Anyone......Quadricep Shrunk

[likewoa2007]

I have had a major case of quadrciep atrophy. Anyone who has had it, has anyone not been able to bend there knee to squat down on the surgical leg???

I had surgery almost 8 months ago (ACL with Meniscus)
I also had a clean out almost 3 months back

My quadricep still looks like a pile of musch
Anyone who has had quadrciep atrophy, have you experienced major knee pain when trying to bend on the bad leg.  And then has anyone not been successful at bending the knee to go dwon into a squat form?

Im still doing my pT.  Some say that this could take years?  My Surgeon is recommending a Cortizone shot but I'm only 28 years old.  There is arthritis in  the knee so maybe that might help with bending my knee.

Thanks

[Snowy]

I'm afraid that you're not going to get any answers that differ from those you've been given when you posted this question before. Yes, it's not uncommon to have major quad atrophy after ACL surgery, especially if it's followed by a second scope. Yes, if your muscle is atrophied than you will have great difficulty performing exercises like squats which put major force through the knee joint. Yes, PT is a significant part of the solution and yes, it can potentially take a very long time. Rebuilding muscle is a long, slow process, and you're not going to be able to run before you can walk - in other words, you won't be able to do a squat comfortably until you've worked through the basic muscle building exercises and rebuilt some strength and definition. A cortisone shot may help with discomfort coming from the arthritis, but it won't magically recreate the muscle that you need to support the knee joint while performing exercises like squats. Only a graduated program of appropriate exercises is going to achieve the results that you want.

[likewoa2007]

I completely agree with you.  Its also kind of hard to hold down a job when you cant do the essential funtions of really any job.  The quality of life just sucks and its like your incapacitated

[Clarkey]

Hi There,

Can anyone give me tips on how to get my right quads the same size as my left quads that was not operated on. I go to the gym 3 times a week and use the bike, cross trainer and treadmill for 20 minutes on each machine and my right quads are nice and firm but are a few inches smaller in size then my left quads. Would it be a benefit to use the rowing machine and use the leg press machine to try and get my right quads to a larger size again as it was pe op.

Nick  {2011}

[kscope09]

My physio told me that the size of the musle is not important as long as it is solid, lean musle and your leg is stronger and tracking well and it functions well enough then bulk doesn't matter.

I've got the same thing  too with my claves; on my left leg the calf muslce is as good as ever and has some roundness to it, though because I'm not doing my karate it isn't as sold as it used to be but with my right leg which had the scope the claf musle has come back nice and toned and the pt say's it looks fine but it isn't the shape it used to be and though it is good it isn't like the other one.

[Snowy]

The best way to build muscle is by doing directly targeted exercises with increasingly heavy weights. To trigger the muscle building process, you need to work out to the point where the muscle develops microtears. Muscle growth happens as these heal between workouts. You should be working out to the point of muscle fatigue, and building rest days into your program to give the muscles time to recover (this is really important.)

There are some good tips on this site: http://www.wikihow.com/Build-Muscle

Obviously anyone in active rehab from surgery or with ongoing knee problems should check with their physiotherapist before starting a muscle-building program, or doing specific exercises.

[kscope09]

Most of us here just can't do anything like that because of the potential of making ourselves worse.

When I was able to walk OK againa nd wanted to have a more aggressive workout I wasked my pt if he thought I should do squatts with weights and do leg extensions and his anser was, "under no circumstances" because of the strain they put on the patella.

Some of the old scholl pts will be more liekly to advise this kind of muslce building, but the more odern ones will say that if your joint is weakened already then avoid it like the plague.

[Snowy]

As I said:

Obviously anyone in active rehab from surgery or with ongoing knee problems should check with their physiotherapist before starting a muscle-building program, or doing specific exercises.

