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Author Topic: Quad Atrophy Definition  (Read 16185 times)

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Offline kscope09

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Quad Atrophy Definition
« on: January 11, 2010, 10:20:35 AM »
Is atrophy simply muscle wasting that can be fully recovered or is ita point of no return, whereby the muscles never recover.

Can you get atrophy in your quads if you've been weightbearing since you first came out of surgery and have been doing the exercises religiously.  I can't get the quads and calf on my right leg as strong as my left even though I've done everything I've been told.  I wonder if there is a point that they will not go beyond and that is why their not getting stronger.  I could accept this if I'd been laid up for weeks on end but I havn't been.  I've been out a lot less, but I've walked on the leg everyday since surgery, done all the prescribed exercises and have full ROM and my quadsare still weak, it just doesn't make sense.  RSD has been mentioned but I don't have the typical symptoms and I'm not in that much pain so I don't think it could be that.

I'm going to have to go back to the OS who will send me for another mri that will come back showing nothing nd be stuck at square 1 again and then have another scope, which I won't be able to recover from and do exercises that don't work.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline kscope09

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Re: Quad Atrophy Definition
« Reply #1 on: January 11, 2010, 10:22:23 AM »
Sorry, I kind of went off on a rant there.  My orignal questions was, could someone please define quad atrophy for me because I'm not sure if when people are refering to atrophy they just mean wasting in general or something specific.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Dad3

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Re: Quad Atrophy Definition
« Reply #2 on: January 11, 2010, 01:23:25 PM »
Its atrophy (wastage) due to lack of use. Plain and simple.

For instance, when you've had ACL surgery your knee sends a signal to your quads saying, "dont need you anymore" the quad "turns off" and shrinkage/wastage starts. This is how my PT described it to me before my ACL operation.
RT Knee collapsed 08/2009
MRI 10/2009 - torn ACL
Arthroscopy and MFX - 10/2009
ACL and OATS 11/2009
RT knee lateral release, mosaicplasty and medial reefing - 22nd September 2010.
Still not 100% OK :(

Offline Lottiefox

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Re: Quad Atrophy Definition
« Reply #3 on: January 11, 2010, 02:14:53 PM »
Nice description of why the quads stop thinking they need to work there Craig. It is like a switch and in rehab you're trying to both turn the switch back on i.e. the quads need to feel needed, and then when they are awake giving them the strength to contract and relax enough to do what they're meant to. Its a hideously LONG process. Many people get by in life with relatively weak quads, or imbalanced quads and hamstrings, but they manage because other things compensate and because the joints that the muscles hang onto work well enough to balance out the imbalances. When you get a lower limb issue, the kinetic chain gets disrupted and a mechanical knee problem (for example) affects the desire/perceived need of the muscles around the joint to want to work. So, anything you can do to teach the muscles to "fire" again will help how much you can then buidl strength - hence why things like e-stim machines can help with passive retraining and let you get on with different active exercises.

I'd also argue that quad strength in isolation won't necessarily be the holy grail. Yes, they are crucial for the knee but don't neglect your hamstrings and your glutes and calves and hip flexors. Stand up straight, tense your butt and watch the effect that this has on your knee position and control.

I see little point in going through another scope especially if you think an MRI won't show anything. Give your body some time to respond to the work you're doing. Perhaps think of adding in different technqiues like e-stim, foam rolling for trigger points (ITB is my big one - it has a direct effect on bits in my knee that go ouch!!) , balance exercises to make alll the little neglected muscles work as well as the big ones (stand on one leg with perfect alignment with your eyes closed - build up your time...its hard!) . Rehab is frustrating, exercises aren't the miracle cure but I guarantee without them you have a far less chance of stopping or improving any atrophy.

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline doublemom

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Re: Quad Atrophy Definition
« Reply #4 on: January 11, 2010, 02:57:50 PM »
Ditto - it can take very little time for muscles to atrophy, and a heck of a long time to get them back again into full working order.  When I had plantar fascia release surgery on both feet (not at the same time) I was in a walking cast boot for 4-6 weeks each, and even though I was walking around daily, because of the boot I didn't use my calf muscles properly for that time and it was amazing how fast my calves shrunk visibly.  As soon as I could walk normally again and could get back into my normal exercises, they came back, but it took a lot longer than it did to have them atrophy in the first place. 

