Wednesday, September 16, 2015

I Know Why My Legs Are Always Stiff

Last night, I had an epiphany.  I woke up at 1:00 AM and realized what’s wrong with my legs.  Then I couldn’t get back to sleep.  Why do I always have my biggest insights in the middle of the night?

I’ve written quite a bit recently about groin injuries in both legs.  As inconvenient as those injuries have been, they’ve been overshadowed lately by other problems with my legs.  Some days, I have trouble just getting around.  The most frustrating thing has been not knowing for sure what was wrong.  I think I finally understand.

First, here’s what I’ve been experiencing lately.  It began in June.  In the first few days after the Bighorn Mountain 100, I had a case of DOMS.  Understandably, some of the muscles in my legs – particularly my quads – were sore and stiff.  You expect that for a few days, but it seemed like I never completely got over the stiffness.

I eventually noticed that I was most prone to stiffness after sleeping and after sitting for a period of time.  Some days were worse than others.  On good days, I felt normal.  On bad days, just walking around at work or at home became difficult.

I also started having legs cramps during the night.  I wake up frequently during the night.  That’s normal for me.  What's not normal is having my legs cramp up as soon as I try to move them.  At first, the cramps were mild.  By mid-August, they became severe.  I’ve learned to prevent them by gently flexing the muscles in my legs before trying to move.

Usually I experienced these cramps in my upper legs, but a few times I’ve had cramps in my calves.  When I mentioned this to Deb, she suggested I might have a magnesium deficiency, so I did a little research.  A magnesium deficiency can cause muscle cramps, but as I did more research, I became skeptical.

Foods high in magnesium include whole grains, green vegetables, nuts, beans, bananas and avocados.  These are all foods that I’ve been eating more of in the last year.  There are also several foods that can cause your body to lose magnesium.  These include carbonated beverages and caffeinated beverages.  In general, I’ve been consuming fewer of these.  If I didn’t have a magnesium deficiency a year ago, it seemed unlikely that I should now.

Although I was skeptical, I tried taking a magnesium supplement for a while to see if it would make a difference.   I eventually concluded that it didn’t.

As I learned about magnesium, I discovered that people taking calcium supplements need extra magnesium, because calcium affects your body’s ability to absorb calcium.  That got me thinking about calcium.  It plays an important role in the way muscle fibers function.  A calcium deficiency can cause all kinds of muscle symptoms, including cramps and soreness.

About a year ago, I started flirting with the idea of switching to a plant-based diet.  I’m more about moderation than absolutes, so I made gradual changes to my diet.  It wasn’t too hard to give up meat, since I didn’t eat much red meat to begin with.  That mostly meant giving up chicken.  Giving up dairy products was another matter entirely.

I live in a dairy state.  I grew up in the city, but my dad grew up on a farm.  I grew up drinking milk with most meals.  Most people have some degree of lactose intolerance.  I don’t.  I’m a descendant of Scandinavian immigrants.  My heritage includes generations of dairy farmers.

While giving up dairy products was a big deal, I was able to do it.  I still sometimes ate cheese when I was dining out, most notably on pizza.  At home, though, I eliminated dairy from my diet completely.  That was about a year ago.  Dairy products are good sources of calcium, so it seemed plausible that I was no longer getting enough calcium.  It also seemed to explain why my symptoms got worse in early August.  I was still getting dairy in my diet when I traveled, but in early August I was home for three weeks.

I made a point of adding some milk and cheese to my diet each day.  At first, it seemed to be making a difference.  After a few days, I noticed my nighttime cramps were less severe.  They never went away, however.  I also didn’t notice any real difference in the chronic stiffness in my legs.  I eventually concluded that calcium wasn’t the answer, but I’ll still pay attention to my calcium intake in the future.

There are other causes of muscle soreness, stiffness or cramps.  Muscle fatigue can be brought on by overuse.  I run a lot.  I race frequently, and conventional wisdom would suggest I need more than one week to fully recover from each marathon.  It certainly seemed plausible that my muscles were breaking down from overuse.  Still, there were problems with that explanation.

First, why did my symptoms get worse as I did less training?  Why did they peak when I had a three week break from racing?  Finally, why weren’t some muscles affected more than others?

The symptoms in my legs had an eerie symmetry.  There weren’t just one or two sore muscles.  All of the muscles in my upper legs seemed equally affected.  Also, both legs were affected equally.  When one leg felt fine, they both did.  When one leg was stiff or sore, they both were.  When one leg had nighttime cramps, they both did.

It was that bilateral symmetry that made me think it had to be a systemic problem, like a nutritional deficiency.  When that theory wasn’t panning out, I wondered if I had some type of strange degenerative disease.

Over the past few months, I’ve written quite a bit about my groin injuries.  I’ve alluded to the other symptoms, but haven’t had much to say.  In fact, the stiffness and cramps have been a bigger problem.  At times, they’re almost debilitating, and they’re having a bigger impact on my racing.  Life would be so much easier if I only had to worry about the injuries.

At times, I was tempted to see a doctor to find out what was wrong.  Two things were holding me back.  First, I would have felt awfully sheepish, since I haven’t recovered from the groin strain in my right leg, and I’m back to running marathons every weekend.  I also didn’t know if I’d have any symptoms when I went into the clinic.  I have good days and bad days.  As bad as I feel on some days, I sometimes have days when I feel fine.

