Is Muscle Memory The Key?
Getting back to life after joint replacement is possible at any age if you’re committed to exercising both pre and post surgery, explains expert Jane Connolly of Whalley Physio
Research shows that what you put in pre-operatively before joint replacement surgery pays dividends in recovery speed and outcome afterwards.
Muscle memory may be a misnomer but perhaps explains why some patients do really well and others struggle reaching their full potential.
Your brain forges connections with muscles and joints through sensors called proprioceptors that feed back to the cerebellum where they are analysed and stored in the long-term memory. The more you do the activity and reinforce those pathways, the easier it is to jump back in and do it smoothly without going through a re-learning process – practice makes perfect.
Recent research also suggests that, unlike many other types of cells in the body, muscle cells have more than one nucleus, which are essential for the synthesis of proteins and muscles building up.
It seems that once a muscle gains extra nuclei by strength training, it never loses them even if they are inactive for a long time. This supports the importance of pre-surgery exercise, particularly the right type of exercise.
One of the main joints replaced in the body is the knee. After a total knee replacement the quadriceps (thigh muscles) are weak, either due to the incision or because swelling in the joint causes muscle inhibition. Physiotherapy improves the knee’s range of motion, reduces the inhibitory swelling and focuses on strengthening the quadriceps and hip abductors (the muscles that bring the leg out to the side and stabilises the pelvis) which are crucial in restoring a normal walking pattern. Even on the uninvolved side, hip abductor strength can be significantly lower due to decreased activity and therefore needs equal consideration during rehabilitation.
In a nutshell, muscle memory isn’t some mythical concept. The utilisation of the additional muscle nuclei developed in preoperative exercises improves outcome in patients who have avoided using the muscles due to pain or stiffness. An exercise programme, such as Pilates, can improve muscle memory in the targeted areas. At Whalley Physiotherapy we work closely with trained Pilates instructor Christine Billington and Hilary Baldwin who, with specialist knowledge, can provide suitable exercises with appropriate modifications.
As a final thought, the ability to recruit new nuclei is harder in the elderly, so maybe we should be encouraging the youngsters to exercise and thus bank myonuclei that may come in useful in older age.