Catherine Norton: Injury - can you eat your way back to recovery?
One aspect of recovery that is often overlooked when an athlete is injured is nutrition. We tend to pay more attention to massage, ice-packs and heat treatments than to what we eat and how we fuel recovery.
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 training can often lead to loss of body weight, muscle mass and 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 intake. Often the first impulse of injured players is that they need to reduce their calorie intake because they can't train.
For professional athletes 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 due to healing process can be increased by as much as 20 per cent.
Another consideration is the energy cost of moving around. If crutches are used they can increase energy expenditure two to three times than 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. Avoiding excesses of other inflammatory foods like caffeine, sugar, fat or alcohol is recommended.
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 overcome this resistance.
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.
Along with calories, protein and essential fat intake during nutrition recovery from injury, 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 may 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!