Performance Diagnostic Team Work In The Daily Life Of An U23 Canoeing Athlete

HISTORY: A talented adolescent athlete faced abandoning her career due to an overwork-induced right ACL knee injury. At the age of 18, I examined her from an internal medicine perspective. Already then, the noticeable high pulse response during training, possibly unjustified acidosis, fluctuations in performance in competitions, and poor results in lactate step tests were evident, meaning the end of her participation in the national team. PHYSICAL EXAMINATION: Routine internal medicine examination: the patient's mother has diabetes; weight 83 kg, BMI 27.5 kg/m2. ECG normal, based on the 2-minute HRV result, respiratory load occurs (LF/HF < 1.00). Right knee surgery six months before. DIFFERENTIAL DIAGNOSIS: Exploring circumstances causing the knee injury, assessment of technical state by coach, considering burnout, possible organic abnormalities, dietetic consultation. TEST AND RESULTS: A 75 g glucose load test (GLT), defining partial pressure of oxygen (pO2), showing the pO2 decrease as described in our earlier study, and the decrease in muscle saturation (SMO2) due to digestion. Creating an SMO2 map confirming the hyposaturation of the injured or stressed muscle groups. Meal-adapted performance test (MAPT) characterising performance zones with fat utilisation, V'O2 and V'CO2, respiratory exchange ratio (RER), pulse, insulin, and blood gas values. Performance measurement during MAPT confirmed the presence of asthma, abnormal, high carbohydrate metabolism indicated by RER and insulin response. Along with the increase in lactate, pO2 and pH decreased, indicating a drop-off in mitochondrial function and a decrease in performance. FINAL WORKING DIAGNOSIS: Allergic asthma, insulin resistance, consequent overweight, underperformance syndrome. TREATMENT AND OUTCOMES: Under the care of a dietitian, a coach, and an internist, the knee rehabilitated, SMO2 values stabilised. Respiratory management was revised by a pulmonology expert, aligning lactate and pO2 values under load. Body weight reduced to 71.9 kg. Controlled MAPT showed improvement in RER and lenght of aerobic zone.Sporting results 2023: World Championship title in U23 K4 and European Championship title in U23 K2.