Limiting muscle wastage

[ChocolateFrog]

Had knee surgery (PCL, MCL and PLC replacement) for the second time in 3 years. I'm a week in to 3 weeks of crutches, non-weight bearing. Last time I lost at least 80% of the muscle mass in that leg and 2 and half years later and up to this surgery it wasn't fully back.

Anything I can do to minimise it this time round? Already lost 2 inches in the 6 days post op and it's incredibly depressing.

[gregs656]

There is a phenomenon where if you train your good leg it will stimulate muscle in the immobilised one.

I can’t remember what the response is called however. Its in overcoming gravity somewhere I will look it up.

[So]

ChocolateFrog said:

Had knee surgery (PCL, MCL and PLC replacement) for the second time in 3 years. I'm a week in to 3 weeks of crutches, non-weight bearing. Last time I lost at least 80% of the muscle mass in that leg and 2 and half years later and up to this surgery it wasn't fully back.

Anything I can do to minimise it this time round? Already lost 2 inches in the 6 days post op and it's incredibly depressing.

Take L-Glutamine.

[ChocolateFrog]

gregs656 said:

There is a phenomenon where if you train your good leg it will stimulate muscle in the immobilised one.

I can’t remember what the response is called however. Its in overcoming gravity somewhere I will look it up.

Yes I think I've heard of that. I do plenty of single leg squats, doesn't seem to be enough to compensate.

[Sheets Tabuer]

OT but I had l5 disc go 3 years ago and no matter how much I do at the gym my left leg is smaller than my right, it looks stupid and I've put in a huge amount of work.

[Gareth1974]

I had knee surgery 8 weeks ago, in a brace for 4 weeks afterwards and now have a very skinny left leg as a result.

I did try try the thing of exercising the opposite leg, but it doesn’t seem to have done much, perhaps it would be worse if I hadn’t.

Good luck with your recovery anyway.

[MurderousCrow]

ChocolateFrog said:

Had knee surgery (PCL, MCL and PLC replacement) for the second time in 3 years. I'm a week in to 3 weeks of crutches, non-weight bearing. Last time I lost at least 80% of the muscle mass in that leg and 2 and half years later and up to this surgery it wasn't fully back.

Anything I can do to minimise it this time round? Already lost 2 inches in the 6 days post op and it's incredibly depressing.

What a pain! Disuse atrophy is tough to combat. If you don’t have a physio assigned to you, demand one. If you get no joy with the Trust, IMO it’s worth paying privately for assessment by a recommended sports physio.

In the short term, you may benefit from applying an EMS (electrical muscle stimulation) device to your quads, hams and calves. These use electricity via a surface pad to stimulate an isometric i.e. non-moving, involuntary muscle contraction. It’s a legitimate therapy in the healthcare context; they are used by physios to treat bedbound patients. While the research overwhelmingly indicates benefit, it is certainly worth discussing with your consultant or your physio first, as everyone is different and you may have a clinical complication which excludes its use.

One effective EMS protocol for leg muscles with immobilised knee, used a 2sec on / 9sec off cycle @30Hz for an hour a day. The 30Hz frequency would appear to be something of a sweet spot in relation to immobilised patients (as opposed to trained athletes), as it seems enough to initially produce an adaptation response without too much sensory nerve stimulation i.e. discomfort. As response improves, the contraction-to-rest ratio increases toward equal. But regardless, it’s important that any such use doesn’t produce pain in the knee, or excessive post-use discomfort in the muscles; it would be sensible to start at a low intensity and work up to tolerable levels of contraction.

Again, discuss available therapies with your physio, as there may be a lot you can do - voluntary isometric contractions and other types of active limb mobilisation may be indicated despite your present non-weight bearing status.

In the long term, don’t lose hope. Your surgery is aimed toward restoring full function in your leg. Hopefully this will eventually see you surpass previous levels of strength! If you rigorously obey your physio you will soon get back to normal, at least in the context of daily living.

For restoration of muscle mass, you need to embark on a specific, progressive strengthening program, once safe to do so. This would likely begin with isolation exercises such as heel raises and leg extensions, but in my opinion once you are pain-free your program should begin to include compound resistance modalities such as barbell squats, lunges and so on. Such exercise is shown time and again to be excellent for restoring muscular mass and function.

[S93]

I had a TTT last year and subsequently had physio after it healed, at the end of my 3/4 month program we did some balance/reactionary tests and my operated knee was just as good if not better than my other leg, showing good recovery, but there is still a size difference.

Sadly the physio didn't really help with this, as I guess their job was simply to ensure my operated knee recovered successfully.

I have tried to build the muscle size back up by utilising single leg exercises, for example instead of doing double leg extensions, I do one and a time, making sure that my operated leg gets the full benefit of the movement, similarly with leg curls, dumbbell lunges etc., I'll start with my operated leg first, maxing out the reps, knowing I've exerted full power, then I'll simply match the number of reps with the other leg, hopefully this will help balance things out in the long run

[gregs656]

ChocolateFrog said:

Yes I think I've heard of that. I do plenty of single leg squats, doesn't seem to be enough to compensate.

I think the effect is slight but hopefully better than nothing.

[ChocolateFrog]

MurderousCrow said:

ChocolateFrog said:

Had knee surgery (PCL, MCL and PLC replacement) for the second time in 3 years. I'm a week in to 3 weeks of crutches, non-weight bearing. Last time I lost at least 80% of the muscle mass in that leg and 2 and half years later and up to this surgery it wasn't fully back.

Anything I can do to minimise it this time round? Already lost 2 inches in the 6 days post op and it's incredibly depressing.

