Extreme quadriceps starting pain after 3-4 rest days

[globecanvas]

I'm really sorry you need to have the procedure and to be honest I feel a bit like you are taking one for the team, if you know what I mean. We will all benefit from whatever information you can gain.

Do you need or want to be experiencing an episode when the biopsy is done? Do you have any sense of whether it will be more informative if the biopsy is done during an episode, or when the muscle is "normal"?

 

[Shayne_G]

No need to feel sorry, I hope to provide some answers for not only myself of course, but others dealing with this phenomenon.

I am meeting with the plastic surgeon and neurologist on Wednesday to discuss exactly that. I would assume they would want me to be episodic when they take the tissue sample, but I am unsure.

 

[trkstr]

all the best with everything Shayne_G! you're a champ!

EDIT:
Update on my current active episode. What follows is purely anecdotal observations from today. More of a "journal entry" of this particular episode.

Legs felt fine walking around the house this morning. No noticeable issues. Decided to go for a brief walk outside to enjoy the weather. Got about 200m down the road and there must have been a very very very slight decending angle to the footpath surface and this was enough to set off the muscle tightness. Have been noticing it does feel like a dull ache to begin with then ramps up as muscle tightness. Aside from the pain, the muscle still seems to function normally allowing me to walk normally, albeit in a lot of pain. However, after sitting down to rest the muscle, bending the leg at the knee stretches out the muscle making it feel like the feeling you get after a muscle cramp. After a few minutes i was able to resume walking for a brief period until the road surface changed again to having a slight but noticeable slope to it. At which point, it was rinse and repeat. For a short period, attempting to walk on the heel of my left leg (almost think: Charlie Chaplin penguin walk style) seems to keep the cramp/pain at bay for a while, but this doesn't seem sustainable.
After brief bit of massaging the leg, it seems the pain was originating (basically this was determined by which bit hurt the most when massaged, tended to be different to where you feel the pain while walking, interestingly) from a different muscle today than yesterday. FIrst bout from two weeks ago seems to be in the vastus medialus obliques, focussed closer to the knee. Yesterday, the pain seemed to originate from the outer muscle, the vastus lateralis nearer to the hip. Today, the pain seems to be originating from either the rectus femoris or adductor longus. In all cases, pain was in my left leg.

Apologies for the wall of text but i'm hoping more anecdotal evidence contributing to the pool may help someone in coming up with some form of a diagnosis!

 

[trkstr]

Quick update and episode journal entry:

Managed to ride out to work (approx. 12 km) taking it easy. No major troubles DURING the ride.
Now, a couple days after, the legs feel a little weak, with some minor niggles with the quads. But nothing major. Next ride is due for Sunday. Will be interesting how that goes.
Currently feel like this issue we all have could be due to pushing too hard on the last ride before the session off the bike
Will keeo everyone posted on how Sunday goes.

 

[Shayne_G]

Re:

I'm really sorry you need to have the procedure and to be honest I feel a bit like you are taking one for the team, if you know what I mean. We will all benefit from whatever information you can gain.

Do you need or want to be experiencing an episode when the biopsy is done? Do you have any sense of whether it will be more informative if the biopsy is done during an episode, or when the muscle is "normal"?

I met with the plastic surgeon yesterday and asked him the above. He said I should be episodic during the procedure :sad: . So, looks like I will be killing it up until a few days before and then slamming lots and lots of sugary carbs to trigger an episode. He also wants me to be non-weight bearing for 3 days post-op and said no cycling for 6 WEEKS post-op. We will see about the latter restriction.

 

[budegan]

Any news Shayne?

 

[Shayne_G]

Re:

Any news Shayne?

No, the biopsy isn't until September 19th, and it will take ~6 weeks to get any results from it.

 

[globecanvas]

Ugh I cannot imagine intentionally triggering an episode, and then getting the "reward" of a large sample biopsy. I wish you the best.

 

[globecanvas]

I have another anecdotal data point to throw onto the pile. I have been riding, racing, and training for years, but these episodes only started last year. The only thing that changed, apart from general aging, is that I added box jumps to my regular training schedule in order to improve sprinting.

Apparently fast twitch muscle fibers store significantly more glycogen than slow twitch muscle fibers. So perhaps it's possible that improved recruitment of fast twitch fibers has also increased the total amount of glycogen stored in the legs, which has increased the risk of the leg-pain episodes.

The leg fatigue feeling after doing a hard session of box jumps is different from the familiar leg fatigue from hard training on the bike, and feels more similar to the crampy leg pain felt during an episode. I know that's a fuzzy connection.

