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Right side only quad 'ache'
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Hi Everyone,

I have been having a strange issue for quite some time now.

On my right leg while cycling, I get a pretty strong quad 'achy' feeling. Mostly on the inner thigh near the knee (VMO area), but it radiates all over the quad and sometimes knee. It's not a really painful, but can be very uncomfortable especially for longer rides.

Getting out of the saddle basically completely alleviates the issue temporarily, and is my go to method for getting some relief on long rides. It also gives me no issues while running.

I have had two professional bike fits this last year, which didn't do much, and I am tapped out on spending any more money on that. I ride a variety of bikes (road, gravel, tri, MTB) and it doesn't seem to matter.

I also see a physio, and do a lot of foam rolling, stretching and strengthening exercises, but its been going on for over a year and while my strength and mobility has increased the pain hasn't changed. I also don't see any loss of strength, I can still squat/lunge a decent amount of weight, and I don't notice any strength or mobility differences between my left and right quad.

I have had my knee checked by an orthopedic doctor and scanned, and it doesn't seem to have any issues.

I also took 2 months of the bike completely this last winter, and the ache came back almost immediately when I started cycling.

I guess I am just a bit frustrated. I can still push decent watts, and my fitness is still good, but it just makes riding bikes a bit of a mental slog and not very enjoyable.

Any other ideas?
Last edited by: Truant19: Jun 28, 22 9:18
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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Sorry, not being able to help.
But I'm experiencing the exact same issue, albeit with my left leg and haven't found any fix for it yet either.

Hope someone on here got the fix, since I'll be racing a couple of IM's this year and riding anything over 3 hours is torture (physically and mentally)
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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does your strength work include adductors and abductors?
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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My experience with PT has been terrible. Years ago I had an overuse injury on the bike and a highly recommended PT told me I should cross train to help things. He recommended some time cycling.

A few months ago, I found a Chiro/PT practice through the LBS. This guy used to be a competitive cyclist and he really gets it. After a few months my wife said she can see a difference in how I run. My advice is to find a PT who is really and truly sports focused.
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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The first thing that comes to mind when someone reports unilateral leg pain is referral from the spine. It's not a strength issue per se as you report not having the pain when more force is placed through the pedals. Though the same thing achieved here is a position change in your spine. It's not uncommon for mysterious extremity conditions to actually be of spinal origin. Do you notice this leg issue at other times during your days? Have you had a real clinical exam of your spine with an attempt at reproducing symptoms?
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Re: Right side only quad 'ache' [AndrewL] [ In reply to ]
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It's funny you should say that, since I also struggle with back problems. I am in the process of getting that more thoroughly examined and actually just got a scan a couple weeks a go though I haven't heard anything back. I am pretty sure I have a bulged disc/sciatica from a previous injury. I guess it makes sense that it might be linked to that.

I do notice a dull ache throughout the day, but its very mild and pretty easy to ignore or even forget about.

And your right, the pain doesn't increase with more force, sometimes it actually makes it feel better to get the quad working harder. Like if I did a tough 5 minute climb over FTP, I barely notice it, but a long sustained 50-70% FTP effort just kills me.
Last edited by: Truant19: Jun 29, 22 9:37
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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Imaging is mostly irrelevant in the majority of spine cases. If you don't have trauma or other "red flags" then imaging doesn't actually help determine a favorable outcome. Start with a real clinical mechanical examination by a physical therapist who is highly skilled in spine care. Rolling, stretching legs, core work, strengthening is not considered appropriate for spine conditions either. You'll likely get the best results for a mechanical exam that can reproduce your pain with simple movements and then the PT will determine other movements that will reduce your pain. Good luck.
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Re: Right side only quad 'ache' [AndrewL] [ In reply to ]
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Well, I hope my doctor can refer me to one, because I am not really sure where to find "physical therapist who is highly skilled in spine care". I live in a pretty rural area and I have gone around to 4 different PTs over the years and they are all very expensive and all seemed pretty mediocre (as far as results go).
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Re: Right side only quad 'ache' [Truant19] [ In reply to ]
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I don't have any great answers, but have a similar issue.
I have a history of sciatica and I'm sure it's in some way related to back / pelvis imbalance but nothing I've done to keep my back in good shape makes the leg issue go away on the bike.

I've also had 2 pro bike fits (well 4, if you include both were for TT and Road bike) and whilst it's felt fine for the short FTP level efforts for the fit the issue is still there at long Z2 and "normal" rides.

Since then I've done quite a bit of pedal analysis - Garmin Vector, Elite Drivo and most usefully LEOMO - which has shown I have definite imbalance in my pedal stroke. Right is slightly weaker, but especially has a significant dead spot at the bottom of the stroke. Based on that I've *slightly* lowered my saddle (I'm sure the bike fits would say it's low) and that's helped to minimize the imbalance and discomfort. I find this especially useful on the trainer, and was pleasantly surprised to read that it's not uncommon for pedal stroke issues to be more pronounced on the trainer due to the static position, especially the bike not rocking.

Hope that helps!
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Re: Right side only quad 'ache' [AndrewL] [ In reply to ]
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AndrewL wrote:
The first thing that comes to mind when someone reports unilateral leg pain is referral from the spine. It's not a strength issue per se as you report not having the pain when more force is placed through the pedals. Though the same thing achieved here is a position change in your spine. It's not uncommon for mysterious extremity conditions to actually be of spinal origin. Do you notice this leg issue at other times during your days? Have you had a real clinical exam of your spine with an attempt at reproducing symptoms?

That was my thought. Assymmetry way up at the lumbar or even thoracic spine and how one compensates for that all day every step all the time
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