Muscle atrophy in the quadriceps

[holliscx]

I think I have acute atrophy in my right quadriceps.

My quad was turned off for about 4 years: for about a year and a half I stopped using my right quad unknowingly before an MRI showed a large tumor in my knee; two weeks later I broke my leg and had tumor treatment for a year until knee surgery; I'm now 2 years post knee surgery.

I've done PT off and on and have been going to the gym for the past few months. At first it really bothered me to do leg extensions through a bunch of clicks in my knee but now I'm showing some progress though my quad still feels about half the strength of my good leg.

A year or two ago when I was at the gym I couldn't do a single leg extension on the minimum granny weight. This was about 10 lbs or the lowest weight setting which is 5 kg. Now I'm able to do 10 reps with 40 lbs (single leg) which is mind blowing for me. It doesn't feel like a ton of progress but it is especially when vast parts of my upper quadriceps appear MIA, middle muscle of upper thigh and above my knee on the inside where the tumor was is still a hole muscle wise.

My question is will my quad ever come back to full strength?

On the bike I feel like I have 1.5 legs instead of 2 though I'm right there riding nearly as well as I was pre-injury. I notice I can't turn my 50 ring as easily as I used to and I'm riding in the 34 a lot more than before but I'm fine with that and don't mind.

This is new territory and I don't know what to expect.

I'm using the Smith machine to squat and I'm doing 4 sets of 5 reps with 50 kgs (2 20kg plates plus bar) right now. I weigh 73 kgs currently. I'm using the Smith because my form feels better and I want to push a lot of weight. I didn't feel as strong doing regular squats and thought I could get a pass with the knee trouble.

Would love to hear about muscle atrophy if anyone has any firsthand experience.

Somewhere along the way my bad leg got bowed off straight a couple degrees which really sucks. I try to push my knees in toward the top tube when I ride. I haven't noticed too much difference on the bike mostly that I'm not able to push the 50 ring like I was so I'm shifting down to the 34 t ring a lot more than prior but that's not a bad thing necessarily.

[Matthew Strongin]

I'm neither a PT nor as much of a gym rat as I used to be, but I'd recommend some single leg exercises so you can build strength in your weaker leg. Split squats, lunges, etc. with or without weights based on what you can handle. My guess is that the Smith machine isn't helping, since the extra stability and extra weight just makes it easier to keep favoring your stronger leg.

[holliscx]

Thanks Matt. Other than leg extension when I try dumbbell squats or anything of that nature one legged I feel so weak around the knee cap that I usually bail for I stress good form always before weight.

I do jump up 12 stairs one legged in between sets on the standing calves raises machine.

The Smith feels good because it keeps my form in line and my sole focus is on pushing the weight up with good form. I can do the regular squat bar but my hip can nag me a little bit so I always move to the Smith to be safe. It's really hard if you workout on both because the weight you can lift for each varies and I prefer to keep going to the same machine so I can note small progress.

I need to research some one legged exercises ... wall sits is on my list for I think the duration of those will build muscle especially in my upper quad. I think you can do those one legged as well though the thought makes me wince!

[lumpy]

I ruptured my quadricep tendon on April 1 and was in an immobilizer into July. The injured leg is still noticeably smaller and weaker than the uninjured one and they tell me that the joint will only ever be 90% as strong as before. It's probably an 18 month process to get back to good-enough function for backcountry skiing. Hoping to be able to do some participant-sport mountain bike racing in 2021.

My PT has me using a leg press machine where there's a big fixed plate to press against, and the seat slides up and down an inclined ramp and you set how much weight you want to pull up along with your body weight. I do this one-legged- my good leg I stick out straight, under the fixed plate. Started with zero additional weight, and six months later I'm up to about 30 pounds. I was actually moving more weight six weeks ago, but my range of motion improved so I could set the seat in a lower initial position, and that position meant I had to back the weight down.

This video shows the machine I'm using; I can't find a decent still picture.

I'm also doing "lunges", in quotes because the leg is so weak they don't look anything like a lunge.

That's a tough long-term injury you've got. I'm glad you can still ride a little; I'm just beginning to be able to do more than sit on the saddle and turn the pedals. It's a real bummer sometimes.

How old are you?

By the way, I was knock-kneed before and it is a little worse now.

