Extreme quadriceps starting pain after 3-4 rest days

[mlbeeman]

Comrades in Pain

Wow, I had all but given up on finding people that were experiencing this weird, highly circumstantial occurrence of pain. Same as others have described on the forum, I can ride every day for months and no problems and then, after taking 3-4 days off, having pain so severe as to make me have to walk home on some occasions (now, when I think it may happen, I ride closer to home). I have been going through this cycle for about 4 years now and spent the better part of one summer going to doctors so they could do various tests when the muscles actually hurt. We never got to a conclusive diagnosis but here is what I learned just in case it helps any else out there.
1. It is not related to hydration. I have had days where I intentionally over hydrated before the ride to preload the system and that did not prevent the pain. I have tried different types of electrolytes with no positive effect.
2. I have had electrical tests done on my muscles and there was nothing unusual in the firing of the muscle when stimulated.
3. We had at one time thought maybe related to myofascia stretching in the quads. What did not make sense to the Dr. was why it would occur after rest periods as normally, for runners, it happens during exercise when the muscle is fully expanded.
4. The Dr. did a test to check my liver enzyme levels during an episode of pain and found them to be VERY high at that time (similar to levels put out during heart attack) and warned me to never try to work through the pain as if it were a cramp. It is not a cramp (hard to describe to others that have not had the experience). The rest of the blood panel came back completely normal.
5. I have had some limited success using stationary bikes and hiking while on business travel but unpredictable as not the same repetitive motion.
6. Have had more reliable (but not 100%) success with the dreaded black foam roller if I use it religiously before I go on a ride and then again after the ride.

As for today.....I just came back from a 4 day business trip and 3 miles into the 40 mile ride (and I did use the foam roller before leaving) I had to regrettably watch my riding companions take off as I turned around and limped home. Hope someone finds a solution soon or I am going to have to quit my job! Thanks for the posts, at least I am not crazy (or not for this reason anyway).

Regards,
Mark

 

[bobhas]

Has anyone figured out what is causing this? I had my first episode after a few days off the bike due to illness. Quad cramps started less than 5 minutes into my ride, I tried to push through them but ended up in so much pain that I had to get a ride home.

I tried to ride again the next day, same thing.

I took 6 more days off the bike to see if it would resolve, tried to ride tonight, 2 minutes in I have a cramp in a very specific spot on my left quad.

Walking down stairs seem to produce the same cramping. I can also confirm that it is not hydration related. I have consumed 5-7 liters a water a day for 6 days with electrolyte drinks mixed in (gatorade and skratch). It is also not fatigue, as it starts at the very beginning of a ride.

 

[Captain Serious]

If it's in isolate spots, especially inner quads, it could be an iliac artery kinking thing. Check out posts 17 and 18.

 

[Captain Serious]

Here's a shot-in-the-dark:

Anyone here have acid reflux?

Most antacids, such as Tums and Quickease are LOADED with calcium -- like, 800mg per lozenge. If someone is having is having a pack a day of this stuff, it can fark up ion muscle balances, as far as I know.

 

[Captain Serious]

However, I doubt that both of my suggestions would relate to time off the bike

 

[bobhas]

Here's a shot-in-the-dark:

Anyone here have acid reflux?

Most antacids, such as Tums and Quickease are LOADED with calcium -- like, 800mg per lozenge. If someone is having is having a pack a day of this stuff, it can fark up ion muscle balances, as far as I know.

How long would you expect it to take to resolve if it were an ion balance issue, assuming no more calcium supplements were taken and sufficient water intake.

 

[Captain Serious]

How long would you expect it to take to resolve if it were an ion balance issue, assuming no more calcium supplements were taken and sufficient water intake.

I don't know, sorry. I admit I'm out of my depth. It's just a wild guess

 

[hiero2]

Has anyone figured out what is causing this? . . .

The possible causes are so numerous and different . . .this thread could be a book trying to answer that.

A lot of potential causes mentioned in various posts. Dehydration, prior alcohol consumption, tight tendons/ligaments, muscle group imbalance, numerous organic (physical) ailments, etc.

I notice one poster had a blood panel done - which could be helpful - and might need some tests included that aren't typical for physical exam type tests. Even a low level of vitamin D can cause mysterious muscle cramping/pains.

It it is bad enough to get in your way - best talk to your doc. If he isn't much help - and some aren't - find a local sports doc or clinic and see what they have to say. Good luck.

