Being injured is extremely frustrating. Not only does it stop you from doing what you love but also sets you back in your training. Knowing what to do nutritionally in the initial period can limit recovery time and influence the quality of repair.
Recovery can be split into two phases: phase one is when the person is completely immobilised or has reduced mobilisation – no training. Phase two is rehabilitation. The main aim during phase one is to reduce muscle loss, which is the main focus of this blog. Typical muscle loss after 5 days of immobilisation is 3% and after two weeks 5%. Studies show that regaining 5% of muscle takes on average 6 weeks of rehabilitation so minimising muscle loss in the initial injury period is important to overall recovery time.
A typical pattern through a normal day is that muscle breaks down between meals and snacks, then re-synthesises after eating. This generally balances out through the day (if not following a programme to deliberately manipulate body composition). What is seen during reduced muscle mobilisation is a lower ability to synthesise muscle; less amino acids are transported from the blood to muscle leading to breakdown outpacing synthesis. High protein intake of 2 -2.5g of protein per kilogram of body weight a day has been shown to increase the uptake of amino acids to some extent – not fully, but it helps. There is evidence that higher intakes of the amino acid Leucine is beneficial during this period. However if consuming protein in the quantities outlined above then Leucine intake will be sufficient. Vegans may want to consider supplementing as Leucine is lower in non animal protein sources.
So protein requirements have gone up but you are moving less, so how much should you eat in total? Healing increases metabolism – post surgery by about 20%, wound infection by 50% and burns by a whopping 100%. Sports injuries are thought to increase metabolism by about 20% but this is hugely variable. Using this as a benchmark that means reducing total calorie intake below that of a training day but about 20% above a rest day. Too low energy intake will decrease the rate of muscle and collagen synthesis and tissue granulation. However that is not a carte blanche to eat whatever you want, too high an energy intake is negative too.
Supplementing with fish oil has been proven to both reduce inflammation and in some studies to reduce muscle loss. Inflammation is initially beneficial and has an essential role in healing but can sometimes outstay its welcome. Check with your physio where you are in the healing process. Eating oily fish has the benefits of providing protein and fish oils but if particularly targeting inflammation a supplement for a limited period will provide a higher and more effective dosage.
Antioxidants, in particular vitamins A, C, D and E are important for reducing inflammation and for tissue synthesis; vitamin C is essential for collagen formation. The balance of research suggests that the main aim is just not to be deficient in these nutrients rather than a requirement for mega dosages. With the exception of vitamin D which everyone should supplement with, a healthy balanced diet will provide sufficient amounts of these nutrients. However if you are not eating a healthy balanced diet you need to supplement.
Other evidence of note for the initial stage of injury is that on balance supplementing with creatine reduces muscle loss, supplementing with collagen or gelatin for tendon injury is beneficial and alcohol reduces muscle synthesis. In fact alcohol has not only been proven to reduce muscle synthesis but also reduced collagen formation, increase inflammation and impair bone and wound healing.
An area that has not been researched in sports science with regards to injury is gut bacteria. However from other areas of nutritional science we know that gut bacteria is a powerful mediator of inflammation. Certainly if your injury has required antibiotics it is advisable to take a course of probiotics. Whilst the research is not available at the moment I do think going forward we will see work in this area related to sports injury. So watch this space.
Once through the initial stage and into rehabilitation it is important to increase energy intake in line with activity and keep protein intake high. At this point you do not want inflammation so omega 3 and antioxidants are important. Movement makes a significant difference to muscle synthesis. The sooner you are moving the better, even moving non injured parts of the body creates neuromuscular signalling increasing protein uptake in the less active muscles.
If injured you may feel frustrated and helpless, but you can influence the speed and quality of your recovery with nutrition. Hitting the pizza and beer for comfort or eating too little through fear of weight gain will impede recovery. A diet high in protein with lots of fruit and vegetables and a fist size portion of complex carbohydrates with each meal will support your nutritional needs. Plus consideration to supplementing with creatine, collagen and omega 3 if appropriate.