Summary

  • Avoid macro and micro-nutrient deficiencies- a blood test to determine micro-nutrient deficiency may be warranted. Eat nutrient dense foods – avoid excessive intake of processed foods.
  • No need for vitamin and mineral supplementation unless deficient. No consistent evidence that higher doses of vitamins and minerals accelerates recovery.
  • Increase protein intake (especially during Immobilization phase) to decrease muscle atrophy (i.e. muscle loss).
  • Adjust energy intake appropriately – you may need to eat more than you think during the initial stages of injury.
  • Avoid alcohol.
  • Creatine supplementation may be warranted.

 

Injury is an excepted fact when participating in athletic activities, whether at the recreational or elite level. An injury may be minor (e.g. slight strain or sprain – a few days absence from training) to major (e.g. ruptured anterior cruciate ligament – six months to one-year absence from training and competition). This post, while being general in nature will provide agreed nutrition strategies to help manage the initial injury and accelerate recovery).

Injury recovery can be divided into two main phases – (1) Immobilization phase and (2) Rehabilitation and Increased Activity [6]. There are slightly different nutritional considerations during these two distinct phases.

 

Immobilisation Phase

The Immobilization phase occurs immediately after the injury. The injured limb is rested or immobilized to prevent further damage at the site of injury. This may involve wearing a boot, casting, the use of crutches or slings for upper limb injuries.

Inflammation

After an injury, an inflammatory response is initiated. This may last a few days or a few hours, depending on the severity of the injury [3]. This inflammatory response is necessary for healing the tissue at the site of injury. It is completely natural and well controlled process. Expert opinion agrees that there is no need for super doses of anti-inflammatory vitamins and other compounds. For example, high doses of omega-3 fats (anti-inflammatory) have been shown to delay wound healing [3]. It is only when the inflammatory response gets out of control (e.g. serious injuries like burns) that super high doses of anti-inflammatory compounds should be consumed. While excess inflammation may be harmful, attempting to drastically reduce inflammation may not be ideal for optimal recovery [3].

One of the major areas of agreements among experts is that nutrient deficiencies should be avoided as these will impair wound healing. If a long-term injury it may be advisable to get a blood test to diagnose any vitamin or mineral deficiencies. For example, if you live in northern latitudes, Vitamin D3 levels can drop during the winter months (Oct – Mar) due to lack of sunlight [7].

If any deficiencies are detected, then steps should be taken to remedy them, either through consumption of whole foods or supplements. Generally, whole food consumption is advised over supplementation. Whole foods offer the best nutrition- they include components not available in pills. These additional components  have a synergistic effect on the action of whole foods [2].

Deficiencies of energy, vitamins, minerals and macro-nutrients – particularly protein – will impair wound healing and exacerbate loss of muscle and tendon mass and function [3].

 

What type of whole foods should you be eating at this stage of your injury?

Natural Anti-inflammatories

Garlic, turmeric, green tea, blueberries, apples, citrus fruits, broccoli, pineapples, dark green leafy vegetables

Healthy fats – avocados, nuts (walnuts, cashews, almonds and nut butters), extra virgin oil [2].

Omega-3 rich foods such as fatty fish (salmon, halibut, herring, oysters, sardines, trout and fresh tuna) and plant-based alternatives (flax, chia, hemp seeds, walnuts).

 

Energy

The natural response of a person who is injured is to reduce energy intake – they aren’t as physically active and may be afraid of accumulating excess body fat. However, energy requirements can increase during the healing process. Energy expenditure may be increased by 15% and up to 50% depending on the type and severity of the injury [3]. Additionally, the extra energy cost of ambulation (i.e. using crutches) needs to be considered (2-3 fold above walking) [3]. Drastically reducing energy intake can impair wound healing and cause muscle loss [3]. As a rough rule of thumb, eat less than when training hard but more than when completely sedentary [2].

Carbohydrate intake levels during this phase of recovery will be at the lower end of the carbohydrate intake spectrum (3-5 g/kg BM). These should be in the form of low to medium Glycaemic Index (e.g. whole fruits and vegetables, whole grains).

