Extreme quadriceps starting pain after 3-4 rest days

[Shayne_G]

Drewza, perfect explanation! This is the theory I am currently going with as well. I have been doing some research on McArdle disease and Tarui's disease which seem to align with the symptoms described by everyone.

I like your prevention and treatment especially. I will do 3-4 rides/day when I have a flare that may last only 20-30 minutes before I cramp initially, but like you said over the course of a few days the rides will gradually get longer and the intensity will increase as the excess glycogen burns off and levels normalize.

So, you have been able to relegate the symptoms entirely with carbohydrate modification during your rest days? If so, do we all just change our diets to low carb/high fat and see what happens? There have been some recent studies done on the ketogenic diet that seem promising.

I am going to see a nephrologist this Wednesday and will be requesting a muscle biopsy (to see the level of glycogen in them) as well as a genetic test to see if I have any mutations that would signify CPT II deficiency, McArdle disease, or Tarui's disease. I will let everyone know when I get the results back.

-Shayne

 

[globecanvas]

I'm 10 days into the current episode. It's ongoing and deeply frustrating. Yesterday I felt much improved; this morning the pain exploded in a brand new quad muscle while I was walking to the car. It's infuriating how the particular muscle being affected seems to change from day to day. 2 weeks ago I was racing, now I can't even walk to the car.

Drewza101, thanks for the summary. I have been limiting carb intake but I will try more extreme limitation. I will also try short, easy exercise sessions, though my last 2 rides have lasted less than 5 minutes.

Once I'm through this episode I will never, ever take more than 2 days off in a row. I just hope I can actually get through it.

 

[Drewza101]

Shane G
I have managed to completely eliminate symptoms - from being unable to do more than 15 min up until Thursday night, I have managed to do 10 hours of pretty easy riding in the last 3 days. Whether this is attributable to going off carbs and sugar altogether (which I did on Tuesday) or to the body starting to regulate enzyme levels isn't clear, but all I cam say is that I've gone from having serious pain to all systems go in a short space of time

In terms of whether a LCHF diet makes sense permanently, I'm not an expert but don't believe that a low carb diet makes sense for endurance athletes. My view is that a balanced diet makes more sense - and the theory is not that the body can't deal with carbs, it's that it cannot regulate glycogen storage in rest. I typically do 15,000 to 20,000km per year and happily eat carbs (focused on more complex carbs like sweet potatoe, butternut etc as opposed to sugars or quick carbs) and don't have any issues until I go into inactive rest.

Globecanvas - good luck, I know how frustrating it is. Maybe give what I've described a bash.

 

[globecanvas]

17 days ago: Raced, felt great.

16 days ago: Started a week long vacation.

14 days ago: Hiking easy on vacation with the family, moderate to severe quad pain walking downhill. Had to walk about a mile down a steep rocky slope backwards. I was dehydrated at the time (in the tropics, didn't quite bring enough water). Assumed it was cramps and didn't think too much of it.

13 and 12 days ago: 15 minute uphill run each day, tempo pace. Some quad discomfort but assumed it was residual from the cramp episode.

9 days ago: Long travel day returning home.

8 days ago: First time on the bike since the race (9 days earlier). 5 minutes in spinning easy, severe/maximum quad pain. Stopped, stretched out, pressed on, became practically incapacitated. Took an hour to pedal about a mile back home.

6 days ago: Tried riding again, this time starting with a climb and pushing a bit, following a recommendation from this thread. Disaster. Lasted less than 5 minutes, practically incapacitated, had to walk home.

3 days ago: While walking about 30 feet downhill in my yard, another pain episode but only in one particular muscle in one leg. Pain lasted about 4 hours. Starting that day, cut out carbs completely following another recommendation in this thread.

1 day ago: Took advil and tried pedaling on the trainer. Moderate pain for first 5 minutes, and a lot of anxiety trying to guess if this was just residual soreness or another severe pain episode about to spiral out of control. Legs settled down after that. Pedaled for 45 minutes including 20 minutes of low tempo. Felt weak but OK, could have gone longer/harder but decided to quit while I was ahead.

Today: No advil, 45 minutes on the trainer, 20 minutes of high tempo, felt weak but just about normal. Still a bit of residual soreness in the legs but totally manageable.


All together, it's been 14 days from the first pain episode. I'm feeling quite optimistic now, a bit out of shape but no longer broken. I have no idea if cutting out carbs is correlated with finally getting through this, but I'll assume it is, and in the future I plan to cut carbs any time I need to take more than a day off the bike. I am pretty sure cutting out carbs is contributing to feeling weak on the bike, but that's to be expected.

I missed 2 races because of this problem and will probably skip one this weekend that I had been targeting, but if that's the only damage to my season from this experience, I'll count myself lucky.

Drewza101, thanks again for your summary and recommendations.

 

[globecanvas]

One last post on this for now. The first pain episode was 4 weeks ago today, the worst of it was 3 weeks ago. I was off the bike completely for 2.5 weeks, and have been back to normal training for 2 weeks. I raced last night and it went fine, it was as if the pain episodes and layoff had never occurred. I'm back on a normal diet as well.

