The end of the year brings a mad rush to meet deadlines, to plan for the holidays, abandon poor habits and make room for new resolutions.
It’s also a time when surgery may be more convenient because the holidays allow extra days for recovery at a time when end-of-the-year deductibles likely have been met.
No matter the time of year, joint replacements of the hip and knee are common surgeries that require an extensive period of limb immobilization during recovery. Patients are placed in braces or casts and are not allowed to place weight on the recovering joints. This period of disuse results in skeletal muscle loss, weakness and loss of function.
Hippocrates once said, “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”
What is the right amount during recovery? Exercise prescription and nutrition can counteract the effects of immobilization. Several factors contribute to muscle loss following injury and surgery.
One is a condition called muscle inhibition. A neurologic response to surgery, muscle inhibition results in the muscle not “turning on” as well as it did prior to surgery. Inhibition can be persistent and result in a difficulty to regain strength.
Muscle disuse atrophy is also attributed to a decline in basal muscle protein synthesis. Dietary protein consumption is of critical importance for stimulating muscle protein synthesis rates throughout the day.
Prior to surgery, it is very important to strengthen the muscles around the knee or hip. The stronger you are before, the better your outcomes after surgery. You will lose some muscle mass after surgery, the extent influences the level and duration of rehabilitation required.
After surgery, it is important to work with a health care professional to set a goal to gain no less than 90 percent strength compared to the uninjured limb. This goal is often not met because of limited visits and a lack of emphasis on the goal. Demand nothing less from your athletic trainer or physical therapist than returning your limb to near-normal levels.
Evidence suggests that maintaining or increasing daily protein intake helps prevent muscle loss. Supplementation with whey protein (easier to digest), creatine supplements and fish oils can help.
Now “use it” to achieve a goal of 90 percent bilateral strength. If you don’t, you may “lose it” and never get it back.
Carl G. Mattacola is a professor and director of the Division of Athletic Training and the Rehabilitation Sciences Doctoral Program in the College of Health Sciences at the University of Kentucky.