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Dr. Andrew Rynne
Dr. Andrew Rynne

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What causes pain in legs, calves and thighs?

Answered by
Dr. Rishi

General Surgeon

Practicing since :1999

Answered : 1312 Questions

Posted on Mon, 12 Sep 2016 in Back Pain
Question: I am writing this on the behalf of my girlfriend who is experiencing a lot of pain associated with exercise. She has consulted several doctors (specialists in the field of sports medicine), physicians, and a masseuse. No one has come up with anything helpful, which have made her lose faith in doctors. I convinced her to let me write this to put on forums open for discussion. Please help if you have any suggestions on what to do, or what might be wrong.
Sex: Female Age: 21 Weight: 55 kg Height: 1,7m Race: Scandinavian Location: Norway, Oslo No medicatons Time of complaint: approximately 6 years
She was very active in orienteering, football and cross-country skiing and running. She wanted to focus on competing in orienteering. Symptoms started as a 16-year-old. No previous related health conditions or signs of other related illnesses. First symptoms appeared after an orienteering training camp for 15-16-year-old girls. The legs started to feel “heavy” and as if they were full of lactic acid, even just from light strain on the muscles. This affected many girls during the camp, but all of them, except my girlfriend, recovered after 6-12 months after the camp. At the time being, it was thought to be because of overtraining.
Symptoms: Pain in both legs, calves and thighs (m. gastrocnemius and m. quadriceps). The m. gastrocnemius is definitely the worst pain-wise (specific where the muscle merges into the Achilles tendon). The pain is “stuffy”/pressuring, burning (as lactic acid) and tying (regarding the gastrocnemius during a running session). Like an outer pressure where the muscle becomes the Achilles tendon. It is very painful and becomes worse the more she runs.
Symptom triggers is: Physical strain: Running, jogging, steep hills or stairs, lifting weights, sitting still (30 minutes or more), standing still (1 hour or more), and unilaterally or too much exercise. Other triggers: Lack of sleep, stress, illness/decreased immune function and such.
Related and unrelated: May have trouble sleeping throughout the whole night without any specific reason. Often wakes up in the middle of the night, but this is not because of pain. Blood tests have not revealed any abnormalities, but lack comparison basis from the time before the disease/injury. A little decreased immune function (always takes 2-3 weeks to get well, not matter the illness be it a small cold or a strong flu). Might have a high level of stress. Get tension headaches often in various degrees. Feels like a tight band round the forehead, and around the head to shoulders/neck. Depends on other factors such as sleep and stress. High tolerance of pain. She gets cold easily – maybe related to low blood circulation.
Tried treatments: Magnat Corpus, physical department, Oslo, from October-December 2011, twice a week: Transverse massage, saline injections and training program. The training program consisted of “ladder runs” (running 50m starting walking while constantly increasing pace to XXXXXXX pace the last 10m), 15 and 30-second intervals. The training program was partly followed, but had little to no effect. Massage, 6 months, 2013-2014: The masseuse was a retired cross-country skiing athlete from the Norwegian national team. She suggested it to be Compartment Syndrome. The massage helped as a temporary pain-reliever, but did not have any long-term effects. Norges Idrettsmedisinske Institutt (Norwegian Institute of Sports Medicine): Suggested Compartment Syndrome to the doctor, but he did not think that was the solution, because it is very rare to feel pain in the thighs with this illness. (Compartment Syndrome usually affects the calves and/or forearms). The doctor conducted a lactate profile and a VO2max-test on treadmill. The values was normal, but then again, no comparison basis from before the symptoms occurred. Tried another training program with focus on endurance, for about 2 months. She was supposed to stay in heart-rate-zones 1 and 2. No effect on illness. Physiotherapist a year later, 5-6 times He recommended weight lifting with heavy weights, few repetitions and multiple series. The physiotherapist was also skeptical to Compartment Syndrome, as it would become worse with the weight lifting. (The muscles would grow, and the fascia would not, which would make the pain constant and not dependent on rest from physical activity). It seems like strength training with this approach has had a positive impact on the disease.
Today: Slightly reduction in pain frequency, but it varies a lot. No difference in level of pain. Some weeks are good and some are bad ones. Still many days with agony and heavy legs/painful calves. The pain often makes it hard to sleep, and sometimes she can wake up in the morning with pain in her legs, even though there was not any pain the day before. Both running and walking can trigger pain, and it feels like the muscles tie up (no, not as in a cramp). The pain in describes as an external pressure mid-calf (gastrocnemius/Achilles tendon) and the feeling of something tightening around the calf. With the weight lifting with heavy weights, few reps and more sets, “ladder runs”, power walks, short intervals and stretching; the pain have, as stated, been reduced slightly in frequency. If this is due to the change in exercise, time, lack of incorrect training, physical fitness, age or daily life (less stressful days with fewer expectations to meet than at the time the symptoms appeared) is hard to say. She thinks it has a lot to do with a less stressful life and more varied exercise, but find it strange it should take so long to get well. Recently she participated in a orienteering race. She said it felt like the calves was about to explode. Even with legs like that, she managed to finish in 3rd place. She is thinking about consulting another doctor and do some tests regarding Compartment Syndrome.
Please, I hate to see my girlfriend like this. She loves to run and discover the world, but has to deal with so much pain just from doing what she loves. I hope that someone have experienced the same and recovered, so please help! Thanks in advance for every constructive reply.
PS: She does not experience any inflammation or swelling in the calves or thighs. Only the feeling of the calves are about to explode, without any actual swelling.
Answered by Dr. Rishi 2 hours later
Brief Answer:
Please get Chronic Exertional Compartment Syndrome ruled out.

Detailed Answer:
Welcome to Health Care Magic.
Thank you for your question.
It is quite a difficult problem as you have explained.
I believe that she could be having CECS - Chronic Exertional Compartment Syndrome or Popliteal Entrapment Syndrome which could lead to such pains.
Its just a doubt and to clear it you will need her to get a Color Doppler of the arterial system of the lower limbs done as well as a CT Angiogram to see whether the arteries are functioning normally. If that is all fine then we can rule out these diagnoses.
Take care and do let me know if there are queries on this issue.
Dr Rishi, Vascular Surgeon, XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Rishi 2 hours later
Thank you so much for the suggestions! They seem really good. But how can I contact you after this question closes in 3 days? I guess it will take some months to be able to take the Color Doppler of the arterial system and the CT Angiogram tests. I am impressed of the quick and accurate answers, thank you so so much!
Answered by Dr. Rishi 12 hours later
Brief Answer:
You can ask me a Direct query.

Detailed Answer:
Thanks for your reply.
To revert back to me you will need to ask me a direct question or probably the Admin of the site could tell you any other way if it is possible.
You could also ask a query directed to me by name.
Take care and I Hope she recovers soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

The User accepted the expert's answer

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