One aspect of recovery that is often overlooked when an athlete is injured is nutrition. We tend to pay more attention to rubs, ice packs and heat treatments than to what we eat. The information here is intended to provide food for thought on how what we eat can play a role in recovery from injury.
Sports injuries that result in limb immobilisation and reduced (or no) training can often lead to loss of 1) body weight, 2) muscle mass and 3) muscle function. The right nutrition throughout the time that an athlete is immobile and recovering is vital to attenuate these losses and expedite return to play.
The first thing to look at should be energy / calorie intake. Often the first impulse of injured players is that they need to reduce their calorie intake because they cannot train. For professional athletes anyway, there is a fear of getting fat while they are side-lined! It is likely that a reduction of total intake will be necessary to prevent unwanted weight gain, but it may not be as extreme as some players think. During the early phase of the healing process, energy expenditure can be increased by as much as 20%, particularly if the injury is severe; this is the acute energy cost of the healing process. Another consideration is the energy cost of moving around. If crutches are used, they can increase energy expenditure two to three times that used up in regular walking. It is important not to over-restrict calorie intake as this can also affect the body’s ability to maintain or increase muscle mass. So a small amount of weight gain may be preferable to a lack of energy to support proper healing during immobilisation.
Straight after a severe injury, the body starts an inflammatory response which is necessary for healing. However after a couple of days (the length of time depends on the injury), avoiding excessive inflammation is a wise course of action. From a nutrition point of view, this may mean decreasing omega-6 fats (which may promote inflammation) and increasing intake of omega-3 fats (which have anti-inflammatory properties). In practice, this means decreasing fat intake from vegetable oils and increasing consumption of omega 3-rich foods such as oily fish. Avoidance of other inflammatory foods is recommended (excess of any of caffeine, sugar, fat or alcohol).
Immobility can also result in losses of muscle mass and function. Nutritional interventions should focus on attenuating the drop in muscle synthesis. It is well accepted that protein or essential amino acid (EAA) intake increases muscle protein synthesis following exercise, but it might not have the same impact during inactivity. Studies have shown that immobile muscle seems to be resistant to the stimulus of EAAs. However it has been suggested that nutrition interventions such as increased intake of a particular amino acid called leucine and omega 3 fats and may help decrease this resistance. Studies are needed to examine this before any firm recommendations can be made, but it won’t do any harm.
As rehabilitation progresses, muscles will begin to grow through protein synthesis. This process requires increased amino acid availability that can be met by increased protein intake. How much is still the big question, but as long as it fits in with adequate carbohydrate and essential fat intake, high protein intake should not be a problem. As well as considering the total amount of protein, the timing of intake in relation to exercise and the type of protein ingested is important.
Whereas calories, protein and essential fat are often the focus of nutrition recovery from injury, other nutrients have a role to play as well. Adequate vitamin and mineral intake, especially zinc and vitamin C is necessary for wound healing and collagen synthesis. Sufficient intakes of calcium and vitamin D are necessary for optimal bone healing. Antioxidant nutrients help to control oxidative stress. A word of caution though – supplementation with any of these nutrients above what should be obtained in a well-planned, varied diet is not advised; indeed supplementation with individual nutrients where not necessary may upset the balance of absorption and metabolism of other nutrients. There is evidence that excessive alcohol can impair muscle protein synthesis and delay healing. So whereas the odd glass of wine will do no harm, don’t drown your sorrows because of your injury!
Putting the theory into practice
- Reduce total calorie intake, but not too drastically. Reduce portion sizes and energy dense but nutrient poor snacks rather than skipping meals
- Ensure you are eating high quality protein at least at every meal and ideally in your between meal snacks too [eggs, meat, fish, chicken, dairy products (milk, cheese, yoghurt – all low fat), nuts, seeds]
- ‘Eat a rainbow’ – try to include a variety of different fruits and vegetables daily to achieve sufficient vitamin and mineral intakes
- Avoid alcohol
- Eat oily fish (herring, sardines, mackerel, tuna, salmon) at least 3 times weekly
- Switch from using vegetable oils (a source of omega-6 oils: corn oil, sunflower oil, safflower oil, cottonseed oil, soybean oil) to olive oils and flax oilsHerbs and spices can also be valuable in the management of inflammation. The following are useful anti-inflammatory agents, which may be included in daily meals:Herbs and spices can also be valuable in the management of inflammation. The following are useful anti-inflammatory agents, which may be included in daily meals:
Curry powder/turmeric – this member of the ginger family has long been used as an anti-inflammatory and for wound healing. The active ingredient, curcumin, is likely responsible for the effects.
Garlic – has been shown to inhibit inflammatory processes. Adding it to the diet is helpful as an addition to meals.
Pineapple – contains bromelain, another anti-inflammatory plant extract that can help with inflammation/pain relief.
The information here is not intended to serve as prescriptive advice for any individual athlete but rather as a guide on what good nutrition might look like in an injured athlete
For individual advice please consult with a suitably qualified professional
Dr Catherine Norton RD, PhD, SENr is a in Lecturer in Sport & Exercise Nutrition. View Catherine’s profile here.
Catherine’s Email Address: Catherine.Norton@ul.ie
Catherine’s Twitter: @NortonNutrition
For Further Information
- View Catherine’s Presentation on Nutrition strategies to attenuate loss of lean mass in the injured athlete here.
- View Nutrition for injury recovery here.
- Tipton, K.D. (2013) ‘Dietary strategies to attenuate muscle loss during recovery from injury’, Nestle Nutrition Institute Workshop Series, 75, 51-61. https://www.ncbi.nlm.nih.gov/pubmed/23765350
- Wall, B.T. and Loon, L.J. (2013) ‘Nutritional strategies to attenuate muscle disuse atrophy’, Nutrition Reviews, 71(4), 195-208. https://www.ncbi.nlm.nih.gov/pubmed/23550781
- Wall, B.T., Morton, J.P. and van Loon, L.J.C. (2015) ‘Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics’, European Journal of Sport Science, 15(1), 53-62. https://www.ncbi.nlm.nih.gov/pubmed/25027662
- Schlabach, G. (1994) ‘Carbohydrate strategies for injury prevention’, Journal of Athletic Training, 29(3), 244-246;249-250;253-254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1317793/
- Tipton, K.D. (2015) ‘Nutritional Support for Exercise-Induced Injuries’, Sports Med, 45 Suppl 1, S93-104, http://dx.doi.org/10.1007/s40279-015-0398-4.