Andi
2000 R patella dislocation
2004 - Soccer injury - LK medial and lateral meniscectomies
2007 - Dx patellar tilt, lateral subluxation, grade III chondromalacia
5/13/08 - RK medial/lateral meniscectomies & patellar chondroplasty
4/6/2010 - RK TTT/LR scheduled

Offline Cosmicsnuffle

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Re: Quad Atrophy Definition
« Reply #5 on: January 11, 2010, 05:58:11 PM »
....Skinny little thigh and chubby knee courtesy of 4 months left knee with only 30o ROM and PWB at best. 2inches lost of quad/thigh girth (and I'm only little!) and have a superb jelly calf despite being religious about what little PT I could do.

Lottiefox recommended the STIM (Neurotrac) which I've purchased (Sports XL) - I haven't had it for long enough to see a significant change in muscle mass but it has certainly been good for working on tension/pain where the muscles have been fixed in a certain position for long periods.... if nothing else it feels great!

:-)
Oct 04 - torn meniscus
Dec 05 meniscal trim and debridement
Sep 09 torn ACL, kissing contusions, knee locked 30-60o
Jan 10 ACL stump debrided, lateral parrot beak meniscal tear trimmed
May 10 ACLr (Hamstring)
Aug 11 mfx (focal lesion lateral femoral condyle)
Jun 14 100k walk London-Brighton 28hrs

Offline jt801

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Re: Quad Atrophy Definition
« Reply #6 on: January 11, 2010, 06:23:54 PM »
My left quad began to atrophy BEFORE i had my first surgery in '99 for lateral release. I did several months of PT trying to strengthen the muscles to improve the tracking of my patella but had no results, thus the surgery was performed. In my case, the volume of muscle never came back in 10 years but the strength of the leg eventually returned to more or less what it was before the problems started.
12/99 left knee lateral release and plica removal
1/09 right knee chondroplasty and microfracture LFC

Offline kscope09

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Re: Quad Atrophy Definition
« Reply #7 on: January 11, 2010, 06:40:56 PM »
Can cycling help your quads?  I've had one pt say it can and another ssay it can't.

Also, what other muscles can cycling help?
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline kscope09

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Re: Quad Atrophy Definition
« Reply #8 on: January 14, 2010, 03:07:21 PM »
I think my quads aren't too bad, their not shrunken on the right leg, but the calf muscle is a lot smaller and nowhere near as defined.  What is the best exercise for the calves?  I stand on tiptoes and slowly lower myself down, but it doesn't really help.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline fraud_ninja

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Re: Quad Atrophy Definition
« Reply #9 on: January 14, 2010, 05:31:51 PM »
It takes a long time to regain back muscle that is lost...much longer than anyone ever thinks it would take.  I had ankle surgery in September and after 3.5 months in a walking boot my calf muscles were shot.  My quads also atrophied during this time.  In the two months since I have been without the walking boot I have worked religiously to get my right leg stronger.  Its coming, slowly, but its coming.  I think we expect it to come back sooner than it ever does.  Best advice, just keep working it.

Here are some things I do at the gym for my quads:
1.) Walk on the treadmill at an incline.
2.) Do the bike or elliptical, but turn up the resistance as much as you can tolerate.  It should be a good workout, but you should not have pain.
3.) Squats, lunges, step downs.  There are so many things you can do here...the key is don't do it if you have pain.  You can add to the challenge by holding 5-10 pound weights in each hand.
4.) Fitness classes such as pilates and yoga are great for this.

In general I do not use any of the machines at the gym.  They are unnatural movements and they isolate your muscles too much. 

For my calves I do the following:
1.) Stand with my heel hanging off of a stair.  Raise all the way up and all the way down.
2.) Walk on my tip toes.
3.) Stand on my tip toes.
4.) There are ramp incline settings on the elliptical that target your calves more than others.  The really low inclines and the really high inclines are good for the calves.
5.) Use flippers while swimming in the pool.

Again, its a long process.  You'll think that you have plateaued but just keep working it.

My right calf is still noticably smaller than my left.  When I got the boot off there was no muscle at all.  I have been able to build back up the basic muscle and it has some definition to it.  Now I need to work on bulking it back up...which will probably take a very very long time.
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline kscope09

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Re: Quad Atrophy Definition
« Reply #10 on: January 14, 2010, 11:42:11 PM »
Thanks for the help with suggessions.  I'm definately going to get a bit more aggressive with my calves and hamstrings.  When the snow and ice go I'm going to see my pt about expanding my exercises and if he gives me the same of squatts again I'll be looking for a new pt, one that does e-sttim.

