It took years for a doctor to finally arrive at the diagnosis of iliac artery endofibrosis for Roy, years of being held back, below her best and with only the nagging suspicion that something wasn’t quite right.
At the end of 2019, she went into surgery to correct the issue and has been in a process of steady rehabilitation since.
Roy is set to receive a late call-up for the Herald Sun Tour - after Jessica Allen, Grace Brown and Georgia Williams pulled out with injury - which will see her 2020 racing debut brought forward slightly, three weeks ahead of a scheduled return.
The 33-year-old talked Cycling Central through her difficult experiences.
“While the last season wasn’t a disaster,” Roy said.
“I did know that I had more in me and I’ve felt like that for the last three or four years. Sometimes, I’d get some nice top 10s or on the podium and on the outside I’d be really happy, but on the inside I was wondering if this was all I could do.”
Roy was right - far from being a disaster, she took a win in the Clasica Navarra and performed ably as a teammate in a number of Mitchelton-Scott’s big wins of the season.
Within her own body however, things weren’t nearly as positive.
“It got to the point last year where my legs would go completely numb from the waist down,” she said.
“Completely numb. That intense feeling would only last for a minute at a time, and there were probably only five times in total when it was that bad.
“It was a complete dead leg, like when you’ve been lying on your arm for awhile and go to pick up – I’m in front of the TV at the moment – the remote. You can see your hand touching it, but can’t feel it.
“My feet were feeling really fluffy and I had to say to myself ‘my bum is on the seat, my feet are clipped in, I’m not going to fall off’ and wait for it to pass. That was when I knew it wasn’t me being soft, a mental thing, low-iron, over-training or not enough recovery.”
Roy’s scary experience was enough to realise once and for all that there was a major problem, and with riders like Pauline Ferrand-Prevot sharing their own history with the condition on social media channels, Roy was able to recognise her own symptoms in the descriptions of others.
“I did some research and I really thought that I had this condition,” Roy said.
“The first doctor … they did a blood flow test at rest on the table and said that I didn’t have it.
“I didn’t trust that diagnosis, I spoke to one of our team doctors who’s really keyed in on this area and he said ‘I don’t think you have it. Your symptoms aren’t consistent with it’. I did manage to get a test set up, it cost €1000, a flight, accommodation and car hire.
“While everyone was at altitude preparing for the world championships, I was faffing about on a treadmill as I couldn’t take my bike with me. I said to the doctor that I just needed to rule it out for peace of mind and then they diagnosed me with it.”
It sounds easy when put as plainly as that, but this was a long process of fighting through other’s opinions, self-doubt and the view that maybe the Sydneysider had simply reached the peak of her abilities.
“When you’re told something enough you start to believe it and at times I was really unsure,” she said.
“The symptoms are so vague and that’s what makes it really hard, it’s really similar to training hard and having sore legs, that’s cycling. Me coming back from training and saying that I’m dead, my legs hurt so much and I feel really lactic, that’s not going to alarm anybody.
“I think it’s pretty common for people with this condition to be mis-diagnosed for years, until they get to the final answer. For me, it got to the stage where my legs were so bad that I had to push and piss people off, get second opinions and trust my instinct.
“In the early process, back in the middle of the year, I was at my wits' end. I just felt so certain about this, I’d actually gone back over comments in my training diary and I’d literally written down that there was no oxygen getting to my legs … years ago.”
The condition of iliac artery endofibrosis is a relatively common one for cyclists compared to the general population at large, but women are generally regarded to be less susceptible than men.
Roy was also presenting with symptoms in both legs, when normally one is affected much worse than the other.
“They could only operate on one leg at a time as it is such an intense operation, so we had to work out which leg to do,” Roy said.
“After getting MRIs and scans done, they asked me to go away on the bike and figure out which leg hurt more.
"There was only a slight difference that I could really notice, but at the end of the day the left leg artery had a massive kink in it, an aneurysm (bulge in the artery which can lead to blood clots) in it and a stenosis (vascular narrowing within the leg).
