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Bilateral leg pain for almost a year!

I am a 31 year old male that has been experiencing bilateral leg pain for almost 10 months. Pain is mainly in thighs and calves. No weakness really, and no numbness. Some spasms... Usually okay if not walking or standing for an extended period of time, but will start to ache when doing so. Hot baths seem to help best.
Pain initially started the same day that I had a stomach bug. Not sure if it is a coincidence. I didn't really have a fever and the bug only lasted a day... Had a little arm soreness that lasted briefly but has subsided.
The only connection I have found was experiencing some rhabdo (high CK levels) a year and half ago after a very vigorous exercise session. I peed brown and went to the doctor. Took Advil and Tylenol. Pain was experienced in same parts of legs (thighs, calves) and I could hardly walk for a week. After that, I appeared to be fine (up until now).
Got EMG and long list of blood tests. have seen 2 specialists... All results were normal. If anyone has any suggestions I would really appreciate it. Thank you!
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Avatar universal
EMGs are usually useless.  I was told that after suffering through one.  Has anyone looked at your hips?  Your lower back?  That pain can radiate to your legs, and it will get worse if nothing is done about it.
Helpful - 0
1081992 tn?1389903637
Hi, Jmc, you can try:
(1) websearching for--> sequelae rhabdomyolysis
or --> chronic complications rhabdomyolysis
and maybe also throw in 'claudication' or 'revascularization' to try to find case studies
(2) I'd try taking bicarb before exercise or a long walk, just to see if acidic metabolites are involved
Helpful - 0
1 Comments
Thanks for the response...
Getting biopsy at the end of month...
Do you think I should be concerned about myopathy?
1081992 tn?1389903637
Jmc, nothing quite fits and that's why the cause hasn't been found yet - so let's speculate: after a little reflection, and as a shot in the dark, I'd guess that it's vascular. Just maybe, artery blockages in the legs are causing present claudication *and* that also contributed to creating the mild rhabdo. Your docs maybe never considered peripheral arterial disease, because you are too young.

A simple initial test is to compare blood pressure in the ankles to the arms (Ankle Brachial Index). You can ask any doc to do that, or even do it yourself if you borrow a BP cuff.

"Premature peripheral arterial disease – difficult diagnosis in very early presentation"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726566/


I'd also guess that genetic myopathy is the least likely, especially since there's no weakness.


Btw, there is a known association between viral illness and rhabdo. Maybe that's somehow related to how you had the stomach bug kicking off this new period of recurrent leg pain.
"Rhabdomyolysis Secondary to Influenza A Infection: A Case Report and Review of the Literature"
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382767/
Helpful - 0
973741 tn?1342342773
Do you take a cholesterol lowering medication, Jmc2835? Were you dehydrated when the initial situation happened?  I know there are a host of reasons for why someone would develop rhabdo but it is  rare. And if there is an underlying reason for why you developed it (like diabetes or some other chronic issue), then you'd be more prone to it recurring.   That is scary you got it and would wonder the source. Rhabdo can do permanent damage.  I have read that it can recur (the bouts of pain) years after the onset.  What are you getting a biopsy of?
Helpful - 0
2 Comments
Hi, SM. He hasn't mentioned dark urine over the past 10 months. Also, after 10 months of pain episodes, I'm guessing he today would have impaired kidney function if he was having recurrent rhabdo all that time. He also hasn't mentioned any kidney damage from his known rhabdo episode, which is why I'd said it was mild.

