Ask the sports doctor

I welcome readers to write in to me with any problems and complaints you wish to receive specialist advice on. Any interesting cases will be discussed, in anonymity, on these pages. Here is your chance to ask for free advice! I await your emails to discuss your own interesting case next month.

Problem

Dear Doctor, I am a keen multisport athlete, but recently have undergone an anterior cruciate ligament (ACL) repair three weeks ago. I have been using crutches since then and I have noticed that my thigh muscles seem to have shrunken up. Is this normal for muscles to waste so quickly? Male, BM, 35 years.

Medical advice

Dear BM, The simple straightforward answer to your question is ‘yes’, unfortunately muscles do waste away very rapidly when they are not used.

Muscles are living cells, and they require energy to keep functioning. Hence when the body is not using a muscle cell regularly, it tends to shrink up the cell, so as to conserve the energy. This is referred to muscle atrophy. After surgery, such as an ACL repair, there will be a period where your knee movement is restricted, but ideally activation of the large muscles, such as the quadriceps, hamstring, gluteal and calf muscles is maintained. This can be achieved through ‘isometric’ contractions, where the muscle is tightened up but remains the same length.

Another option is through the use of electrical muscle stimulation, where electrodes are attached to skin in order to maintain muscle activation and hence decrease the muscle atrophy that occurs. Obviously, good progressive physiotherapy is essential during the rehabilitation process as you recover from your surgery, so as to enable you to rebuild up the muscle strength once again.

And here is a case from clinics

A 67-year-old male who had been a lifelong endurance runner underwent surgery for a medical condition. Following this, he opted to change to fast walking, instead of his usual running regime with friends. After about 8 months of fast walking exercise, he started to gradually develop bilateral shin pains and was finding it harder to keep up with his fast walking exercise. Interestingly, he mentioned that in the past two weeks the tried to run a little bit and he feels that his shin pain actually gets better with running.

This gentleman presents with what is often termed as ‘shin splints’. This is an umbrella term for various issues that can be going on, and the actual medical terminology is ‘medial tibial stress syndrome’ (MTSS). This pain arises due to increased stress on the shin (tibial) bone that is attributed to various possible causes. On examining him, his ankle range of movement was found to be markedly decreased and this was the main cause of his problem. When he is walking with a fast pace, this requires more dorsiflexion (movement of his foot towards his shin) in comparison to his running and since he had stiff ankles, the strain was going onto his shinbone. In running, he did not require as much dorsiflexion and this would explain why his pain was absent when he tried to run. He was advised to work on his ankle flexibility to increase the range of movement in his ankle, as this will result in less strain being put on the tibial bone, and the long-term result was lessened pain whilst fast walking.

The medical advice provided is intended is for educational purposes and not for self treatment. Should you experience similar symptoms, you are advised to contact your doctor/specialist for individual specific advice.

Dr Danica Bonello Spiteri