“Whereas my right leg had mild indications that there might be some endofibrosis in there, but otherwise it was pathologically fine.
"The specialists said often they find that when there are symptoms in both legs, they operate on one leg and the symptoms for both legs sort themselves out.
"The other leg will often (during the other leg’s condition) then produce the symptoms as over-compensation, especially if you’ve had it for a few years like me.”
Roy underwent the surgery, with the operation taking nearly twice as long as initially indicated, meaning that recovery from the invasive procedure would also be lengthened.
Time off the bike was increased, time to effectively be able to do anything was increased and any sign of pain meant that the 33-year-old would have to shut down immediately to avoid stitches being pulled and muscle tissue tearing.
It’s been a long road, but Roy identifies herself as a fighter, keen to overcome the difficulties to make her comeback, possibly to the best condition of her career.
“If you look at the way I became a pro cyclist, I did it all on my own, going to Europe by myself,” she said.
“I guess it’s in my personality to fight. I was lucky to have the support of my team, coach and people back home.”
“I’m not going to lie, it’s been pretty difficult. From the outside you appear fine. Walking into the gym when I first arrived back in Australia, my trainer gave me this programme and I couldn’t do any of it.
"People didn’t realise how stripped down I was from being a fit and healthy athlete and it was a bit of a shock for everyone.”
Detailing her recovery on social media in the midst of searching for any and all women’s cycling news, to keep her in touch, Roy found the difficulties of taking the rehabilitation process slowly difficult.
“It was quite frustrating,” Roy said.
“I’d have this energy and then I’d go for a walk on the beach and pull up super sore. I was like ‘are you serious’? I couldn’t even walk on the sand because it was an uneven surface.
“At the time, I felt I might as well be in a full body brace. It was only six weeks like that. I got myself involved in activities and charity events to keep myself busy.”
Now back riding for almost two months, Roy is going well and dreaming of the next step - despite the blockage of her old condition there to impede her.
“Getting back on the bike, things have gone quickly,” she said.
“It’s been seven weeks now and I had a test at NSWIS (New South Wales Institute of Sport) and the level was similar stuff as the last time I had a test, just before the Commonwealth Games (January 2018).
"So I’m there, it just a matter of getting the good feelings back, maintaining that and hopefully going to another level, that’s the goal.”
The only question that now remains is what is the limit for this new and improved version of Sarah Roy, star athlete?
“I think everything across the board will improve,” she said.
“But with being the type of rider I am, I’ll have more of the top-end stuff and being able to repeat it and recover and go again.
“Often what I found in the races where I wasn’t going as well as I wanted was when it got really intense I’d drop off, fall back into the second group and then I’d recover.
"That’s a textbook description of the condition, where going above threshold you get that burning sensation or dead legs, like there’s nothing you can do with yourself. Then you back off and feel good again.
“I’d often find myself in the second or third bunch in the race feeling awesome. It was so confusing.”
With Roy already renowned as a classics-style rider, with a pretty good sprint to boot, the immediate goal will be the cobbled and early season classics that kick-off the European season.
An Australian summer spent watching her Mitchelton-Scott teammates race left Roy admitting that she shed a few tears during nationals, but it all forms part of the larger plan for 2020.
“The team have put no pressure on me to race over the summer, which is good as I can get some consistent training and not have to travel around,” Roy said.
“The first race won’t be until Belgium at Omloop het Nieuwsblad and the goal is just all the classics.
“I really want to be able to prove to the team and myself that I can do it. There’s a little pressure to be race-ready at the first race without any lead in” - Roy pauses as it sinks in.
“Oh my god, just five weeks to go.”
With the hardest parts now over, it’s time for Roy to emerge into the cyclist that she’s meant to be.
A well-liked rider within the peloton, she’ll be a very popular winner if she can turn her new condition into a big result.