 

[waynepovey]

me too

I'm amazed i have actually found riders having the same horrible experience. I have been battling it for years. I'm in the middle of an episode now, having to stop riding yesterday on the indoor trainer because i could feel the pain starting, once again. This time it arose after two days off the bike and while i was doing a project at home that required many trips up and down stairs. Three miles into my next ride my lower right quad began to burn and seize. I've learned you can't "ride through it" and soft pedaled it home. I made it home but as usual, felt like i'd been hit with a hammer. This time was a little unusual as the pain didn't begin on the lateral side (IT band ) area. Once an episode starts, i'm afraid to ride outdoors until I've had at least two trainer rides. It is usually about a week until I'm back to normal.

It has always struck me that it only occurs after a layoff of two or more days and when my fitness seems good. I had previously thought it was due to missing days due to illness. However, it has happened when I've been on vacation or just too busy to ride. It also hit me after chasing my son on the beach.

I suspect the cause is muscle imbalance and IT band, quad tightness. I use a roller but only when the problem hits me. Rolling my quads and IT band is agony. Maybe bike position is an issue as well, although I've been professionally fit. I must stress that the pain is more like a switch has been flipped and acid is burning my quads, rather than muscle spasms. I've had many cramps and this is totally different.

I am starting a stretching program tonight and will use the dreaded roller. I would love to hear ideas, comments.

 

[waynepovey]

same thing, different day

Day 11 of this episode. Rode trainer, almost no resistance. 30 minutes in and burn started crawling down my right IT band area. I shut it down, avoiding the knifelike pain that comes with trying to continue.

I used foam roller last night for 40 minutes. I don't know what to do tonight. Ice, stretching, roller, rest, or some combination? I'm at my wits end. At 57, fitness floats away quickly and takes a long while to regain.

 

[waynepovey]

day 13

Indoor trainer for 23 mins and burn started, about two inches lower than previous ride. I felt fine until it started burning. One moment normal, the next my quad turning slowly to stone.

Rested leg after last ride. This time used the roller for an hour. Trying something different. Geez it's painful.

 

[oldcrank]

I'm amazed i have actually found riders having the same horrible experience. I have been battling it for years. I'm in the middle of an episode now, having to stop riding yesterday on the indoor trainer because i could feel the pain starting, once again. This time it arose after two days off the bike and while i was doing a project at home that required many trips up and down stairs. Three miles into my next ride my lower right quad began to burn and seize. I've learned you can't "ride through it" and soft pedaled it home. I made it home but as usual, felt like i'd been hit with a hammer. This time was a little unusual as the pain didn't begin on the lateral side (IT band ) area. Once an episode starts, i'm afraid to ride outdoors until I've had at least two trainer rides. It is usually about a week until I'm back to normal.

It has always struck me that it only occurs after a layoff of two or more days and when my fitness seems good. I had previously thought it was due to missing days due to illness. However, it has happened when I've been on vacation or just too busy to ride. It also hit me after chasing my son on the beach.

I suspect the cause is muscle imbalance and IT band, quad tightness. I use a roller but only when the problem hits me. Rolling my quads and IT band is agony. Maybe bike position is an issue as well, although I've been professionally fit. I must stress that the pain is more like a switch has been flipped and acid is burning my quads, rather than muscle spasms. I've had many cramps and this is totally different.

I am starting a stretching program tonight and will use the dreaded roller. I would love to hear ideas, comments.

What have you done to address the muscle imbalance?
I'm guessing that, in general terms, you are talking about
quad/ham imbalance...not left leg/right leg imbalance?

 

[waynepovey]

Thanks for the reply. I think the imbalance must be quad/hamstrings. I plead guilty to ignoring stretching and not making it to the gym since my wife delivered a third child. Time is something i have very little of. I haven't raced in two years but plan to return to it. But I've been riding a lot.

I'm guessing that the imbalance increases and my IT band tightens when I've been riding a lot. I have no clue however why a few days away from the bike preceeds the symptoms.

 

[oldcrank]

I think you could attempt to address the
muscle imbalance without going to the
gym...but start very slowly (I'm a
few years your senior ).

Just some simple standing/1 leg at a time
hamstring curls (just raisng a heel towards
your rear, as I'm sure you know) without
weight or resistance, but gradually adding
reps might make a difference.

 

[waynepovey]

I'm starting today, easy as you suggest. I'm blasting the IT band and quads with the roller though.

It's a gorgeous day for a ride, sunny, warm and best of all, no wind. Ugh.

Thanks for the post. I can't count how many times my teamates have told me to ride through it and suck it up.

 

[oldcrank]

Best of luck, my friend, I hope you are
back racing next year as planned.

 

[waynepovey]

After a successful 60 minute indoor ride yesterday, i rode outside today. MISTAKE. After 4 miles i pushed a little up a rise and the burn switched on in my right IT band area. I backed off and turned for home. By the time i got home, my left and right quads were screaming, just above the knee. My right leg is extremely sore.

Back to square one, again. Into the third week with this, a week longer than any previous episode.

