At Zero Pred for a bit more than a year - and a false alarm

[Boss302Fan]

So, ever since I got diagnosed with PMR I always wondered what was the cause. Seems nobody knows so leaves plenty of room to speculate. Has any interviews been conducted and studied for the presence of commonalities?

Years ago, pre-retirement our company promoted a healthy lifestyle and presented the best nutritional diets (Mediterranean still wins) and subsidizing memberships to the local Nautilus Gym, like a 40% discount! I still remember my first appointment when this very fit, shapely woman came over and took my BP, measured me for BMI, weight and muscular build and coming up with a program that focused on build up of muscle mass in some areas and toning in others. The one thing that stuck was told not to focus on the same muscle groups each day. More important if using dead weights. Muscle builds by stressing and tearing muscle fibers and some healing time is necessary. So, it got me to thinking…what if…one abused the same muscle groups for 6 hours a day, 3 days in a row? Could enough damage be done to skeletal muscles to cause severe inflammation and a self perpetuating cytokine storm? Forgive my ignorance as it’s been almost 50 years since I cracked open a Grey’s Anatomy textbook (no nothing to do with the TV series) and studied Human Anatomy & Physiology. But…what if? In my case I had spent 3 days under my car removing OEM parts and replacing with better(?) aftermarket parts and doing alignments. So, 2 foot crawl space and I’m repeatedly sliding around (not using a creeper), getting out from under standing, walking, going back under, repeat. I wonder, prior to others’ first symptoms had they been doing a bit of repeated exhaustion of skeletal muscles causing a bit of repeated excessive Lactic acid build up?

So, what got me back on this kick, and fortunately a false alarm? This past week my wife and I went on vacation. Did a LOT of walking, more walking than I probably do in a month and I’m not exaggerating. Well, on day 2 of our walking excursions I felt something I hadn’t felt in a year, an ache in the back of my hams and I’m like, “Oh Crap!” So, found a bench, sat down and relaxed for about 5 minutes, discomfort abated. Ok, that’s not like PMR at all, but I told my wife I was going to be taking frequent breaks (we were at the beach and visiting various small towns so plenty of “park” benches around). So instead of accompanying her into every store I took a break. By the end of each day, I still felt some fatigue in my legs and ankles, but after a break, I could go about 15-20 minutes before the ache reappeared. Next day, no pain (that was different than what I experienced leading up to my PMR ER visit), and during the subsequent day same process. By day 3, I could go quite a while before some discomfort and taking a break. Was I ever relieved!

So what’s my point? Well, 1) I wonder if repeated excessive muscle abuse can lead to PMR and 2) normal muscle fatigue can feel like the beginning of a PMR flare. The only difference is usually a few days after intense workout normal muscle fatigue starts to abate, and rest helps alleviate the pain, with PMR it’s the opposite, rest seems to make it worse and walking reduces the pain. Ignore this observation and the muscle fatigue discomfort will keep getting worse each day until the morning pain is so intense it exceeds one’s tolerance threshold.

No, I didn’t reach for the Pred. But when I got back to the hotel I did take some Ibuprofen!

[PMRpro Ambassador]

We do talk a lot on the forum about DOMS - delayed onset muscle soreness. How it is caused exactly as you describe but if you have PMR it doesn't heal/achieve the training effect in the same way. And that DOMS will usually fade after a few days, a PMR flare will grow. But in some people with PMR, a really bad DOMS may take weeks if not months to resolve - so it is better not to risk that and take it much easier with exercise.tasks in the first place.

I'm not sure that overdoing it can CAUSE PMR, although there are doctors who have postulated it, I had had mild symptoms for a few months, nothing major, couldn't sleep with my arms above my head, step classes were getting harder, Then I did a full day circular hike at about 2000m - and that wasn't JUST DOMS, it was more than that, and soon after Christmas I had proper PMR symptoms. And for another 4 years sought a diagnosis. I'm pretty sure that if you are on the cusp - that sort of thing can tip you over the edge,

[PMRnewbie2017]

I can relate to some of what you say. For four months I thought the discomfort in my thighs was DOMS. I am very active. It would improve slightly, then deteriorate. A dose of Ibuprofen at bedtime would cure it and I'd waken with no symptoms. The stiffness in my quads would start at 4pm almost on the dot!?!?. Only when my shoulders joined in and I suddenly had that odd feeling of PMR sickness which is hard for me to describe did i realise that I had overshot my ideal dose and inflammation was rising. Now I'm stable again,for me there is definitely a difference between PMR twinges and too much gardening twinges.

