Extreme quadriceps starting pain after 3-4 rest days

[budegan]

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.

I'd say I'm in the same boat I think.

I did 2.5 hours on the road today; all good, and the issue seems to have gone for now.

 

[CheckMyPecs]

Beans are a good source of healthy carbs.

 

[jsk]

Well I had my last episode of this back in April. Once recovered I got back to training, and have been steadily building fitness since then. I'm back up to 10-12/hour weeks with a fair amount of intensity including VO2Max training. At this point I'm back pretty close to peak fitness and have been feeling good. The only problem is that I now need to ease up to taper for my 'A' race of the season - state time trial next weekend.

Normally I would cut back volume pretty significantly while still keeping some high-intensity stuff in there, but I'm a little worried that even without taking several days off, trying to taper could be enough to trigger an episode. I'm hoping that if I do at least some easy recovery-type spinning on the days that I would normally rest and be careful with my diet that I'll be able to bring my TSB up without bringing on an episode. My worst fear is getting on the bike for warmup before the TT and having the cramps start.

The thing I find really odd about this condition is that aside from a few threads on cycling forums, nobody seems to know anything about it including medical professionals and sports scientists. Given that "tying up" is a well-known phenomenon in horses you would think some of these professionals would have made the connection. After all there are lots of article about it relating to horses (here's one of the better ones I found), yet none about it happening in humans.

 

[CheckMyPecs]

Have you raised the issue of "tying up" with your doctor?

 

[globecanvas]

Normally I would cut back volume pretty significantly while still keeping some high-intensity stuff in there, but I'm a little worried that even without taking several days off, trying to taper could be enough to trigger an episode. I'm hoping that if I do at least some easy recovery-type spinning on the days that I would normally rest and be careful with my diet that I'll be able to bring my TSB up without bringing on an episode.

Hey, don't I know you from another forum?

I don't think you need to worry. A strong common thread through all the reports is that episodes follow a period of time completely off the bike.

 

[budegan]

Normally I would cut back volume pretty significantly while still keeping some high-intensity stuff in there, but I'm a little worried that even without taking several days off, trying to taper could be enough to trigger an episode. I'm hoping that if I do at least some easy recovery-type spinning on the days that I would normally rest and be careful with my diet that I'll be able to bring my TSB up without bringing on an episode.

Hey, don't I know you from another forum?

I don't think you need to worry. A strong common thread through all the reports is that episodes follow a period of time completely off the bike.

Agree, it looks like the key is to keep the legs ticking over with recovery rides and by not having more than a couple of days completely off.

Best of luck with your event. Do report how it goes.

 

[dcolvin]

I posted this earlier in the thread. I too suffer from this phenomenon, same triggering method as previous posters.

I can abort the event from happening by taking 800mg of ibuprofen as soon as it starts. Further, once aborted, I can cycle later in the day with no issues. 800mg is higher than the stated dose on retail packets of this NSAID, but is within clinical guidelines for this medicine. Although this works well for me with no side effects, I am not a doctor, so please speak to a medical professional before trying this.

Since the start of this year I've cycled over 5000km and have managed to abort this event using this method on 3 occasions.

 

[budegan]

Oh my God, this is the most irritating thing.

Since my most recent episode I have been so careful not to take time off the bike. I've definitely not had more than a day completely off in almost a couple of months.

But this week due to a combination of a exceptional workload and a stomach bug I didn't ride yesterday.

I jumped on the turbo tonight to ensure I didn't go reach 48 hours without riding and ..... it's happening.

So frustrating, I want to scream. Right in the middle of the season, brought on by less than 36 hours off the bike.

ARGH.

 

[globecanvas]

Did you try the double-dose of advil as suggested by dcolvin?

 

[budegan]

Re:

Did you try the double-dose of advil as suggested by dcolvin?

Unfortunately not mate, I'm not tolerant to ibuprofen

I made a 20 min spin on turbo tonight before I felt it creeping on so I immediately stopped.

Hoping that because I only had 36 bloody hours off it means that it won't be long until it goes away again.

So demoralising though - I have a TT tomorrow I was bang up for.