 

Protein

One of the main consequences of immobilization is loss of muscle mass (atrophy) in the affected limb. This is particularly prevalent during the first two weeks of immobilization [1]. Electro-stimulation of injured limb and training the uninjured limb or other muscle groups can exert some cross-effect to reduce muscle loss [6].

From a nutrition perspective, the best way to reduce this muscle loss is through increased protein intake. Intakes of 2.0 – 2.5 g protein per kg Body Mass (BM) are advised during the immobilization phase [3]. Consuming protein consistently and distributing it evenly throughout the day, rather than back loading at dinner, is the best practice to follow [2].

Leucine rich foods such as chicken breast, lean beef, tuna, salmon, turkey breast, eggs and peanuts should be consumed [2]. Intake of leucine should be in the range of 2.5 – 3g per meal [1]. Because animal protein sources have higher leucine content than plant protein, vegetarian and vegan athletes might contemplate supplementing their diet with a leucine supplement [9]. Vegan athletes may also need to consider a protein supplement (e.g. soy or pea protein) to reach these high protein intake targets.

Ingesting 40g of a casein supplement or whole food source (e.g. cottage cheese) will continue muscle building during sleep and may further prevent muscle atrophy.

 

Creatine

Supplementing with creatine has been shown to reduce muscle atrophy. However, upper and lower limb muscles respond differently to creatine supplementation during immobility. Creatine has a more protective effect on the muscle of upper limbs (e.g. arms) versus lower limbs (e.g. legs) [3]. A sensible loading strategy would be 20g/day for 5 days (loading phase) followed by 5g per day (maintenance phase) [7].

 

Rehabilitation and Increased Activity

This second phase is characterized by progressive hypertrophy and functional recovery [7]. The goal of this phase is to improve the athlete’s functional capacity and fitness to allow a full return to training and competition.

Protein

During this phase, the athlete is able to begin exercising the previously injured limb. Progressive loading of the limb will occur in an attempt to promote hypertrophy of the muscle in the injured limb. Protein intake will be important during this phase. Recommendations for protein intake during this phase may be slightly lower than during the immobilization phase. Higher protein intake during the immobilization phase are warranted to overcome anabolic resistance of the muscles in the injured limb. During the rehabilitation phase, exercise of the muscle in the previously injured limb will potentially negate this anabolic resistance.

Slightly lower intakes of protein may be applicable in this phase – 1.2 – 1.8 g protein per kg of BM [10]. Protein should be consumed consistently throughout the day in the form of meals and snacks. Leucine rich foods such as chicken breast, lean beef, tuna, salmon, turkey breast, eggs and peanuts should be consumed.

 

Creatine

Creatine supplementation results in an increased rate of muscle growth and strength gains so should be considered to accelerate recovery of muscle mass and function [3]. A similar loading strategy to the immobilization phase should be followed – 20g/day for 5 days (loading phase) followed by 5g per day (maintenance phase).

 

Energy Intake

Energy intake will increase during this phase as the athlete will be more active and training will become progressively more intense. Most of this extra energy intake will come in the form of additional carbohydrate intake. The following published guidelines will help to tailor carbohydrate intake based on the intensity and duration of training [8].

Description   Carbohydrate (g per kg BM)
Light Low intensity or skill-based activities 3-5
Moderate Moderate exercise program (approx. 1 hour per day) 5-7
High Endurance program (1-3 hours/day moderate to high-intensity exercise) 6-10
Very High Extreme commitment (> 4-5 hours/day moderate to high intensity exercise) 8-12

 

During initial rehabilitation phase, athletes will be at consuming at the Light level (3-5g Carbohydrate per kg BM). As exercise intensity and duration increases as functional recovery improves, carbohydrate intake will increase.

 

General nutritional recommendations

During this phase, it would be advisable to consume a variety of whole fruits and vegetables, adding spices and herbs to foods where possible and consume healthy fats high in omega-3 and essential fatty acids. This will help to prevent nutrient deficiencies which may hinder recovery and adaptations to training.

