No one likes being injured. Follow this advice to supercharge your injury recovery and get you back in the game.
This section is focusing on soft tissue injuries. This includes muscles, ligaments and tendons.
When we get injured there are three main stages that the body undergoes to allow us to get back to full function. Each of these phases is crucial to the healing process and our primary goal with nutrition is to support and manage them.
When we get any injury there is a level of inflammation that occurs. Understanding how to manage inflammation in all stages is crucial and can accelerate the healing process.
There are two types of inflammation - acute and chronic.
Acute inflammation can be a response to exercise stress, an injury or infection. Physiological changes that occur include increased blood flow, accumulation of white blood cells, redness, heat, swelling and pain at the affected site. We need acute inflammation to promote the regeneration of new cells which leads to healing. This is the body's defence mechanism.
Acute inflammation is crucial but it needs to be managed in the correct way.
Chronic inflammation is a long term physiological response to one or more factors. It is a failure of the body’s immune system to maintain a healthy homeostatic state. It occurs when there is repeated exposure to acute inflammation or it is poorly managed. Factors such as poor nutrition, environmental toxins, overtraining or infection can lead to chronic inflammation. If you do not address your nutrition and lifestyle then it could lead to the clinical symptoms of disease and poor performance.
Chronic inflammation is something we want to minimise as much as possible.
If we manage our injury in the correct way we deal acute inflammation and minimise chronic inflammation.
THREE PHASES OF NUTRITION FOR INJURY
Eat the rainbow simply means lots of colours on the plate at each meal. Don't be beige. ABC is explained later and is a simple acronym to include the nutrients needed in the initial phases of injury
This is where we introduce strategies to support repair and regeneration. Protein and fats are our friends in this phase. Carbohydrates are taking in line with activity. This depends on the severity and nature of your injury
Where we transition back to your performance nutrition plan
The acute phase is the initial stage post injury. During this stage, an inflammatory response is initiated. The inflammatory response initiates activation of many processes that are crucial for optimal healing (REF). This inflammation may last for a few hours up to several days depending on the type and severity of the injury (REF).
Our primary goals for dealing with acute soft tissue injuries are
Support normal function
We don’t want to avoid the inflammatory process in the acute phases of an injury. It’s critical for long term recovery. However we don’t want to make inflammation worse. Excessive inflammation could increase total tissue damage, slowing down the repair process, which is obviously counterproductive for healing.
While managing inflammation in the early stages, we want to reduce pain, as this can cause bio-mechanical compensations and changes that may lead to secondary injury.
We actually want to limit the use of high dose omega 3 until the repair phase. Remember....controlling inflammation is what we want...not reducing it completely.
SO HOW DO WE MANAGE INFLAMMATION AND REDUCE PAIN?
Eat the rainbow
Brightly coloured fruits and vegetables are rich in antioxidants such as vitamin A, C, E, zinc and selenium which will reduce inflammation.
Vitamin A is found in eggs, pumpkin, carrots and sweet potato.
Vitamin C is found in broccoli, cauliflower, citrus fruit, tomatoes and berries.
Vitamin E is found in nuts, seeds, avocado and eggs.
Zinc is found in meat, nuts and seeds
Selenium is found in Brazil nuts and seafood
Pineapple and papaya contain enzymes (bromelain and papain) that lower inflammation
Great recipe is the coconut hydration smoothie on the recipe page
Spice it up
Certain spices aid in reducing inflammation in the body, as well as making your food taste better! Be generous with the ginger, turmeric, cumin and cinnamon.
Remove pro - inflammatory foods
We keep mentioning including more anti inflammatory foods, but limiting pro inflammatory foods is also essential. The foods listed below should be removed -
- Fizzy drinks
- Biscuits and chocalote bars
- Refined sugar
- Deep fried food
- White flour (bread, pasta, wheat)
- Processed meats such as sausages, bacon and deli meats
Steering clear of processed foods is a quick way to avoid many inflammatory agents. Remove any excess sugar can inhibit the production omega 3’s as they inhibit delta 6 desaturase, one of the enzymes on the anti-inflammatory prostaglandin pathways.
The use of anti inflammatory drugs such as ibuprofen, celebrex etc is purely down to the severtiy and pain of the injury. If you can...avoid.
Sleep is when the body can repair and regenerate. If we are sleep deprived there are a number of hormonal changes, there is an increase in cortisol and a reduction in testosterone and Insulin-like Growth Factor 1, favouring the establishment of a highly proteolytic environment.....the opposite of what we want. Research has shown that sleep debt decreases the activity of protein synthesis pathways and increases the activity of degradation pathways, favouring the loss of muscle mass and thus hindering recovery (REF).
When we are sleep deprived, T cells (important for immunity) are lowered and cytokines (inflammatory cells) are raised. This anti inflammatory environment we are wanting to create is hard to achieve when we don't get enough sleep.
Taking some form of protein 30 minutes before bed can help to preserve muscle mass during times of immobility.
This phase is where we see the formation of scar tissue, reduction in inflammation and the return of oxygen and nutrients. This scar tissue will be laid down in alignment with the forces that are placed on the site (highlighting the importance of rehab in this stage). This scar tissue will eventually reduce in size during this phase.