Appreciate that all this has been discussed to death on this thread but am using it as an outlet to moan as my missus isn't being all that sympathetic! I think she thinks I have invented all this as an excuse so I get away with daily riding!

 

[jsk]

Guess I kind of lost track of this thread and forgot to report back, wish there was a subscribe option. Anyways, the TT went fine, came home with two state champ jerseys. The reason I was worried about it happening after a taper without multiple days off is because that's how my last espisode started: a reduction in volume (but not total rest), along with too much sugar/carbs (I think) triggered the initial episode when I started to ride. Then I stopped riding because of the initial cramping on the bike and they just got much worse. So for me, it seems like cutting back training volume without reigning in carb intake is enough the trigger the less severe version of the condition.

It happened again this week, although I was able to work through it (I think - we'll see how tomorrow goes). Last weekend was a stage race, but I ended up not being able to ride the final stage on Sunday due to a mechanical. So no riding Sunday, then a ride on Monday, and no riding on Tuesday (lifted weights instead). Diet also got a bit off track Sun & Tues, which certainly didn't help. On Weds I did about 70 mins of low-z2 spinning and was fine. But today about 10 minutes into my ride, I could feel an episode starting in the left leg. I backed off to super easy pace and tried to keep riding, along with a couple stops to get off and get down into an ATG squat to stretch things out. It never quite got bad enough to force me to completely stop, and after another 20 minutes or so the cramps faded away. I was able to resume normal training and even do some threshold intervals with no ill effects. I'm hoping that in this case I was able to stop the episode before it fully started, although the fact that it was only one leg today has me wondering if tomorrow the same thing will happen with the other leg. But as long as it doesn't get any worse I feel like I dodged a bullet this time.

budegan, my advice to you is to get back on the bike and try to ride through it. Rest is the worst thing you can do right now. When I did that back in march it turned into a full-blown episode that was so bad I couldn't get back on the bike for almost two weeks. Just take it really easy and try to gradually warm up until you feel like you can build some intensity without causing the legs to completely seize up.

 

[budegan]

Hey JSK,

Massive congrats on your results - that's brilliant work.

I'm leaning more towards the carb influence than I previously was. During the day and a half off which caused this episode I went OTT beyond imagination with the sugary carbs. Bloody stupid in every way I know. I'm pretty certain I won't be making that mistake again.

Finding it impossible to ride through it mate. Every day or two since it started I have had a go on the bike - extremely easy recovery zone (if you can even call it that at less than 100bpm), but every time it has hit me after between 20 - 30 minutes. When it arrives there's no way I can push through as unless I stop immediately the "cramp" just increases until it's simply unbearable to the point of leaving me fearing permanent damage!

I think the previous episode lasted around 10 days so I'm hoping in a day or 2 it will go as it did last time. I'm now really restricting carbs in the hope that helps as it seemed to do for other posters here. I'm just in fear that it will never pass, and even if it does I despise the way it ruins my season

PS There is a way of subscribing to threads btw

 

[globecanvas]

Re:

Finding it impossible to ride through it mate. Every day or two since it started I have had a go on the bike - extremely easy recovery zone (if you can even call it that at less than 100bpm), but every time it has hit me after between 20 - 30 minutes. When it arrives there's no way I can push through as unless I stop immediately the "cramp" just increases until it's simply unbearable to the point of leaving me fearing permanent damage!

Exactly matches my experience. To me it feels like there's some sort of tipping point, below which you can sort of pedal through the minor cramping (more like hints of impending cramping), but once the pain sets in in earnest, even just spinning easy feels like a genuine risk of rhabdo type muscle damage. Just excruciating, unbearable pain.

 

[jsk]

Re:

I'm leaning more towards the carb influence than I previously was. During the day and a half off which caused this episode I went OTT beyond imagination with the sugary carbs. Bloody stupid in every way I know. I'm pretty certain I won't be making that mistake again.

Yeah, it's definitely given me some extra incentive to be more careful about the sugary carbs in my diet. It seems like for me the occasional indulgence is OK if I'm riding every day, but the combination of cutting back training volume and eating too extra junk carries too high a price.

