[Zuko]

Hello Pete,
I was doing the 24 week Mountaineering Plan for Denali, and right around week 12ish I starting having problems with my quads. I started getting this sluggish, tired, fatigued feeling when I would start my runs/hikes. After .25miles of running my thighs would feel like they already ran a marathon. The same with uphill skiing or hiking. It felt like I already climbed a mountain, they felt tired and I just couldn’t move at my normal pace.

I eased off the training plan for a week or two, but was still having trouble. I started seeing a Physical Therapist once a week, he did dry needling of my hams, glutes, calfs. After a few weeks the pain was reducing, but now I’ve hit a flatline and we haven’t been getting any more progress. He has tried needling my back/spine, and hip adjustments. But nothing is helping. It’s been three months so far since starting PT sessions.

I’ve been doing extensive foam rolling, stretching, and massage gun the first two months I was having trouble. I’m also doing 30min of yoga daily.

Do you have any thoughts or suggestions? My PT is a little stumped on why my quads arn’t progressing. Just recently he suggested trying to get more anti-inflammatory into my diet, so I’m drinking 8oz of tart cherry juice and two servings of brown rice a day. I have also been focusing on core and leg strengthening exercises. It’s just been frustrating as I haven’t been getting better.

Any thoughts you have would be appreciated.

thanks!

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on June 8, 2020 at 10:40 pm #42561

Interesting symptoms. I would recommend your PT perform a femoral nerve tension test to see if you are getting some neural inhibition from L2-4 of your spine. Age of your spine, previous injury, genetic predispositions can contribute to shutting down your quads. Treatment would be directed at more focused spinal mobility and neural mobilization. Failure to progress would indicate benefit of an MRI and further consult. If no neural involvement, then strength and fatigue resistance is a concern. You might have hit the wall for what your strength and aerobic conditioning will allow. Some individualized coaching would then be in order to identify some training holes in your preparation and physical capacity. Hope this gives you some ideas, I know how frustrating this situation feels! There IS a path forward.
Cheers,
Pete

[Zuko]

Zuko on June 10, 2020 at 8:42 am #42611

Thanks Pete,
He’s done extensive dry needling along my spine and we didn’t get any positive results, I’ll ask at my next appointment though.

What do you think about this being caused by overtraining, or possibly a poor diet? I check Myfitnesspal around the time I started having pains and my iron levels are consistently 30-40% below the daily recommendation. I don’t know how accurate the app is at tracking that though.,..

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on June 10, 2020 at 4:20 pm #42639

Well, spinal dry needling isn’t diagnostic of any nerve tension condition. I’ve had athletes with extreme leg symptoms due to low iron, definitely worth pursuing!! Get the blood test for iron and go from there. We see VERY high percentage of our nordic female athletes with low iron, it’s almost expected and can require supplement treatment, and close attention to iron sources in diet. Stacey Sims ROAR book is a good resource.
Pete

[Zuko]

Zuko on June 10, 2020 at 5:08 pm #42641

Thanks Pete, I had a ferritin iron test done this morning. We’ll see what the results say!

[Zuko]

Zuko on June 11, 2020 at 8:43 am #42661

Hello Pete, here are the test results from my blood test yesterday. I have an appointment with my primary doctor to do a full comprehensive blood test next week. But it looks like an iron shortage. Hopefully a combo of boosting my iron levels and rest will allow my quads to heal?

I just ordered Stacy’s book from the library, thanks!

Attachments:

You must be logged in to view attached files.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on June 11, 2020 at 9:53 am #42676

I think this is a very significant direction of care to pursue! Keep us posted.
Pete

[Zuko]

Zuko on June 25, 2021 at 2:52 pm #55149

Hello Pete,
After 1.5 years I’m still having the same issue with my quads. I have stopped all hiking and running, I now just dog walk and rock climb. Now the pain/fatigue is getting worse where a simple 10 minute hike uphill feels exhausting to my quads. And doing hard rock routes with powerful leg movements is very fatiguing.

Oddly swimming feels ok, but running in the pool is fatiguing. Downhill skiing was also ok. Biking, row machine, running, uphill hiking all hurt.

I had spine/back xrays with an Orthopedic that found no issues. Tons of labwork tests that came back normal. I meet with an sports medicine Osteopedic who thought it was Chronic Compartment Syndrome, but two MRIs did not show any signs of it. I have an appointment with a Rhumatologist in a month.

I have also noticed that my menstrual cycles have been very abnormal for about a year or more, possibly coinciding with when my quad problem started, but I do not recall the exact timing.

Do you have any thoughts on what I should be doing? Since stopping all training the chronic pain/fatigue is less, but now doing simple short hikes or climbs causes rapid fatigue. Should I keep hiking and climbing, or just total rest? Any ideas you have would be appreciated.

thanks,

[Thomas Summer, MD]

Thomas Summer, MD on June 26, 2021 at 5:49 am #55166

Hi Zuko,

difficult situation!
An appointment with a Rheumatologist is a good idea. If he/she doesn’t find anything, I would also recommend seeing a Neurologist.
Did the Orthopedic have any idea about the cause of your symptoms?
I would continue with light activity, but only what feels not too bad.

lg!
Thomas

[Zuko]

Zuko on July 20, 2021 at 8:29 am #55855

Hello Pete,
the Rheumatologist had no idea what is causing the fatigue and didn’t have any suggestions. Here are the labwork results the Osetopedic ordered.

I am now getting the same muscle fatigue in my upper body. After climbing three easy rock pitches my arms are totally exhausted and can’t hold on anymore. It feels like I have zero muscle endurance.

Do you have any ideas what I should do?

Attachments:

You must be logged in to view attached files.

[Thomas Summer, MD]

Thomas Summer, MD on July 23, 2021 at 4:26 am #55927

Hi Zuko,

so with the labwork the Rheumatologist could rule out some things and it’s good that everything is normal.
Really difficult giving any concrete recommendation without seeing you in person. But I would recommend an appointment with a Neurologist.
Of coures that’s not the right question on a forum, but just to answer it for yourself: any mental/psychological issues?

I hope this helps?!
lg!
Thomas