He hasn't mentioned an Fx of early CVD or hypercholesterolemia - but you're of course right: it wouldn't hurt to get a cholesterol panel nevertheless. Unless that was already done in his "long list of blood tests" that might or might not have included Lp(a), Hcy, and all the rest.
My main familiarity with rhabdo came from someone taking a statin medication which is the rare but serious side effect they can cause and why they (statins) are monitored closely when patients take them (well, one of the reasons).  https://www.aafp.org/afp/2011/0315/p711.html  So, was just curious if his rhabdo was in any way associated with that but assume not and they'd have stopped it immediately if he were takign a statin.  Yes, I guess it would make sense they've monitored him and he has no kidney issues or issues with his blood work now showing up. I do think though that you read about people that after rhabdo have chronic pain situations that take a good long time to go away.  But obviously I am no expert and am just giving anecdotal information which isn't worth more than the words I type if you know what I mean.  But I am curious what exactly the biopsy will be of.
1081992 tn?1389903637
"people that after rhabdo have chronic pain situations that take a good long time to go away."
But then there is the fact that he had ~8 months symptom free after the rhabdo. That's why I was thinking that the current 10 mos. pain didn't result from the rhabdo, but that maybe both the rhabdo and the seeming claudication are from the same cause.

"...which isn't worth more than the words I type if you know what I mean"
No, no... not at all. To the contrary, thanks for going back and forth on this, SM. MH could use more of that kind of thing, in a respectful think-tank kind of way. So please do more :)

"But I am curious what exactly the biopsy will be of."
Since he mentioned myopathy, I'd guess it will be several cores taken from areas of the thighs that have the pain. 'Several' because they wouldn't want to miss by taking just one (just like with FNA), and 'thigh' because it would seem wrong to do the calf - which is more stressed afterward in plain walking.
Helpful - 0
1 Comments
Hello! Thanks so much for your response. Yes, the rhabdo did go away. I believe it was on the milder side (didn't go to hospital and only peed brown once or twice). Quite painful though at the time! I was dehydrated and did a Soul Cycle class... bad idea.
This is less painful by far and only really seems to badly flare after too much exercise. Sometimes a burning feeling. The heat really helps this situation!
Right now the pain after walking is more around the knee than the thigh and calf. But initially it was thigh and calf. Has became a major issue!

Recently I've had a little arm soreness too. Not sure if related or anxiety.
Hopefully I'll get some answers soon!

The doctor wants to do a biopsy on my thigh...
I'm a little hesitant but it just seems odd to have lasted this long.
Maybe I should try something else first?

1081992 tn?1389903637
[The system seems to have mangled my last reply, let me try again.]
"Maybe I should try something else first?"
Sure, the bicarb, and the Ankle Brachial Index and cholesterol panel. They can also feel for pulses in the lower legs. But since you probably mean: to directly look at the muscle instead of having a biopsy? I don't know, besides possibly MRI.

Maybe your doc mostly wants to rule out something bad like a muscular dystrophy. If the biopsy is negative, you are back where you started. After all, most muscle biopsies are seemingly done to investigate problems with muscle activation, not with pain alone.

You do say, "Right now the pain after walking is more around the knee than the thigh and calf. But initially it was thigh and calf" - so maybe it's time to wait and see, if the muscle is indeed getting better.

Here's a vid showing a Muscle Biopsy:
https://www.youtube.com/watch?v=uMItkkbXUD0


What if we disregard the rhabdo? Here's a DDx for exertional leg pain:
https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/JFP06510672_t1.JPG
Note 'arterial endofibrosis' which is blockage without plaque (not uncommon in cyclists); but that's unilateral and is not sudden onset.


Come to think of it, let's maybe change having the Ankle Brachial Index done after you exert and have the pain... AND ask them to do a blood draw from a leg vein then, too. The muscle state might be different then. How's that sound?
Helpful - 0
2 Comments
Thanks! Will do!
Basically the neuromuscular doctor seemed stumped and said the next step of diagnosis would be a biopsy. Said perhaps it's something in my diet...
I'll give the bicarp a shot. The Ankle Brachial Index is interesting...I didn't think of that. Neither did the docs!
Hopefully this will be resolved soon!

I would like to add that I also have a recurring yearning to stretch...
Since this started, I haven't been completely normal...i would say a pain/uneasiness of 2-3/10...
When flared pain/uneasiness increases to about a 7 I would say.
A couple times after exerting a lot of energy (through walking or sports), the legs have felt almost jelly like. Not a common feeling though...
Stairs hurt as well... Although I never feel weak... apart from the jelly like feelings a couple times
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