Extreme quadriceps starting pain after 3-4 rest days

[sidpanda]

I'm another sufferer of this bizarre condition. I’m 44 and I've probably had about a dozen episodes over the last 6 years since taking up cycling and each episode seems worse. Originally it was approx. 3-4 days of pain with 2 or 3 events each day. Last one was in August 2014, which was 7 days of agony with about 5/6 attacks each day. The other difference is the first attack of an episode would typically come about after about 10 minutes of walking, whereas the last time I was hit getting out of bed in the morning. My typical cycling pattern was 30k a day 5 days a week cycle commuter, with the occasional 40k Sunday ride. Consistent with others I can pretty much guarantee an episode if I take 4/5 days break, either for illness, snow or holiday. I'd tried various physios during the period to no success.

Again as with other posters the pain is always in quads, seems to start with a knife-like pain in a muscle which then radiates within that muscle. Intense pain lasts for approx. 30-45 minutes than then recedes, but that muscle then feels sensitive for a few hours afterwards. Meanwhile at an unspecified period the next attack will emerge, usually in the opposite leg but not necessarily mirroring the same quad. I had convinced myself until last time that the same muscle wouldn’t repeatedly hurt in any given episode, but that wasn’t the case last time. However, the specific spot on the muscle from which the pain started seemed different each time.

Once I’ve had an episode, if I don’t get back to regular riding I won’t get another one. I’ve had no episodes in the period since August 2014, but I’ve barely rode 100k in total since then.

On day 2 of that last event my GP ordered bloods and these picked up CK levels c.5-6000. Since then I've been referred through two hospitals and had the electrical tests referred to earlier in the thread, all drawn a blank.

I’m now with another consultant at a different hospital who is attempting a systematic diagnosis. He's secured new baseline CK tests, bloods and an MRI scan, and so the plan is to start cycling again. In a month or two I'll get another CK test whilst cycling regularly, then ahead of my next appointment I'll take 5-7 days off the bike, which will likely trigger an episode (can’t wait) which will allow him to observe the symptoms whilst it's happening. The blood tests are looking to rule out Muscular Dystrophies.

Will post updates with any more info.

Without a diagnosis there seems to be three options:
1. Don’t ride again
2. Never stop riding for more than 2 days
3. Deal with it when it happens.
I’d love a fourth.

coldizoard, I’m hopeful we will find an explanation in our lifetime! We all know the dangers of diagnosing over the internet but my son has an unrelated but ridiculously rare allergy (1:250000) which we managed to identify through internet searching, get referred to the only expert in the UK who quickly able to confirm with a simple blood test. It saved my son years of confusion and pain. Hopefully someone will crack this and share their insight.

 

[multiweb]

Re:

What is your hip flexibility like? If I say "do an ilio-psoas stretch" do you know what I mean? And if you do, what does it feel like? What about if you do the Cobra yoga position - do you feel that pulling down the front of your abdomen?

I'm not anything medical, but I have had similar problems in the past - feelings like a massive build up of lactic acid, walking stairs making things worse, major pain when biking even short distances, etc, etc ...

For me the problem was massive tightening in the hip flexor muscles. They get a real pounding on the bike - and mine also got a good workout with skate skiing and skating over the winter. Then just to help them shorten up, I have a job that involves me sitting at a desk all day. Sitting on a plane for any length of time is also a good one for sparking this off - combination of the seated position and inability to move much when you are seated.

Two occasions that really set this off for me related to really big increases in mileage. A couple of years ago I had been doing very little riding - probably 150-200km/week - and then decided to try to ride 100km a day during a two week long "Bike to Work" promotion. By about day 10 I was in major pain.

The other occasion was last year when we moved to our current house. Mileage increased a bit from what it was before, but intensity increased markedly (my commute is about 40km each way of hilly roads).

What has fixed me is a lot of stretching. I'm talking general lower body and back stretching. Of course specific hip flexor stretching comes into play as well - check out this: http://www.markmcgrath.com.au/2011/06/hip-flexor-opening/
If you're super tight, you'll need to build up to this - either by having your rear leg flat on the ground or holding onto it behind you (like your would for a standing quad stretch) or just having your knee a bit out from the wall/shin at less than vertical.

