Attilio

Hello Everyone, I think I fell into the dreaded OTS trap last year. Been riding for 3-4 years pretty consistently and slowly increasing. Also weight training, kayaking, yoga/flexibility with walking. It was all seasonal with doing most sports most of the time but obviously outside temps have dictated what I do. So summers I would ride and weight train far less and spend more time swimming or kayaking. Winter I would be more weight training and mountain biking with hiking. And so forth. As the kids are getting older and I took time ferrying them around sports I got time to do some group rides and got REALLY into it last year. I was over-reached on and off starting maybe July until mid November when I hit a wall. Decreased activity a LOT and almost no riding and a lot less of everything else but my quads are just sore, very sore and it's not getting better.

Yes I consulted coach saw a few doctors including ortho, got blood work and actually all my hormones are HIGH including the LH/FSH, testosterone, cortisol. My endocrine feels it's a compensation and the start of overtraining but good in a sense in that my brain/adrenals and balls haven't shut down and were working as they should. But this soreness.... isn't going away despite being off the bike. I did continue to do some light weights and yoga and hikes at a far lower rate than before but that didn't help so it's been a couple weeks it's just walking. I know OTS can be permanent in the worst of cases and have spoken to a lot of people, nobody knows of anyone with permanent OTS but with this soreness here for a few months is driving me nuts. My whole team (also PT and ortho) basically banished me to just walking or light manual labor around the house. Am taking the rest super seriously and doing the requisite stretching for the tightness as well as deep tissue massage and foam rolling. Anyone else get into this hole of this long term soreness? Is it a sign of permanent damage? Any insights from fellow cyclists would be appreciated.

MoAlpha

Have you checked specific biomarkers of muscle damage, e.g. CPK, LDH, aldolase, myoglobin, etc. or gotten a needle EMG or MRI to look for signs of myopathy? There are a lot of rare genetic muscle syndromes out there, some of which predispose to rhabdo with exercise.

Koyote

Just fyi: chronic muscle soreness is not a symptom of overtraining.

MoAlpha has given some good advice. Take that to your doctors.

jnbrown

chronic muscle soreness is.a symptom of overtraining along with other symptoms such as insomnia, fatigue, inability to keep riding at the same intensity, mood disturbances, lack of recovery.
I know because it has happened to me numerous times. Recovery time is typically 6 months.
if muscle soreness is the only symptom you have then it could be something else.

wolfchild

How is your nutrition ?. How is your sleep ?. How much stress do you have in your life ?. Do you get enough rest between your workout sessions ?..Chronic muscle soreness may be the result of inadequate protein intake/ and lack of proper recovery between workouts.. Take some rest, feed yourself with some good food, pace yourself and take it easy with your workouts and see if anything changes.

rosefarts

I would highly recommend checking your CPK levels.

About 10 years ago I just wasn’t climbing (rock) like I normally did and my upper back was really sore.

I finally got to the doctor and my CPK was 2800. This is still a long way from Rhabdo but it showed that I was chronically losing muscle.

Prednisone sometimes helped. Immunosuppressants didn’t help. They liked to throw around words like dermatomyositis. And scan every inch of me for cancer, since myopathy is sometimes a symptom of cancer.

I went from being the strongest person in any situation to the weakest. Rock climbing is where I really suffered but in cycling I can’t get anywhere near what I used to be able to do. The body is just too weak.

There is no cure and I can do things still, I just basically suck at everything I used to excel at.

I can’t actually say that medical intervention actually helped. What it did do, was let me know what was going on. That redoubling my efforts wouldn’t help. To watch the food and drink that contribute to inflammation. I would have just been frustrated and angry otherwise.

If there is a silver lining, I can’t bring my body weight above 140 (I’m 5’9”) no matter what I eat.

MoAlpha

Sorry. I don’t want to “like” this, but this is the kind of thing I was thinking of. I assume you’ve had a biopsy or two and the genetics looked into…

rosefarts

All the stuff.

Dermatomyositis seems like a decent fit, but there are too many things that don’t fit me. I do have some autoimmune diseases in my family so it’s not impossible.

Lately, my numbers hover around 400. Which is on the high end of normal, but is kinda normal. It took years of muscle loss to finally get to a decent balance. There’s definitely some cervical stenosis going on too, which may be contributing more to my upper body weakness than the other thing. Hard to know if a decompression surgery would help or just cost me money/time/risk.

If you subscribe to Outside Online, they recently had an article about someone who was way worse off than me. He went from full on professional athlete (again, rock climbing) to bed ridden over the course of a few months. They called it Chronic Fatigue Syndrome and that there was nothing they could do. He ended up getting a neck fusion and filium lysis and is currently doing OK though can never be athletic again.