 

[parfore]

I'm way late to this string and it appears that the interest has wained. Probably because it's depressing to talk about.

Anyway, like others have said, I'm just glad to learn I'm not alone. With that said this phenominon is so depressing every time it occurs I wish a MD or physiologist would join the forum and provide a definitive solution/answer for all of us. Not to mention, when I come home crying and crawling in the door my wife typically starts in, which is a hole other bummer.

In response to possible remedies, one thing I have found that can work is wrapping my legs very tightly. It doesn't always work but often does. When the pain begins to manifest itself as has been described throughout this thread, when my legs are wrapped very tight I can often make it through the initial pain signal that absent any wrapping typically becomes debilitating. I do this for 3, 4, 5 or 6 days and I can take the leg wraps off and I'm usually good to start punishing myself in earnest again absent the wraps.

Good luck to all and to all a good bike!

Best

 

[gloworm558]

Another sufferer here. Again, this is almost the only reference to this condition anywhere that I have been able to find. I too am at my wits end, after 16 years of suffering this intermittent pain in my quads and glutes.

I have had two biopsies and no end of tests at a muscle specialist hospital in London with no prognosis. The tests have revealed sky high creatine kinase levels during attacks. The episodes of pain last from a couple of days up to 17 days and I'm now into my 16th day of it, having gone for a ride yesterday thinking I was OK, only to have to be 'rescued' a couple of miles from home.

As others have noted, walking is also hard when it's bad, especially downhill (and steps). I have not been able to link episodes with diet and had my worst ever attack in February during a month off the grog, so I can probably rule out alcohol (though excess would no doubt not help!). My quads feel like a knife is being pushed into them during attacks, and then feel sore and incredibly 'tired' (tender) for 24 hours afterwards. I have no external signs at all (swelling etc).

The current attack began a week or so afer a 70 mile ride (long for me) and does seem to be linked to delayed onset pain after long rides.

Anyway, although thoroughly depressed by this, at long last I have found somewhere where others seem to have a similar issue. I only hope someone can come up with a suggestion.

I have been prescribed co-enzyme Q10 - said to assist muscle function (though I don't notice much improvement) and I drink cherry juice as I have read it is a good anti-oxidant. Other than that, I'm pretty much out of ideas.

The only other site I have seen reference to this problem is here: http://translate.google.com/translate?u=http%3A//www.feltet.dk/forum/read.php%3F22%2C233909&hl=en&langpair=auto|en&tbb=1&ie=UTF-8
It's a Danish site (translated) with some ideas that may help some. Some suggested excercises too. There are mentions of carbs too there which is interesting. The caviat is of course we may well all have different conditions which just happen to manifest themselves in a similar way, so always be cautious before trying any treatment.

 

[BMooreFit]

Hello from my vacation along the Amalfi Coast. I can't believe but, I'm currently experiencing this situation. I cycle in the U.S. anywhere from 3 to 5 times per week. I decided to take a vacation and not cycle. Fast forward five days into my vacation we decided to go hike uphill one hour to ruins. Everything was splendid until it was time to descend. The pain in the front upper region of my quads was unbearable. I couldn't decend the hill like a normal human. I actually found it easier to walk down backwards. Talk about embarrassing. Each day I've been healing more and more. Crazy to think rest is a key ingredient to this injury. Makes zero sense.

 

[BMooreFit]

I have noticed if I sit down on my ankles and lay backwards until my shoulders touch the ground the quads get the stretch they need. I will continue to do this stretch to see if this solves the issue.

 

[pheonix026]

I have had this no and off for the last 3 depressing years. I've spent a fortune on physios and had 2 MRI's. The pattern is always the same. A heavy block of training, hitting some form, a day off more than usual and then BAM, it strikes. I've tried all of the above and the only thing that seems to sort it is rest. I've given up finding a cause and just accept that 3 times or so a year I face 2 weeks off at a time.

My final port of call was going to be a visit to a rheumatologist but seems that people have already been there.

Maybe one day we will all find out.

 

[garywyatt]

I have also suffered with this for quite a few years and have seen a number of specialists to try and diagnose the issue, all to no avail. However, over time I think I have worked out the cause and while I don't know of a cure I can manage the issue. The symptoms are exactly as described: it only come on when I have been doing a lot of cycling and have rested for 3 days or more; the pain is always in my quads but it moves around them; it takes up to 2 weeks to clear up and when the pain comes in it is very severe and can make even walking difficult; it seems to be triggered especially when walking down stairs/down hill but it can be cycling gently or just walking on the flat; once I can exercise fairly hard the issue resolves itself until I next rest.

