Nutritional Intervention and Supplementation in a NCAA Division I Soccer Player Following ACL Reconstruction: A Case Study

Injury during participation in college athletics is common, and as physical demands and an athlete’s playing time increases, so do the odds of experiencing an injury. According to the National Athletic Trainer’s Association (NATA), the rate of injury in intercollegiate athletics is one injury every 2 games, and one injury every 5 practices for a team of 50 participants. Fortunately, most of these injuries do not result in extensive loss of playing time. Of the injuries reported by the NATA’s Injury Surveillance System (ISS) in 15 men’s and women’s NCAA sports (divisions I-III) per 1,000 participants, more than 50% (53.8% during game time, 53.7% during practice) were to the lower extremities. One injury of particular concern is the anterior cruciate ligament (ACL) tear. During the NATA’s ISS 16-year collection period, approximately 5,000 ACL injuries were reported (about 313/year) in the sample of NCAA athletes, which included just over 1 million exposure records and 182,000 injuries between 1988 and 20066. Regardless of the mechanism of injury (contact or non-contact with another player), ACL injuries accounted for 3% of all injuries in the observed cases. In men’s soccer players, ACL injuries had a frequency of 168 incidences – about 1.3% of all injuries reported. These numbers show that the ACL injuries are in fact rare, compared to other injuries, however 88% of ACL injuries reported resulted in an extensive (greater than 10 day) time loss from practice or sport activity. This loss of training time can lead to deconditioning, atrophy, decreased endurance or cardiovascular conditioning in the injured athlete. Regardless of the type of injury, one of the primary goals for the sports medicine staff that care for these athletes is adequate healing and ensuring prevention of future injuries in that individual. Primary concerns with recovery and rehabilitation are focused on preventing extensive muscle atrophy, regaining normal range of motion (ROM) and functionality of the injured area, followed by total body strength, agility and balance. During injury recovery, there is typically prolonged muscle disuse, which results in progressive loss of skeletal muscle mass. Nutrition is a means to preserve body mass by ensuring adequate intake and balance of nutrients in concert with the promotion of healing and rehabilitation activities. The following case study focuses on Pluto, a 21-year old NCAA Division I men’s soccer player 13 weeks following the surgical repair of a torn right ACL experienced during sport activity. After surgery, typical lean muscle mass as a result of disuse atrophy can be upwards of 1 kg per week. At UNC, the sports medicine team utilizes a physical rehabilitation strategy along with their own nutritional protocol in which supplementation of Juven (an Abbott product which contains the amino acids arginine, glutamine and β-Hydroxy-β-Methylbutyrate (HMB)), and fish oil are prescribed, and creatine monohydrate recommended in order to prevent extensive loss of lean tissue due to disuse atrophy following surgery. Pluto had a 0.9 kg lean muscle mass loss between the date of injury (August 5th) and a reassessment 10 weeks later (October 20th) as measured by dual-energy X-ray absorptiometry (DEXA). Through continued adherence to his nutrition prescription and rehabilitation, Pluto is expected to return to play in early March of 2015. By preventing extensive loss of lean body mass through supplementation, timing and composition of meals and snacks, the sports dietitians work with the athletic trainers, team physicians and physical therapists achieve their goals for a more effective recovery and quicker return-to-play in athletes.Master of Public Healt