Iliac artery endofibrosis

Whether you’re a weekend cyclist or a high-level athlete, injuries spare no one. They make us sad and grumpy and each deserves an explanatory sheet using the 5W1H method. The idea behind this series of short articles is to better understand them, adopt the right behaviors to avoid them, and know what to do to recover better.

I propose to review each time, in the form of the “5W1H” (What, Who, Where, When, How, Why) and in as many articles as there are recurring injuries in cycling and triathlon, all possibilities of frustration linked to forced rest.

After the knee, the collarbone, saddle sores and back pain, today I offer you an explanatory sheet – still using the 5W1H approach – this time for endofibrosis, particularly of the iliac artery.

By Jean-François Tatard – Photos: Frédéric Poirier, wikimedia commons/Henry Gray, Flickr.com

WHAT?

Iliac artery endofibrosis is a condition that affects the external iliac artery, as its name suggests. Only a clinical examination can determine the circumstances of its onset and its symptomatology. The examination will assess the cyclist’s physical condition, training habits, training volume, and modifications related to various past or recent changes (change of bike, coach, methods, categories, region, organization, etc.).

Symptoms manifest as discomfort or pain during intense effort localized in one leg. This pain can extend from the thigh to the foot, and leaves a sensation of a numb leg, or overly tight bib shorts. This is a sign of arterial endofibrosis, more precisely a constriction of the iliac artery located in the groin area, which limits blood supply to the leg.

The iliac artery is located in a very mobile area at the flexion crease of the leg. When pedaling, the iliac artery bends and deforms. In some cases, this repetitive movement causes a thickening of the inner wall of the artery. This can be accompanied by a reduction in the internal diameter of the artery, known as stenosis.

WHO?

Did you miss the Pauline Ferrand-Prevot episode? Iliac endofibrosis is often found in male or female cyclists, and more notably in those who train at a high level, both in terms of volume and intensity. Nevertheless, even touring cyclists can be affected by this debilitating pathology. Other athletes besides cyclists can be affected, but it is rather rare.

WHERE?

It often happens at the back of the pack. As long as the pace isn’t too fast, it’s fine, but as soon as the speed and intensity of the effort increase, the cyclist gets dropped. This unusual situation is quite indicative of endofibrosis and helps to point towards this diagnosis.

WHEN?

The cyclist feels diminished and their results decline, especially when there are climbs on the course. Or when it’s about riding fast. In a time trial, for example, or at the end of a race. They are even unable to sprint. Since the onset circumstances are slow and progressive, and the pain doesn’t clearly manifest, a certain amount of time can pass between the subjective perception of the problem and the initiation of a specific assessment. Without preventing him from continuing his job (laboriously handicapped), former pro Boris Zimine, for example, took several years to understand the reason for this notorious weakness in his leg.

HOW?

The cyclist initially feels a sensation of a weaker leg compared to the contralateral side. A progressively more significant decrease in strength over time until, at some point, they have no choice but to notify their doctor because they are dropped every Sunday and it becomes unbearable.

Start by checking your posture. The pelvis, to begin with. Also check for any leg length discrepancy or plantar static disorder. The quality of venous return will also be checked. A systematic search for metabolic indices will be carried out. Another examination: arterial Doppler also falls within the scope of specialized angiologic examinations. The examination can be done at rest, but also during exertion. And finally, arteriography will complete the diagnosis before surgery. Because indeed for treatment: There are not 36 solutions! You have to do like Pauline Ferrand-Prevot and go under the knife. Surgical intervention is essential in case of confirmed pathology. Unless you decide to stop intensive training, and at the same time, high-level sport. Surgery consists of removing the partially blocked artery and replacing it with a vein. A heavy and complex operation.

A gradual return to sports activity generally occurs after four weeks of post-operative recovery. Cycling is not necessarily the first activity recommended for a gentle return, given the location of the injury. But you can quickly walk and swim before starting to ride quietly again. There are many examples of riders who underwent surgery in early autumn and were able to regain their full abilities in the middle of winter.

WHY?

A doctor’s interrogation, Colombo-style, will help trace family history. This clinical examination will also primarily look for an immediately perceptible vascular factor, with a very clear decrease in vascular signals in the affected leg. If the examination is good, it’s because you will have had an oscillometry, which would immediately point to the diagnosis.

CONCLUSION

In the next explanatory sheets, I propose to continue reviewing the injuries that most often paralyze us. We will thus see next time, head traumas, wrist pathologies, digestive pathologies, plantar fasciitis or otherwise called aponeurosis, Achilles tendonitis, periostitis, compartment syndrome, and pubalgia.

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