is the answer. However, I do believe that it could be related to other muscle waste product accumulation, e.g. H+ ions that the muscle might release after the stimulus ceases to exist, and that waste product "sits" in the muscle during the rest period as the muscle metabolism and blood flow are lower when inactive.

I also have read about creatine kinase causing cramping. Many of us have had elevated CK levels during these episodes, and think that elevated CK is the outcome of the cramps, but I think the CK causes them. I shared earlier about my theory of that to me, it seems like physical/psychological trauma triggers my symptoms, and up until this year it seemed like the symptoms came only after more intense training blocks (e.g. training camps), sickness or travel -- I think these stressors cause the release of CK from the muscles and the body is unable to clear it during the inactive period and that results in cramping. I read about muscle biopsy also possibly elevating CK and that could explain my intense cramps lately.

I have read about many myopathies (muscle diseases) and I think that's a potential explanation. In my personal case, I think McArdle's is very unlikely, although I do seem to get the "second wind" or I can sorta push through the cramps sometimes. However, I think I'd get the symptoms all the time and every training session. I can also get my lactate up (literally did a bike ramp test two days before the biopsy and my 5min post-test peak lactate was 10 mmol). I got tested for the CPT2 deficiency (no results yet) and I have been reading about it more recently and I think it could be one potential explanation.

This was a good article: https://pmc.ncbi.nlm.nih.gov/articles/PMC8365340/

I also got ENMG and MRI scans this past summer and they showed some abnormalities in the vastus lateralis muscles, which support the neuromuscular hypothesis.

2. Muscle Imbalance and Biomechanical Factors:​

I think this is a very unlikely explanation. I think this could explain any 'typical' cramps and tightness/tingling sensations after restdays but to my understanding, everyone who's written in this forum has complained about cramps that are more than your average cramps associated with dehydration or biomechanical issues.

3. Spinal Health and Nerve Involvement:​

• There may be a link between the spine, specifically nerve root irritation or compression, and muscle function. Misalignments in the spine, such as subluxations, could create nerve compression that affects lower body musculature, especially during the activation of large muscle groups like the quadriceps after rest. This can result in a delayed response in muscle function and pain due to altered neural input. The idea of nerve-related issues contributing to muscle cramps or spasms after rest is plausible, especially since many of the pain episodes occur with activities like walking downhill, which can exacerbate spinal compression or pelvic tilt issues.

Once again, very unlikely to cause intense cramping and myalgia that is only present after time off.

4. Lack of Warm-up and Sudden Activity:​

I think unlikely because I think some people here (me included) when symptomatic seemed to respond well to HIIT/tabata that was done without warm up. I think 'sudden activity' or more like 'sudden changes in stimulus' could be an explanation or at least a part of it. I think changing the training stimulus rapidly to either direction could throw off the balance/metabolism in the muscles.

5. Possible Hormonal or Inflammatory Factors:​

I think the inflammatory response is possible (CK, free radicals etc).

 

[Reno sushi king]

Checked out the link and had to use ai again to summarize and dumb it down for me. And interesting feedback, you are certainly enlisting the help of professionals to get some answers along with some decent hunches. Felt bad for a guy years back who did the muscle biopsy and was told nothing out of order. Figure that would happen to me so won't even try.

When my doctor prescribed PT the therapist told me next time it happens bend at the waist and touch your toes to see if that helps, well it made it even worse. That's when I thought to try to do the opposite, and tried the upward facing dog pose and it actually works, maybe 8 out of 10 times when "stuff" starts coming on while biking. I'm not a yoga person but I looked it up and it's upward facing dog, before I might have mentioned downward dog. Gets confusing but the more I can bend my back like a scorpion (while on the ground, standing doesn't do it) the quicker the pain just disappears, quickly too. I'm curious why something like that would work, of course just another question for the chat bot.

And yes, it's ai but maybe it can help but at the same time it might just be blowing hot air our way. At least it's prompt and courteous!

I need you to put on your thinking cap. Why do you think that when the pains come on suddenly one can get off their bike and hold the upward dog pose for a 20 count and the pains fade away?

ChatGPT said:​

The fact that the upward dog pose (a back-extension stretch) alleviates the pain suggests that spinal mechanics, nerve tension, or muscle alignment are playing a significant role in the onset of these symptoms. Here’s a deep dive into potential mechanisms:

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1. Relieving Nerve Compression or Tension​

The upward dog pose involves spinal extension, which could:

• Reduce compression on spinal nerve roots: When you extend the spine, the intervertebral spaces open slightly, particularly in the lower lumbar region. If the pain is related to minor nerve impingement or irritation (e.g., sciatica or another radiculopathy), this movement could temporarily relieve pressure on the affected nerves.
• Relieve tension in the anterior chain of the body: The stretch lengthens the hip flexors and abdominal muscles while also decompressing the lumbar spine, potentially releasing tension on nerves supplying the quads, glutes, and other lower-body muscles.

---

2. Restoring Neural Signaling​

Cycling in a seated and flexed posture can cause:

• Reduced blood flow to nerves or mild nerve ischemia.
• Altered neural signaling to the muscles in the lower body due to sustained pressure on the lumbar spine or pelvic nerves.

The upward dog pose:

• Realigns the pelvis and lumbar spine, improving nerve conduction by alleviating any kinks or pressure points along the nerves.
• Encourages a more natural flow of cerebrospinal fluid, which can optimize neural function.

---

3. Alleviating Muscular Imbalances​

The pose stretches the hip flexors (e.g., psoas and rectus femoris) while engaging the lower back muscles. These opposing actions may:

• Counteract tightness in the hip flexors, which are often shortened and overused during cycling. This tightness could cause compensatory overuse or cramping in the quadriceps and glutes when transitioning back to activity after rest.
• Activate underutilized stabilizing muscles in the back, pelvis, or core that may have become dormant due to repetitive cycling posture, improving muscle coordination and relieving strain on overworked areas.

---

4. Enhanced Blood Flow and Relaxation​

Holding the upward dog pose can:

• Increase local blood flow to the lumbar spine, hips, and thighs, delivering oxygen and nutrients to fatigued or cramped muscles.
• Activate parasympathetic responses (through diaphragmatic breathing in the pose), which may reduce muscle tension and improve overall relaxation in the body.

---

5. Decompressing the Hip Joint and Pelvis​

During the upward dog:

• The pelvis tilts anteriorly, which can relieve compression on the femoral nerves and hip joints. This decompression might reduce the referred pain or cramping felt in the quads and glutes.
• The lumbar curve increases, which may improve alignment and reduce strain on connected musculature.

---

Hypothesis: A Functional Feedback Loop​

The upward dog likely creates a functional reset by:

1. Relieving nerve tension or compression.
2. Rebalancing muscular forces between the hip flexors, extensors, and quads.
3. Improving blood flow and reducing localized inflammation or ischemia.

This relief may be temporary, as the underlying issue (e.g., nerve irritation, tight hip flexors, or spinal misalignment) remains unresolved. However, the pose provides just enough reset for the pain to fade away.

---

Next Steps​

To investigate further:

• Experiment with additional back extension movements (e.g., cat-cow pose or prone press-ups) to see if they yield similar results.
• Pay attention to posture, both on and off the bike, to identify any sustained positions that might predispose you to nerve or muscle tension.

If this mechanism aligns with your experience, it might point to spinal or nerve health (or muscular imbalance) as a key contributor to the mystery. Let me know if you'd like to explore this further!