10 I Fall 2018 www.anjc.info TEC Returning an athlete to sport post immobilization type injury without increased risk of re-injury is truly an art. To execute a return well, we need to consider not only the mechanism of injury, the mechanics needed to return, sport and position demands on the region injured, past injuries as well as loss of strength and symmetry. Arguably the most critical factor is loss of strength and symmetry. This factor alone leads to a cascade of events that change the functional movement patterns of the athlete, which in turn raises the predictive factor for re-injury. However, post immobilization research tells us that there is more going on in the muscle tissue post immobilization than just disuse atrophy. One example of this research is a study conducted by Arkan Abadi et al, August 2009, “Limb Immobilization Induces a Coordinate Down-Regulation of Mitochondria and Other Metabolic Pathways in Men and Women.” This study found a significant sustained down regulation of mitochondria 48 hours post immobilization and sustained at 14 days post immo- bilization. This creates an anabolic resistance that delays the return of muscle mass in the affected region. Could this be the reason that past injury is our best predictive measure of re-injury to a region? How can we use this science to facilitate the complete return to play? The logical approach would be to facilitate the up-regulation of mitochondria while increasing protein synthesis during the rehabilitative phase. This in itself would help diminish the anabolic resistance, thus regaining symmetry sooner and reducing the occurrence of faults in the functional movement patterns. Robert Silverman, DC, MS, CNS, CCN, CSCS, CKTP, CES, CIISN, DACBN, DCBCN, HKC, FAKTR, states, “Mitochondrial resuscitation can be stimulated by two distinct treatment approaches: low level laser therapy (LLLT) and supplemental protocols. Low level laser therapy is shown to increase ATP produc- tion, oxygenation and decrease free-radical damage – all leading to improved mitochondrial function. Adding specific nutrients such as Acetyl-L-Carnitine, magnesium and NAC have enabled many of my patients to restore their mitochondrial support and recovery.” Instituting these protocols in our patient that have been immobilized is very easily executed. This would then speed up muscle hypertrophy, diminishing anabolic resistance during the rehabilitative phase of care. Therefore, it is probable that instituting a regime of the proper nutrients and laser treatment to the post immobilized region will help expedite and reinforce a complete return to sport by combating post immobilization anabolic resistance. Christine Foss DC, M.S.ed., ATC, DACBSP, ICCSP, is past president of the NJCCSIR and an ANJC member. She and her husband, Dr. Glenn Foss, own Advanced Sports Medicine and Physical Therapy practice in Riverdale. By Dr. Christine Foss HOW TO COMBAT POST IMMOBILIZATION ANABOLIC RESISTANCE