I do have to take issue with your suggestion that muscle building with weights is in some way old fashioned or not progressive, however. This is the most effective way to trigger muscle growth, and any restrictions on such a program would be based only on the individual patient's condition. A good physiotherapist will evaluate your condition and your goals and give you appropriate advice for achieving the latter without causing deterioration in the former. It has absolutely nothing to do with an old fashioned vs. modern approach to physiotherapy.

I'm curious as to what you would advise as an alternative to "this kind of muscle building" for someone who is actively looking to increase the strength of their muscles. It's true that a small muscle can be perfectly functional if it's in good condition, but its potential strength is finite unless you increase its size. There are also many, many different exercises that can be used to build muscle without straining other areas. There are plenty of things I can't do because of my patellar problems (like squats with weights) but my PT has found alternatives that are enabling me to gradually rebuild my quad and calf muscles, albeit more slowly than if I could do a full range of exercises.

[kscope09]

Weights are great for building muscle, no problem with that at all and they are great for people with ehalthy joints.  Leg extensions will just wreck the cartliage under your kneecap and you'll be worse than ever.  Mine is thin enough and I'd like to last another 20 eyars befroe I get a TKR if that is possilbe.

OK this is just my experience, some peo0le can probably manage a muslce building program on the legs but it seems risky.

[Snowy]

I understand completely that you have concerns about muscle-building exercise based on your own knee issues, but I'm going to continue to argue the point because I think it could be very damaging for someone with entirely different knee problems to read your posts and assume this is applicable to their own situation.

Leg extensions will just wreck the cartliage under your kneecap and you'll be worse than ever

Not true. For someone who doesn't have existing cartilage damage (or a new ACL graft, or other quite specific issues), leg extensions are a perfectly safe exercise.

some peo0le can probably manage a muslce building program on the legs but it seems risky

Not true. Most people can manage a muscle building program just fine. There are specific knee problems that mean certain exercises should be avoided, but very few people are incapable of participating in any kind of muscle building program. In fact it's a lot riskier to avoid building muscle around your knee, because weak muscles don't provide sufficient support for the joint and leave you at high risk of further damage.

OK this is just my experience

Bingo. This is your experience based on your own knee issues. It may be applicable for someone else who shares those specific problems, but it's certainly not applicable to everyone. If someone with knee problems is looking to build muscle, they should be talking to a physiotherapist to design a muscle building program that takes whatever issue or injury they have into account. They should absolutely not be assuming that any kind of muscle building is a high risk endeavour that could potentially destroy their knees.

[Clarkey]

I can use the leg press no problems but can not do leg extensions as the whole of my right kneecap hurts. I am going to the gym shortly and will increase the crosstrainer resistant from 60 to 80 and increase the speed on the treadmill from 4mph to 5mph. I have not used the rowing machine since I had my knee injury in October 2007 and would it be ok to go ahead and use the rowing machine as well as using the crosstrainer, bike and treadmill and maybe do a few leg weights.

I go to the gym 3 times a week on Mondays, Wednesdays and Friday so would give my leg muscles a rest. I will print off the webpage Snowy has pasted as it looks like it could be a good way to increase the quads in size.

Nick {2011}

[kscope09]

Leg extensions are great if your knees are healthy.  They don't wreck healthy kneecaps but they would wreck ones that are wearing out and full of holes.

The physios I've met all say different things.  Some tell me kneeling does no damage and otehrs tell me how much weight is goign through the knee and scare me from ever trying to kneel again.  Of course I will but I don't liek doing it.

Ok fair enough we're all differnt and you've had knee problems longer than I have.

Look at my signiture, could I do leg extensions with wirghts and squatts with weights?  Because I would like to.

[Snowy]

I can't answer that; I'm not a medical professional. If you're getting different answers from physiotherapists, you need to go back to the surgeon who worked on your knees and ask what a realistic expectation for weight-bearing exercise is given your knee issues. My guess is you'll find that some exercises are fine, but others will need to be avoided; once you have knee injuries you inevitably have to make some compromises. You may also find that you can do exercises with one leg that you can't with the other, depending on the exact nature of the injuries.