I think the issue is to do with excess glycogen build up in the muscles. This would be consistent with the causes and the "cure". I now try not to take a rest of more than 2 days and if I feel that the problem may be coming on I try and cycle hard for at least 30 mins which does resolve the problem. I have even done this with pain killers so I can cycle through the pain and again once I have been cycling a while the problem seems to go away. I can feel that my legs aren't right before I get a severe bout of pain so that helps me manage it.

I would love to know why it is so painful and what is the exact cause but I am happy that I can manage the problem particularly if I have a big event/race coming up. I am pretty sure my self diagnosis is not far from the mark but if any one knows how I could get this tested more thoroughly I would be very grateful.

 

[pasaglia]

I've had this for 10 years. Finally went to the ER after a particularly painful week. Spent 24 hours in the hospital on an IV. Sorry to say it is recurrent rhabdomyolysis. Could be dangerous if not properly managed - treatment being hydration.

The pain is caused by the muscle breaking down and releasing myoglobin. Myoglobin can cause renal failure. Hydration helps dilute the myoglobin and prevent injury, but does not mitigate the pain. The relevant test is for creatine kinase (CK) in blood and can be performed in the ER, though a rheumatologist is probably more appropriate. The test should be performed early on during your painful episode, otherwise your CK levels will drop and the test will be useless.

My symptoms have been identical to those described above. The pain and duration of episodes reflect the length and intensity of each workout. Like clockwork, the pain begins 2-3 days after cycling and is often triggered by walking down (though not up) stairs. If I keep cycling every day or so, I'm fine. My first and longest episode followed a 2500 mile trip and lasted one month, though it typically disappears in a day or so - less if I resume riding. My current episode began a week and a half ago. The location of the pain often varies, from my rear-end at times, to the outside, inside, front or rear of my thighs. It often terminates on the top of my calves. Keeping the leg outstretched and relaxed, and waiting, is the only way to relieve the pain. Stretching, NSAIDs, etc have no measurable effect. I've recently discovered (while on a very long and painful flight) that torquing the leg inward while resting also helps. I've had some luck with cross training. The more I jog, the less likely it seems I am to have an attack.

I'm 35, male, and ride about 70 miles/ week. I'll stop cycling this year. My busy travel schedule punctuates my riding too much and the pain is becoming both unbearable and a nuisance. I hope to ride again in the future if things slow down. But the key seems to be riding everyday, and right now I can't do that. This forum has been a godsend for the past several years. It's one of two I've found that actually discuss this, and it's good to know I have company. Best of luck to everyone!

 

[coldizoard]

Hi All
You are not alone. I found the following forums about exactly this story:
http://forum.tour-magazin.de/showthread.php?44615-Muskelentz%FCndung
http://www.bikeforums.net/commuting/632008-quad-pain-hiking-down-hill-could-related-commuting-too-much.html

Hi guys

I am from switzerland, ambitious rider doing about 10k km per year, 45 years old and dealing with the problem for a long time. It comes up after 2-3 rest days from cycling. I have searched the the net a lot about this issue: there are other people dealing with this problem.

so far the cause for this is unknown. but basically it results in extremely high CK values (up to 20000 - normal 100-200). This means the muscle is terribly inflamed and temporarely damaged. why it only happens after restdays is a mystery.
there are several theories discusses:
-DOMS
-genetic defect which results in faulty glycogen processing (Mc Ardle Disease)
-simple over training

different people believe that it is related to nutrition. Others encounter it only after strong workouts. Many person have been to many doctors without any results. The symptoms can be as strong that you collapse completely or need to be hospitalized. if the CK values get over 20K it can be dangerous. the symptoms seem to weaken after years of training.

what do the people to deal with it:
- DO NEVER STOP CYCLING -> people bought ergometers to cycle at home when the weather is bad.
- changing nutrition (this is a philosophy)
- adapt the cycling workouts -> do not train too hard

when it starts there are different methods for resetting:
- if you encounter it during cycling which might be the case already after 1 rest day -> NEVER use high gears, take the strong gears !!! Apply high pressure and pedal slowly and GO OVER the pain - ride for another 45 mins . the next day you are fine.
- other people do not ride anymore at all when it started. they say the risk is too high to damage the muscle resulting in dangerously high CK values. with this method you have to stop for 1-2 weeks because the symptoms peak after 5-6 days. the CK values then go down rapidly again from 1 day to the other- another mystery.

I still did not find any solution to the problem but riding every day. this is not always possible. i try the strong gears after 2-3 rest days; this can be sometimes extremely painful but it works. after years of cycling i get the problem only once or twice a year - but hiking is no longer possible to me which is a pain too ...

I would be happy to know one day what is the cause of this disease, but probably not during my lifetime. Anyway it is good to know that you are not alone.

Cheers
coldizoard