Muscles have forgotten how to grow after surgery

June 27, 2022 6:52 PM

I had shoulder surgery on my left arm in October 2020. In terms of range of motion and functionality it's about 95% of what it was, but all of the muscle on that side just never catches up to my right side, despite doing workouts that load them equally (weights, yoga, etc.). And when I flex that side, it can't really engage those muscles to form, say, a hard bicep. It's just kind of puny and soft. But it lifts the same weight, etc., that the right side does! What is happening and how can I fix it?
posted by HotToddy to Health & Fitness (11 answers total)

Following this with interest since I'm having similar issues with recovering from a broken knee and resultant surgery in almost exactly the same time frame.

Although, from what I was told by my physical therapists, muscles just take a really long damn time - and it's the last 5% that takes the longest. They said not to be surprised to just hit this plateau that feels like it takes forever, and to not worry, just keep plugging away at it.

Although I will also be watching to see if anyone has advice for speeding things up a bit because yeah, it's kinda frustrating.
posted by EmpressCallipygos at 7:06 PM on June 27, 2022

I recently went to a physical therapist for the first time for my own shoulder problem. They really know their stuff. You don't need a doctor referral, just go. I found mine through a friend, and it was like three minutes from my house.
posted by intermod at 8:06 PM on June 27, 2022

My guess would be some sort of nerve damage--but, yeah, see a physical therapist!
posted by pullayup at 8:48 PM on June 27, 2022

Response by poster: Yes I spent months and months in PT after the surgery . . . I'm sure she can help but omg the money I have spent!
posted by HotToddy at 9:45 PM on June 27, 2022

It’s likely that either the “puny” arm can lift the same amount because neural adaptation is happening (without muscle growth - sometimes training only one side leads to strength transfers in the untrained side!) or if you’re using a bar, the other arm is doing more of the work, or, if you’re using dumbbells, that other parts of the body are compensating (like there might be small movements happening in your core or elsewhere).

I would try doing lots of reps at a low weight, even using just bands. This will help both increase your awareness of how the smaller muscles feel, and promote growth. (Some old-school bodybuilders used to train exactly this way. Some research I read found they were right, as long as you’re at 30% of your 1RM. But I think it would be beneficial to do it at a very low weight to start.)

As well, focus on single-armed movements, do one arm and then the other. *Then*, once your muscles are more activated, try a double-armed movement (eg bench press with bar).
posted by cotton dress sock at 9:56 PM on June 27, 2022 [3 favorites]

Have you done the exercises where you touch those muscles with all sorts of different textures? Figure out where it’s not engaging and touch with soft cloth, ice, hair brush, any and every kind of texture you can think of. And do lots of isometric work while you do this. You need to remind your nerves about engaging there separately. This is what helped me.
posted by Bottlecap at 1:06 AM on June 28, 2022 [4 favorites]

Response by poster: To clarify, the weights I’m using are dumbbells, not barbells.
posted by HotToddy at 1:52 PM on June 28, 2022 [1 favorite]

Find a trainer or physical therapist who can support your rehab with mix of unilateral (single side) and bilateral (double side) work and also both compound (lots of muscles working in concert) and isolation (one muscle primarily doing the work) work and understands how to retrain your mind muscle connection with the smaller bit! Also know that the size and the strength of the muscle are connected but aren't the same thing. You've lost muscle mass but you've rehabbed your smaller muscles so even if there are fewer motor units available in the muscle, they may be doing a more.powerful contraction enabling you to deal with larger weights. Also check that the movements you are comparing are true bicep isolation movements, and that other muscles aren't assisting. If you want to look symmetrical, some single.side hypertrophy work might help. Hope this helps a bit 😊
posted by eastboundanddown at 2:39 PM on June 28, 2022 [1 favorite]

Neural cueing (the touch mentioned above).is a good thing for developing the mind muscle connection!
posted by eastboundanddown at 2:40 PM on June 28, 2022 [1 favorite]

Also rock-hard muscles aren't what you want really - a contraction yes, but buns of steel are actually not helpful to us, we want long and strong muscles , not muscles that are eternally contracted as they can't contract if they're already contracted. So a softer muscles may have more available motor units to contract whereas motor units within a big hard muscle might not be able to contract. You may just be talking abt in here moment of flex tho so I may be totally off base
posted by eastboundanddown at 2:42 PM on June 28, 2022 [1 favorite]

You can also get an Electrical Muscle Stimulation (EMS) or TENS machine and stimulate the smaller muscles before you exercise them (or even during exercises). Amazon has a few well-rated ones.
posted by cotton dress sock at 11:08 PM on June 29, 2022