[Toolie2]

I was interested in your description of working on / under your car for three days before the onset of PMR. I don't have PMR, but I do have GCA. It manifested itself after I had spent three days cleaning our little balcony, bending, moving heavy plants, scrubbing the decking on hands and knees, moving things back and cleaning a bit more. Similar to the sort of exercise you did. On the third day, I noticed little misty blobs appearing and disappearing in my left eye. By the evening, they weren't disappearing. I had a bit of a headache across my forehead, but not enough to bother with painkillers. The next day I went to the eye hospital and was diagnosed with GCA, although there was doubt because of my lack of symptoms – apart from loss of vision in my left eye!

I thought for a long time that all the bending down had something to do with it, but Dorset Lady convinced me otherwise. I don't know if this fits in with your theory, but obviously, three days exertion is too much!

[Twopies]

All I can say is when pmr hit, I was in the best shape I had been in in years—walking 10,000 steps a day, doing physio exercises as prescribed and loving my new body (well, within reason, you understand). Then: pmr. With a vengeance. I’m not saying the exercise/movement brought it on, I’m just saying that for me, there was some kind of relationship.

[marionofnorwich]

Just replying out of curiosity not because I really have an intelligent or well-informed reply. I think something else has to be going on, not just repeated use of muscles as we have probably all over-used our muscles in some way without it resulting in PMR so it must be some other factor that triggers PMR I would have thought. I think we have all wondered what started our PMR, I doubt we will ever know...

[Boss302Fan in reply to marionofnorwich]

You may be correct, I don’t know and if there is any credence to my thought I’m thinking it would be age and lifestyle related. I’m think being sedentary and suddenly doing intense physical exertion of the same muscle groups resulting in a buildup of muscular damage. I was retired for 2.5 years and prior, both my horses died and I exited the hobby, replacing it with a low activity lifestyle. Prior I also was an avid water skier (3x per week May-Nov) & snow skier in the off season plus trail riding year round with jousting during the summer.

During my “Active” lifestyle my best friend and I signed up a year before attending week long class at a tournament water ski school near Orlando, FL. During this year we took 3, 1 hr high impact Aerobic classes each week plus weight lifting and jogging 2 miles a day. Even with all that the day after our first day on the water we were so stiff and in pain we told our instructor we wouldn’t be able to ski, and he said unacceptable that the worse thing we could do is not get back on the water. So we had to help each other get into our wet suits. The instructor had us do an extra 30 minutes of stretching exercises. By day’s end it wasn’t too bad and by day 3 the stiffness was almost gone. In my life I had never experienced that level of ache before. Sure, each Spring after our first outing we’d get a little stiff the next day, but not like that!

So, like I said out of the blue I decided to do significant changes to my car, 3 full days of effort. Next day, was a little stiff - to be expected and it was gone within a few feet of getting up and walking. Day 2 after another day of working - same deal a little bit worse. Again, not used to it, 2 days in a row of work, again, dissipated quickly. Day 3 same deal. But after 3 days of work I was done so expected the stiffness and pain to lessen, but it didn’t, it started getting worse! I took 600 mg Ibuprofen and 1,000 mg Acetaminophen and it didn’t make a dent! Very unusual.

So, I was perfectly fine leading up to getting diagnosed with PMR. Symptoms didn’t hit until after spent a few days doing intense work under my car. Coincidence? Maybe, but maybe not.🤷🏼‍♂️ I know intense workout causes some muscle damage with inflammation, which is an immune response. Is it far-fetched to think that extreme exercise of same muscle groups, not used to that level of use, wouldn’t result in significantly more muscular damage and inflammation than would normally occur if I was still active and fit?

Don’t know, but now I pay attention to what I’m doing and stop or rest a bit before continuing. I’m assuming I may be correct. Better to be conservative and not risk it.

[PMRpro Ambassador in reply to marionofnorwich]

As I said in my reply above, some experts think there is a possibility over exertion can be the final trigger. We say over and over again there is likely to be no single cause of the immune system going haywire - genetics also plays a critical role together with the person's entire medical history.

[marionofnorwich]

Sounds again, like a mixture, not least the trauma (I am assuming here) of losing two horses. I link my PMR journey to a period of stress some years before it started and then a trip to Finland a year or so before when I returned with a virus and then inflamed tooth and gums all of which affected my sinuses - tooth was removed and things improved a bit. But nothing was ever the same after that so in hindsight I think that the stress combined with the extra inflammation from infection and post-viral created a perfect storm. Who knows? Doubt I ever will!