What a pain! Disuse atrophy is tough to combat. If you don’t have a physio assigned to you, demand one. If you get no joy with the Trust, IMO it’s worth paying privately for assessment by a recommended sports physio.

In the short term, you may benefit from applying an EMS (electrical muscle stimulation) device to your quads, hams and calves. These use electricity via a surface pad to stimulate an isometric i.e. non-moving, involuntary muscle contraction. It’s a legitimate therapy in the healthcare context; they are used by physios to treat bedbound patients. While the research overwhelmingly indicates benefit, it is certainly worth discussing with your consultant or your physio first, as everyone is different and you may have a clinical complication which excludes its use.

One effective EMS protocol for leg muscles with immobilised knee, used a 2sec on / 9sec off cycle @30Hz for an hour a day. The 30Hz frequency would appear to be something of a sweet spot in relation to immobilised patients (as opposed to trained athletes), as it seems enough to initially produce an adaptation response without too much sensory nerve stimulation i.e. discomfort. As response improves, the contraction-to-rest ratio increases toward equal. But regardless, it’s important that any such use doesn’t produce pain in the knee, or excessive post-use discomfort in the muscles; it would be sensible to start at a low intensity and work up to tolerable levels of contraction.

Again, discuss available therapies with your physio, as there may be a lot you can do - voluntary isometric contractions and other types of active limb mobilisation may be indicated despite your present non-weight bearing status.

In the long term, don’t lose hope. Your surgery is aimed toward restoring full function in your leg. Hopefully this will eventually see you surpass previous levels of strength! If you rigorously obey your physio you will soon get back to normal, at least in the context of daily living.

For restoration of muscle mass, you need to embark on a specific, progressive strengthening program, once safe to do so. This would likely begin with isolation exercises such as heel raises and leg extensions, but in my opinion once you are pain-free your program should begin to include compound resistance modalities such as barbell squats, lunges and so on. Such exercise is shown time and again to be excellent for restoring muscular mass and function.

Thanks for the detailed response. I have good access to physio's as I'm serving forces. Interesting about the EMS, although the incision cuts into the quad near the knee so a little bit of pain if I try to contract it.

Hoping to get down to Headley Court on their lower limb rehab courses, which are great but even then are not perfect.

[ChocolateFrog]

S93 said:

I had a TTT last year and subsequently had physio after it healed, at the end of my 3/4 month program we did some balance/reactionary tests and my operated knee was just as good if not better than my other leg, showing good recovery, but there is still a size difference.

Sadly the physio didn't really help with this, as I guess their job was simply to ensure my operated knee recovered successfully.

I have tried to build the muscle size back up by utilising single leg exercises, for example instead of doing double leg extensions, I do one and a time, making sure that my operated leg gets the full benefit of the movement, similarly with leg curls, dumbbell lunges etc., I'll start with my operated leg first, maxing out the reps, knowing I've exerted full power, then I'll simply match the number of reps with the other leg, hopefully this will help balance things out in the long run

I know from the first op that even when healed I subconsciously stood on one leg and when told by the physio to correct it, 50 50 weight felt almost like I was standing on the bad leg. Takes a long time to rewire the brain.

[MurderousCrow]

ChocolateFrog said:

Thanks for the detailed response. I have good access to physio's as I'm serving forces. Interesting about the EMS, although the incision cuts into the quad near the knee so a little bit of pain if I try to contract it.

Hoping to get down to Headley Court on their lower limb rehab courses, which are great but even then are not perfect.

The military tend to have good physios, who understand the desire to get back to fitness.

I forgot to mention - eat. Loads! Don't worry about putting on a little fat, as this can easily be lost when you are back to fitness. Try to eat whole foods with an emphasis on protein; avoid sweets and keep alcohol intake very low (as if you needed telling!). But treat yourself, this will spare muscle atrophy to a surprising degree. You may also wish to supplement with an amino acid metabolite known as HMB; there have been promising results in regard to prevention of atrophy from this. It's cheap enough, available from the likes of myprotein. Dosage is around 3g daily in divided doses if I remember correctly.

[Herbs]

If you are in a full brace could swimming be an option?

[WinstonWolf]

Concentrate on getting your range of movement back first, this is the most important part of your recovery. You want to eliminate scarring, the loss of muscle mass can be addressed down the line, scarring can't be.

[popeyewhite]

popeyewhite said:

While you're lying there you could familiarise yourself with motor imagery and functional equivalence. Professor Paul Holmes is a leading light and his work is generally a straightforward read, compared to some.

[ChocolateFrog]

MurderousCrow said:

ChocolateFrog said:

Thanks for the detailed response. I have good access to physio's as I'm serving forces. Interesting about the EMS, although the incision cuts into the quad near the knee so a little bit of pain if I try to contract it.

Hoping to get down to Headley Court on their lower limb rehab courses, which are great but even then are not perfect.

The military tend to have good physios, who understand the desire to get back to fitness.

I forgot to mention - eat. Loads! Don't worry about putting on a little fat, as this can easily be lost when you are back to fitness. Try to eat whole foods with an emphasis on protein; avoid sweets and keep alcohol intake very low (as if you needed telling!). But treat yourself, this will spare muscle atrophy to a surprising degree. You may also wish to supplement with an amino acid metabolite known as HMB; there have been promising results in regard to prevention of atrophy from this. It's cheap enough, available from the likes of myprotein. Dosage is around 3g daily in divided doses if I remember correctly.

Yes the abs have disappeared after 10 days of being sat on my arse and mum's cooking.

I'm taking protein and creatine still to hopefully aid with repair.

[ChocolateFrog]

Herbs said:

If you are in a full brace could swimming be an option?

I think it increases the risk of infection, at least until the staples come out.