Finding it impossible to ride through it mate. Every day or two since it started I have had a go on the bike - extremely easy recovery zone (if you can even call it that at less than 100bpm), but every time it has hit me after between 20 - 30 minutes. When it arrives there's no way I can push through as unless I stop immediately the "cramp" just increases until it's simply unbearable to the point of leaving me fearing permanent damage!

Sorry to hear that. It seems that for me, sometimes it's possible to work through the initial occurrence and avoid the longer, more severe version; other times the initial occurrence is bad enough that you can't really work through it.

 

[jsk]

Re: Re:

Exactly matches my experience. To me it feels like there's some sort of tipping point, below which you can sort of pedal through the minor cramping (more like hints of impending cramping), but once the pain sets in in earnest, even just spinning easy feels like a genuine risk of rhabdo type muscle damage. Just excruciating, unbearable pain.

Yeah some times are much worse than others. So far I've had two of the really bad episodes that last 10-12 days, where I didn't even have to get on the bike for it to start; it would happen first thing in the morning or even while still laying in bed. Other times it was less severe and could be worked through in 2-3 days of really easy spinning. This last time it was just a "hint" as you say and once I got through that I was OK, no recurrences in following days. I think it has to do with how much of a drop-off there was in training versus how much excess sugar/carbs are consumed. But for me I now know that even a light week without multiple consecutive days of total rest can still be problematic if I'm not careful with my diet.

I also think that hitting peak fitness and doing lots of really high-intensity stuff sets me up for an episode. Last weekend I did a stage race that started with a 2.6 mi prologue TT that I hit a power PR on, followed by the hardest crit I've ever done (NP for the 40 minute race was about 50W over my threshold). I don't think those efforts themselves actually caused any damage (if that were the case I would expect the episode to happen much sooner like in traditional rhabdo cases). It's just that efforts like that seem to prime the system in a way that can cause glycogen storage to go into overload in the following weeks if I'm not careful. At least, that's my current working theory. The fact that I was able to stop this most recent occurrence before it really got started gives me hope that I can manage this going forward and hopefully avoid the more severe version.

 

[lewling]

Hi guys
I have been reading through the posts and am also a sufferer of this strange “phenomenon” and thought I would also share a bit of my story. My most major attack occurred about 10 years ago and I ended up in a German hospital for 2 weeks. I just got into bike riding and had been riding mostly on weekends about 100km or so for about 10 weeks. Suddenly (I guess after not riding for a week or so) I started to get excruciating pain in my quadriceps after walking a distance of 50m (or going up/down stairs) so bad that I had to stop walking. I was crying with pain and didn’t know what was wrong with me. I ended up seeing the doctor at work one day – I could hardly walk there, then I went to my house doctor, who sent me to a sports doctor who sent me to a neurologist who sent me to the hospital emergency department. At the emergency department they measured an extremely high CK level such that they immediately admitted me to neurology and put me on a drip to get the CK level down and protect the liver. For the next two weeks the German doctors did lots of tests including taking daily blood samples. They did a quadriceps muscle biopsy, heart ultrasound (they were concerned that the high CK level could indicate heart muscle damage – the heart turned out fine), Computer tomography scan of the quads, MRI scan of the quads, lumbar puncture (and testing of spinal fluid), X-Ray of Lungs and Eye examination (to rule out sarcoidosis). After all these tests and 2 weeks in the hospital the CK levels went back to normal and the pain resided and I went home with the doctors unable to explain the cause. They wrote unexplained rhabdomyolysis on the final report.

I had another major attack I guess about of 5 years ago after a 3 day mammoth drive to Spain on holiday. Previously I had been jogging every day. When we arrived at Spain we walked from our accommodation to the sea which was a 500m steep downhill walk. Suddenly I got pain in my legs and couldn’t walk properly – this episode lasted about 2 weeks and got worse during the first week of the holiday and got better at the end. After this episode I was starting to understand what was causing this and remembered a time probably 15 years ago when I went through an intense jogging phase followed by a flight to Bangkok when I experienced the same issue just walking in Bangkok.