This is the crucial phase for accelerating your return to full function. It is a fine balance between doing too little and doing too much.
From a nutrition perspective we want to
- Ramp up the anti inflammatory nutrition
- Provide the building blocks for new tissue
- Support the preservation of lean muscle mass
To do this we like to follow ABC
Following the guidelines for macronutrients is essential. Protein intake needs to be slightly higher in this phase.
The addition of specific nutrients will help immensely. Foods in the green table will help provide the necessary micronutrients to supercharge healing. EAT THE RAINBOW.
Specific supplementation protocol is advised. Building on what we started in the acute phase.
In this phase the requirement for anti oxidants is increased
Omegas and inflammation
This is the time to be adding smart fats and taking a fish oil supplement. In the acute phase we want to MANAGE inflammation but not INHIBIT it. Now we want to blitz it and kick start the recovery process.
Omega 3 fatty acids are an anti-inflammatory powerhouse. The highest levels are found in wild salmon, mackerel, sardines, eggs, walnuts, flaxseed and green leafy vegetables.
Other anti-inflammatory nutrients include the spices mentioned in the acute phase but also bromelain, papain and digestive enzymes. Bromelain is found in pineapple but can be taken in a supplement form also.
All of these nutrients help to lower CRP which is the primary inflammatory marker in the body and well as promoting an optimal environment for healing.
Anti oxidants have a little bit of a good cop bad cop relationship with healing and adaptations. High dose anti oxidants around training CAN impair the bodies ability to adapt to the stimulus. However when we have an injury we need to provide exogenous antioxidants (from an outside source) and support endogenous (from within) antioxidant production.
The best way to do this is by eating a broad spectrum of foods that are in season. Focus on the green table foods!
Glutathione is a molecule that is classed as the master antioxidant. There are 4 primary things that glutathione does within the cell that are critical for cellular functioning, injury recovery, performance and health:
- It’s the primary anti oxidant inside of every cell
- It’s the primary anti inflammatory of every single cell in your body
- It’s the primary detoxifier of the cells in your body.
- It directly supports the production of ATP which is the energy currency the body uses
We suggest using food to get anti-oxidants and supplementing with a high strength b vitamin, glutamine and collagen. These are precursors to glutathione and will help with muscle and ligament repair.
Creatine and HMB
With any injury we will have to reduce our level of output. This may be a small reduction or if the injury requires immobilisation then function will be severely reduced. Two things we want to focus on is increasing muscle protein synthesis and preventing a catabolic environment.
Alongside the macro nutrient recommendations we advise adding in a creatine and HMB supplement. This is to promote anabolism (creatine) and prevent muscle protein breakdown (HMB).
The length of injury will dictate whether this is needed. If you are looking to be back training within 3 weeks then this is not needed but if you are post surgery or the injury is going to be longer than 3 weeks we advise to add this in.
Now we can start to ramp things up! This is where you accelerate rehabilitation and start to introduce scaled versions of your training. Nutrition consideration of this phase include
- Support muscle and tendon function in line with the training load
- Correlate intake to energy output
- Change supplementation and get back into your performance based nutrition plan
As you start to ramp back into full training you may experience more muscle soreness. We want to increase your carbohydrates to support this alongside eating a varied diet with lots of veggies and fruits. We want to try re-integrate your pre injury nutrition plan by focusing on achieving training day calorie needs and macro-nutrient breakdown.
This is also the time to start thinking about body composition. You may have added a little bit of body fat or lost some muscle mass so lets identify what our primary area of focus is and align our calorie and macro targets to this.
We pretty much want to follow the same recommendations as the previous phase. We can also follow this advice regarding supplementation
- Lower intake of omegas back to maintenance level
- Take cherry juice in evening to help with muscle soreness
- Keep fluid intake high as you will be exercising more.
Immediately after a fracture a blood clots forms. This causes the influx of inflammatory ‘cleanup’ cells. Cytokines then flood the area to and bring ‘repair’ cells into the fracture site. These then differentiate into specialised cells that that build new bone tissue (osteoblasts) and new cartilage (chondroblasts).
Taking B vitamins, antioxidants and ZMA alongside an anti-inflammatory diet is crucial in this stage.
This begins around two weeks after the fracture occurred. In this stage, proteins produced by the osteoblasts and chondroblasts begin to consolidate into a soft callus. This soft, new bone substance eventually hardens into a hard callus as the bone knits together over a 6 – 12 week period.
Aminos and vitamin C are crucial in this stage as vitamin C converts proline to hydroxyproline - which is major component to collagen.
The bone substance begins to mature and remodel itself into stronger lamellar bone by the bone formation cells.
Vitamin D, K and calcium are vital in this stage.
THE NUTRITIONAL DEMANDS OF HEALING
Every stage of the fracture healing process has increased nutritional needs. This is why the nutrition for injury plan is divided into PHASE 1, PHASE 2 and PHASE 3. Importantly, the healing process requires a lot of energy, however, we need to have a balance between supporting healing and increasing body fat. Additionally, the fracture requires a constant supply of amino acids – in particular lysine, proline and glycine. Finally, the trauma of the fracture itself creates an increase in free radicals (pro-oxidants), resulting in oxidative stress that can lower the body’s antioxidant reserves.