This makes a lot of sense. Like most of you I ended up here googling the issue. It happened on my ride yesterday arvo after a two day break. I had to stop after 3km and try to walk it out. It was so bad I was seriously thinking of going back. I stuck it up by keeping the cadence high on low resistance to keep the blood flowing. It moved up to different parts of my legs then disappeared. From there on, once warm, I could press on hard, no issues what so ever but 30min before I was a sight for sore eyes. Never happened to me before. I tried to figure out what I did wrong and it dawned on me that I had been very slack with my stretching routine and again I sit on a computer desk 24/7 so all the stuff that was said resonate with me. So I second the advice here. Make sure you stretch for a good half hour after your ride, while you're still warm and sweaty. It should alleviate the issues. Nothing sinister such as nerves or clots. Just really tight and shortening muscles over time.

 

[ScottyC1969]

I'm another one.... 17 years of it. Have had every test under the sun. MRI, Arteriogram. Massages, Chiropractors, X Rays. Have seen every doctor and health expert out there I've spent tens of thousands of dollars. Same symptoms. Usually after a hard bout of training and a rest of 2-3 days then bam. If I can get through the first 15 mins of the ride then I am away again but if not its 2-3 weeks off the bike. Walking downstairs is excruciating after 6 steps when its at its peak. Even walking on the flat can be a killer. I would love an Option 4 also. Keep posting though people. Its a relief to know I'm not alone or insane...

 

[ScottyC1969]

Find a hill that's about 1-3 km long. Not too steep. 4-7%. Stay out of the saddle.... Don't sit... and push a decent gear at roughly 70 rpm. You want your legs to start filling with lactate and your heart to be pumping a bit. Go at 80% -90% effort. Keep going as long as you can. You will probably feel the "cramping " trying to come on. If it's not a full blown attack you are suffering from you can hopefully ride through it and flush your legs out and get going. The key is to stay out of the saddle. Sounds like the opposite of what you want to do I know. Yes it may hurt a bit but hopefully not to the point you have to stop with that hideous knife like pain. The pain should hopefully subside. If you can then carry on riding for a good 90mins at least. Once you get this ride out of the way you should hopefully be back in the game.....until the next time. It's about the only thing that often works for me if an episode is starting before it spirals to a full blown attack where I need 2-3 weeks off. Just thought I would share. If it helps anyone get back on the bike from this shitty ailment then great.

 

[Shayne_G]

Same here...I have been cycling for years and am always struck with the same symptoms previously described after 2+ days of rest. Question: Does anyone here supplement with beta-alanine, creatine, and/or GPLC? I have been reading that supplementing with beta-alanine will decrease the amount of taurine in muscles which will lead to cramping. This is because beta-alanine and taurine use the same uptake system.

The whole rhabdo thing has me worried...I think I may get my CK levels checked to rule it out.

 

[dcolvin]

Created an account just to add a 'me too' to this list. I've got reasonable Google skills, but this is the only forum I've found that talks in any detail about this "disorder".

A lot of what already has been described is the same for me. When not travelling for work, I commute 4-5 times a week on my road bike, 32km each way, a 64km round trip. That's about 40 miles in old money. On average, I've covered 10,000km per year for the past 2 years. I've been physically fit pretty much all my life, and have always had strong legs - but never had anything like this before.

The same trigger points for me as others have mentioned, though it's never happened as I've been riding. The trigger day for me is Monday after 2 days rest Sat-Sun. I'll cycle to work, shower, and then as soon as I walk DOWN the stairs, one thigh, then almost immediately the other, will erupt in the most unbearable pain right in the middle of my quads. There's no cramp per se as the quad tissues are soft, but the pain is extreme and I'm barely able to walk. The core pain lasts for a minimum of 24 hours, but the episode takes at least 72 hours from start to end. I've tried: magnesium, potassium, multivits, overhyrdating, overprotein-ing (is that a thing?), squats, stretches, NSAIDS (both topical and oral), salting, starving, no booze, too much booze (!).

Nothing works. Muscle roller is semi-useful but isn't getting to the core of the pain.

This is unpredictable from an episodic perspective, sometimes I'll have 2 events a month, other times I'l go for a few months with nothing. I've had perhaps 12-14 episodes over the past few years.