Hopefully I can prevent a recurrence by light exercise on rest days and diet management when the training workload decreases.

 

[Shayne_G]

Hey everyone,

I am currently experiencing yet another episode which, of course, means more scouring the internet for ideas and solutions! I came across this thread which aligns up with what we are all experiencing: http://www.bikeforums.net/commuting/632008-quad-pain-hiking-down-hill-could-related-commuting-too-much.html

It is more of the same with people trying things and not seeing results, but I figured I would share in case someone else sees something I missed.

I am going to see another specialist on Wednesday and will fill everyone else in again as to what her theories are.

Still scratching my head...

-Shayne

 

[globecanvas]

Sorry to hear it, Shayne. I hope the specialist can offer some guidance.

 

[budegan]

I think I can say I'm in this brotherhood too. Bloody odd eh? I won't go through all the symptoms and circumstances but suffice to say they include most or all of those stated earlier.

During the first flair up a couple of months back I saw a physio who diagnosed a muscle strain which never made sense to me as I'd not been exercising - I'd infact had 3 days off after a very hard training period then had a long-haul flight and it appeared whilst walking following that; once DVT was ruled out via a blood test I ended up with said physio.

Now it's back.

I'm wondering what the best bet is - total rest and then easing in after X many days? Or giving it a go again as soon as pain subsides?

 

[globecanvas]

Re:

I'm wondering what the best bet is - total rest and then easing in after X many days? Or giving it a go again as soon as pain subsides?

I can only speak from the experience of my two episodes.

The first episode was after a 2-day layoff. I got on the bike the next day and although I could feel that the pain wanted to come back on, it never quite set in and I ended up doing a regular 2x20 workout with no trouble. In hindsight I think I dodged a bullet in recovering so quickly.

The second episode was after a 9-day layoff. During the episode I made the bad mistake of trying hard to pedal through the pain and it was just a prolonged disaster. I tried to ride again 2 days later and did not last even a minute. I then took 4 more days completely off the bike, and eased back in to riding starting on the 7th day after the episode, ramping back up to where I could do a normal-ish workout a week after that. I did cut carbs completely for about a week while trying to recover; I have no idea if that contributed to recovery at all, but it was suggested by a friend who is a vet who treats horses suffering from recurrent rhabdomyolysis,

So in my experience, the recovery time varies with how long the layoff was prior to the episode, and possibly with the severity of the episode. I know that if I experience this again I will be very, very careful about not trying to pedal through any pain as I come back from it, because I think that was really damaging, not just physically but mentally. Overall I lost 3 weeks of fitness that it took me literally months to claw back.

My major takeaway from the experience was never, ever take more than one day off of the bike. I know that's just not always going to be practical though.

 

[budegan]

Re: Re:

My major takeaway from the experience was never, ever take more than one day off of the bike. I know that's just not always going to be practical though.

Thanks for all that. What do you think would be the minimum duration ride to keep ticking over?

 

[globecanvas]

Personally, on "off days" I try to get on the bike for a minimum of 20 minutes. Even if it's just ridiculously easy spinning, getting on the bike seems to keep the wolves at bay. Last weekend I was at my college reunion and despite a two-day hangover forced myself to go into the college gym and ride the stationary bike for a half hour easy.

 

[budegan]

Re:

Personally, on "off days" I try to get on the bike for a minimum of 20 minutes. Even if it's just ridiculously easy spinning, getting on the bike seems to keep the wolves at bay. Last weekend I was at my college reunion and despite a two-day hangover forced myself to go into the college gym and ride the stationary bike for a half hour easy.

Thanks pal. Feels back to normal today. Undecided whether to try a little on the bike today.

First hit with it last Sun, rested till yesterday (Thur), went out for a potter and approx 30 mins in it returned

Maybe should have increased duration more gradually???

 

[globecanvas]

When I've tried to come back too soon, the pain sets in almost immediately, like I didn't even get 500 meters down the road and had to walk home. But I don't think it could possibly be bad advice to try to ease back in gradually. Maybe try a 10 minute ride just to turn the legs over a bit, go longer the next day, etc? I think the biggest risk is trying to push through the pain, but it doesn't sound like you're trying to do that at all.

Good luck with it. I know it's not much consolation, but all the rest of us who have experienced this know how frustrating it is.

 

[Shayne_G]

Re:

I'm wondering what the best bet is - total rest and then easing in after X many days? Or giving it a go again as soon as pain subsides?

I have not been able to figure out the best course of action over the past 4 years of having this, except for resting until I can descend the stairs without spasming. Once I can accomplish this, I can usually begin cycling again without issues. However, sometimes it takes 3+ weeks to be able to do this. I have adopted using crutches to descend the stairs when I am going through an episode which helps a lot.

I know massage and other active release techniques makes me feel worse and can sometimes bring on a spasm, so I would advise against these. I also have had varying success with static stretching; sometimes it is great, sometimes it causes a spasm. Also, try to keep warm; if I become cold this can also set off a spasm.

