Attilio

I stopped riding in late November and the soreness has not gone away. I am starting to think that the damage may indeed be permanent.

rsbob 

You may want to consult a pain management specialist at this point. Best wishes

Attilio

I agree ortho isn't the best as well but in my local area nobody really is any good at this. Damn I am a physician myself and primary care internist, I should be able to digest this and indeed what little I find I understand quite well but there is a paucity in the literature on this kind of stuff. I did buy a book on overtraining published recently, it's very scary and depressing!

With normal MRI and normal labs I doubt a rheumatological or genetic myopathy. What I fear is the permanent form of overtraining known as "Fatigued Athlete Myopathic Syndrome" (FAMS for short) more recently known as "Acquired Training Intolerance". It seems the only way I have read in any literature anywhere to diagnosed it is indeed through muscle biopsy and the telltale signs are shortened telomeres (genetic damage) and abnormal mitochondria plus or minus fibrosis. MRI is not good at detecting either of those, only gross myopathy which has been ruled out. The one possibly reassurring thing in this literature is that article after article says you have to overdo it for years. I have been exercising very regularly for decades but I really only overdid it for ~6 months this past year. Then it was insane with lots of group riding. Before that was a lot but I'd be riding 3-4,000 miles a year with occasional kayaking, semi regular weight training and walks nothing crazy. That said as we see in the patients everyone is different.

Nobody in my family has had this although we have a long line of type 1 diabetics myself included. Thankfully that is amazingly well controlled, like A1c's in the 5's without lows. I take very good/intense care of myself!

Attilio

No I have not ridden in over 4 months and I am still sore every day.

Attilio

No I am not in pain per se. It is sore but I would give it a 2-3 out of 10 it's not that bad. I can walk even hike for a couple hours, or perform light manual labor like household chores, yard work. I just can't do anything intense like running or riding a bike or weight train. Pain is absolutely not the problem, merely the symptom of damaged muscles.

MoAlpha

All I can say is it sounds most unpleasant and scary! I have never seen that overtraining entity and would love to know the mechanism. I’ll look it up when I have time. Take care, brother, and post whatever you learn.

Attilio

OK so I finally have an answer and a happy ending!!!!!

I was found to have neural tension for which the treatment is nerve flossing.

Neural tension is a condition where the nerves don't glide along their sheaths as they should while your extremities and body moves. Losing this flexibility causes inflammation of the nerve itself which is transmitted downstream causing orthopedic symptoms like my soreness and especially debility as well as exercise intolerance. The treatment is to do specialized stretches that pull the nerve from its origin inside your brain all the way through the end of your extremity and through the spinal column.

I found this googling "is overtraining permanent". The main article was Joe Uhan's writings on irunfar the website for ultra marathoners. He wrote of a permanent form of muscle damage known as Fatigued Athlete Myopathic Syndrome. There is very little info on this even being a physician I can't find anything. There are handful of google hits and Joe is either the main author, co author or behind a lot. He is a physical therapist on the West Coast so I finally arranged for a visit with him. I explained what was going on, he audited my Strava and not only agreed that while the second half of last year I was overdoing it, but that just like the literature all says, you have to over cook it for years. He said he suffered from the same thing, recommended I see a local PT with his same certifications which I did and the rest is history. I am not only riding and weight training again but easing back into all my fitness. I was able to tolerate 28 miles last week and will be doing 40 this Sunday very slow, nice and easy. It's all coming back so happy ending here.

The condition often is permanent, but it can be managed with daily stretching. I am still sore but as I said before it's mild, fortunately the actual debility of the muscles is easily resolved with this special stretching. So I am all set and should be back to riding and high fitness as the year progresses. One year older/wiser and five months off the bike I will be more respectful of my body and include one rest day per week along wtih a deload week every few accordingly.

VERY grateful. I don't know what I would have done if I hand't found Joe Uhan and his article which led me to contact him. He wrote it in 2013 and if it was before that I would have been doomed to a life of soreness or having to struggle with this for many more months or years before finding a solution. Thank goodness for the internet.

MoAlpha

Good luck with that. You sure you're a physician?

This is nonsense, but I do sincerely hope it helps.

Attilio

Yes I am. Agree it sounds like one of those crazy people problems like fibromyalgia but I couldn't find anything on the topic nor anyone that could propose a solution to this debility and I am very well connected in the business! Unlike the poor patients that can't get seen for anything, even well insured ones with like the "good" BCBS these days, being a busy primary care internist with huge referral network I can get anything I want all I have to do is make a call. Couldn't find a solution.

Even overtraining isn't covered by much regarding medical texts and I got plenty of subscriptions like uptodate, medscape etc. I had to learn all this stuff on my own! Our industry unfortunately covers mostly dealing with old fat lazy people and their attendant problems.