Like others, I've also had blood tests, as I'd read about the potentially dangerous effects of rhabdomyolysis. My CK levels were 6-7x elevated above acceptable levels, however my reasonably well informed doctor said that raised CK levels are normal in athletes. She had no idea what could be causing the leg pain but suggested it could be a combination of factors including biochemical and muscular.

I'm reassured that there are others like you suffering the same thing, so I know I'm not dying (even though it feels like it when it's happening, I initially though I had a DVT!), but it's also sad to hear that so many of you are also suffering.

If anyone gets to the bottom of this, please do let this thread know.

Safe riding.
DC, London, UK.

 

[ScottyC1969]

Re:

Same here...I have been cycling for years and am always struck with the same symptoms previously described after 2+ days of rest. Question: Does anyone here supplement with beta-alanine, creatine, and/or GPLC? I have been reading that supplementing with beta-alanine will decrease the amount of taurine in muscles which will lead to cramping. This is because beta-alanine and taurine use the same uptake system.

The whole rhabdo thing has me worried...I think I may get my CK levels checked to rule it out.

Hi
It's not caused by any of those and it's not just normal cramping so don't stress. I would probably discontinue the creatine though. I've read it's not ideal if CK levels are already elevated. Ive used them all and the "issue" is the same with or without them.

 

[ScottyC1969]

Not saying we are all horses... but I'm sure whatever is going on is strongly linked to " tying up" in horses
Also called " Monday morning disease" amongst other things. A few links for people to read that you may find useful. A lot of similarities.

http://www.aaep.org/info/horse-health?publication=782

https://en.m.wikipedia.org/wiki/Equine_exertional_rhabdomyolysis

 

[Shayne_G]

Thanks for the vote of confidence, ScottyC. My urine has not been discolored and is always clear to a pale yellow, so I did not think it was rhabdo, just wanted to be sure. Sorry if that was TMI...

So it looks like there can be multiple causes of this idiopathic issue including:

1. Rhabdolysis (Rhabdo) - This doesn't sound like we all have this though as no one has said their urine was dark and, as ScottyC pointed out, it is normal for athletes to have elevated CK levels anyways.
2. Femoral nerve entrapment - Maybe? We do spend a ton of time in a hunched position and I know for sure that my iliopsoas can become tighter after a few days rest. Plus, I tend to sit more when I am resting which will further shorten the muscle. Has anyone tried stretching this with any signs of relief? I am also curious if the inguinal ligament has anything to do with this.
3. External iliac artery endofibrosis - Similar method of action to femoral nerve entrapment and this has been seen numerous times in professional cycling. This one seems like a maybe, especially because the majority of us seem to be riding >10 hours a week and have done so for many years.
4. Genetic defect in which muscles store excess glycogen during rest days. This has also been seen in horses. Has anyone modified their diet to limit their carb intake on their rest day to see if this makes any difference? Or had a muscle biopsy done to see their glycogen levels on a rest day?

What makes the most sense though? Not to try and pigeon hole everyone, but I want to start somewhere and attack this.

The "cures" seem to be few and far between with the only one I have seen being to never rest more than 1 day which seems to concur with everyone else's observations on this thread.

 

[ScottyC1969]

Re:

Thanks for the vote of confidence, ScottyC. My urine has not been discolored and is always clear to a pale yellow, so I did not think it was rhabdo, just wanted to be sure. Sorry if that was TMI...

So it looks like there can be multiple causes of this idiopathic issue including:

1. Rhabdolysis (Rhabdo) - This doesn't sound like we all have this though as no one has said their urine was dark and, as ScottyC pointed out, it is normal for athletes to have elevated CK levels anyways.
2. Femoral nerve entrapment - Maybe? We do spend a ton of time in a hunched position and I know for sure that my iliopsoas can become tighter after a few days rest. Plus, I tend to sit more when I am resting which will further shorten the muscle. Has anyone tried stretching this with any signs of relief? I am also curious if the inguinal ligament has anything to do with this.
3. External iliac artery endofibrosis - Similar method of action to femoral nerve entrapment and this has been seen numerous times in professional cycling. This one seems like a maybe, especially because the majority of us seem to be riding >10 hours a week and have done so for many years.
4. Genetic defect in which muscles store excess glycogen during rest days. This has also been seen in horses. Has anyone modified their diet to limit their carb intake on their rest day to see if this makes any difference? Or had a muscle biopsy done to see their glycogen levels on a rest day?

