Muscle imbalance rehab

I could not find specifics so I posted this. I noticed that my right leg calf and quad muscles are smaller than my left. I just past 50 and never really lifted weights but played lots of sports (basketball 4 days a week for 30 years) mostly. I have had back pain in my lower back for years on and off and it got really bad on my right side. Is this the cause of the difference? I started doing yoga and stretching and it has been helping my lower back so I am going to start weight training and my question is, should I lift only on my smaller leg to catch up to the stronger one ? I am quitting hoops for the time being so that my lower back doesn't hurt. Skiing doesn't seem to hurt my back so I am doing a lot of that and figure that is enough to keep my stronger leg strong. I did have my patella cleaned up a few years ago on my right knee so it is possibly from that .

Eccentric/Single leg exercises-the limits will be set by the weaker leg

May want to investigate if the atrophy is related to the back issues with your doc...

How much of a difference? No one is completely symmetrical. Non-weight-bearing periods like those after surgery can affect symmetry bigly. Second the recommendation of exercises for each limb. Do a couple extra reps for the smaller side but work both.

A significant difference in calf or thigh diameter is possibly due to nerve compression to the smaller leg and is a potentially serious problem. You should see your doctor and hold off on lifting weights until you are cleared to do it.

Consider a functional leg length difference. See a physical therapist, chiropractor, or osteopathic manipulative medicine specialist. Yoga might fix the issue for you unless it is an anatomical leg length discrepancy. Could be lots of reasons actually. Once you figure out the cause then a physical therapist can help you with resolving the imbalance.

I don't really ever go to the doctor so I don't really have one and my insurance sucks so I will likely be paying out of pocket so I would prefer to go straight to a specialist. So what sort of doctor should I go see? I had an orthopedic guy that did my knee 10 years ago should I go to him ? The difference isn't a lot but I went to do leg the leg extension machine and the smaller side was definitely weaker so I don't think it's my imagination. I don't have a limp or anything but I just am not sure if the back issues caused it or the other way around.

If you want to go directly to a specialist try to see a Physiastrist, also called PMR doc--for physical medicine and rehabilitation. This is an MD that specializes in things like back pain, diagnosis of neuromuscular disorders, amputations, rehabbing people with serious spinal injuries--a lot of assorted stuff. Different from a physical therapist who is not an MD. I'm assuming your legs weren't always different in diameter (we are talking diameter here aren't we? Length is different.) Good chance you would be looking at an MRI as well, which won't be cheap. Physiatrists do tend to be less pricey than orthopedists though, and more likely to be helpful . This is potentially a situation where a chiropractor or manipulation could be dangerous. I'm sorry to advise you to spend money, but frankly I hope the money is wasted and that everything is fine. If I could see you my advise might be completely different but obviously I can't and you have described something that is possibly serious. Anyway, at 50 it's time to think about getting a doctor, getting your blood pressure and blood sugar checked, and of course your prostate and sigmoid colon : ). But don't worry--within a few months we'll all have great, cheap health insurance. He promised.

I hope I'm wrong.

Don't take old doom and glooms worst case scenarios here, since you are not talking about a sudden loss of mass or a loss of strength or a traumatic event.

I have had a 1/2" difference in calf circumference probably my entire adult life, pointed out to me in my 20's by an elderly lady
friend of the family when I came back from a run. "Did you know your right leg is visibly bigger thand the left?"....and it was.

For years I did isolation exercises to try and get the left one bigger, but the size imbalance persisted. I have had 3 knee surgeries on the left so that may have been a factor (though 1 on each before the imbalance was pointed out).
I thought it might even out after my right achilles repair, but even after 4months of almost no weight bearing the right calf was still larger than the left. 9 months out the right is back to 1/2" bigger again. My right leg is 3-4mm shorter than the left according to one PT I saw years ago, and I'm pretty sure that and being right side dominant cause the size imbalance, though mine does not extend to the quad.

My advice- work on strength and balance and ignore the size.

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Originally Posted by Ski to Be

leg the leg extension machine

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and dont use the leg extention machine, ever. Horrible for your knees.

Great information guys. Thanks. BTW I did go get checked a few years ago for all of the preventive stuff but that was a one off with Group Health and no longer in their network. It is a small difference it just startled me to see.

Ahh, the joy of turning 50!

I'm 55 now. When I turned 50, I was greeted with patella tracking problems with my left knee. My left Quad, specifically the VMO was much smaller than the right VMO. Further investigation found my hormones were shutting down. I was low thyroid and low T.

Exercising your small leg will help the 2 legs catch up by shrinking the bigger leg... probably not what you want.

You will need to perform a variety of 2 legged exercises and single leg exercises. Squats, single leg squats, step ups, and lunges. I like the P90X leg workout and the Cathe's gym style legs DVD.

For me, lower back pain is weak core and tight hamstrings. For reference, I have a strong core when I do P90X ab ripper X twice (back to back). Also, I perform 200 situps (twice with 5 minutes rest).