Over the last 4 years I have got back into cycling and ride my E-bike a total of around 160km a week to work and back. If I stop riding for about 3 days (and do little activity) the quadriceps pain starts and if I don’t get back on the bike immediately I will experience a full blown episode where it will take about two weeks till things are back to normal. Pain starts to occur particularly walking down hill or down stairs.

Just over Christmas 2016 I traveled to Australia from Europe after continuous bike riding and partly managed to avoid having quad pain come on by keeping the quads working. On the stopover in Singapore I went to the gym and used the treadmill for at least 30 minutes a day and during the flights I did lots of on the spot walking working the quad muscles for a number of 20 minutes cycles. When I got to Australia I immediately jumped on the bike/went jogging to keep the muscles moving. Towards the end of the 2.5 week holiday it seemed I had perhaps not done enough because the quadriceps muscles started to swell (you could actually see fluid had accumulated around the knee) and I started to get some pain – although only minor. On my immediate return to Europe I got on my E-bike again and with high gear started riding. Over the next days I rode the bike, including the 16km to work and the swelling went down and I avoided a major event.

On a 3 week holiday 2 years ago in Norway and Greece (also with lots of car driving) I also managed to avoid an event by going running every day for about 30 minutes, using the treadmill at the gym and doing sets of squats just randomly during the day. So to cut a long story short the only way I have found to avoid the quad pain occurring is to basically never stop riding my bike, 3 days seems to be ok but anything after that is entering dangerous territory. When on holiday and away from a bike keep the quads moving by doing squats, going jogging, using the treadmill/bike training in hotel gym.

I am off to Spain (flying) for summer holiday in about 2 weeks and I have decided to hire a bike down there and basically go for a minimum 30 minute ride every day to stop me falling into another episode. Will let you know how I get on as I am still experimenting myself.

 

[lewling]

I thought Drewza101 post from 31. March 2016 was very interesting with the hypothesis that muscle cells get overloaded with glycogen and when exercise is introduced, the cells literally tear as a result of being overloaded. I rechecked my documents from the hospital and the main diagnosis was “granulomatous myositis unexplained genesis”. I had a follow up MRT of the quads about 6 weeks after the hospital visit and result was that all was back to normal. When I was admitted to hospital the CK level was 8786U/L and normal was stated to be 0-171, the CK-MB level was 118. Other blood levels above normal limits were:
GPT 251 (norm 0-45)
GOT 426 (norm 0-35)
LDH 712 (norm 0-248)
Myoglobin 277 (norm 0-72ug/l)
(Names above are the German abbreviations so might be different from english). The levels were all back to normal after 11 days.

 

[budegan]

Lewling, have you found a correlation between your carb intake and the episodes?

Not related to carbs that I know of - and I appreciate that this is hardly groundbreaking - but from what I'm reading here and elsewhere I thinking it's a type of rhabdomyolysis, but perhaps so niche it's never before been identified.

A general question to anyone following this thread - whilst recovering from an ongoing episode has anyone tried swimming? I'm gutted not to be able to exercise other than upper body weights, and wouldn't dare try running as if low intensity pedalling is going to kick it off then I hate to think what pounding the pavement would do!

 

[lewling]

Hi budegan, No I haven't really checked if there is a correlation. I haven't tried swimming either. After my experience with this I know that an episode will occur when I take more than 2 to 4 days off the bike. It seems to come on worse or faster if I have been sitting in a car for hours (or a long haul plane). As soon as I start to feel an episode coming on - minor pain in quads after doing some walking or stairs/walking downhill then it's an alarm signal for me to get back on the bike or do some squats and go jogging otherwise it will develop into a full blown episode where I am basically crippled for two weeks. I even notice that after 2 to 4 days of the bike and little quad activity that the quads start to feel strange (hard to explain) and seem to even swell a little (I guess some fluid accumulation). This is another alarm signal for me to get the quads moving again.

 

[budegan]

Thanks mate. Like, I believe, everyone on here it's days off that trigger it for me. In all cases I've also smashed the sugars and carbs (though that could or could not be an additional factor). The worst I've had it (thankfully the only time it's been so bad as to kick in when I've even been walking) was following a long-haul flight. There is a definite pattern.