 

[Shayne_G]

Re:

Ugh I cannot imagine intentionally triggering an episode, and then getting the "reward" of a large sample biopsy. I wish you the best.

Thank you, I will enjoy my last week and ride as much as I can

 

[budegan]

Although not knowing you from Adam I am thinking of you Shayne.

SSRIs? As in the medication. It's since taking that my episodes started. Not that I think it's connected but worth a shout out I think.

 

[CFM]

I just joined this forum so I could comment on this post. Sadly, I suffer from the exact same thing as described in these 7 pages. Not sure where everyone is located but I am an Aussie. I have read every post and some of the post's made me shake my head... (did I write that, never seen such an exact description of what I experience) I first suffered from these cramps in my early to mid 20's. I was a speed skater and when that finished took up bike racing. The cramps experienced were the same in both sports, no medical practitioner was able to help. Fast forward 30 years..... last nine months I have been getting fit again with gym and spin classes. Have had 3 attacks in the last 4 months, each attack followed by 7 days of no spin classes due to interstate travel with work commitments. Never have I associated the attacks with a break from cycling but reading these posts it is exactly what has occurred and I guess the trigger when returning to spin for another attack. Thank you all for taking the time to post about this condition, as mentioned previously it is the only place I have ever seen any information about it. Hopefully a reason will be found for the cause.

 

[trkstr]

Haven't experienced another episode since the last episode. Have been having a look at the frequency of rides over the last little while and i have not had more than two consecutive days on the bike without a day or two off it afterwards.
A few things to think about and maybe posting if you keep track of this stuff. Also may be some kind of a template for future posters. I find these to be the points of interest that come up quite frequently:

- how many days in a row were you intensively riding before your break (irrespective of distance)
- what was your diet like during and after these riding sessions
- level of hydration before, during, and after each riding session
- electrolyte balance
- what foods do you eat throughout the day while riding and while off the bike
- how long were you off the bike before you experienced an attack
- did the condition get worse after you first noticed the cramps or did they improve after day 1
- during your time off your bike, what was your level of activity during the two days following

Needless to say, the need for honesty is important.

Here are my responses:
- was riding for 3 days then 1 day off then 2 days before being off the bike and experiencing the last episode
- i had a rather balanced diet while i was on the bike. after the last ride, it was associated with a break from an intensive bit of work so was relaxing more, ended up consuming lots of very sugary foods (chocolate, biscuits, ice cream, etc). Drank regular water without any supplements in the water (so was not paying too much attention to electrolyte balance). Hydration was maintained, to the best of my ability, but now i'm thinking it may not have been sufficient and may have been one of the causes of my episodes
- was off the bike of 3 days before episode
- condition was worst at the start but got better as time went on
- first day after riding involved just the regular amount of walking around the house, but was rather sedentary

the last point seems to be common between the episodes. 2 days of slobbing around the house and then going out to walk somewhere triggered each episode.

Now, when i'm off the bike, i've been actively trying to keep myself active for at least 30 min - 1 hr every day

This post now seems a bit messed up but may help trigger any thoughts from others...

 

[budegan]

Re: Re:

Ugh I cannot imagine intentionally triggering an episode, and then getting the "reward" of a large sample biopsy. I wish you the best.

Thank you, I will enjoy my last week and ride as much as I can

Hey Shayne. How did you go? Did you trigger the episode as planned?

 

[Shayne_G]

Hey everyone -

I figured I would reanimate this zombie post yet again! I did not go through with the biopsy a few months ago. I just did not want to be cut open for only a chance of figuring out what was going on. Fast forward to last week, I had another cramping episode after a couple days of rest. Did the usual working through them for a few days and about 5 days later I was back to "normal" again. Since Western medicine continues to fail me time and time again, I decided to seek the advice of a naturopathic doctor who had some interesting opinions on what was going on, please let me explain his thought process:

I started drinking a TON of seltzer and other carbonated beverages a few years ago as well as increased the amount of carbohydrates and other simple sugars to fuel my workouts (which interestingly correlates with the onset of my symptoms). His thought process was the amount of seltzer and other carbohydrates (pasta, rice, grains, etc.) was creating a hyper-acidic environment in my bloodstream. If I am exercising frequently and doing hard efforts, this causes a buildup of lactic acid in the muscles which will further the acidosis. If we are exercising frequently, the blood will stay moving and the muscles will pump out the excess acid and stave off the cramps. If we are resting, the blood will pool in the muscles, the acid will not be pumped out of them, and cramping will result. His advice to me was to avoid all carbonated beverages and increase the intake of alkalizing foods over the next month, then rest and see if this prevents cramps from occurring.

