Where did all your muscles go?
There are pieces of my body missing. Well, technically they’re still there, but I can’t see or feel them anymore.
Anyone who’s taken months off from the gym or spent time in recovery from an injury, particularly after years of exercising, can relate. Your legs feel weaker, muscles on your shoulders have seemingly vanished, and your abdominals have retreated behind an expanding layer of fat. To use a medical term, it sucks.
A few months ago, after pushing through a lower back injury and an abdominal tear on ibuprofen and denial alone, I finally took a sabbatical from lifting weights and running. The changes in my body have started to set in. I still mostly look like myself, just a slightly softer version. At first it was almost fascinating, like a science experiment where you leave a moldy vegetable out for a few months to see what gross new shapes it can mutate into. But the novelty quickly faded.
It’s not just a physical change either, as athletes, from the highly competitive to the casual-but-dedicated types (like me), will attest. After a while it starts to screw with your mental health as well, complicating your sense of self. You might start to think this is it, it’s all downhill from here.
It’s not, of course. Or at least it doesn’t have to be, as orthopedists and physical trainers will tell you. I asked two, Dr. Elizabeth Matzkin, a spokesperson for the American Academy of Orthopaedic Surgeons and surgical director at Brigham and Women's Hospital in Boston, and Ryan Balmes, a spokesman at the American Physical Therapy Association and a physical therapist at ENDVR Health in Chamblee, Georgia, to walk me through it. Laying off the workouts for awhile might cause your body to change, they said, but you can always change it back.
Are my muscles getting smaller, or are they just…gone?'
“When we see the muscles getting smaller, you’re not really losing muscles, but the muscle fibers are getting smaller, shrinking. They’re not as hypertrophied,” Matzkin says. "For an athlete or a recreational athlete who isn’t going to work out for six months, you’re probably not going to see it turn to fat. [The muscle fibers] are still there, they’ve just decreased in size.”
How long that shrinking takes to kick in depends. It could be two weeks, or more gradually, over the course of a few months, depending on what kind of shape you were in to begin with. For runners, it is usually a slower process, because their muscles take longer to atrophy than those of weightlifters and bulkier types.
Why do the fibers shrink?
Let’s say you immobilize a leg after an injury. The muscles starts to waste away because the body is both efficient and lazy, Balmes says. Think of it as an energy-saving sleep mode. “Muscles, for the most part, need energy to maintain themselves. Once the body recognizes the muscle isn’t being used, either because of injury or a sedentary lifestyle, the body has no incentive to keep up the upkeep of that muscle. The muscles is always going to be the right size and strength for whatever you need," he says.
So where did my abs go?
“They’re still there,” Matzkin assures. If you’re not using them, they become less noticeable, but they’re waiting to come back out. Use and maintaining your diet will help uncover them from a layer of subcutaneous fat.
How long does it take to make muscles big again?
“Believe it or not, it would probably be easy to rebuild it once your injury heals,” Matzkin says. If you were pretty fit before you were sidelined by injury or took some time off, once you’re released to go back to activity you will regain that muscle mass faster than someone who never had it to begin with. “Someone who is in better shape is probably going to notice it more quickly than someone who is a recreational athlete who maybe works out once a week,” she says.
What about the old wives tale that working out for a long time then stopping makes you look worse than not working out at all?
“Definitely not. You’re still better off than someone who did nothing,” Matzkin says.
Should I work on other muscles if I'm recovering?
“I’m a runner, and I strained my quad, but I didn’t stop running completely,” Balmes says. “I had to figure out ways to continue staying in shape while the injury itself healed.” That meant starting out on the stationary bike because it didn’t aggregate his quad, then progressing to the elliptical, then light strengthening exercises for the quad, all so muscle atrophy didn't kick in. He didn't stop doing upper body exercises, either.
Exercise is a total body response, Balmes says. Working on any part will benefit the entire body in the long run. “The alternative is if you rested and completely shut things down. Your injury will still heal, but once you are ready to go back you're in lesser condition then before.”
At what age does it all go to hell?
“I’m not sure there’s an exact age where the switch turns,” Matzkin says. “I’ve seen 70 years olds with incredible muscle mass because they take care of themselves. It’s partly genetics too. Certainly over the age of 60, and definitely 80, you’re going to see more of that sarcopenia, or muscle wasting. As you get older you have to work harder to retain what you’ve got.”
Do current exercise trends cause more injuries?
“We see injuries across the spectrum: walkers, runners, Crossfitters, obstacle course racers. I’ve had people who do yoga that tear their hamstring from trying to stretch too much. I don’t know if I can blame it on one craze," says Matzkin. "If you can do things in moderation with a good head on your shoulders, you’ll probably remain injury-free.”
What about the increase in guys trying to look good for the ‘gram?
Balmes emphasizes to all his clients, but dudes in particular, to stop focusing on the mirror muscles. “The one thing we know in life is gravity is always constant. It’s the same when you're 1 or 99, so if you want long-term health, work the muscles on the backside, the glutes, the hamstrings, upper back, and everything that keeps your body upright. Squats, deadlifts, pull-ups, and rows are my personal favorites, because I know I’m investing in my future self.”
There’s nothing wrong with bench presses and biceps, but if you’re in a time crunch, best to focus on the muscles group on the posterior chain.
How do you keep calm throughout the process without giving up?
It’s common to be depressed while taking it easy, Matzkin says, and she often finds herself bargaining with athletic patients. “The rest is often the hardest part. They don’t want to rest," she says. "Once they’re cleared to start working out again, that’s easy. I tell them, 'Look, let this heal, get your strength back. Yes, your leg looks smaller or your arm looks smaller, but it will come back. Don’t worry about it.'”