I’m worst in the morning.  Before I can move, I need to gently flex the muscles in my legs.  Then, one leg at a time, I need to slowly bend and straighten my knees.  After exercising each leg while still lying in bed, I can finally get up.  Walking to another room is initially a chore.  I gradually loosen up, but not much.  Then, after taking a hot bath, I’m instantly cured.  It’s only temporary, but I feel good as new after a bath.  That was an important clue.

I also noticed that my problems seemed to be temperature related.  If I was in an air conditioned room, I got stiff after sitting for relatively short periods of time.  My symptoms were worse when my legs were cold.  I can’t sleep if I’m warm, so we keep the house cold at night.  My legs tend to get colder toward morning.  Not surprisingly, that’s when I stiffen up the most.

I tried sleeping with PJs on my legs, instead of just sleeping in my underwear.  I still had some stiffness and cramps, but my symptoms weren’t as severe.  Unfortunately, I couldn’t sleep all night that way.  I got too warm and started having trouble getting back to sleep.

When I started reintroducing dairy products into my diet, it happened to coincide with the nights I was sleeping in PJ bottoms.  I thought the calcium was helping, but it was actually keeping my legs warm that was helping.

That was the last piece of the puzzle.  I don’t know why it took so long, but I finally connected the dots.  I DO have a strange disease.  It’s not a degenerative disease.  It’s a circulatory disease.  I’ve had it all my life.

I have a vascular disorder called Raynaud’s Syndrome.   This is a condition that causes a loss of blood flow to the extremities when you get cold.  If I get cold, my hands turn white, almost immediately.  It’s kind of like this.

One of the characteristics of Raynaud’s Syndrome is that it’s symmetrical.  Both hands turn white at the same time.  It doesn’t matter if one hand is exposed to the cold and the other is covered.  They’re both affected.  This is why I’m so sensitive to cold and wet conditions in races.  I’ve lost track of the number of times in the last year alone that my hands went numb during a race.

When I was young, I had the same problem with my feet.  I can recall times when I started getting cold while I was outside on a winter day, and I couldn’t get warm, because I was away from home.  My feet often got painfully cold.  This is why I never took an interest in winter sports, despite living in Minnesota.

After I took up running, I stopped having problems with my feet.  I still had symptoms of Raynaud’s in my hands and arms, but I developed such good circulation in my legs and feet that my feet seemed to be cured.

It’s possible that my circulation is decreasing gradually with age, but I never noticed because I constantly generate good blood flow by running.  Why am I having symptoms now?  For the first time in several years, I’ve cut back significantly on training for more than a week or two.

I mentioned I have good days and bad days.  I’ve noticed recently, the good days are the days I run.  After a run, my legs feel normal for the rest of the day.  At night, I’m inactive for several hours and my legs cool down.  Then my symptoms return.

After the groin strain in my right leg, I cut back on running, but I started cross-training on a stationary bike.  During that time I was fine.  The first time I went several days without either running or cycling was after the Bighorn Mountain 100.  That’s when my symptoms started.  In July, I started noticing soreness in my groin, even riding the bike.  After noticing that on two consecutive days, I stopped doing the cycling workouts.  I never got back to them.  That’s when my symptoms got worse.

I’ve been both puzzled and frustrated with the way my marathon pace has deteriorated.  At first, I thought I was just getting out of shape, but I was surprised by how quickly my performance was dropping off.  More recently, I noticed that my race performances have been all over the board.  I think that’s a combination of two factors.  My overall cardiovascular fitness has declined, but that’s only part of the problem.  I also often start races with stiff legs.  While my overall fitness has declined a little, the blood flow to my legs has apparently declined more.

I never had symptoms in my legs as a child, but I’m starting to realize that what I’m experiencing now has come on gradually as I’ve aged.  For years, I’ve been a bit stiff when I first get up.  That’s the main reason I prefer to run in the afternoon.  If I’m going to run in the morning, I need to take a hot bath first to loosen up my legs.  On race days, I get up as early as I need to, so I can take a bath and do some stretching.

In recent years, I’ve been running more than ever.  May was the 13th consecutive month that I ran at least 200 miles.  On the days I didn’t run, I usually did some type of cross-training, even if it was only for 20 minutes.  Doing some activity every day generated enough blood flow to my legs that I didn’t notice any symptoms other than being a little bit stiff in the morning.  That seemed normal.

Do I know for sure that I have Raynaud’s Syndrome?  Yes.  I realized I had it when I was young, although I didn’t know what it was called.  Do I know for sure that it’s the cause of all my recent symptoms?  No, but everything adds up.  I expect I’ll be fine when I can resume daily activity, similar to what I was doing before my groin injury.  Unfortunately, I have to heal first.

I have a long road ahead of me.  In the short term, I’m still determined to finish my race schedule.  That’ll be 13 more weeks of races.  I probably won’t be able to heal from my injuries until my race season is over.  In the meantime, my training will still be limited.  When I eventually heal, I’ll be able to gradually return to a daily training schedule.  I’ll have a reduced training volume at first, but if I can do a short workout each day, I’ll hopefully have better circulation in my legs.

In the short term, I’ll still have the same stiffness, and I’ll still have nighttime cramps.  While that’s uncomfortable, at least I have a better understanding of what’s wrong with my legs.  Not knowing has been driving me crazy.  In recent weeks, I’ve had bouts of depression and anxiety.  I haven’t been very productive, and I’ve been irritable.  Hopefully, my mental state will improve now, even though my physical state is still the same.  Understanding is half the battle.

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