Injuries are unfortunately, a normal part of competitive sport. Although injuries need time to heal and often require the expertise of rehabilitation specialists, there are a few areas of nutrition you can focus on to aid with the healing process. An in-depth guideline was recently published by The Journal of Athletic Therapy, it covers nutrition considerations and strategies to facilitate injury rehabilitation and recovery. This article will be based off the recommendations from that guideline.
*Always seek individualized care and guidance from a Registered Dietitian or Physician. The following are general guidelines, not specific to individual needs.
Nutrition & Injury Rehabilitation - Areas To Focus On
Regardless of their severity, injuries often require a period of time where you can't train and are stuck watching from the sideline. You are likely working your butt off at rehab, but it probably still feels like it is taking forever to be cleared to play. While there is no magic food or supplement that will get you back on the field - nutrition can be a key player in your recovery. The main roles of nutrition in injury rehabilitation are maintaining lean muscle mass, supporting optimal healing, and reducing prolonged inflammation. Let's take a look at some of the areas to focus on when it comes to your nutrition while rehabilitating:
Energy Intake
Many athletes believe they need to decrease their caloric intake because they're not training as much. The reality is, athletes likely need to increase their caloric intake as their metabolic rate will increase due to the stress response and healing process. At a fundamental level, the main goal of rehabilitative nutrition is to consume enough calories and protein to help with wound recovery and prevent the loss of lean body mass (LBM).
Caloric needs for an athlete are highly individual and are based off many aspects including your type of injury, your medical history, your daily activity, level of rehabilitation, etc. Therefore, I will not be getting into the specifics on how to calculate your energy needs while injured because I believe that process should take place under the supervision of a professional. However, the take away from this area is to make sure you are not cutting calories while injured because it may lead to loss of muscle mass and prolonged healing time.
Protein Intake
The demand for amino acids (the building blocks of protein) is significantly higher after an injury is sustained because they are needed for wound healing, immune support, and glycemic control. If protein needs are not met, the body will begin to breakdown your hard-earned muscle to get those amino acids. The protein recommendations for active individuals looking to maintain muscle mass is already higher than average, at around 1.4-2g/kg per day. When recovering from an injury, the rate of muscle breakdown increases which means your protein needs will increase as well.
The amino acid, leucine, is extremely important during injury recovery, as it's the most responsible for stimulating muscle protein synthesis. It is recommended athlete's aim to consume 3g leucine per protein serving. Sources of leucine include animal proteins (chicken, beef, fish, milk) or whey protein.
Protein recommendations:
At least 1.6g/kg per day, and closer to 2-3g/kg per day.
Consume 20-40g protein per meal to maximize muscle protein synthesis when injured
Aim to consume 3g of leucine per protein serving, to aid in faster recovery while injured
Protein sources: chicken, beef, fish, milk, yogurt, cottage cheese, eggs, beans, tofu, edamame, etc.
Carbohydrate Intake
Carbs play many roles during injury rehabilitation - including immune support, hormone support, enzymatic processes, and of course, our main source of energy. While athlete's may not be as active as they were when they are training, consuming enough carbohydrates is crucial for injury recovery.
Carbs have a protein-sparing effect when the body is in a catabolic state (ex. injury). If you cut your carbohydrate intake, your body needs to turn somewhere else for energy, and often that place is your muscle.
Carbohydrate Recommendations:
3-5g/kg per day or ~55% of your caloric intake
Focus on complex carbohydrates which provide micronutrients and fibre that help with the healing process
Complex Carbohydrate Sources: whole grains (e.g. brown rice, oatmeal, quinoa, barley, whole wheat pasta, etc) fruits and vegetables
Essential Fatty Acid Intake
With injuries, an inflammatory reaction is a natural part of the stress response and is crucial for healing. However, a prolonged inflammatory response can be counteractive for healing. That is where healthy fats come in. Monounsaturated and polyunsaturated fats help with inflammation, wound healing, and cell proliferation.
Fat Recommendations:
Aim for 0.8g/kg - 2g/kg per day or 20-25% of your caloric intake
Sources of monounsaturated and polyunsaturated fats: olive oil, flax, fish, nuts, seeds, and avocado
Specific Nutrients to Focus On
While the most important nutrition-areas to focus on while recovering from an injury is getting enough, high-quality calories and macronutrients - there are a few specific nutrients you can focus on to aid with healing and future injury prevention.
Micronutrients - Vitamin A, C, and E
Vitamins play an important role in facilitating healing and having an antiinflammatory effect, which helps prevent that prolonged inflammation. Vitamin A and E both have antioxidant properties, meaning they reduce oxidative stress caused by an injury and therefore, decrease wound healing time. Vitamin C has been shown to have a role in collagen synthesis - an important component for the healing of ligaments, tendons, and bones. The good news is Vitamin A, C, and E can all be easily found in diets rich in fruits, vegetables, whole grains, seeds, nuts, and fatty fish.
Vitamin D
Vitamin D plays a role in immune regulation and muscle function and may have potential benefits when it comes to injury recovery. Those with insufficient Vitamin D levels (I'm talking to you Canadians), may experience impaired muscle repair, regeneration, and muscle growth. Vitamin D can be found in small amounts in some foods such as cheese, yogurt, fish, orange juices and some fortified cereals. However, supplementation may be necessary if you live in certain countries, but always speak to your doctor or RD before you begin supplementing!
*Tip: Vitamin D is a fat soluble vitamin, so always make sure to have a source of fat with your vitamin D-rich foods or supplements.
(Check out my post on Vitamin D for Athletes to learn more about it)
Supplements to Consider
While there is no supplement that will magically cure an injury, there are a few that can help mitigate with the side effects of an injury and muscle loss during time off from training. The important thing with supplements is choosing the right one, particularly for university athletes who are under the Canadian Anti-Doping Program (CADP). Look for the logos NSF Certified for Sport, Informed Choice Logo, or Banned Substances Control Group, letting you know the product has been tested to ensure it is free from banned substances.
Creatine Monohydrate
Creatine occurs naturally in our bodies and is stored in our muscles as phosphocreatine. Phosphocreatine is needed for short, explosive exercise, muscle mass, and strength. Creatine supplements are one of the most evidence-backed, ergogenic aids that help improve intense exercise performance and increase lean muscle mass when paired with exercise. They can also be quite useful when injured, by helping to preserve lean muscle mass while immobilized.
Omega -3 Fatty Acids
Omega-3 fatty acids are made up of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Like we mentioned earlier, fatty acids like omega-3's have antinflammatory properties, which helps prevent prolonged inflammation. EPA and DHA are essential nutrients, meaning we need to get them from our diet because our body does not produce them. Some athletes may have trouble consuming enough omega-3's through their diet and may need to turn to supplementation to help achieve these amounts.
**Always, always, always speak to your RD or physician before you start a supplement routine! They can help you determine if you need the supplement, the dosage, and how long you should use it for.
Article written by: Stefanie Di Tella, MScFN, RD
Be sure to check out my instagram page @fuelwithstef for more evidence-based, tips and tricks on how to use nutrition to maximize your performance!