Muscle atrophy- why?

[archkiter]

So I wanted to get some other peoples views on the causes for muscle atrophy after an ACLr.  Obviously some of the atrophy is due to not being able to use the leg normally for a period of time, but why does a person who goes into surgery with strong quads and hamstrings come out with a withered week leg when you look at the leg the next day or two days after the op.  I think that there is more going on than just inactivity.  Your muscles don't waste that fast if you are really sick and have to stay in bed for several days.  What are peoples thoughts? 

[Alla]

I was told that after 3 days of inactivity (or not using the muscle) it starts to waste away.  While often you think you are using you legs properly after an ACLR you often arent and so some muscles recieve more activty and exercise so to speak then others.  They compensate for one another.

In my case I lost 9 cms of quad muscle after my ACLR, and this was largely because I lost the ability to use the muscle for a number of weeks due to swelling etc.  My PT said that while the area is sore and swollen you dont have full control over the muscles and dont use them properly.  HEnce the reason it is important to control the pain and swelling.

Alla 

[feeny]

I lost 6kg of leg within 10 days of surgery! Its intense!

As far as I know the reasons are:

- Every day off the quads is up to 7 days (for an athlete) rehab to recover lost ground. We spend 10-15 days off our leg immediately after aclr so thats already up to 105 days rehab just to return to where we were!

- A torniquet is used in the procedure which effectively shuts down the blood supply to the leg. Its in shock and takes a while afterwards to fire up again - this is why we spend 10-15 days on our backsides and "kickstarts" the atrophy process

- Our legs are in utter shock and indignation at what has happened to them. Usually half the hamstring is chopped out, holes are drilled, screws are put it and the whole thing is somewhat traumatic to the leg. Our two biggest bones are drilled out - the leg responds by going on strike!

- Our nerves are a bit damaged and rearranged - the brian takes its time to wrok out how to use the new joint and in that time it just doesnt know or want to use the muscles around the knee.

Its a bit jumbled but I believe the reason is a combination of all the above

[knee deep in Goo]

Yummy

Has anyone really ever tried explaining the horror that was done to your knee to a friend ?  After awhile they start turning green and you are like I better stop. 

[zengirl]

Hey knee-deep. I am not in the least bit sqeamish - but my boyfriend is. I requested to be awake during the operation and wanted to see everything that was going on. I want to talk about it with Mr. Boyf but he starts shaking and putting his fingers in his ears. He hates it! Any friend who hasn't already seen gets to see my scars immediately... but I can see them all going, "ew, gross, see you later then..." while I'm left without even having described the drilling yet. Everyone is a wuss!  ;-) What's wrong with gory details? I'd like to hear about theirs if they had any.   

[murf]

Hi.
I have found that the inner quad just above my knee has wasted the most, is this the same for all or just me?
Murf

[harry78]

Hey all,

Yes murf, the inner quad does atrophy the most after none using of the leg. Mind you this was the muscle that my OS told me to target after surgery - and that was 10 minutes before the surgery. I always looked forward to the surgery and rehab, no matter where in the timeline - in this way my leg is guarded by a large qudriceps group and hamstring too. The vastus medialis is the muscle that is responsible for extending the leg at the knee and is crucial for the protection of the reconstructed ACL, amongst other patellofemoral benefits. I don't just say this. I REALLY mean that exercising this inner quad makes the knee feel a lot stronger and more stable. This along with the lateralis, which both need to fire together.

[feeny]

YES the VMO is key. (the inner quad that wastes away)

Unfortunately it is also really hard to isolate Apart from leg extensions which are a big acl nono, squats are probably the best bet for working the vmo.

[Banner]

Hi Feeny,
I have started doing leg extensions about 2/3 weeks ago and hadn't realised that they are not for acl recoveries. Is the reason for this that it puts too much strain on the new acl.

[kevc]

Squats are brilliant  Especially on the Smith machine - a very safe exercise I think.  I did it at 6 weeks post-op.