What makes the most sense though? Not to try and pigeon hole everyone, but I want to start somewhere and attack this.

The "cures" seem to be few and far between with the only one I have seen being to never rest more than 1 day which seems to concur with everyone else's observations on this thread.

I'm more inclined to think something along the lines of number 4.
Have had a full arteriogram in operating theatre and all arteries etc were perfect. Have also had extensive massage ( painful) and stretching on psoas with no joy.
It's a mystery alrite.

 

[Shayne_G]

I am going for a blood panel tomorrow morning and will fill everyone in with what it shows...

 

[ScottyC1969]

Re:

I am going for a blood panel tomorrow morning and will fill everyone in with what it shows...

How'd the bloods go Shayne. ?

 

[Shayne_G]

The blood came back with normal except for my liver function. The Bilirubin and AST levels were elevated which indicates Gilberts Syndrome. This is really nothing though and would not cause the cramping issue. My CK levels were elevated a bit too, but in the normal range for an athlete. The doctor is going to run some further tests on the liver and blood next week, but as of now no answer...

 

[Eltorovcb]

It hurts

 

[Irondan]

Re:

Hi guys, I've cycled for 7 years now after playing football at a good standard for 20 years and never suffering from this. I'm literally laid on the couch now in pain as I've been ill for 4 days, and just tried spinning the legs as have a cx race on Wednesday night and a TTT on Saturday, after 5 mins on the turbo the inevitable happened, severe pain in both quads to the point where had to stop, I had 3 days off 2 weeks previous and went on the turbo and caught it just in time, I haven't really done much cause of the weather so I think it's questionable that it's over training, I'm struggling to tense my muscles or stretch them cause you f the pain, it's so annoying as I was going really well and the season is just starting, I am dubious about wasting my money at a physio and going to the doctor I feel could be a waste of time going by what you guys have already tried?
This literally is the only forum I have ever found. HELP!!!!!

Hi! Welcome to the CN Forums.

I'm glad you found us and I'm sorry you are in such pain.

This thread has some wonderful information about other members previous and ongoing experiences with certain cycling related conditions. The people that post to this thread do so knowing that what they say may or may not be of help to others experiencing the same problems.

I say this because your comment has me concerned that your looking for medical advice on this subforum in lieu of seeking professional medical attention from a licensed practitioner. The information you read on this thread is not meant to be used as medical advice and is only to be used for informational purposes. Please see a physician if you need medical treatment.

Cheers!

 

[ScottyC1969]

Re:

The blood came back with normal except for my liver function. The Bilirubin and AST levels were elevated which indicates Gilberts Syndrome. This is really nothing though and would not cause the cramping issue. My CK levels were elevated a bit too, but in the normal range for an athlete. The doctor is going to run some further tests on the liver and blood next week, but as of now no answer...

Cheers Shayne,
Pretty standard for everyone here I guess. Blood tests all normal. Looks like Gilberts Syndrome is nothing to worry about either. Sounds like a minor condition which is good news for you. Keep us posted if your doc performs a miracle and finds anything. I have just come out of a 2 week bout of it and am back on the bike thank god. Took 4 days off after a week long tour so knew it would come on. Never pleasant... The enforced rest is probably a blessing so won't rest more than 2 days as usual from now on as that's the only way to manage it thus far. Keep hunting for the answer. It's out there somewhere.... Even if we find out it can't be cured it would be good to know what it is.

 

[ray j willings]

Re:

Hi guys, I've cycled for 7 years now after playing football at a good standard for 20 years and never suffering from this. I'm literally laid on the couch now in pain as I've been ill for 4 days, and just tried spinning the legs as have a cx race on Wednesday night and a TTT on Saturday, after 5 mins on the turbo the inevitable happened, severe pain in both quads to the point where had to stop, I had 3 days off 2 weeks previous and went on the turbo and caught it just in time, I haven't really done much cause of the weather so I think it's questionable that it's over training, I'm struggling to tense my muscles or stretch them cause you f the pain, it's so annoying as I was going really well and the season is just starting, I am dubious about wasting my money at a physio and going to the doctor I feel could be a waste of time going by what you guys have already tried?
This literally is the only forum I have ever found. HELP!!!!!