Seemed so wild that I looked it up and there are case reports of cervical fusion or decompression helping other chronic fatigue patients. Even without neck or radiating nerve pain.

This stuff is super rare, and probably isn’t what the OP has. He’s probably getting over the flu or something, it’s usually something simple. But it’s definitely worth knowing about the weird stuff, just in case nothing else seems to make sense.

Attilio

Thanks for the replies scary as they are. I have not had CK or muscle enzymes checked yet nor imaging but that's on the docket if I don't get better in a few weeks.

Been off the bike for the most part since late November and I had to stop weight training a month ago. I was keeping off the quads and mostly legs but it seems anything sets me off. I can't do anything except walk the neighborhood for an hour and maybe 1-2/10 intensity manual labor around the house basically chores. I can walk and work and do low intensity stuff but it's pretty debilitating. And very scary it's not getting better despite rest.

The one glimmer of hope is all the articles and medical texts for the permanent form of overtraining mention years of overdoing it, mine was 4-5 months tops last year when I Started group riding in May 2022. I could do centuries at high speed now it's hard to do more than a few miles and it starts to HURT.

I was feeling all the other symptoms of OTS too, the fatigue, sleep, inability to focus but those have improved with rest. And yes I was sick for like 2 months with cold after cold after cold after cold (6 or 7 total one after the other) but so was everyone else in our medical office. It's like 3 years of not updating the firmware for our immune systems with this isolation, social distancing and all that covid baloney may have contributed but I also had other stressors like a friend who wanted to kill himself. Thankfully that all got better but.... here I am still sore. Am about to start PT as well and the other tests are definitely going to happen soon. The consensus is that I have muscle tears and it's going to take a while to heal but I hope it's nothing worse and I can at least get back to what I was doing if not group riding in 2022 at least riding most days for an hour just enjoying the scenery as well as semi regular weight training with active stretches to burning some calories and look/feel much younger than my age like I always did.

AS far as nutrition I ate a lot when I was very active. Have type 1 diabetes so low sugars was always a threat and I would commensurately eat enormous amounts of everything. I avoided gaining weight recently by eating a lot less and ended up shedding some pounds as I am kissing my muscle mass goodbye but have heard not to do this. So now aiming to get a little bit of a daddy belly (not much just a few weeks pregnant worth or no six pack and a slight bump) just to be fat, happy and promote recovery. Like 5ish lbs that's all.

Absolutely terrified......

Attilio

Sleep not great but improving as much as possible as I have to get up at 0415 for work but get out early. I am doing everything else including high protein diet.

Attilio

Condolences. It's a huge loss. So much of my life I was extremely active and very fit, felt like a million bucks thanks to how I took care of myself. Lots of exercise was instrumental in quality of life especially being on insulin for my type 1 diabetes. I didn't feel limited in terms of what I could eat. What a difference now. Trying not to starve myself and am gaining a little weight which I HATE but I need the extra fat to be happy and recover or so that's what everyone tells me. I do feel very bored now. and ran out of things to "do while you're not active". Life isn't the same at all. Need to know if I have to sell all my toys. I definitely need closure but don't look forward to "why don't you just read a book" I hate that poo.

rsbob 

Please keep us posted on what your testing reveals. Fingers crossed.

Attilio

I got back from a family cruise just now which made the symptoms a little worse. It was booked well ahead of time like a a few years ago actually as it was supposed to happen during COVID and we got it at no cost forward booked. Even being on a ship is a lot of walking with stairs which under normal circumstances causes slight soreness. I made sure to take elevator but was walking like 6 mi a day with ports and whatnot plus snorkeling. Nothing I could do as the whole fam (10 of us) was already in plan. Did (overpriced) massages and stuff on the ship where they tried to hawk me all kinds of "natural" BS remedies.

PT told me they have seen their share of a few atheletes burned out like me from overtraining with soreness. It's usually chronic muscle tears and that is what my ortho feels as well. All the literature I have read about permanent damage basically states you have to overdo it for years whereas I over did it for about 5 months last year like June-Nov, or really May and then from July-Nov. Am told across the board that it is most likely chronic muscle tears and the way tears work is they don't slowly improve. You get constant and consistent symptoms for the entire duration until at some point over the course of a couple days the symptoms suddenly vanish. I hope this is the case.

But that said am seeing ortho in a couple weeks and likely going to be doing all the extra muscle related blood works as well as MRI looking for myopathy. Cross your fingers, pray and all that good stuff. Life really isn't the same after everything I tasted and all the beautiful people and places I visited, long rides, centuries in the mountains, kayaking into such serene places. I never would have thought to experience such incredible sensations in this life but I did. I miss it.