My new doctor has ordered me an EMG as well as metabolic tests. I will update the forum if these show anything.

 

[jsk]

I know massage and other active release techniques makes me feel worse and can sometimes bring on a spasm, so I would advise against these.

Oh man, tell me about it. The very first time I got this, I tried foam rolling after the initial attack/episode. HUGE mistake, it triggered an episode that was excruciating.

 

[Shayne_G]

Another interesting article here that speaks about McArdles disease: http://quest.mda.org/article/mcardles-disease-diagnosis

Has anyone here experienced the second-wind phenomenon?

 

[budegan]

Re:

Another interesting article here that speaks about McArdles disease: http://quest.mda.org/article/mcardles-disease-diagnosis

Has anyone here experienced the second-wind phenomenon?

Have you been getting the brown urine thing? Sounds to me that most sufferer's reports on here don't include that.

I have wondered if there's a trend on here that most people who've experienced this appear to be over 40, though that could be as much to do with the MAMIL phenomena of which I too am part of.

BTW for those interested my rehab seems to be going okay: 3 rides in 3 days, 20 mins, then 30, today 45. All on turbo at zone 1 / very low zone 2, around 90 rpm. Happy to report no cramps. Am thinking of hopefully being able to up it to an hour tomorrow and thereafter start adding some efforts in. All will be on turbo though - I'm terrified of going out and then not being able to find a taxi home (I'm overseas at the moment)!

 

[globecanvas]

Re:

Another interesting article here that speaks about McArdles disease: http://quest.mda.org/article/mcardles-disease-diagnosis

Has anyone here experienced the second-wind phenomenon?

Very little of that article rings familiar with me. Not the second wind, not the inability to run the bases, not the discolored urine (which is a sign of full blown rhabdo). There's no mention there of trained athletes or the link with longer-than-usual rest, which seem to be common themes here.

I think it's likely that the underlying cause is a genetic disorder that is perhaps in the same general category as McArdle's disease, but McArdle's disease itself does not sound like a smoking gun to me.

 

[Shayne_G]

budegan - Did you do the whole no carb thing? You got back on it very quickly! I am 30 years old and have been dealing with this since ~25.

I would agree that McArdles isn't it, but I think it's along the same guidelines...

 

[Shayne_G]

Has anyone tried trigger point injections or dry needling?

 

[TOHolm]

Hi everyone
First off, pardon my English.

I felt I had to contribute to this discussion because I've had this for years (all the symptoms described above) and I have found a solution that works for me. After hard training on my bike (10+ hours a week including intervals and long distance) I never abruptly cut off riding. I gradually go shorter time/distance each day before a break (travel or vacation etc). I never take a day off the bike unless I have to. I spin at least 20 minutes without resistance on my balance-rollers. When I travel, I always stay at hotels with a gym.

If I get an "attack", this is how I cope with it: I take double dose of painkillers (double the recommended dose), wait for 20 minutes (kick-in time) and do 30 fast squats (all the way down) x 4 (short break in between). I have found that I need to do this immediately after the symptoms occur. Yeah, I know, a few people will give you a look when you do this in the movie-theater restroom, but it must be done. Then I get on my bike as soon as possible and do a one hour hard ride (90-100% of FTP, or around 85-90% of HRmax). This does the trick for me. Hope it can help some of you.

 

[budegan]

Re:

budegan - Did you do the whole no carb thing? You got back on it very quickly! I am 30 years old and have been dealing with this since ~25.

I would agree that McArdles isn't it, but I think it's along the same guidelines...

Hey Shayne. I didn't try the no carb thing, but as explanation what might appear to be a quick recovery I should explain that in my case on this occasion it first appeared a few days before I posted on here. I rested fully for a few days then went out for a ride around the town I'm staying to test the water. It was probably 30 mins into this that I felt it tightening / cramping / spasming again. I immediately stopped and waited till a taxi came past (I'm on a European holiday island so it didn't take long) and that afternoon found this thread and posted for the first time. The next day I woke up and it felt fine so I tried 20 easy mins, and then onwards.

Today I made 75 mins with 5 x approx 8 min zone 2 efforts - still gradually upping the time and intensity. No spasms. Hopefully tomorrow I can do 90 mins with the same but zone 3 efforts. If that goes well then I'm going to brave it and try the next ride on the road.

I'm curious as to whether this has only occurred to people after a few days completely off the bike following a period of heavy training. It's not likely to hit me out of nowhere is it? Eg unassociated with rest?

 

[CheckMyPecs]

No carbs is bad for you. Your metabolism needs carbs.

 

[globecanvas]

Re: Re:

I'm curious as to whether this has only occurred to people after a few days completely off the bike following a period of heavy training. It's not likely to hit me out of nowhere is it? Eg unassociated with rest?

For me the episodes are 100% correlated with taking multiple days completely off the bike following a training period.

 

[CheckMyPecs]

And not eating enough carbs.