Today, we’re covering a rehab protocol that I wish any athlete didn’t have to go through; ACL reconstruction.
By all means, this is a pretty huge topic, but I’ll cover the key points outlined in a recent case study by Shaw et al (2019) who helped two international rugby players with their return to play (RTP).
As you’re probably aware, muscle mass and connective tissue loss is accelerated after surgery when the limb is immobilized. It’s inevitable, if you don’t use it, you lose it. However, the less atrophy experienced, the quicker your recovery becomes and RTP becomes.
Therefore, the interventions we put in place are designed to offset this where you’ll soon find yourself living the project gainers life. Without further ado, here are the cliff notes:
1) Calories are king. The calories you consume (energy availability) is paramount. When you combine limb immobilization and calorie restriction, tissue loss is accelerated. Therefore, trying to shred body fat during the early phases rehab is a big no go. Likewise, there’s some evidence that high calorie/high fat diets cause muscle loss when bed bound. So, calorie restriction is bad, calorie excess is bad, calorie maintenance is magic.
2) Protein. Consuming adequate protein on a per meal basis (0.4g/kg bodyweight) stimulates muscle protein synthesis and initiates muscle remodeling and growth. However, there’s evidence that you get ‘anabolic resistance’ during limb immobilization. Therefore, a higher protein intake per meal may be required to overcome this (as seen in the elderly). Therefore, aim to consume adequate protein with each meal, 5-6 meals per day.
3) Gelatine. Beef of pork gelatin is very high in collagen which can increase collagen synthesis when taken before loading. When stacked with Vitamin C, can increase collagen cross linking and make the tissue more robust. As blood flow to connective tissue is very poor, the timing of this is very important; 60 mins before loading, even during ROM exercises in the first few weeks.
4) Omega 3’s. This is perhaps speculative in this exact scenario, but, omega 3’s can help overcome anabolic resistance when tested with elderly individuals. Since the injured and immobilized athlete also has anabolic resistance in the disused muscle, it’s worth supplementing with. The case study used 2g/day, however newer studies have shown that up to 4g/day is effective.
Two additions I’d like to add; 1) creatine and, 2) don’t be deficient in anything.
The major gains in rehabilitation are very much down to the work of physios, medics and S&C coaches. Without them, recovery will be extremely slow. However, nutrition can play a supporting role to accelerate recovery.
So, it’s something of great urgency to get right!