Getting older means spending more time staying strong and stretching.... and tracking your hormones and figuring out what to do.

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Originally Posted by Ski to Be

So what sort of doctor should I go see? I had an orthopedic guy that did my knee 10 years ago should I go to him ?

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My layman's opinion is that this seems like a situation to see a good PT/DPT, or maybe a physiastrist per OG. No reason to see the ortho except for a referral/recommendation, or you just want him to find a reason you need surgery. Also, I'll second OG's recommendation to get yourself a GP. Even the worst insurance plans are required by the ACA to cover basic physicals 100%, so get one now before they repeal it.

I'm a PT. Go see a good PT in your area. Look for one with an OCS and manual therapy certification. Atrophy is most likely coming from your back. You can strengthen all you want but if you don't get the lower back taken care of it likely won't help. You need to get to the cause before trying to strengthen on top of your dysfunction. Depending on your state and insurance you will likely be able to just go see a PT without a referral from another Dr.

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Originally Posted by Mofro261

Don't take old doom and glooms worst case scenarios here, since you are not talking about a sudden loss of mass or a loss of strength or a traumatic event.

I have had a 1/2" difference in calf circumference probably my entire adult life, pointed out to me in my 20's by an elderly lady
friend of the family when I came back from a run. "Did you know your right leg is visibly bigger thand the left?"....and it was.

For years I did isolation exercises to try and get the left one bigger, but the size imbalance persisted. I have had 3 knee surgeries on the left so that may have been a factor (though 1 on each before the imbalance was pointed out).
I thought it might even out after my right achilles repair, but even after 4months of almost no weight bearing the right calf was still larger than the left. 9 months out the right is back to 1/2" bigger again. My right leg is 3-4mm shorter than the left according to one PT I saw years ago, and I'm pretty sure that and being right side dominant cause the size imbalance, though mine does not extend to the quad.

My advice- work on strength and balance and ignore the size.

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The difference here is that the OP has back pain as well and the difference was just noticed.

One way to self diagnose here if seeing a physician is cost-prohibitive is to test the strength in each leg in a gym--calf strength if it's the calf that's smaller, quads and hamstrings if it's the thigh. If there isn't any difference in strength then you can likely rest easy. If there is a difference in strength then definitely see the doctor. If you do have nerve impingement you will be probably be treated with exercises, but the cause of the impingement should be determined and you need to know what to look out for--look up cauda equina syndrome.
IME doing internet diagnosis most things turn out to be less serious than they sound. I hope that's the case here. But that's what you get for looking for health advice in an internet forum.

I am fine with paying for doctors. Just didn't want to be transferred to 3 different ones. Yoga for 3 weeks got rid of the back pain till I went back and played hoops for 2 and a half hours thinking I was cured and 21 again. I will just quit hoops and keep on the yoga for now. I have heard a lot of nightmare stories about back surgery not working and even making it worse is also a factor. I was mainly interested in finding out if the atrophy was caused by the back pain or the back pain was being caused by the atrophy. As well as the original question on how to lift. Thanks for the tips and insight

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Originally Posted by Ski to Be

I am fine with paying for doctors. Just didn't want to be transferred to 3 different ones. Yoga for 3 weeks got rid of the back pain till I went back and played hoops for 2 and a half hours thinking I was cured and 21 again. I will just quit hoops and keep on the yoga for now. I have heard a lot of nightmare stories about back surgery not working and even making it worse is also a factor. I was mainly interested in finding out if the atrophy was caused by the back pain or the back pain was being caused by the atrophy. As well as the original question on how to lift. Thanks for the tips and insight

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The treatment would probably not be surgery. I'm with you--I've seen enough failed back operations to be wary. I have nerve compression in my spine myself. I've come close to surgery but managed to avoid, as long as I can ski. If you can get an appointment with a physiatrist there's a good chance that's the only doctor you would need.

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Originally Posted by Ski to Be

I am fine with paying for doctors. Just didn't want to be transferred to 3 different ones. Yoga for 3 weeks got rid of the back pain till I went back and played hoops for 2 and a half hours thinking I was cured and 21 again. I will just quit hoops and keep on the yoga for now. I have heard a lot of nightmare stories about back surgery not working and even making it worse is also a factor. I was mainly interested in finding out if the atrophy was caused by the back pain or the back pain was being caused by the atrophy. As well as the original question on how to lift. Thanks for the tips and insight

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My wife sees a lot of back surgeries and knows a lot of ortho's. From hearing her stories, I'd say it's best to avoid any major procedures on your back unless you just can't take it anymore.

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Originally Posted by Yonder_River

My wife sees a lot of back surgeries and knows a lot of ortho's. From hearing her stories, I'd say it's best to avoid any major procedures on your back unless you just can't take it anymore.

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If I do need back surgery I would want to have a neurosurgeon who specializes in backs do it. And if it was an orthopedist--again, a back specialist. Either way--fellowship trained.