Anyone like Ronnie James Dio? Loved his stint with Black Sabbath and one reason I respect(ed past as he died) him is that he wasn't into drugs. Knowing that fact this really reminds me of one of my favorite songs of his:

I've been higher than stardust
I've been seen upon the sun
I used to count in millions then
But now I only count in ones

rsbob 

If your symptoms don’t resolve and your ortho is stumped, find a sports medicine doc. Best wishes

Attilio

The problem here is that "sports medicine" anywhere near where I live is more like ortho joint replacements. There are multiple such known offices but they mostly take care of fat old lazy people with bad hips and knees.

I do trust this ortho very much. I like him because he doesn't operate a lot and is, at least as far as a surgeon is concerned, about as knowledgeable of the medical end of things as one could expect maybe a bit more. He is also pretty athletic and into training himself. My case is not common at all. I so, so, so, so hope this is not a permanent myopathy!

This last week has seen a slight improvement by doing active stretching. Stuff like reaching down while hunched but rotating my arms and not going all the way down, walking while quad stretching every step. That sort of thing my PT explained is preferrable because a lot of the problem from this spasm and tightness is also excess neurological blockage.

The way nerves work it causing movement by inhibiting the inhibition which is wierd. The movement activates the nerves a bit to be more "free" instead of frozen. It really helps. Also a lot of massage and rolling. It almost feels like I am starting to turn a little corner. Cautiously optimistic.

Attilio

Update I am still sore and unable to ride but saw my ortho this week, got labs and MRI everything is normal. Muscle appear as they should on the imaging no sign of scarring, no swelling and no signs of myopathy so the likelyhood this overtraining is permanent is very low. Just damaged and need some rest but thanks to stretching and massage the last few weeks am starting to feel a little bit better. I was able to do a bit longer hike like a couple hours without too much trouble and was one of the faster people on it which is encouraging. Was told that if I truly had the exercise induced myopathy I would struggle to go up stairs and have a lot more pain which I don't. It's going to be a long one but doc says not to sell my bikes I'll be back on them.

MoAlpha

Good news, but that’s still a crazy story! Maybe check a CPK and aldolase right after a hard workout some time?

rsbob 

Take it easy and let put your competitive instincts in the backseat until you are recovered. Don’t over due, don’t try to be the fastest, just enjoy movement and the massages. It’s good to hear you are making progress. Slow but steady.

shelbyfv

Unless you have storage space constraints, I'd suggest giving it at least a year before selling all of your bikes. Keep at least one, just in case.

Attilio

The labs were all normal except slightly high tesosterone (1200) with marginally elevated gonadotropes. Obviously am not abusing hormones as the LH/FSH were slightly high so no suppression! Am physician myself never seen anything like it. My fear is "Fatigued Athlete Myopathic Syndrome" as obviously MRI isn't great at detecting scars. I may wait a few more months and ask about muscle biopsy as the tell tale sign is the shortened telomeres with some deranged mitochondria. But still just as sore as the day this began, I hope ortho is right and it's just chronic muscle tears. That is also possible because with torn muscles the symptoms don't gradually improve like with so many other injuries. It consistently hurts until one day when you suddenly just get better and it goes away.

Attilio

Those days will always be gone I learned my lesson. I was riding 3-4000 miles a year for like 3 years in a row and loving it, getting faster every year. It was an amazing complement to weightlifting and an overall active life at the "just right" level.

As a friend told me "riding your bike 10 miles a day is what you need for health. Any more than that is pure ego."

Attilio

Regardless of what happens my plan if I don't improve is to sleep on it for a full two years before starting to sell bikes off. Before getting rid of anything if I don't improve by later this year my plan is to push for a muscle biospy as stated above. I need the closure.

seypat

The simpliest answer would be as long as the overtraining continues. Keep it up and you risk permanent damage. After reading the thread, you might have already done that.

MoAlpha

I think what you've described already is inconsistent with normal wear and tear and, with all due respect to the many wonderful orthopods, muscle disorders are not really their thing. The question in my mind would be if you have an inborn susceptibility to muscle damage with "normal" exercise, such that the enzymes go back down after a few days and the damage is too subtle to see on MRI.

I have no particular expertise in this area, other than having worked as a neurologist in an academic/tertiary setting for 35 years and seen a lot of exotic stuff presented by local sub-specialists. Bottom line, these things are out there and I think a biopsy is a good and harmless idea, provided you can get it done right, viz, at a center with a good muscle pathology program. The tissue handling is not a job for amateurs.

Anecdotally, I had a research assistant many years ago who got rhabdo in her legs after a single vigorous session on some piece of gym equipment, developed a compartment syndrome, and narrowly escaped permanent renal damage. She eventually had a genetic workup, but I can't remember the outcome. Have you asked your family about similar symptoms?

seypat

One thing not mentioned yet. Is the soreness strictly from the cycling? If so, you should look at your bike fit. Maybe something there could be causing the problem.