 

[trkstr]

After reading through most of this thread, i thought i'd jump in and add my experience with this condition into the pool.
Has happened twice now for me (currently in the second episode at time of writing). I'm more of a beginner rider, only averaging 20-26 km per day for commuting to work and only about 3-4 times a week.

First time it happened was just over 2 weeks ago where the last ride was on a Thursday morning. Then didn't notice anything until the following Monday morning where i couldn't complete a 12 min walk (on almost completely flat footpaths) to the office. Felt like the muscle was slowly tightening over the course of a minute or so, at the peak of intensity, it felt like the pain expanded to the tendons and nerves in the whole leg. Started to freak out as this hadn't happened before so struggled through to get to work (which i later learned was a bad idea). Spent the next 20 min at the desk kneading out the quads. Managed to isolate the pain to the vastus medialis obliques. Aggrevates the muscle after walking downstairs or down hill even for very small angle of descent. Perfectly ok to walk around on flat ground for the rest of the day, until i had to go down a flight of stairs to go home...
What helped get through it was if i noticed it occuring, i'd almost consciously try and shift my weight off that leg as much as i can as i walked. If it didn't help and it got worse, i'd sit down with my legs dangling and relaxed and just knead out the quads, focussing on the point where it hurt the most. after a few days it went away (was pretty much recovered by friday morning). Don't try and suffer through it, rest it and let it relax if it starts happening.

One interesting thing was the location of the origin of the pain. First time was focussed around the VMO just above the knee. The current episode appears to focused further up on the vastus lateralus. Both times, it has happened in my left leg the worst, only starting to notice similar signs in the right leg if i tried to push through the pain a bit on my left. This correlate well with the balance muscles needed when walking downstairs, hence why it seems to hurt most after walking down stairs and with the fact that i feel my right leg is my dominant leg, which could explain why my left is always feeling it first?

Anyways, that's just my experience so far. If anyone's interested, i can update in here everyday with how this episode is doing and with any information anyone is curious on.

 

[budegan]

Re:

Sorry to hear you're in the club, it's a nightmare!!

Do let us know if you find anything interesting - in particular if you discover a cure!!

 

[Shayne_G]

Re:

I thought Drewza101 post from 31. March 2016 was very interesting with the hypothesis that muscle cells get overloaded with glycogen and when exercise is introduced, the cells literally tear as a result of being overloaded. I rechecked my documents from the hospital and the main diagnosis was “granulomatous myositis unexplained genesis”. I had a follow up MRT of the quads about 6 weeks after the hospital visit and result was that all was back to normal. When I was admitted to hospital the CK level was 8786U/L and normal was stated to be 0-171, the CK-MB level was 118. Other blood levels above normal limits were:
GPT 251 (norm 0-45)
GOT 426 (norm 0-35)
LDH 712 (norm 0-248)
Myoglobin 277 (norm 0-72ug/l)
(Names above are the German abbreviations so might be different from english). The levels were all back to normal after 11 days.

This is really interesting to me. When I first saw a physiatrist, she performed a diagnostic ultrasound of my quads which revealed "unexplained growths in the muscle tissue". They looked like multiple opaque bulbs sitting in my tissues. More interesting was where the bulbs were is exactly where my pain/spasming was located. I will definitely bring this up at my next doctor appointment.

I have exhausted all other treatment options and diagnostic evaluations on my end. So, they are going to be cutting me open and extracting a large sample muscle biopsy via my quad in mid-September. Hopefully this will reveal something!

 

[budegan]

Re: Re:

Good luck with that Shayne. Does it hit you regularly?

 

[Shayne_G]

Re: Re:

Good luck with that Shayne. Does it hit you regularly?

Hi Budegan -

It occurs along the same manner and frequency as everyone else in here; if I take a few days rest, the legs become angry. I have spent a week in the hospital due to recurring non-traumatic rhabdomyolysis, had metabolic, genetic, and autoimmune testing performed, seen a physiatrist, nutritionist, neurologist, cardiologist, and internist all with no answers or the slightest hint as to what is actually happening. This is why I have arrived at the large sample biopsy and is really one of the last and most invasive things they can do to test stuff out. If the sample comes back inconclusive, I am not sure what the next step will be...