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In addition to the clinical outcomes related to long\u2010term dysfunction, co\u2010morbidities and reduced mobility and physical activity, this review addresses several underexplored physiological limitations of VML at both the whole\u2010body level and within the injured muscle. Our objectives with this review are to provide: (1) critical understanding of the pathophysiological limitations related to VML injury; (2) evidence for emerging treatment options that target the VML\u2010induced metabolic dysregulation; and (3) early functional data on metabolic treatments as a component of regenerative rehabilitation. We highlight new attempts to intervene in this unique pathophysiology, in addition to current unanswered questions for the field.<\/jats:p>","DOI":"10.1113\/ep093074","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T18:15:43Z","timestamp":1763662543000},"page":"1718-1732","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When rehabilitation is not enough, how targeting metabolism can overcome the limited plasticity of skeletal muscle after traumatic injury"],"prefix":"10.1113","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9285-4908","authenticated-orcid":false,"given":"Sarah M.","family":"Greising","sequence":"first","affiliation":[{"name":"School of Kinesiology University of Minnesota  Minneapolis Minnesota 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