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Creatine Supplementation Proven To Maximize Muscle Recovery After Limb Immobilization: Important implications for fracture patients

James Meschino DC, MS, ROHP
Although it has been known for a number of years that creatine supplementation is the gold-standard method to re-establish muscle size and strength after limb immobilization (example – after having your arm or leg in a cast due to a fracture), very few family doctors, physiotherapists and orthopedists recommend creatine supplementation to their fracture patients. This is indeed unfortunate.

A published report in the Journal of Physiology (Hespel P et al, 2001) was the first to show that providing test subjects with creatine supplementation, along with standard rehabilitation exercises, was the most effective way to help patients recapture strength and muscle size (girth) after limb immobilization.

According to the researchers, the 2 weeks of leg immobilization induced the expected reduction in quadriceps muscle cross-sectional area of about 10%, and the 10 weeks of rehabilitation training increased muscle cross-sectional area by about 15%. These strength and muscle size gains were significantly higher than was found in the subjects given the placebo instead of creatine supplementation.

The increase in muscle size in the creatine group was accounted for by hypertrophy of both type I and type II muscle fibres. Type I muscle fibers are your slow-twitch, aerobic muscle fibers, and type II muscle fibers are your explosive, high-intensity, fast-twitch fibers, which are more anaerobic in nature.

The study by Hespel et al proved that oral creatine supplementation enhanced the recovery of muscle mass during rehabilitation in human subjects and thus, shortens the duration of rehabilitation needed to restore muscle mass induced by disuse atrophy.

They also demonstrated that the ‘anabolic’ action of creatine loading had equivalent positive effects on both fast- and slow-twitch muscle fibre types. This has important implications for athletic performance for athletes involved in endurance sport and explosive sports, and in sports where both kinds of conditioning are important (e.g. tennis, hockey, basketball, soccer etc). There study indicated that the individual’s muscle fibre distribution is probably not critical to the impact of creatine supplementation on muscle mass during strength training, as creatine impacts anabolic gains in both type I and type II muscle fiber types, as well as intermediate fiber-types.

Finally, this study also suggested that the anabolic strength and size gains associated with creatine supplementation were likely due to increased activity of myogenic transcription factors. Previously, rat studies have shown that creatine intake affected myogenic transcription factors, but the study by Hespel  (2001) was the first to suggest that same effect occurs in humans.

Coaches, athletes and physiologists have wondered for years (since 1992 when creatine was first shown to increase muscle strength and size) through which mechanism creatine is able to produce these significant anabolic gains. The study by Hespel et al, suggests that creatine supplementation may up-regluate myogenic transcription factors, in addition toit’s known role in providing the muscle with more available high octane fuel for muscle contraction.

The Bottom Line
If you ever find yourself in a cast or sling, where limb immobilization is mandatory for more than a few days, taking creatine supplementation (20 grams per day – or 4 teaspoons) during and after limb immobilization will likely help you reduce muscle atrophy during immobilization (some studies have shown this effect) and recapture muscle loss very quickly, when accompanied by standard rehabilitation strength training, once limb immobilization is concluded.

Hespel P et al.Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. The Journal of Physiology. Vol 536, (2):625–633. October 2001

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