[patpalloon]

Hi Kev,
I like the Smith machine also. Do you know how much the bar itself weighs? And what's a good weight to start with for squats?

[kevc]

Id say between 5 and 10 kg.  However cos of the pillars and controlled movement it is much easier than squatting with free weights.  I wouldnt even consider the bar as weight to be honest.  Just focus on weight you are putting on it.

In your video you look to be a big guy Robin.  Im only 5ft 7 and 70kg so i'd say you'd be different to me.

I actually kept a weight training diary noting weight, sets and reps performed.  This was excellent on allowing me to effectively monitor my progress and to keep progressing forward, not becoming stagnant.

At week nine post-op I was squatting Set 1 25kg x 10 reps
                                                     Set 2 30kg x 10 reps
                                                     Set 3 35kg x 10 reps
                                                     Set 4 35kg x 10 reps

I used to asterix a set I found really tough.  At that time it was 35kg so at next gym visit I new to stay in and around 35kg.  I was increasing my weight almost every week by about 10kg.  If you look at my sets I always started light and finished heavier.

According to my diary at week 12 post-op I was doing Set 1 30 kg x 6, Set 2 40kg x 6, Set 3 45kg x 6, Set 4 50kg x 6 and Set 6 55 kg x 6.

Five months post-op I did Set 1 40kg x 12, Set 2 60 Kg x 12, Set 3 70 kg, Set 4 70 kg x 12, Set 5 80 Kg x 12 and set 6 90kg x 6 (that was a hard set).

Towards the end I was doing big weight and high reps.  This was really hard and I couldnt have done this before 4 months post-op.  High reps will exhaust you.  When I started doing them my heart was going like a train.  I went dizzy once and thought I was gonna black out so be careful and focus on breathing properly.

You can see how I progressed well with the weights.  Without a diary I wouldnt have challenged myself like this.  You can see my quads on the other thread.  I used leg press too but in my opinion Smith is far superior.

Since 4.5 months post-op I did one legged squats as well as two legged.  I only do one-legged now.  I think I was probably over training though. 

[kevc]

P.S use a weight lifting belt.  I think the nylon velcro one is most comfortable.  I started getting lower back pain.  Once I used belt it went right away.  And my form was better too. I hate wearing it cos usually all the jocks in my gym walk around with it just to make them look like they are working hard which they never are.  I didnt really want to be one of those guys.  But I dont want to wreck my back.  As soon as I finish on the Smith its off immediately

[archkiter]

I lost 6kg of leg within 10 days of surgery! Its intense!

As far as I know the reasons are:

- Every day off the quads is up to 7 days (for an athlete) rehab to recover lost ground. We spend 10-15 days off our leg immediately after aclr so thats already up to 105 days rehab just to return to where we were!

- A torniquet is used in the procedure which effectively shuts down the blood supply to the leg. Its in shock and takes a while afterwards to fire up again - this is why we spend 10-15 days on our backsides and "kickstarts" the atrophy process

- Our legs are in utter shock and indignation at what has happened to them. Usually half the hamstring is chopped out, holes are drilled, screws are put it and the whole thing is somewhat traumatic to the leg. Our two biggest bones are drilled out - the leg responds by going on strike!

- Our nerves are a bit damaged and rearranged - the brian takes its time to wrok out how to use the new joint and in that time it just doesnt know or want to use the muscles around the knee.

Its a bit jumbled but I believe the reason is a combination of all the above

Feeny I think that you are spot on.  I too suspected that the tourniquet played a role in muscle wasting.  I discussed this idea with my mom who is an emergency room doctor but she doesn't think that a tourniquet could cause muscles to atrophy- makes sense to me that lack of blood flow and there fore oxygen to the muscles must had some detrimental effect.

As others have said- my VMO seems to have suffered the most atrophy since the op.  It is inspiring to already be seeing signs of these muscles coming back even though I am still in the early stages.

[kevc]

I had a tourniquet on for 3.5 hours and I reckon it had a detrimental effect on my quads.