A prize or atrophy?

April 2nd, 2009 by Harrumpher Leave a reply »

legdiff.jpgIt’s the difference between a hot dog and a bratwurst. My surgically repaired lower left leg is much rounder than the right one, while lacking muscle tone. This was an opportunity to learn a bit about muscular atrophy.

I’ll find out in two weeks at my next appointment with the surgeons:

  • Whether I am a fast or slow bone grower (key to when I can get back on a bike)
  • Whether the extra metal rod and screws have permanently changed the size and landscape of my shin
  • Whether I can expect symmetry from my two lower legs eventually
  • What the devil those little caves and new odd lumps under the shin skin are about (pic on the left)legcaves.jpg

Having broken a wrist twice, I thought I had this thing down. That was just the cartoon before the feature, as it was when I was a kid. When my wrist was in a hard cast, I continued to write, cook and otherwise use it. When the doc buzzed the plaster, my skin was peeling and smelly but there wasn’t much difference in size or contours left to right.

The immobilization of my shattered bones guarantees real atrophy, even as I thumped up and down the stairs, went to the gym (working the non-leg machines of Scifit and rowing, used first a walker and then crutches, and clung to car doors as I crawled in and out. It turns out that the flaccid muscles don’t care how much weight bearing you do; that seems to fall to the bones instead.

As a click around the net showed, lie around for a couple of days and you’re screwed. The National Institutes of Health notes:

Bedridden people can have significant muscle wasting. Astronauts who are away from the Earth’s gravity can develop decreased muscle tone and lose calcium from their bones after just a few days of weightlessness.

From a variety of sources, I see that there is a consensus that the longer an extremity is immobile, the greater the atrophy. Lots of disclaimers read that it varies by person, age, health, injury and on an on.

There is an underlying tipping point though. Immobile muscle fibers decrease in diameter, which is the size difference as well as the flaccidity. They come back relatively quickly under use, unless they have been out of play for a long time. In the worst case, the muscles effectively die and never regain size or strength even if the body an neighboring bones and muscles take them along for the ride. That’s the true use-it-or-lose-it phenomenon.

When I began removing the Aircast and flexing my leg, I was deeply distressed by the lack of muscle tone. I was just ignorant. I’d grab the calf and find it hanging like a pork loin on my fingers. That’s the norm it turns out.

I hadn’t realized that I had any ego involved. After being a team swimmer  — breaststroke, so many thousands of whip kicks, maybe millions over the years — produced large, well cut calf muscle. As an adult, I’ve bicycled for years, reinforcing that musculature. In fact, in a couple of gyms, guys came over to ask me what exercises they should do to get calves like mine.

Well, that’s not going to happen anytime soon.

My Brigham and Women’s surgeons are in no hurry to return me to that old norm. In fact, they waited over three weeks before removing the surgical staples, to the point where my skin had overgrown some of them. Now, they scheduled the follow-up x-rays and maybe a referral to physical therapy for the middle of this month, two and one half months after the surgery. Their office says they won’t do anything about PT or moving to a cane or anything until after the appointment.

The indifference and arrogance of surgeons is a complex and beautiful tableau. I am merely in the audience.

For small, but annoying, details this means I have satisfied my impatience with healing otherwise. My wife had a working Thera-Band from her own leg break well over a decade ago. She had tips on using it and I have been. Also, having gone from a walker to two crutches to one of those, I am ready to see if I can get safely up and down stairs with a cane, and whether that will cause leg pains and cramps if I use a cane for walking.

Brigham had put me in a limbo though, not saying anything about moving to a cane. My primary care folk at Harvard Vanguard are more accommodating though. I have a follow-up with my regular doc and can stop by their PT shop to see if I can pick up the right size cane tomorrow.

I can see modest improvement from my exercises and look forward to improving the muscle tone before my next Brigham visit. So there.

As it turned out, there isn’t a whole lot on PT after such a break and surgery and casting. There are a few folk out there who said their real PT was walking as much as they could tolerate.

There was good advice though on bodyresults.com.  The guy swears you can build up the muscles in the cast by exercising the good limb. He used the example of one-legged biking, which I assume was on a stationary bike-like object. Those of us where are less hard-core can marvel in his:

After one week of 1-legged biking, I was able to return to gentle 2-legged biking to until I had full range of motion, and I added single-leg free weight strength exercises such as reverse step-ups, gradually increasing functional range of motion to a 10” step height, and then dips, lunges, and eventually squats and deadlifts. My first major activity three months following the surgery was a full day hike down into and up out of the Grand Canyon.

He writes that the aerobic activity stimulates both the inactive and active limb.He suggests that:

  • Increased blood flow from aerobics gives even the injured limb more oxygen
  • Good muscle tone maintenance elsewhere limits atrophy
  • Exercise as you can gets you ready to tone up when you can
  • Isometric and stationary exercise keeps some muscle tone

I have no doubt there’s a great psychological benefit. Do we want to think like invalids or like athletes? The former is boring.


2 Responses

  1. Deepak says:

    The cure of muscular disotrohy is present in INDIA (Punjab)(Nawanshahr) with hands & fingres therapy ,yoga,ayurvedic medicines, homeopathy remedies,massage therapy & I m the patient who suffers from the muscular disotrophy since my childhood ,now i m 22yrs. old ,now i m 85% fit .My all body muscles are fit & properly in working position of 85%. My treatment is still going on. My doctor’s name is G.P.Singh of Dasuya distt. Hoshiarpur(Punjab)(INDIA).

  2. Harrumpher says:

    Likewise, a long-term friend of mine is a massage therapist. At least one of his clients with MS says that he walks only because of the massage.

    Surgeons tell me that only weight-bearing exercise, including walking, can help me. My experience was that other exercises, including the rowing machine, stationary biking, and the Scifit increased the blood flow and advanced healing long before I could walk.

    Surgeons seem to have sound theories, but there are other things patients learn and practice on their own.

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