Case Study: Muscle Atrophy, Hypertrophy, and Energy Expenditure of a Premier League Soccer Player During Rehabilitation From Anterior Cruciate Ligament Injury

Abstract

Maintaining muscle mass and function during rehabilitation from anterior cruciate ligament injury is complicated by the challenge of accurately prescribing daily energy intakes aligned to energy expenditure. Accordingly, we present a 38-week case study characterizing whole body and regional rates of muscle atrophy and hypertrophy (as inferred by assessments of fat-free mass from dual-energy X-ray absorptiometry) in a professional male soccer player from the English Premier League. In addition, in Week 6, we also quantified energy intake (via the remote food photographic method) and energy expenditure using the doubly labeled water method. Mean daily energy intake (CHO: 1.9–3.2, protein: 1.7–3.3, and fat: 1.4–2.7 g/kg) and energy expenditure were 2,765 ± 474 and 3,178 kcal/day, respectively. In accordance with an apparent energy deficit, total body mass decreased by 1.9 kg during Weeks 1–6 where fat-free mass loss in the injured and noninjured limb was 0.9 and 0.6 kg, respectively, yet, trunk fat-free mass increased by 0.7 kg. In Weeks 7–28, the athlete was advised to increase daily CHO intake (4–6 g/kg) to facilitate an increased daily energy intake. Throughout this period, total body mass increased by 3.6 kg (attributable to a 2.9 and 0.7 kg increase in fat free and fat mass, respectively). Our data suggest it may be advantageous to avoid excessive reductions in energy intake during the initial 6–8 weeks post anterior cruciate ligament surgery so as to limit muscle atrophy.

UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

“…To date, establishing nutritional guidelines along this continuum, especially with such diverse injuries (in terms of duration, severity and type), are not available. A recent case study measured energy expenditure of ~3100 kcal/ day during the first 6 weeks of ACL rehabilitation in an elite Premier League player, 159 close to that of outfield players in full training. Given the metabolic demand of tissue/wound recovery processes, staying as close to energy balance as possible and thus avoiding drastic reductions in energy intake, is perhaps the most crucial nutritional aspect during rehabilitation.…”

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“…It is clear that the extreme models of disuse described above do not reflect the experiences of athletes during most periods of training restriction. However, case-study data on elite footballers suggest that injury induced periods of disuse (e. g. Anterior cruciate ligament [ACL] surgery) lead to rapid tissue and performance det-riments that reflect the changes seen in laboratory trials (e. g. loss of muscle mass and function, gain in fat tissue and alterations in metabolic rate) [69,70]. Such effects are evident despite 'best practice' in terms of nutritional and physical therapy countermeasures being applied.…”

Integrating Heat Training in the Rehabilitation Toolbox for the Injured Athlete

“…Depending on the severity of the sustained injury, time-loss could be substantial, leading to profound de-conditioning effects within the cardiovascular, metabolic and muscular systems. For instance, following ACL reconstruction, athletes' return to sport may range between 16 and 52 weeks (Anderson et al, 2019). Case studies in elite soccer players have reported profound losses in whole body fat-free mass (5.8 kg), as well as in lean leg mass (0.9-1.5 kg) following immobilization and inactivity during this period (Milsom et al, 2014;Anderson et al, 2019).…”

“…For instance, following ACL reconstruction, athletes' return to sport may range between 16 and 52 weeks (Anderson et al, 2019). Case studies in elite soccer players have reported profound losses in whole body fat-free mass (5.8 kg), as well as in lean leg mass (0.9-1.5 kg) following immobilization and inactivity during this period (Milsom et al, 2014;Anderson et al, 2019). Moreover, a 4-20% decline in maximal aerobic capacity (VO 2max ) has been reported following 2-8 weeks of physical de-conditioning, owing largely to the decline in blood volume, and consequently stroke volume and cardiac output (Mujika and Padilla, 2001).…”