It just concerns me that you're very quick to generalize based on your own experience, and make blanket statements like leg extensions destroying knee cartilage or all weight-bearing exercise being a high risk activity. Each of us has a unique set of knee issues, and part of managing that is understanding our individual limitations and, with appropriate professional support, making any necessary adjustments in our routines. We all have unique requirements both in terms of what we're capable of, and what we need to be doing to support our damaged knees. That's why it's so important to work with someone who understands the injury and can make appropriate recommendations for exercise.

Nick - you should ask Dr. Brown about the rowing machine. If he's fine with you using it, start off gradually - maybe with a 5-minute session to begin with - and see how your knee handles it before working up to longer sessions. If it causes any problems, check in with Dr. Brown at your next session before trying again. The rower is great exercise but can cause discomfort if you have tracking problems, so it's worth starting off carefully.

[Clarkey]

This is a good topic to discuss and was wondering if scar tissue in the knee can stop me from using the leg extension machines at the gym. I can use the leg press no problem and can even press using only my right leg which is the knee that had the surgery. 

People on KG and some of my family say you can not be certain it is scar tissue causing the knee pain. Then why would my PT do friction massage to break up the scar tissue and when I had a ultrasound scan the Doctor that looked at the screen said it was scar tissue only to say in my report a thickening of the collateral ligament but 110% was certain he told me it was scar tissue! Its normal after a scope to get some scar tissue just some get it more then others and seem to be more prone to scarring then others as my PT pointed out.

Would the leg press be the best machine to use at the gym to get my right quads larger as I am not too strong on my upper body so could not do normal weights. I would really like to get my rights quads the same size as my left and is this possible or not. Will the right quads always be a bit smaller then my left even if I manage to build up my right quads!

I did try to increase the resistance on the cross trainer yesterday and the bottom of my right knee started to hurt but managed to go a bit quicker on the treadmill without feeling too much pain. Snowy will ask Dr Brown about using the rowing machine and sure he will say it is ok as long as I do not overdo it. If they cannot solve my knee problems would at least like to know what wrong with my knee is it maltracking, PFS or scar tissue that could lead to AF. Surely Dr Brown could work out whats up with my right knee as well as my left knee that also causes me problems.

Nick {2011}

 


 

[Hopesmom]

Nick,

When I had my surgery to remove the scar tissue at Steadman-Hawkins Clinic, my physical therapist told me no more knee extensions, not ever, never.  She said they cause too much compression.  Based on her recommendations, you might consider staying away from extensions, and stick to the leg press.  I will never do extensions again.  As a matter of fact, I think it was all the extensions I was doing in a weight-training program that flared up my existing fat pad problem that had been basically dormant for the most part for 15 years. That has led to two surgeries to remove scar tissue in the fat pad and anterior interval area.

Karen

[vsummer1]

You wrote:  "Then why would my PT do friction massage to break up the scar tissue and when I had a ultrasound scan the Doctor that looked at the screen said it was scar tissue only to say in my report a thickening of the collateral ligament but 110% was certain he told me it was scar tissue!"

I can only surmise that the cause of the thickening of your collateral ligament is scar tissue.  They just don't write that in the report as it is understood by the medical people, and it would be too easy to write something normal people could read 

[Clarkey]

Hi Karen,

I agree with you that I should avoid using the leg extensions and happy using the leg press instead. I have been told by many KG members give IMS a chance as it may help solve or reduce then knee pain and will have a 2nd scope as a last option if conservative methods fail. As long as you stick to rehab after surgery and follow strict guide lines from your OS can beat AF and scar tissue.

vsummer1, I think you may be right that the collateral ligament is scar tissue and they always make it sound too technical on the report.

I am going to see my Physio sometime next week to give me advise about increasing my quad size. I hope it improves the pain at the bottom of my right knee that still remains swollen 15 months post op. Fingers crossed IMS works but if it does I am not afraid of having a 2nd scope but will not think about it unless it happened.