Symptoms
◾Pain when flexing, stretching, or using the thigh muscles to move.
◾Muscle spasms
◾Swelling
◾Bruising on the front of thigh if blood vessels are broken.
◾Loss of leg strength.
◾Crackling sensation when you push your fingers on the injured area.

Initial Treatment
◾Rest, and avoid activities that require lower leg strength and power.
◾Apply ice or cold packs for 15-20 minutes, three to four times a day for the first 48-72 hours.
◾Apply moist heat after the first 48-72 hours for 15-20 minutes, three to four times a day.
◾Use an elastic wrap or bandage around the area to minimize swelling.
◾Use a pillow or cushion to elevate the affected leg as much as possible during the day and while sleeping at night.
◾Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain.

Comeback Strategy

Mild quad strains usually heal within 10 days. Moderate strains take 10 days to six weeks, and severe strains require three months or longer for recovery. Your return should be based on the absence of symptoms and the presence of normal leg strength and range of motion, not a certain number of days, weeks, or months. Use these tips to make a comeback:
◾Go through each movement required in your sport without pain before resuming normal training and competition.
◾Use heat on the area before an exercise session.
◾If running is part of your comeback program, don't run at full speed.
◾If you're running, avoid sudden stops until there are no symptoms and you have regained full strength and range of motion.
◾Cross-train in sports that don’t place a heavy demand on the quadriceps (upper body strength training, easy lap swimming, soft tossing a baseball, hitting off a tee, etc.).
◾Apply ice packs for 15-20 minutes after working out

 

[Eltorovcb]

Muscle shortening, get a foam roller and iron them quads out

 

[Shayne_G]

Hi everyone,

I had another episode this Sunday while walking down the stairs in both quads. The pain was so severe that I thought I had compartment syndrome and went to the ER. ER doc cleared me for compartment syndrome, but my CK levels were >2500 and they admitted me for rhabdomyolysis. They tested me again yesterday and the CK levels were >6000. I am still here today (Tuesday) and basically just getting a ton of IV fluid pushed into me. Fortunately, I have no accompanying liver or kidney issues (and I never have with any previous episodes), but now at least I know what the deal is. I think this may have been precipitated by a viral infection on Wednesday, but no body at the hospital has been able to give me any answers or point me in a direction yet. Still more questions than answers unfortunately...

 

[globecanvas]

I also just joined the forum in order to participate in this thread. I have experienced these episodes twice, most recently yesterday. It is spooky how exactly my experience matches the stories in the thread. Right down to wondering if I was experiencing DVT.

I race bicycles and train consistently. I very rarely take more than 2 days off the bike. I raced 2 weekends ago and felt great, then left the next day for a week's vacation with the family. Off the bike and minimal exercise all week. Mid-vacation, during an easy hike, experienced a lot of pain when walking downhill, had to hobble about a mile walking backwards. Felt OK for the rest of the week, snorkeled etc, no pain.

Long travel day Sunday, 12 hours of sitting. Monday went out for a ride and 10 minutes into warming up was hit with debilitating pain in both quads. Pain was sharpest on the upstroke. It took me an hour to pedal 2 miles back home. I felt as if somebody had beaten my legs with a stick, nearly throwing up levels of pain, couldn't think straight.

The affected muscles were different on the left and right. No muscle knotting, no visible signs of trauma, but the affected muscles were very sore to the touch.

I am particularly interested in the "muscles storing excess glycogen on rest days" theory (aka Monday Morning disease in horses). I will try a lower-carb diet on rest days. I will also try the suggestion to work through it with low-cadence, high torque pedaling.

It's a real catch-22 that the trigger is taking a number of rest days, because it feels risky to try to come back from the episode by not resting.