I know the real path forward for me is to lose significant weight but it's easier said than done. Heading out now for a fat bike ride. Good luck.

[JoB]

Exercise Physiology person here. Whoa, that is an extreme amount of disuse. No surprise you're struggling.

Couple of things to read up on if you're interested:

Luc Van Loon is an international expert on protein balance. Brad Stulberg and Alex Hutchinson in Outside Online has featured him on a few occasions:
4 Laws of Muscle | Outside Online
What Protein to Eat—And How Much of It You Actually Need | Outside Online

If you're a Twitter creature, Stuart Phillips (@mackinprof), Graeme Close (@close_nutrition) and Keith Baar (@MuscleScience) are experts on nutrition, protein synthesis, and muscle function.

Good luck and report back!

I think I have acute atrophy in my right quadriceps.

My quad was turned off for about 4 years: for about a year and a half I stopped using my right quad unknowingly before an MRI showed a large tumor in my knee; two weeks later I broke my leg and had tumor treatment for a year until knee surgery; I'm now 2 years post knee surgery.

I've done PT off and on and have been going to the gym for the past few months. At first it really bothered me to do leg extensions through a bunch of clicks in my knee but now I'm showing some progress though my quad still feels about half the strength of my good leg.

A year or two ago when I was at the gym I couldn't do a single leg extension on the minimum granny weight. This was about 10 lbs or the lowest weight setting which is 5 kg. Now I'm able to do 10 reps with 40 lbs (single leg) which is mind blowing for me. It doesn't feel like a ton of progress but it is especially when vast parts of my upper quadriceps appear MIA, middle muscle of upper thigh and above my knee on the inside where the tumor was is still a hole muscle wise.

My question is will my quad ever come back to full strength?

On the bike I feel like I have 1.5 legs instead of 2 though I'm right there riding nearly as well as I was pre-injury. I notice I can't turn my 50 ring as easily as I used to and I'm riding in the 34 a lot more than before but I'm fine with that and don't mind.

This is new territory and I don't know what to expect.

I'm using the Smith machine to squat and I'm doing 4 sets of 5 reps with 50 kgs (2 20kg plates plus bar) right now. I weigh 73 kgs currently. I'm using the Smith because my form feels better and I want to push a lot of weight. I didn't feel as strong doing regular squats and thought I could get a pass with the knee trouble.

Would love to hear about muscle atrophy if anyone has any firsthand experience.

Somewhere along the way my bad leg got bowed off straight a couple degrees which really sucks. I try to push my knees in toward the top tube when I ride. I haven't noticed too much difference on the bike mostly that I'm not able to push the 50 ring like I was so I'm shifting down to the 34 t ring a lot more than prior but that's not a bad thing necessarily.

[Blue Jays]

I was just going to remark on the nutritional aspect of healing when @JoB shared the insightful post above.

[JoB]

Thanks Blue Jays.

Larger/more overarching points may be that there is good science out there on regaining lost muscle mass that gets lost among the hucksters selling supplements. Also, your physician(s) is/are likely also impressed with your progress and may have labeled you a 'success' - but for athletic folks those clinical definitions don't necessarily match their own goals.

Lastly, the lack of balance (within the leg, but also between legs) may cause secondary issues. I'm guessing the last thing you want is to see another doctor, but find a good orthopedic to think through this if you haven't?

[bigbill]

On my last deployment in 2010, I broke my back at L5. The fracture wasn't displaced so the docs left it alone to heal. By the time I retired in 2012, I had periods of severe discomfort with sciatica in my left leg. I was ok on the bike, the position unloaded my spine. In 2015 I had a microdiscectomy for a herniated disc L5-S1 that was pressing on my sciatic nerve. Initially successful, since then I have had atrophy on the inside part of my left calf. EMG and Nerve Conduction indicate that it gets no signal. I still ride and do boot camp classes with lots of squats and lunges, but as the rest of my strengthens in compensation, I'm having some bad patellar tendonitis. In the eyes of the VA, this isn't a big deal compared to what they see on a daily basis, but the PM&R doc has me set up for a full lumbar MRI this week with another nerve conduction study within a few weeks. It's likely scar tissue but we'll see. I don't care about the cosmetic aspect, it is more about the knee pain that appears to be associated.