Nick {2011}

[mermaids]

Don't forget about your diet.  After my TTT (which was my 3rd surgery in less than two years), my OS suggested that I really bump up the protein and fat in my diet.  (I am quite thin and otherwise healthy)  He said to build muscle, you need the right exercise and the right fuel in your body.  It is very interesting... after a killer PT session, I am ravenous and crave something hearty like a bacon cheeseburger. 

I clicked on this thread because I am fighting desperately to keep my quad from shrinking.  My TTT was only three months after a scope that did not heal well.  My poor little quad was a shriveled mess by the time the TTT healed enough to get serious in the PT clinic.  We worked so hard and we were finally starting to see some muscle coming back, there was almost definition.  It was very exciting and gratifying until I tore the cartilage and PCL in the same knee.  Ugh.  Suddenly, I could no longer do any of the quad building exercises because any time I tighten the quad, it pulls the patella across the cartilage tear and is extremely painful.  At less than four months post op, I went from being able to to do 50 pounds with only the bad leg on the leg press to unable to do even a straight leg raise.  So, now we are struggling to find things I can do to strengthen the quad while we wait to see if the HA injections will help the tear... because I really, really don't want to have yet another surgery. 

I have done e-stim, HA injections, Russian stim, and started pool therapy this week. 

[Clarkey]

Hi There,

Can anyone give me tips on how to get my right quads the same size as my left quads that was not operated on. I go to the gym 3 times a week and use the bike, cross trainer and treadmill for 20 minutes on each machine and my right quads are nice and firm but are a few inches smaller in size then my left quads. Would it be a benefit to use the rowing machine and use the leg press machine to try and get my right quads to a larger size again as it was pe op.

Nick  {2011}

Since the above post I have now fully recovered from my knee surgery and can now run, kneel and squat more and less pain free. The only thing that bothers me now is that I cannot seem to get my right quads larger so it is the same size as my left quads. I am sure it can be done and do not believe that they you can never get them large again. Will leg weights and jogging increase the quads in size as it would be nice if both quads where the same size again!

Nick {2011}

[Suejs14]

Nick,
My PT does not want me doing any strengthening exercises with my good leg (it's taken the load for the past 4 months) - so I start the leg press with both legs and drop the good one until the last rep then add it back.  Maybe all your exercises are working both quads and the good one just had a head start and the other can't catch up if you work both?

I know this is a very naive response, which makes sense to an average kneegeek.

Sue JS

[slyguy1]

Interesting post.....i totally agree with what snowy pointed out. Healing takes a lot of time especially if they are joint related. There are many ways to get the quads bigger but as snowy pointed out must increase weight and rest appropriately. Doing a lot of reps with lighter weight will not increase size as i learned.....running will also not increase size of quads....it will tone. Everybody is different in their capability .....if leg extensions were that bad for you nobody would do them.....guessing machine would not be there.There is a right and wrong way of doing leg extensions and i would ask the PT if you have one and as long as you don't overdo it it does help tendons around knee get strong. I've learned that to get the most benefit it's important to get your whole body strong.....i try to mix upperbody and lower body routines.The hamstring muscles get weak if you neglect it by working too much quads so make sure you balance your workouts. The standard basic leg raises and wall squats are still the best when i can't get to the gym....my 2cents

[Clarkey]

Hi All,

Snowy gave some very good advise a couple of months ago and just wanted to know if jogging would increase the quads and kind of knew they would not as slyguy1 pointed out. I go to the gym 3 times a week and use the leg press and leg extension machines. I know a staff member at the gym who gives advise to members at the gym about what workouts to do for to build up on specific muscles of the body. Is it safe to do one leg presses rather then use both legs as you then putting more pressure on the quads so should become bigger quicker or is too much of a risk on a operated knee as Sue JS has mentioned.

