AboutCourtney Expertise I am an Orthopaedic Physical Therapist with 8 years experience. I can answer questions re: orthopaedic injuries & rehabilitation. I treat patients with a variety of problems including back, neck, shoulder, hip, knee, & ankle injuries / surgeries. If you have questions about your elbow, wrist, or hand, you will most likely get better information / assistance from someone else on this website.
Experience I have been practicing in an orthopaedic setting for 8 years & have experience primarily with shoulder, neck, back, & lower extremity injuries.
Organizations American Physical Therapy Association (APTA)
Orthopaedic Section of APTA
Expert: Courtney Date: 5/15/2008 Subject: calf muscle, Schatzker 4, post surgical intervention,
Question I had a tibial plateau fracture last summer with extensive soft tissue damage, including gastrocnemous muscle tear and popliteal artery damage. My left leg was immobilized for 4 months, recovering from 3 surgeries - (external fixator, ORIF, and popliteal bypass) I had physical therapy 3 times a week for the first 3 months to maintain ROM - but aside from that, I kept it completely immobilized.
My question is in regards to cramping & LACK of muscle atrophy. I am approx 9 months out from initial injury, and my left calf muscle is bigger than my right. I have muscle cramps every day, especially if I am idle for any period & then try to walk again. My vascular surgeon told me to watch out for sudden cramping during a walk, which could signify claudication. But if anything - the cramping eases up after walking a bit.
My orthopedic surgeon told me to count my blessings that I didn't get any atrophy, and seems bored by my complaint that I get muscle cramps after I'm idle.
Why didn't the muscle atrophy? and is there anything I can do to ease the cramping (aside from being in constant motion)?
Answer Paula---
Sorry to hear of your injury. My suspicion is that your calf muscle did indeed atrophy. Being immobilized for that length of time I would find it virtually impossible to not be atrophied as the muscle had no source of activity to "keep it strong." My best guess is that the calf is actually "swollen" which may make it appear larger. Atrophy is actually a term used to define the girth / size of a muscle, not a structure. So, it would be possible for the muscle girth to be smaller, but the "compartment" to be larger as a result of swelling. I am not qualified to "diagnose" what is happening, but it sounds like the swelling may be constricting your blood flow. When you move or are active, that improves blood flow which in & of itself will help decrease the cramping. My suggestion to determine if this is partly true involves a few "experiments."
The next time your leg feels that way, try the following:
1.) Elevate your legs (this will help gravity pull the swelling from
your calf), but don't move around much
2.) While sitting, move your toes & ankles as much as you can, but
don't stand (this will increase circulation & help "pull" the
swelling out of your calf
If both of these improve you symptoms, it is possible that blood is "pooling" in your calf due to lack of movement / circulation & when you provide an environment to help decrease fluid build up. If #1 helps more than #2, this in my head reitterates that it is a swelling issue. If this is the case, I would contact your vascular surgeon & make him aware of your findings & determine the best course of action.
The other thing you might want to be aware of is if your calf feels "tight." Also, have you noticed any visibile fluctuation in your calf size? My thought process would lead me to think that your calf most likely feels "tight" shortly or immediately before your symptoms ("cramping") present.
Let me know how this works for you.
Good Luck!!
