Microbiome modulation after injury to reduce muscle atrophy and accelerate return to play in adolescent basketball players: a randomized controlled trial
DOI:
https://doi.org/10.47197/retos.v82.119259Keywords:
Gut-muscle axis, muscle atrophy, return-to-play, basketball injuries, probiotics, microbiome modulation, sports rehabilitation.Abstract
Introduction: Musculoskeletal injuries in adolescent basketball athletes often lead to periods of immobilization, resulting in disuse muscle atrophy and delayed return-to-play (RTP). Emerging evidence suggests that the gut-muscle axis plays a key role in regulating muscle mass, systemic inflammation, and recovery.
Objective: This randomized controlled trial (RCT) investigated the efficacy of a targeted post-injury microbiome modulation intervention (probiotic and prebiotic supplementation) on mitigating muscle atrophy and accelerating RTP in adolescent basketball players.
Methodology: One hundred adolescent basketball athletes (aged 14–16 years) who sustained acute lower extremity injuries requiring at least two weeks of immobilization were randomized into an experimental group (n=50) receiving a daily multi-strain probiotic (including Lactobacillus plantarum and Akkermansia muciniphila) and prebiotic fiber, and a control group (n=50) receiving a placebo. Both groups underwent standard rehabilitation. Primary outcomes included changes in muscle mass (dual-energy X-ray absorptiometry), muscle strength (isokinetic dynamometry), and time to RTP. Secondary outcomes included systemic inflammatory markers (TNF-α, IL-6) and gut microbiome diversity (16S rRNA sequencing).
Results: The experimental group demonstrated significantly less muscle mass loss during the immobilization phase than the control group (2.1% vs. 4.8%, p < 0.001). Furthermore, the experimental group achieved RTP criteria significantly faster (38.5 vs. 46.2 days, p < 0.001). Systemic inflammatory markers were significantly lower in the experimental group, correlating with increased gut microbiome diversity and short-chain fatty acid (SCFA) production.
Discussion: The results were contrasted with the literature, confirming that targeted post-injury microbiome modulation is a highly effective adjunctive therapy.
References
Aksović, N., Bubanj, S., Bjelica, B., Kocić, M., Lilić, L., Milanović, F., & Stanković, M. (2024). Sports injuries in basketball players: a systematic review. Life, 14(7), 898. https://doi.org/10.3390/life14070898
Byeon, H. R., Jang, S. Y., Lee, Y., Kim, D., & Kim, J. (2022). New strains of Akkermansia muciniphila and Faecalibacterium prausnitzii are effective for improving the muscle strength of mice with immobilization-induced muscular atrophy. Journal of Medicinal Food, 25(3), 268-277. https://doi.org/10.1089/jmf.2021.K.0148
Chen, Y. M., Wei, L., Chiu, Y. S., Hsu, Y. J., Tsai, T. Y., Wang, M. F., & Huang, C. C. (2016). Lactobacillus plantarum TWK10 supplementation improves exercise performance and increases muscle mass in mice. Nutrients, 8(4), 205. https://doi.org/10.3390/nu8040205
Clanton, T. O., Matheny, L. M., & Jarvis, H. C. (2012). Return to play in athletes following ankle injuries. Sports Health, 4(6), 471-474. https://doi.org/10.1177/1941738112463347
Frampton, J., Murphy, K. G., Frost, G., & Chambers, E. S. (2020). Short-chain fatty acids as potential regulators of skeletal muscle metabolism and function. Nature Metabolism, 2(9), 840-848. https://doi.org/10.1038/s42255-020-0188-7
Hardy, E. J. O., Inns, T. B., Hatt, J., Doleman, B., & Atherton, P. J. (2022). The time course of disuse muscle atrophy of the lower limb in health and disease. Journal of Cachexia, Sarcopenia and Muscle, 13(5), 2293-2306. https://doi.org/10.1002/jcsm.13067
Howard, E. E., Pasiakos, S. M., & Blesso, C. N. (2020). Divergent roles of inflammation in skeletal muscle recovery from injury. Frontiers in Physiology, 11, 87. https://doi.org/10.3389/fphys.2020.00087
Huang, W. C., Lee, M. C., Lee, C. C., Ng, K. S., Hsu, Y. J., Tsai, T. Y., ... & Huang, C. C. (2019). Effect of Lactobacillus plantarum TWK10 on exercise physiological adaptation, performance, and body composition in healthy humans. Nutrients, 11(11), 2836. https://doi.org/10.3390/nu11112836
Kang, C. H., Jung, E. S., Jung, S. J., Han, Y. H., & Chae, S. W. (2024). Pasteurized Akkermansia muciniphila HB05 (HB05P) improves muscle strength and function: A 12-week, randomized, double-blind, placebo-controlled clinical trial. Nutrients, 16(23), 4037. https://doi.org/10.3390/nu16234037
Lahiri, S., Kim, H., Garcia-Perez, I., Reza, M. M., Martin, K. A., Kundu, P., ... & Pettersson, S. (2019). The gut microbiota influences skeletal muscle mass and function in mice. Science Translational Medicine, 11(502), eaan5662. https://doi.org/10.1126/scitranslmed.aan5662
Przewłócka, K., Folwarski, M., Kaźmierczak-Siedlecka, K., Skonieczna-Żydecka, K., & Kaczor, J. J. (2020). Gut-muscle axis exists and may affect skeletal muscle adaptation to training. Nutrients, 12(5), 1451. https://doi.org/10.3390/nu12051451
Roberts, J. L., & Park, C. C. (2025). Emerging roles of the gut microbiome in musculoskeletal injury and repair. Microorganisms, 13(9), 2193. https://doi.org/10.3390/microorganisms13092193
Stratos, I., Behrendt, A. K., Anselm, C., Gonzalez, A., & Mittlmeier, T. (2022). Inhibition of TNF-α restores muscle force, inhibits inflammation, and reduces apoptosis of traumatized skeletal muscles. Cells, 11(15), 2397. https://doi.org/10.3390/cells11152397
Taberner, M., Spencer, N., Murphy, B., Antflick, J., & Cohen, D. D. (2023). Progressing on-court rehabilitation after injury: the control-chaos continuum adapted to basketball. Journal of Orthopaedic & Sports Physical Therapy, 53(1), 1-12. https://doi.org/10.2519/jospt.2023.11981
Tu, H., & Li, Y. L. (2023). Inflammation balance in skeletal muscle damage and repair. Frontiers in Immunology, 14, 1133355. https://doi.org/10.3389/fimmu.2023.1133355
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dorian Meta, Oltiana Petri

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and ensure the magazine the right to be the first publication of the work as licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of authorship of the work and the initial publication in this magazine.
- Authors can establish separate additional agreements for non-exclusive distribution of the version of the work published in the journal (eg, to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Is allowed and authors are encouraged to disseminate their work electronically (eg, in institutional repositories or on their own website) prior to and during the submission process, as it can lead to productive exchanges, as well as to a subpoena more Early and more of published work (See The Effect of Open Access) (in English).
This journal provides immediate open access to its content (BOAI, http://legacy.earlham.edu/~peters/fos/boaifaq.htm#openaccess) on the principle that making research freely available to the public supports a greater global exchange of knowledge. The authors may download the papers from the journal website, or will be provided with the PDF version of the article via e-mail.