Nick {2011}

[Brambledog]

I was glad to see this thread...my quads are just mush (very accurate term!) after knee pain, limping and crutches since January.

I'm doing PT and am starting hydro next week, but the exercises I was given (slight squats, side leg raises, attempting leg raises - can't do it at all yet!, gentle lunges) were all before my diagnosis of patellofemoral arthritis the other day and my next appointment with my physio isn't for a week. I've been doing a lot of reading, and lots of different sites and people say that doing this kind of exercise with PFA will just aggravate it and make it worse. I can certainly feel the pain under the front of my knee when I try them.

How true is this and what should I do? I'm going to ring the physio on Tuesday (good old bank holiday) but in the meantime I'm scared to risk them.

Ho hum. 

[LKnees]

I had a TTT in January and I'm only now starting to see a slight improvement in my quads. It's frustrating waiting so long. I was starting to think it would never come back.

[Suejs14]

Brambledog:  I was given new PT exercises a couple of weeks ago and developed a sharp pain below my knee.  It almost felt like a bad tibia bone bruise.  PT said lay off rehab until it resolves (took five days to completely go away) and use ice.  Someone on the board suggested it might be patellar tendonitis.

Now I'm back doing what I was before without trouble.  I am being more careful to warm up prior to the exercises and to cool down with a couple of laps around the track and some stretching.

Good luck, ice and rehab conscientiously

Sue JS

[Clarkey]

Hi All,

I would say my quads are nice and firm as they felt like jelly for a few month post op just now need to increase my quads in size and it can be done and will have a word with Collin at my local gym who does some personal training so can give me some guidance and advise on how to go about increasing the size of my right quads.

Brambledog, Lisa & Sue JS it easy to get the quads firm again with PT but hard to get the quads to increase in size post op.

Nick {2011}  

[Brambledog]

Thanks Suejs14 and Clarkey.

My problem with the exercises to strengthen quads is that they tend to focus a lot of pressure on my kneecap, which is where my arthritis and PAIN is.  Are there exercises I can do that don't overload my patella at the moment? I find it difficult to do enough reps to make any sort of difference without causing some horrendous pain, then I end up suffering the next day as well and feel like I'm taking one step forward and another one back!

I'm doing the straight leg tightening, and the ROM exercises, but even they cause pain. But the mini squats, lunges and cycling are a mare... I'm waiting to speak to my physio about this (she's away) but don't want to not be doing enough (double negative there, whoops).

 

[Clarkey]

Hi Brambledog,

Sorry you still experiencing knee pain and before I had IMS sessions I was unable to run and hurt to kneel and squat and felt pressure and pain along my kneecap every time I fully squatted. After having four IMS sessions I was able to run again and could kneel and squat more and less pain free.

IMS is stands for intramuscular stimulation dry needling a medical form of acupuncture and linked with nerve pain and very tight leg muscles and IMS loosens the muscles that reduces the nerve pain. I had it done under the NHS under Dr Grahame Brown at the Birmingham Royal Orthopaedic Hosptal.

It may not solve you knee pain but could reduce it and is worth looking into as it worked well for me!

Nick  {2011}

[Brambledog]

Thanks Clarkey, I've not heard of IMS before. I had my first hydro session today and feel a lot more positive. It might take a while, but they think I'll be able to get some significant improvement, so I'm going to work hard like a good girl and see what happens. I might have to make some tougher decisions down the line but for now I'm going to cross my fingers and hope that the hydro and physio make enough difference to keep the surgeons knife away for a while!

 

[Clarkey]

Hi Brambledog,

I saw Dr Grahame Brown for my IMS sessions under the NHS at the Birmimgham Royal Orthopaedic Hospital at the sports injury clinic. He also works at private hospitals and does IMS there as well. I found Dr Brown a really nice guy and treats his patients with respect and really cares about his patients.

http://www.drgrahamebrown.co.uk/

He works at the Droitwich Spa Hospital on a Saturday morning and would not be too far for you to travel and does not charge as much as an OS and is worth paying to see him.

