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  • Blaine Hawkes, DPT

Muscle Atrophy: A Major Side-effect of Surgery No One Talks about, and How to Avoid it


Muscle atrophy is the loss of muscle mass and strength. It can be caused by disuse, aging, or certain diseases. Muscle atrophy is closely correlated with decreased quality of life, decreased life expectancy, and correlated to common diseases. When a person has surgery, the associated rest afterward generally results in significant muscle atrophy. It can take months or even years to rebuild the muscle and strength, and without proper rehabilitation some people never fully regain their muscle mass after a surgery.


Atrophy is very common after a joint replacement surgery. The atrophy generally begins many months prior to the joint replacement as people are struggling with arthritis pains and their activity level declines. Then after the surgery activity levels really plummet as patients are often homebound and very sore for several weeks, and the atrophy accelerates. To make matters worse, the neurological connections between the brain and muscles can also be partially lost during painful bouts of arthritic pain and after a surgery.


Some traumatic accidents that often require surgery include fractures, ligament tears, or tendon tears. Some common ones are achilles tendon ruptures, ACL tears in the knee, ankle fractures, and wrist and hip fractures.


Oftentimes when something needs surgically repaired, people become so laser focused on the damaged structure and they forget all the surrounding muscles and tissues also need to be functioning well in order to get back to a normal active lifestyle. Some common scenarios could include:


- An athlete tears her ACL, and has it surgically repaired, but without adequate rehabilitation is not confident returning to the basketball court next year because there is too much muscle weakness in her leg.

- An older gentleman is excited to get back to his annual hunting trip after a knee replacement, but discovers he is unable to handle hiking over the uneven terrain after losing too much muscle mass and coordination following the surgery.

- A factory worker wants to return to work after bunion removal surgery by her podiatrist, but return to work is delayed several weeks due to excessive stiffness and weakness in the foot and ankle after spending several weeks in the post surgical boot without physical therapy.

- A new mother who was never referred to postpartum physical therapy is struggling to resume her previous fitness routines, and even struggling to climb in and out of bed 6 months after a c-section and doesn’t feel she can regain her core muscles.


New advancements in technology and deeper understanding of muscle physiology have given us better tools to prevent atrophy, and even gain strength while safely protecting the surgical site so that these types of scenarios don’t happen.


If you have to have surgery, here are some things you can do to keep your muscles strong:


  1. Pre-surgical Rehabilitation, or “Prehab”


Some surgeries are elective and planned, and if you know you are going to have one in the future, the best thing you can do is start strengthening your muscles beforehand. If you go into surgery with good strength and flexibility, you’ll regain your strength and mobility much faster after surgery. This has been shown repeatedly in medical studies and we see it happen all the time in the PT clinic; people that do their prehab simply recover faster. People planning on elective joint replacements should see a physical therapist to learn how to properly strengthen the right muscles before a surgery. Prehab also works great after an ACL tear, as people generally need to wait about a month between the tear and the surgery for the swelling to come down before a surgeon will operate. Physical therapy can start before surgery to strengthen the musculature around the knee, and there are also things that can be done in therapy to more quickly resolve the joint swelling.


If you are worried exercise might be too painful before surgery, you will be pleasantly surprised at the resources and techniques available to make it a comfortable experience. Your therapist can modify exercises in a variety of different ways and use some very neat equipment to target the muscles we need to strengthen without causing harm.


2. Take advantage of new Technology to Accelerate Muscle Growth


In recent years physical therapists have begun using an exercise technique called “Blood-Flow Restriction Training,” or BFR. With BFR, a pressurized tourniquet is applied around the arms or legs, partially occluding the blood flow. With the tourniquet applied at the proper pressure, a physical therapist can guide you through appropriate exercises. Since the muscles are not being supplied with as much blood as normal, they perceive the exercise as being much more challenging than it actually is. You may be lifting very light weights but with limited blood flow it is quite challenging. The physiological response to this after the BFR training is that your body sends resources to rebuild and strengthen muscles as if they had just been through a high-intensity workout, even though the exercises were very light. This is a great prehab option for people who may not be able to exercise normally due to joint pains, and a great post-surgical option when resistance training is not yet safe, like after an achilles tendon repair or an ACL repair. BFR is also a great strengthening option for tendinitis issues even when surgery is not needed.


At Recover Physical Therapy, we often use our ‘Neubie’ machines (Neurological Bio Electric Stimulation) on the muscles. The Neubie uses a pulsed DC current directly over the muscles during exercise. It works in a few different ways; one is by improving neuromotor connections between the brain and the muscles for optimal nerve signals. It also improves muscle recruitment, or ensures you are fully engaging all fibers in the muscle to their full potential. Exercising with the Neubie machine can also include very simple, low resistance exercises that don’t over-stress the joints, but actually work your muscles quite intensely. Recent studies have shown the Neubie to improve muscle mass and strength just as well as high resistance strength training, without all the resistance. This makes it a great option for older adults working to avoid muscle atrophy, or athletes needing to keep their muscles strong after surgery so they can return to play sooner.



Both BFR and the Neubie machine are great biohacking tools to accelerate strengthening. Neither of them are painful to use, but can feel somewhat intense. Sometimes we even use BFR and the Neubie machine simultaneously!


At Recover PT, we also have available in-house aquatic therapy that can be used where appropriate, as well as a special treadmill called the Alter-G, anti-gravity treadmill. This machine supports you while you are walking or running, and we can offload as much weight as is appropriate. It feels like walking on the moon! This technology enables us to safely start therapy earlier than what was traditionally possible, and an earlier start to therapy means less muscle atrophy!


3. See a Physical Therapist with Orthopedic Expertise and the Best Tools


Sometimes people needing surgery are unaware of how much physical therapy can accelerate and optimize their recovery and do not seek out physical therapy. Surgeon’s will often make a referral after surgery, but sometimes things fall through the cracks and no referral is made. If you are planning on an upcoming surgery, see a physical therapist before the procedure so that you can get a head start on your strengthening and optimize post-surgical recovery. If you have already had surgery, make sure you see a physical therapist as soon as possible. Even if there are post surgical restrictions, like being in an air-cast boot, or being on crutches, there are so many things we can do with the Neubie and with BFR to start strengthening the muscles so you don’t lose them, without causing any harm to the surgical site or breaking any of the surgeon’s instructions. Many surgeons will also allow us to begin gait training (walking) a bit earlier than normal either in the aquatic center or in the anti-gravity treadmill.


Having good muscle mass and muscle strength is very closely correlated to quality of life, longevity, and also correlated to reducing your chances of developing diseases. Don’t let a surgery rob you of your muscle mass. If you need surgery, we can keep your muscles strong through the ordeal!



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