My question to all of you is: Do you guys drink a lot of seltzer and / or other carbonated beverages?

 

[budegan]

Re:

Hi mate. Glad you are still alive! Sorry to hear about the cramps again - it's such a pig isn't it?

Me, I've manage to stave an episode since August by riding every single bloody day (I might have had the odd one day completely off but no more than 2 or 3, and obviously never concurrently); obviously this isn't the best thing in the world and my missus hates me for it.

Bad news for you on latest theory sorry - next to no fizzy drinks for me. Like maybe occasionally but no more than once every month or 2 I'd say.

I've been doing some work on this myself though and am in touch with a researcher who studies Exercise Related Muscle Disorders. Hopefully in the new year I will be meeting her at the National Hospital For Neurology and Neurosurgery in Queen Square, London.

Have you or anyone else already met anyone in that sot of field?

 

[jsk]

I don't drink much in the way of carbonated beverages (almost none at all, in fact). And frankly the notion that you can significantly affect the ph of your blood by your diet is not only unsupported by science, but thoroughly debunked.

The carbs are a different matter though, I truly believe that for me it comes down to balancing carb intake with training volume. Even a few days of reduced training volume combined with bad diet (excess sugar and refined carbs) can trigger a mild episode if I'm not careful. On the other hand if I moderate my carb intake when training volume drops off or stops, I seem to be OK.

 

[Shayne_G]

Very true, but at this point what else can I do? Ya know?

 

[globecanvas]

No carbonated beverages here either. The search for correlation continues

 

[Shayne_G]

How about a magnesium deficiency?

 

[jsk]

I take a daily magnesium supplement as well as ZMA before bed, so I don't think that it's.

I'm pretty confident at this point that for me, it really just comes down to carb intake vs training volume. If I'm going to be riding less (or not at all), I have to watch my carb intake, particularly sugar.

I've actually come to recognize a certain feeling in my legs that warns me an episode is coming if I don't do something about it. It's this tightness/twitchiness in the muscles, kind of a 'tremor' but not the same as the actual cramping. When that happens, I know I need to get on the bike ASAP and start with a long, gradual warmup before trying to raise the intensity.

I had that happen to me over Christmas weekend. Normally a short ride Friday morning and a day off on Saturday wouldn't be enough to trigger an episode, but I ate WAY too many cookies/fudge/etc (like, an embarrassing amount) starting Friday night through Sunday morning, and I could tell by the way my legs were feeling that I was in trouble. Sure enough, went for a ride Sunday afternoon and my legs started to 'cramp' a little. Fortunately I was able to gently pedal through it, and they the feeling gradually passed and I was able to continue riding as normal after that. Pretty sure if I had waited another day to get back on the bike things would have been much worse.

 

[Shayne_G]

All right, magnesium and bubbly drinks are out...

Has anyone tried to go completely ketogenic? If this issue seems to be carbohydrate related, I wonder what completely eliminating carbohydrates would do for us.

 

[budegan]

Re:

All right, magnesium and bubbly drinks are out...

Has anyone tried to go completely ketogenic? If this issue seems to be carbohydrate related, I wonder what completely eliminating carbohydrates would do for us.

Shayne did you ever see a neurologist?

 

[Shayne_G]

I did, yeah. She performed an aerobic forearm test, nerve conduction velocity test, and an EMG over the course of a couple weeks that all came back clean. She then wanted to cut me open and biopsy my quads, which I wasn't keen on and backed out of. Plus, I had a baby a few months ago and didn't feel like being laid up for a few weeks (the missus wouldn't appreciate that!). So, long story short, I have seen my PCP, a neurologist, a physiatrist, a nutritionist, a naturopath, and a witch doctor (just kidding) who have all been able to tell me jack-squat. That seems to be the MO of this whole thing though...

 

[budegan]

Re:

I did, yeah. She performed an aerobic forearm test, nerve conduction velocity test, and an EMG over the course of a couple weeks that all came back clean. She then wanted to cut me open and biopsy my quads, which I wasn't keen on and backed out of. Plus, I had a baby a few months ago and didn't feel like being laid up for a few weeks (the missus wouldn't appreciate that!). So, long story short, I have seen my PCP, a neurologist, a physiatrist, a nutritionist, a naturopath, and a witch doctor (just kidding) who have all been able to tell me jack-squat. That seems to be the MO of this whole thing though...

Yeah I hear you on the biopsy. That said I think I'll pursue things with the neurologist I'm in touch with - I'll post on here if and when there is anything to update on.