Nick  {2011}

[Brambledog]

Cheers again Nick!

 

[likewoa2007]

Brambledog -

It's been 15 months since my ACL/Meniscus surgery and my quadricep i still looks as flat as a pancake that has been run over several times.

 I never had enough muscle to be able to control the knee cap correctly in performances such as squatting, lunges, running, leg extensions, leg curls, leg press so on and so forth.  Those performances build muscle.  I can’t do those performances because my muscle is not there to get the patella to glide correctly. I have Grade 3 Arthritis and no quadricep to onload off the cap.

I just had 3 synvis shots and stil no relief and I'm only 28.  It's going to be a long crappy life.

Hope u feel better!
Tommy

[Brambledog]

Oh dear Tommy, difficult when you have had no improvement for so long. Hope you are feeling a little better today. Has your surgeon suggested anything they can do to relieve things? I know physio is preferable, but it sounds like your arthritis is preventing you from being able to do the exercises in the first place. At 28, they should be able to offer some kind of plan for how to manage your knee for the future. Might be worth trying a different physio (or even OS), even if just to get another opinion on things and help you feel more positive.

Have you had hydrotherapy (physio in the pool!)? I am finding that the warmth helps, and the day after hydro was the first time my quads felt like they had done anything for months. The physio hasn't touched it so far, although I'm hoping that wil change this week now that they have my diagnosis.

Good luck with it all. You're not alone!

 

[slyguy1]

Hey Tommy.....wow at 28 you have so much to look forward to.....i would not give up....as Brambledog pointed out warmth does help as most on here have some form of arthritis or will eventually get it unfortunately. I am looking for a knee sleeve that is comfortable and can keep area around knee warm.....anyone out there know of any or tried any? You are young enough to build muscle with the right regimen.....if you feel you cannot do on your own invest in a good PT....if you have good insurance go get another opinion from other docs on your specific situation....good luck

[Clarkey]

Hi Tommy,

Sorry that you have not seen any improvements after your ACL and meniscus surgery and never nice when you still at a young age to be limited in what you can do. I gave up all hope after being unable to jog for 3 and a half years. Had 2 cortisone injections and a scope to remove the medial plica and trim the fat pad and then had some IMS sessions and was 18 months post op before I was able to run once again.

As the others have said try hydrotherapy & maybe see a new OS for a 2nd opinion or even what I had IMS, dry needling as it helped sort out my knee problems. Good luck in trying to sort your knee out.

Nick {2011}:)

[likewoa2007]

I've been through 8 orthopedics so I don't really have any more options. In fact I've been through 5 different PT's and was just recently discharged once again.  The orthopedics all say you lost too much muscle and if they were to go in and do another major surgery I could be crippled because the muscle would be worse then it is now. I've had everything done including water therapy as well. No improvements and just countless dollars spent.

[Brambledog]

Hi Tommy,

There's not much I can say to that! You've obviously been through the mill and got nowhere, and I'm sorry you feel so helpless. When it comes down to money there's only so far you can go.

Just don't give up all hope. At 28 you have got a life ahead of you, and maybe it's not going to be what you hoped, but it's still yours to do what you can with. Doctors don't always have all the answers, and it might be worth doing as much research as you can on the web. There will be other people out there who are in a similar situation and have found a way through. Whatever you do, get some help, even if it's just support from friends and family.

There are so many people on here who live with pain and have had their future changed forever by their knee problems.  Most still lead a full life and you can as well. Plenty of us have had to look ourselves in the eye and accept that some things just aren't going to happen any more. It's tough, and its not fair. I hope you don't mind my comments Tommy. I have huge sympathy for you, and really hope you can find something or someone to help you rediscover your mojo.

Please let us know how you get on and I'll keep my fingers crossed for some better news.

Good luck!