Question
What are the most effective strategies to prevent muscle atrophy in the perioperative period?
Answer
Muscle atrophy begins as early as two days after immobilization, with quadriceps volume decreasing by approximately 1% per day. By day seven, individuals can lose up to 3.1 pounds of lean body mass, significantly impacting post-surgical recovery. To mitigate muscle loss, enhanced recovery after surgery (ERAS) protocols focus on nutrition, early mobilization, and targeted rehabilitation strategies. Preoperative carbohydrate loading has been shown to reduce insulin resistance and minimize muscle catabolism, while free-form amino acids when taken before and after surgery, support muscle protein synthesis and wound healing.
In addition to nutritional interventions, rehabilitation should begin as early as safely possible. Delayed initiation of post-surgical therapy—often due to systemic barriers—leads to unnecessary muscle loss. Blood flow restriction (BFR) therapy is an effective adjunct to early rehabilitation, especially for individuals unable to fully load their limbs postoperatively. BFR helps maintain muscle volume and strength by creating a metabolic environment similar to high-intensity resistance training without excessive mechanical stress. Additionally, neuromuscular reeducation techniques, including electrical stimulation and open-chain strengthening, can counteract arthrogenic muscle inhibition (AMI), a common neurological deficit following surgery. Implementing a structured recovery plan that integrates these strategies leads to improved functional outcomes and a faster return to activity.
This Ask the Expert is an edited excerpt from the course, "Advances in Recovery: A Muscle-Centric Approach," presented by Adam Cady, MHS, ATC, CSCS, PA-C.
