Iliac Artery Circulation Issues

I think I’ve alluded a few times to my leg, and dealing with excessive leg pain while riding, but I don’t think I’ve actually explained what the deal is. Partly that’s because I’m still not 100% sure myself, and partly because it’s hard to describe. But I am going to be trying not aggressively to figure out for sure what’s going on and, if I’m really lucky, find a treatment. I imagine I’ll talk about that journey here, so this post is the prologue.

Once upon a time, in April 2016 to be exact, I went out one day after work and did some very, very vigorous hill repeats. The hill was steep and I attacked each repeat with the ferocity of a rabid squirrel.

Towards the end, my left leg really started feeling fatigued, much more than the right. But I pushed on through, because that’s the point of intervals. If they don’t hurt, you’re doing them wrong.

I rode home and thought no more about it. I’d recover and move on with my training.

But my left leg didn’t recover fully. It still felt fatigued long after the right leg had gotten back to feeling fresh and ready to go. When I tried to do a hard effort, the left leg started giving out sooner.

One day, that winter, I was riding in a group up a hill. I have historically done well on hills, spinning up even fairly steep hills thanks to my beneficial power to weight ratio. But that day my left leg suddenly gave way: It went from tolerable effort feeling to excruciating, agonizing fatigue feeling in a moment. My leg burned, not a cramping burn, but the burn of pushing super hard, but beyond anything I’d ever felt.

I stopped. I’ve never stopped on that or any other hill, but I couldn’t continue. After a moment I limped on, but it hurt so much I was crying as I slowly crept up to the top.

My leg has never been the same since then. When I’m fitter or better rested, the fatigue sometimes takes longer to hit; when I’m less fit or start a ride more fatigued, it takes almost no time at all.

Training for the Levi’s Gran Fondo, every training ride was just a matter of time until my leg gave out. Whenever I tried to put out a lot of power — BAM. Whenever I tried to do long, aerobic spinning — BAM. It felt crippling at times, and I wasn’t even sure I’d be able to do the Gran Fondo.

I went to Dan Druckhammer, a cycling coach and PT I have many years of experience with. He did some tests and research and eventually diagnosed me with iliac artery compression.

This happens to 10% – 15% of cyclists who ride a lot over many years. There are various causes — a torturously long atrery, thickening of the wall at the bend near the hip joint — but the result is that the artery that carries blood to the quad and calf muscles is restricted. Less blood gets to those muscles. They recover more slowly and fatigue more quickly due to oxygen deprivation.

The only treatment at this time is arterial surgery. Professional cyclists sometimes get this condition, and some of them have the surgery with good outcomes… But at least one pro cyclist died from internal bleeding while on a ride after having the surgery. It’s a big artery and surgery is dangerous. Some pros choose to give up riding rather than take the risk.

Meanwhile, Dan has given me some stretching, to facilitate blood flow as much as possible, and some exercises to strengthen my glutes and hamstrings, which aren’t impacted by this circulation issue. I stand to climb hills now, when I very rarely did before, because standing uses those alternative muscles more.

But, to be honest, although I’ve religiously followed his suggestions, things aren’t any better. It feels almost random, that some days I’ll have an okay ride with mild pain, and other days it will cripple me. Lately it’s been more of the latter, and I cannot understand why.

I’m starting to feel really discouraged. What if this ends my cycling?

Before I give up, I’m going to get a referral to a sports medicine doctor to absolutely confirm the problem, and see if there’s anything else to be done. I’m not hopeful, but I’m also not ready to give up yet.

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