Former World Champ Pauline Ferrand-Prevot Reveals Iliac Artery Endofibrosis Diagnosis

Dec 13, 2018
by Mike Levy  
Pauline Ferrand Prevot gave it her all and showed a glimpse of a return to her pace with a battling 15th place.

Multi-discipline champion Pauline Ferrand-Prevot revealed on her Instagram and Facebook pages yesterday that she's been diagnosed with iliac artery endofibrosis, a painful condition that's generally not common but also isn't unheard of among endurance athletes. The condition is affecting both of her legs and will require surgery, with Ferrand-Prevot expecting to be on the sidelines for around four months. You can see her full Instagram post below.

Ferrand-Prevot is a powerhouse in mountain, cyclocross, and road circles, having been the first athlete (male or female) to be a World Champion in all three disciplines simultaneously. Her 2014 and 2015 seasons were phenomenal, but injuries over the more recent years have slowed her down some, especially a tibial fracture that put a damper on her 2016 Olympics.

Pauline Ferrand-Prevot is back with a vengeance. The French rider took the lead in the race but ultimately had to let Langvad go.
Pauline Ferrand-Prevot seems to be getting back to her old self. She finished in 15th today.

By the sounds of it, Ferrand-Prevot had been struggling to diagnose her issues, and a quick Google search reveals that IAE is often misdiagnosed or missed completely. A big reason for that is that vascular problems aren't often suspected in fit athletes, even though high blood flow, repetitive hip flexing, and an athlete's position on the bike are all known factors. The result is damage to the layers of the artery wall and decreased blood flow throughout the legs that can translate to unprecedented weakness.

You can no doubt see how that would be an issue for an elite cyclist, and although Ferrand-Prevot has had some impressive results during the past year (including 2nd at the European cross-country Championships, four World Cup podiums, and a National cyclocross championship win), she hasn't been able to ride to her full potential.

IAE hits each person differently, but what can Ferrand-Prevot expect in the future? A fifteen-year-long study by three Stanford University MDs in 2016 looked at eighteen patients between 2000 and 2015 who underwent operative intervention, with all of them being high-performance endurance cyclists, triathletes, and long-distance runners. Here's what the paper had to say: ''Primary patency was 93% at one year and 82% at latest follow-up. Whereas 82% of patients were able to return to their prior level of physical endurance, in a long-term follow-up survey, 50% of these patients experienced some recurrence of symptoms.''

Although she could be dealing with some symptoms down the road, it sounds like there's a good chance that Ferrand-Prevot will return to full strength. Here's hoping that's exactly what happens.

Must Read This Week


  • 45 0
 I'm sure the most painful part for her has been having three years of her peak fitness racing years wasted on a misdiagnosis - it all started after her triple discipline World Champion stint. Here's to hoping she can get back to the top step, because women's racing is as exciting as it's ever been.
  • 15 0
 Courage Pauline ! Tu vas revenir plus forte que jamais !!!
  • 13 2
 Well fuck. I get dead leg in my left leg and hip every time I ride these days and it hurts at night. Sometimes I can't even stand on it. As well I have been way too short of breath and sweaty after small runs, even at Northstar on the blue runs. Guess I'm going to the doctors, right now. Damn it.
  • 6 0
 I honestly want to hear how you go. Good luck man.
  • 18 0
 Totally agree with seeing a doctor but it doesn’t sound like IAE. Typically issues with the arteries will cause pain/cramping with exertion but not at rest/when sleeping unless it’s very severe. My hunch is that it’s a nerve getting compressed/pinched somewhere like your back or hip. As for getting short of breath and sweaty, those are probably unrelated but definitely worth getting checked.

FWIW I’m a vascular surgeon in the army, and I see a lot of the rarer things that affect young people—soldiers are professional athletes in many ways, so there’s some definite overlap. I hope you can get to a quick and accurate diagnosis and effective treatment soon. I’ve dealt with my own issues that have kept me off the bike and it just sucks.
  • 4 0
 @DrPete: Thank you for the information. You are also correct. I just found out my left leg is shorter than my right leg and that it's effected everything from the base of my neck, my back, glutes, hip, knee and ankle on my left side.

As well, the fatigue and shortness of breath, sweating too much were from not being in great shape. I didn't realize how much I was sitting and assumed that all the hike a bike to get my DH rig up mountains was enough exercise. Sadly it is not. It makes sense that it really showed up riding more park this year.

