Nutrition for the Injured Athlete

We talk all the time about nutrition for performance and nutrition for recovery but there is not much talk about nutrition for injury. Is there even a specific regimen for the injured athlete?!
Unfortunately, there is not much research out there on the injured athlete so we don't have a specific regimen, however, we do have some knowledge and recommendations to help heal faster and get back in the game sooner.

Injury has 3 healing phases:

1. Inflammation - occurs immediately up to 2-5 days post injury
2. Proliferation -  occurs 5 days - 3 weeks post. During this phase there is rebuilding and repairing 
3. Maturation - occurs 3 weeks - 2 years (depending on severity of injury). During this phase there is remodeling to a stronger structure

If the injury is serious we may not be able to immobilize which in turn will cause less muscle building, muscle loss, decrease in strength and of course decrease in performance.  

Nutritionally, we divide recommendations to 2 phases: 

1. Injury and immobilization - during this phase most of the muscle loss occurs
2. Rehabilitation - during this phase exercise is re-introduced in the form of therapy and advanced to full practice when able

Nutrition recommendations during Injury and immobilization (= inflammation and proliferation phase of healing):

• Energy (kcal) - demands of energy are slightly higher in order to assist with the healing processes. If injury is severe, energy expenditure can go up by 20%. If on crutches, energy expenditure can be 2-3 times higher than walking. Sometimes, a small weight gain is beneficial because with out enough calories we can prevent muscle protein synthesis (building muscle)
• Protein - During the immobilization phase we lose muscle which then causes us to lose strength. Protein helps us build and repair, therefore, are needs for protein are higher. Although we do not have an exact number of grams/lb we need per day, we assume its more than the DRI (dietary reference intake) which is 0.8 grams/kg (0.35 grams/lb). Some research suggests we need close to 1-1.2 grams/kg/day (0.45-0.55 grams/lb/day). Since the majority of us eat more protein than we need this should not be an issue
• Carbohydrates - When we exercise, carbohydrates are our main source of energy. However, when injured, we don't need as much, therefore, we may decrease carbohydrates slightly to prevent excessive weight gain. Sports beverages, gels, sodas and concentrated sweets are highly discouraged during this time
• Fats - very essential for healing. What type of fats is most important. Omega 3s (found in fatty fish as well as certain seeds/nuts) have been found to possibly help increase muscle protein synthesis (building muscle) as well as help with recovery and decreasing inflammation
• Vitamins and minerals:
             * Vitamin C - Helps with wound healing, tissue repair and increased immune function. Foods rich in vitamin C include: citrus fruit, strawberries, red bell peppers, watermelon, etc.
             * Vitamin A - Helps with cell growth and development as well as immune function. Foods high in vitamin A include: sweet potatoes, tomatoes, carrots, papaya (orange/red fruits and vegetables)
             * Zinc - Helps with wound healing, protein synthesis and immune function. Foods rich with zinc include: beef, almonds, seeds (sunflower, flax, pumpkin, etc.) and seafood
             * Vitamin D - Important for bone health and immune function. The sun vitamin - get 5-30 minutes of sun between 10 AM - 3 PM (time is based on skin color, the darker the skin the more time you need) or it can be found in dairy products, fatty fish or fortified foods

                      

• Fluids - fluids are needed in order to deliver the different nutrients to the different organs and tissues. Moreover, its needed to support joints and soft tissues. Roughly, you should be drinking half your weight in ounces, preferably water. 

Nutrition during rehabilitation phase

We treat this phase as we were to treat someone who does strength and conditioning. We put emphasis on enough energy and protein as well as healthy fats and plenty of vegetables and fruits. More on strength and conditioning nutrition in a future blog.

There are also foods/beverages that can prevent us from healing optimally, which we should avoid:

• Fried fatty foods (example: pizza, fried chicken, french fries, etc.)
• Added sugars and concentrated sweets (soda, candy, ice-cream, etc.)
• Being malnourished (more common in elderly but applies to people that restrict eating a lot)
• Less than optimal sleep (athletes should sleep 8-10 hours/day)
• Alcohol - it inhibits muscle protein synthesis and increases muscle loss 

So, if you or any of your friends get injured, remember to also focus on nutrition to help speed your healing and recovery! Food always comes first and if need be, consult a sports RD or a sports MD for supplement recommendations.