 

[ScottyC1969]

Re:

Hi everyone,

I had another episode this Sunday while walking down the stairs in both quads. The pain was so severe that I thought I had compartment syndrome and went to the ER. ER doc cleared me for compartment syndrome, but my CK levels were >2500 and they admitted me for rhabdomyolysis. They tested me again yesterday and the CK levels were >6000. I am still here today (Tuesday) and basically just getting a ton of IV fluid pushed into me. Fortunately, I have no accompanying liver or kidney issues (and I never have with any previous episodes), but now at least I know what the deal is. I think this may have been precipitated by a viral infection on Wednesday, but no body at the hospital has been able to give me any answers or point me in a direction yet. Still more questions than answers unfortunately...

Hi Shayne
Hope all is ok and I'm sure it will be. Bet you're loving that hospital food... Did the episode come on after hard training or had you been resting for a few days? Weird how they diagnose rhabdo but then can't tell you much more. Hang in there mate.

 

[globecanvas]

I had the quad pain episode Monday as described 2 posts up. This morning I went to a sports PT who thought it was a classic overuse injury. I disagree with this diagnosis. The level of pain, the unfocused nature of it (different specific muscles in each quad), the unusual triggers (spinning easy after a rest week), it just doesn't make sense. I am a well trained athlete but I am not overtrained.

I tried riding again today, pushing a little harder from the beginning as somebody up-thread suggested, but I didn't make it 5 minutes from my house. I had to walk home. There was no question of pushing through the pain, when I got home I was afraid that bending my leg would rip the quad in half. I can understand how some sufferers have gone to the ER for fear of compartment syndrome or some other emergency. I can move around now but my legs feel sore and bruised, as if they were beaten with a pipe.

I feel that I can rule out a localized physical cause such as muscle pull, trapped nerve, etc. The pain is on both sides, and the specific affected muscles were different today than they were Monday.

I don't see any alternative now except to take yet more time off the bike. This is very disappointing to me as the racing season has just begun and this is usually my best time of the year.

 

[ScottyC1969]

Re:

I had the quad pain episode Monday as described 2 posts up. This morning I went to a sports PT who thought it was a classic overuse injury. I disagree with this diagnosis. The level of pain, the unfocused nature of it (different specific muscles in each quad), the unusual triggers (spinning easy after a rest week), it just doesn't make sense. I am a well trained athlete but I am not overtrained.

I tried riding again today, pushing a little harder from the beginning as somebody up-thread suggested, but I didn't make it 5 minutes from my house. I had to walk home. There was no question of pushing through the pain, when I got home I was afraid that bending my leg would rip the quad in half. I can understand how some sufferers have gone to the ER for fear of compartment syndrome or some other emergency. I can move around now but my legs feel sore and bruised, as if they were beaten with a pipe.

I feel that I can rule out a localized physical cause such as muscle pull, trapped nerve, etc. The pain is on both sides, and the specific affected muscles were different today than they were Monday.

I don't see any alternative now except to take yet more time off the bike. This is very disappointing to me as the racing season has just begun and this is usually my best time of the year.

You're not alone and the episode you just described right down to walking home is not unfamiliar. Once it gets that bad I know from years of this that rest is the only cure. Then depending on how you feel trying some very light spinning on the indoor trainer. As the days pass you can hopefully go longer and increase the intensity. The foam roller 2-3 times a day can be helpful in the recovery/rest process too. Just thought I would share so you know there are others who know exactly how frustrating this can be. Hang in there. It will come right. Once it does don't stop riding...

 

[dcolvin]

Following my earlier post...

I could feel an 'attack' of this coming on the other day as I walked down stairs following my morning commute (usual 2 day rest syndrome!). I immediately stopped, went back upstairs to my desk, and took 800mg Ibuprofen (which is double the stated retail dosage but still within acceptable clinical guidelines). This was something my GP said to try next time I could feel it happening. I sat at my desk for about 45 minutes to give the drugs time to act and, surprisingly, this completely aborted the episode.

Why I think this matters is that I think I can discount the 'sitting for 45 minutes' as being the aborting factor, as I've tried immediate rest so many times in the past with no success. The key difference here was the large dosage of NSAIDs before the event really took hold.

Whilst the plural of anecdote isn't data, this was the first and only time I've managed to effectively stop this happening. If you are tolerant of ibuprofen, then it might be worth giving this a shot as soon as you feel the tension in your quads rising. I'm unsure how effective this will be once the attack as fully started.

 

[Drewza101]

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!!