Muscle mass and rehab after casting

In a previous post I talked about scaphoid fractures. Mine has been a very long journey. I broke my scaphoid 21 weeks ago and for most of that 21 weeks my wrist has been immobilized either in a cast or a splint. What’s more is that for scaphoid fractures they include your thumb in the cast so my thumb hasn’t really moved either.

So I started rehab three weeks ago. My first appointment was depressing but not surprising. The occupational therapist asked me to move my wrist in different directions: I tried. I had basically lost all motion in my wrist. I don’t mean that it moved a little. I mean that as hard as I tried there was no motion in most of the directions.

Again, I wasn’t particularly surprised. I knew that I was having trouble moving it every time they took me out of the cast to do x-rays. For the scaphoid, they need a particular angle of x-ray that is normally achieved by putting you hand palm down on the table and then bending your wrist towards the outside (away from your thumb). Well, they had to adapt their approach to the x-ray for the last few because try as I might it just wouldn’t bend.

At the same time, moving your wrist is something you never think about. Basic tasks like squeezing a tube of toothpaste don’t seem like a big deal. Three weeks into rehab I still can’t do these things without a lot of effort and some pain. So, is my rate of rehab unexpected? Is my degree of loss more than it should be?

Well, I found an article that makes me happy I have any movement and strength at all. A group of researchers in Copenhagen set out to find out what the effect of aerobic retraining was on leg strength and some other factors after short-term leg immobilization. They had two groups: one of younger men (around their 20s) and one of older men (60s). They immobilized one leg of each subject for 2 weeks.

In two weeks the subjects lost between 20 and 35% of the max contraction strength and a whole bunch of leg lean mass. So even on the low end of 20% that is pretty significant. So 2 weeks = 20%, what does 18 weeks (the point that I started rehab) equal? Obviously it can’t go down 20% every two weeks, and I was still using my fingers and arm as much as I could so I probably lost less than I could have. But any way you look at it it will be extreme.

So how did the rehab go for their leg strength? Well, they only did bicycle endurance retraining. In that re-training period they increased, but did not rehabilitate, the muscle strength. So there was still work to do. What that means is that to do rehab you need to combine endurance and strength training.

From my perspective it means that I have a long, long rehab ahead of me.

Vigelso, A., Gram, M., Wiuff, C., Andersen, J., Helge, J, & Dela, F. (2015) Six weeks’ aerobic retraining after two weeks; immobilization restores leg lean mass and aerobic capacity but does not fully rehabilitate leg strength in young and older men. J Rehabil Med. http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-1961