Does a Tens machine do roughley the same thing as e-stim?  Is it as thourough.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline fraud_ninja

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Re: Quad Atrophy Definition
« Reply #11 on: January 15, 2010, 03:58:48 PM »
In defense of your PT, squats are one of the best things you can do to build back up your quads.  There are so many variations to squats and you can add to your challenge level by holding weights in your hands.  I do squats every time I go to the gym.

There are different schools of thought involving e-stim for building back up muscles.  The more into fitness I have gotten the more I would want to get away from using e-stim.  An e-stim machine specifically isolated one specific muscle and forces it to contract.  In my opinion you are not training the body or the brain to contract that muscle in a situation where you would really use it.  In theory, you are never going to use that one muscle in a totally isolated situation.  This is just my opinion so do not take it as anything valid.  All I know is that the more I have gotten away from isolated muscle movements and focused on entire muscle groups...the better I have been able to build back my muscles.
12/26/02 LR R
10/26/06 TTT R
1/25/07 TTT L
12/17/07 TTT revision, MPFL recon R
2/7/08 TTT revision, MPFL recon L
3/24/08 screw removal R
4/30/08 screw removal L

Knees are fixed, training for a triathalon.

9/21/09- Right ankle reconstruction

Offline Lottiefox

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Re: Quad Atrophy Definition
« Reply #12 on: January 15, 2010, 07:51:30 PM »
I'd agree on the e-stim machine not taking the place of functional strength/balance training. using muscles in everyday actions is THE best way to build them up and develop optimal function - hence why I love free weights and not weights machines as they force you into one position and isolate too many muscles. Free weights on an uneven surface (gym ball, power plate etc) - now you're talking! BUT - I think an e-stim can help if the muscles have "forgotten" how to fire - to me they bridge the gap between the inability to get a muscle or its group working and then using it effeciently. E-stim is helping me use my quads a bit more effectively, although they are still weak as ****. When my husband had patella issues e-stim for 3 weeks got his quads firing and he was then able to do PT properly and start doing exercises tailored to his sport - golf.

Ninja have you ever come across Vibram 5-Fingers footwear? A trainer friend of mine swears by them for promoting natural movement and muscle usage - he lives in his and has different ones for running, weights etc. I'm not sure my bumpy feet would fit in them!

 ;D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline jenbas01

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Re: Quad Atrophy Definition
« Reply #13 on: January 16, 2010, 06:14:51 AM »
Hi Everyone! I am new to this site and this posting on quad atrophy really caught my attention. I had Patellar Realignement Surgery on Dec 7th.. I had 3 screws put in the tendon, a lateral release and of course putting that knee cap in place.. I am going into week 6 post op and I am in an immobilizer and crutches. I have such quad atrophy and have not been able to get it to fire. This in turn is causing all sorts of issues with trying to do PT. I cannot even lift my leg yet and just walking in the immobilizer is very difficult. It is like my leg is jello and keeps jolting when I walk almost like a buckle. I do my PT excercises but am very apprehensive at PT and very scared. I went to try and put pressure on my knee and stand up the one day, the entire kneecap locked up and got very tight. I feel so scared and just want to know that I am going to be okay. They keep telling me at PT that the things that are happening are normal, but I am so scared that I will never walk again. I wish I never had this surgery! Ever!
Any advice would be great, especially if someone has had this type of surgery since it is not very common.


Offline Cosmicsnuffle

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Re: Quad Atrophy Definition
« Reply #14 on: January 16, 2010, 05:19:51 PM »
Hi jenbas01 -

I'm a relative newbie to this site and to knee injury, terminologies and recovery.... I haven't had the same surgery as you but hopefully my words and limited experience may be of some comfort.

Being scared is natural (I've learnt), especially when things aren't going as well as you expected - regretting the surgery when you can't see an end is natural too but knees seem to be notoriously slow in their healing - listen to what your PTs are saying, and take a good trawl around this site to see what others have experienced..

If your PTs seem to think that everything is on track then try to relax into the timescales they are giving you, there will be a light at the end of your tunnel :-)
Oct 04 - torn meniscus
Dec 05 meniscal trim and debridement
Sep 09 torn ACL, kissing contusions, knee locked 30-60o
Jan 10 ACL stump debrided, lateral parrot beak meniscal tear trimmed
May 10 ACLr (Hamstring)
Aug 11 mfx (focal lesion lateral femoral condyle)
Jun 14 100k walk London-Brighton 28hrs