Thank you for the information and reassurance, and I wish you luck in dealing with anything and everything keeping you from riding.
  • 4 0
 @patrickbatemanworldtour89: glad to hear it’s getting evaluated... as for me I’ve managed to avoid any new injuries so the only thing keeping me off the bike is the insanity of work/kids/etc. Good problems to have though. Smile Good luck getting back at it!
  • 3 0
 @patrickbatemanworldtour89: I have a 15mm leg discrepancy, I had knee pein for 3 years because my saddle was setup based on the short leg, and consequently the long leg had to find some room, so it was moving slightly outward at each pedal stroke, pulling slightly on the patella, creating an inflammation.
I had a physio look at me pedalling on the bike and he quickly noticed the problem, but he was afraid not much could be done.
So I bought 2 different cranks (170 & 175mm) and 2 different pedals (20mm Xpedo Detox and 11mm Xpedo spry) to compensate the leg discrepancy, and haven't had pain ever since.
Of course it depends were the size difference is, mine is on the femur.
It probably also wasted a lot of energy.

I also have orthopedic soles in my shoes, and I can clearly feel when I don't have them, I lose my balance very easily.
Though I feel my left leg is always more tired/tight, as it gets more weight on it, and my left foot is one size longer.
  • 1 0
 That sounds also like a bulging disc in your back
  • 1 0
 @Will-narayan: Yeah apparently the way I walk I constantly slam my short leg into the ground, then when I'm standing my short leg is doing all the work. Add to that the fact that, as you well know, your pelvic bone is tilted standing so your back is effected and possibly everything up to the base of your skull...

15mm sounds like a lot! My physio thinks a good insole and better body awareness/form will fix it. Creative solution too, with the different sized cranks and pedals.

On the plus side, great to find a potential solution to so many aches and pains that doesn't involve surgery or pain killers. Glad to hear you could take care of the knee pain!

Also, feel like kind of a dick because my comment was classic pinkbike: almost nothing to do with the article. It's not about me!

Pauline Ferrand-Prevot good luck, I hope you sail through this challenge and get back to full health, sounds like a scary situation and we're all rooting for you. I hope the specialist has answers and you can make a concrete plan to move forward.
  • 8 1
 Crazy for such a high level athlete.

She is the only professional cyclist(male or female) to hold 3 rainbow jerseys in Road, XC, and CX all at the same time.
  • 3 0
 It’s not a super well understood disease but the thought is that it’s the result of extreme amounts of time in the saddle in a low/aggressive position. It’s extremely rare but the fact that she is such an elite cyclist actually increases her risk for it. We mere mortals don’t ride enough to get it.
  • 7 0 she's been killing it for the last 3 years with 70% of one leg.

That's an amazing threshold of pain and I hope she gets both legs 100% soon!
  • 1 0
 If I were the other women in the events she enters...I would be concerned. If she is always at the front of the pack with diminished leg strength/feeling capacity (70%)...Uhhh, where is she going to be in the pack when she comes back at 100%???

Maybe she might get bad coaching that make it easier on the other women in 2019. Oh yeah, she dating Julian Absalon so thats a negative on the bad coaching.
  • 2 0
 My brother had a variant of this condition, and surgical side-effects killed him. He would have been better off if we had not let the vascular surgeon carve him up. His last 6 months of life were pure misery.
  • 5 5
 The human body is such a flawed design, it functions at acceptable levels for several decades at most. If one is lucky that is.
  • 27 1
 Yeah we should ask for a refund
  • 4 0
 @freerabbit: Where can i file a warranty claim?
  • 1 0
 @hirvi: It seems we have to manage with DIY repairs.
  • 4 0
 If human survival had depended on being the fastest cyclist for a couple million years we'd be way better evolved to ride bikes... So we can blame the bike industry for not inventing the bicycle sooner.
  • 1 0
 Get fixed, heal up and get back on that bike girl!
  • 1 0
 Ouch! Sending healing vibes...
  • 1 0
 Wishing PFP the best health!
  • 1 0
 Dang just found this out. Hope to see her back out there soon.
  • 4 6
 press f
  • 9 5
 uck the police
  • 1 1
 @js11 don't mind colin. I'm with you.


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