 

Ligament and Tendon Injuries

Supplementing the diet with collagen rich foods can potentially accelerate ligament and tendon healing and recovery. Foods with high levels of collagen include bone broths, gelatin and jelly. Batch tested collagen supplements may also be recommended during this phase. Consuming 15g gelatin one hour prior to a loading exercise has been shown to increase collagen synthesis in humans [5].

Deficiency of Vitamin C and Copper may impair recovery from ligament and tendon injuries [7]. Therefore, it would be prudent to increase consumption of foods rich in these micro-nutrients. The requirement for Vitamin C is 46 mg per day and for Copper is 1 mg per kg BM [7].

Vitamin C – citrus fruits (e.g. oranges, lemons, broccoli, bell peppers, tomatoes, green leafy vegetables).

Copper – liver and other organ meats, spirulina, shitake mushrooms, almonds and cashew nuts, sesame seeds. Kale and spinach, dark chocolate.

 

Bone Injuries

Adequate intake of Vitamin D and Calcium is necessary for proper healing of bone injuries. As previously discussed, Vitamin D levels may be insufficient in northern latitudes during the Winter months. A blood test will determine if supplementation is warranted. If deficient, intake of 2,000 – 4,000 IU per day of Vitamin D3 until Vitamin D levels recover is warranted [7]. Sensible sun exposure during the summer months will also boost Vitamin D levels.

Foods that are rich in Calcium include dairy products (e.g. milk, cheese, yogurt), chia seeds, sardines and canned salmon, almonds, beans and lentils.

 

Alcohol

During a period of injury, it may be natural for an athlete to feel sorry for themselves and consume alcohol in greater amounts than they would if training. This should be avoided during all phases of recovery from injury. Alcohol can impair would healing, can slow down the muscle building process and accelerate muscle loss during immobilization [3].

 

References:

[1]          B. T. Wall, J. P. Morton, and L. J. C. van Loon, “Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics,” European Journal of Sport Science, vol. 15, no. 1, pp. 53–62, Jan. 2015.

[2]          J. Kloubec and C. Harris, “WHOLE FOODS NUTRITION FOR ENHANCED INJURY PREVENTION AND HEALING,” ACSM’s Health & Fitness Journal, vol. 20, no. 2, p. 7, Apr. 2016.

[3]          K. D. Tipton, “Nutritional Support for Exercise-Induced Injuries,” Sports Med, vol. 45, no. 1, pp. 93–104, Nov. 2015.

[4]          K. D. Tipton, “Nutrition for Acute Exercise-Induced Injuries,” ANM, vol. 57, no. Suppl. 2, pp. 43–53, 2010.

[5]          G. Shaw, A. Lee-Barthel, M. L. Ross, B. Wang, and K. Baar, “Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis,” Am J Clin Nutr, vol. 105, no. 1, pp. 136–143, Jan. 2017.

[6]        Medina, D., Lizarraga, A., & Drobnick, F. (2014). Injury prevention and nutrition in football. Sports Sci Exchange, 27(132), 1-5.

[7]          G. L. Close, C. Sale, K. Baar, and S. Bermon, “Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes,” International Journal of Sport Nutrition and Exercise Metabolism, vol. 29, no. 2, pp. 189–197, Mar. 2019.

[8]          D. Thomas, K. Erdman, and L. Burke, “Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance” Journal of the Academy of Nutrition and Dietitics, vol. 116, no. 3, pp. 501–528, Mar. 2016.

[9]          S. van Vliet, N. A. Burd, and L. J. van Loon, “The Skeletal Muscle Anabolic Response to Plant- versus Animal-Based Protein Consumption,” J Nutr, vol. 145, no. 9, pp. 1981–1991, Sep. 2015.

[10]        T. A. McLain, K. A. Escobar, and C. M. Kerksick, “Protein Applications in Sports Nutrition—Part I: Requirements, Quality, Source, and Optimal Dose,” Strength & Conditioning Journal, vol. 37, no. 2, p. 61, Apr. 2015.