Nutrition for the Injured Athlete

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It’s been 12 weeks since I broke my tibia, fibula, and calcaneus. (Basically I broke 3 parts of my lower leg/ankle). It all started when I was building up to a one-rep max when upon coming up from the bottom of the squat, my shoulders shrugged up, trapping my pony tail under the bar. When the bar slid down my back with 250#, it whipped me back down and I didn’t have a chance to get away from the bar. I sat up in shock to realize my foot was dislocated and I couldn’t stand on my other foot. Disaster! Panic set in and I started to think about everything I would be missing from training, including the “hard work” I had done with my nutrition to create the physique I desired. My training and nutrition plan was now over.

But was it really? Not entirely. What most athletes don’t realize is that there are very important roles that nutrition plays during an athlete’s recovery process. Although my back squatting days were put on hold for a while, I could still focus on nutrition and eventually get back to physical movement and what I loved. For the sake of this post, we are going to focus on the nutrition piece.

The immediate prescription for sport’s injuries is typically the RICE method (rest, ice, compression and elevation). Sadly, doctors and PTs often overlook the importance of nutrition during the recovery process. How many of you remember a doctor talking to you about how much protein to eat during your last surgery or ankle sprain? Probably not. Your caloric and macronutrient intake is not only crucial during the acute phases of early recovery but also later during the rehabilitation process.

Although most of think of our injuries as a big disaster or disarray of pain and discomfort, there is actually a very specific process in which your body goes through stages of an injury for soft tissue. We start at stage 1, inflammation, where our body has been deprived of oxygen and nutrient-rich blood flow. Between these two along with the actual damage suffered, our cells die and our body attempts to clear out the dead cells. You may experience pain, swelling and redness, all a part of the functional process. Although pain is annoying, it’s necessary for repair. The next stage is the proliferative phase whereby inflammation subsides (damaged tissue is mostly removed) and restoration begins. After that, the remodeling phase concludes (21 days to 2 years) where the scar tissue formed in the prior phase is shifted to much stronger collagen and laid down in it’s place. Although the new tissue is likely to be 100% normal, often times it can become 80% as strong as uninjured tissue. A similar process takes place for bone healing when compared to soft tissue healing.

Now onto the good stuff. If you’ve worked with me, you’ve heard me talk about increased activity results in greater energy needs (more exercise = more calories). And yet, some folks intentionally under-eat, perhaps to lose body weight or by accident because they are ill or injured. Under-eating can lead to an increased chance of stress fractures, ligament injuries, and so on[1]. Because of these instances, we can deduce that not eating enough, even in a healthy elite athlete, can lead to injury. Likely during an injury, physical activity is reduced which probably leads to a lowered appetite. If you are living your life off of hunger only, you WILL be under-eating! This leads to less mass, poor healing, and slow progress. Who wants to stay injured and out of the game longer? Surely, not me!

Once an injury has occurred, not consuming enough hinders your recovery or prevents you from progressing. Energy needs increase during acute injury. In fact, your BMR (basal metabolic rate) could increase upwards of 50% depending on the severity of the trauma![2] This need for increased metabolic rate comes as a result of the body’s need to repair itself and the increased demand on your systems. We can’t ask our bodies to do additional repair work as well as support our daily function and expect to run on less fuel can we?

Sounds simple enough right? You’re injured, eat more. But how much more? A stay-at-home mom with a recovering leg fracture who does CrossFit 4 times a week will have to eat less than during her competitive training days. But, if she returned to her baseline or regular caloric intake (maintenance), chances are, she would be under-eating. As you can see, although energy intake should decrease or be below that of competitive training, eating at maintenance is too little to help fuel your body during recovery.

While it’s important for injured athletes to reduce intake during recovery, they should still be aware of their intake just as much as they are during competitive training. Stay ahead of the game with multiple meals, adequate protein, sufficient macronutrient and micronutrient intake (vitamins and minerals) etc. Generally speaking, it’s important for an injured athlete to consume 1.5kg-2.0kg of bodyweight (above the normal 0.8kg). Since most of my athletes are already on this plan, their needs are covered. Regardless, if a rapid return to normal function is desired, protein intake is essential. Individuals should strive for 1 g of protein per pound of bodyweight as a minimum.

Supplemental amino acids have also shows to have powerful effects on injury healing. The two amino acids, arginine and glutamine, have been shown to speed up the healing process in the body.[3] Regarding the other two macronutrients, fat has been shown to help alleviate inflammation and have an anti-inflammatory effect if the diet is high in monounsaturated fats and omega-3 (stay away from trans-fats, omega-6, vegetable oils, and saturated fat since these are pro-inflammatory). Lastly, for carbohydrates, although we need glucose for injury healing, there is no specific recommendation. However, carbs that are unprocessed should be included as much as possible (with micronutrient density) to keep insulin levels stable. Highly processed carbs should be avoided as they may trigger inflammation and could potentially affect wound healing.

Between all of the above recommendations, it’s easy to become confused or frustrated with your needs. In a nutshell, eat more than baseline during recovery but less than competition training and be careful of under-eating. Consume your approximate body weight in grams of protein and seek out nutrient dense carbohydrates (i.e. sweet potatoes, rice, squash, root vegetables, and fruit) along with monounsaturated fats (i.e. avocado oil, olive oil, nuts, seeds, and nut butters). If you are injured, or recovering from an injury, I offer custom macronutrient plans and am happy to help nutritionally guide you. Please contact me for more information.

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[1] Berardi, John MD and Ryan Andrews, RD, “The Essentials of Sport and Exercise Nutrition,” Precision Nutrition, June 2014, pp 222-225.    

[2] Ibid.

[3] Ibid.

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