Your iliac artery supplies blood, and therefore oxygen, to the muscles in your leg. Due to the bent position on the bike or in the skating posture, combined with the large number of revolutions your leg makes, the iliac artery can repeatedly develop a “kink.”

You can compare it to a garden hose: if you bend it, less water flows through and the flow speed increases. During heavy exercise, this results in an insufficient blood supply. Over time, this repeated kinking can even lead to damage to the artery.

Poor blood flow in the artery causes a lack of oxygen in the leg muscles, leading to the feeling of quicker fatigue or “burning.” You may notice symptoms such as loss of strength and pain in the leg muscles. Often, one leg is more affected than the other, which is characteristic, the sense of fatigue or burning develops sooner in one leg. The symptoms almost always disappear within a few minutes of rest, and can typically be triggered again within minutes when cycling above your “symptom threshold.” Unlike a simple muscle injury, the symptoms are usually not limited to one specific muscle but involve multiple muscles.

These symptoms are typical of a vascular problem. However, they can also be caused by many other conditions. It is therefore important to determine what is truly going on and what the best approach is. A vascular issue is usually not the first thing a healthcare professional considers in otherwise healthy athletes with these symptoms.

For this reason, a self-check has been developed to help athletes and healthcare providers estimate the likelihood of an iliac artery problem and identify the best next steps.

On average, an athlete with a vascular problem has cycled around 45,000 km with symptoms and consulted multiple healthcare providers before the correct diagnosis is made. That’s unfortunate, because the longer you wait to take action, the greater the chance of permanent arterial damage.

With early recognition, adjustments to your sport, posture, or equipment (for example, your bike) can be an effective solution, and in some cases a less invasive surgical procedure may be sufficient.

• Fewer training hours.
• A less aggressive, more upright cycling position (raise the handlebars, move the saddle forward, use shorter cranks).
• Using a different type of bike (hybrid/city bike, possibly with butterfly handlebars); avoid pulling on the pedals, use a pushing motion only.
• Skating in a more upright position; during the swing phase, make a larger arc so the hip extends more.
• In athletes with leg symptoms suspicious for a vascular problem, it is important to determine whether a vascular issue is present. If so, appropriate measures should be taken to prevent progression and/or to consider surgical treatment.

Adjusting training to reduce symptoms
Training can be modified so that symptoms are triggered less often. This can be done by performing endurance training below your symptom threshold. Short interval sessions are also possible, such as 30–60 seconds of high intensity followed by about 30 seconds of rest, repeated in sets of 5–10.

Interval training with intervals lasting 3 to 15 minutes is discouraged, as this type of training most often provokes symptoms.
Adjusting your training can significantly reduce symptoms. Exercising with a vascular problem above the pain threshold can cause substantial overuse symptoms in the leg that may last for several days.

Increasing the hip angle during exercise
A more open hip angle can help reduce compression of the iliac artery.

Stopping the sport that causes the symptoms
In some cases, it may be necessary to stop the specific sport that triggers the problem.

These measures naturally have a major impact on your athletic activities. If no vascular problem is present, they are likely unnecessary.
Therefore, complete the self-check and, if needed, have your symptoms evaluated by one of our healthcare professional to determine the best approach for your situation.

• If adjusting posture or equipment is not sufficient — and the compression is very severe — surgery may be an option.
• In the early stages of vascular problems, the iliac artery is surgically released from the underlying tissues.
• In later stages, a more extensive vascular reconstruction may be required. This means that the artery is not only freed, but also repaired. If the iliac artery has become too long, it can be shortened. If scar tissue has formed inside the artery, it can be widened by inserting a vein patch taken from the leg. These vascular reconstructions carry greater risks.

Both the diagnostic process and the surgical treatment of these vascular problems require highly specialized expertise. We are therefore the only center with a top-clinical expertise designation for this condition.