Nutritional Strategies to Optimize Injury Recovery

Sports injuries directly affect an athlete's health and performance. It is well known that repeated injuries throughout a season interrupt the training period, affecting the resulting adaptations and preventing participation in competitive events. The main priority should be to prevent these injuries through appropriate training, proper nutrition and rest.

Nevertheless, injuries can inevitably occur. When they do, the nutritional objectives are to: i) optimize the response to treatment for the injury and/or surgery; ii) maintain an appropriate weight and body composition; and iii) ensure a return to training as quickly as possible [1]. We should also remember that injury-related immobilization increases the risk of muscle atrophy as well as reducing the capacity to gain muscle mass and causing a loss of strength [2].

Energy Intake: The Major Overlooked Factor During Sports Injuries

Energy intake plays a fundamental role in maintaining muscle mass. In addition, resting energy expenditure during an injury increases by 15-50% compared with the pre-injury state [3]. This reflects the energy needed to repair damaged tissue, support related inflammatory processes, and mount the hormonal response to injury. However, if the athlete must remain completely immobilized or confined to bed, energy expenditure from physical activity and exercise will decrease.

Therefore, during an injury, energy intake should not be drastically reduced . Requirements should be adjusted to the individual's physical activity and exercise and to the injury's stress factor.

Protein Intake: The Second Link in Nutrition During Injury

As mentioned above, injuries lead to a loss of muscle mass and strength through several mechanisms, including muscle disuse, greater inflammation and hormonal factors [4]. Protein requirements may consequently increase by up to 80% [2]. Therefore, protein intake should be increased compared with the period before the injury.

In addition to increasing total protein intake, other points should be considered: i) if strength training is performed as part of rehabilitation, include sufficient protein intake after training; ii) consume an adequate amount of high-quality protein before sleep; and iii) try to include high-quality protein sources with sufficient essential amino acids, especially leucine (e.g., whey protein, meat, fish and eggs) [2].

Considerations for Carbohydrate and Fat Intake

Although physical exercise may be reduced, we should not completely eliminate carbohydrate intake. Carbohydrates help regulate inflammation, maintain muscle mass and support other hormonal functions. Although carbohydrate intake should be adapted to training, priority should be given to fruit, vegetables, legumes and whole grains, mainly reducing the sugary foods or products usually consumed.

Regarding fats, we should prioritize monounsaturated and polyunsaturated fats because they may beneficially regulate inflammation after an injury. Nuts and seeds, oily fish, extra-virgin olive oil and avocado should be prioritized as the main fat sources.

Potential Supplements During Injury

Studies show that creatine supplementation may mitigate muscle atrophy caused by disuse and improve recovery from muscle injury [5,6]. Meanwhile, omega-3 supplementation could positively affect muscle mass during disuse and reduce injury-related inflammation [7]. Finally, HMB is a metabolite of the amino acid leucine with anti-catabolic properties. Using this supplement during periods of inactivity in which one or more muscle groups are not used could therefore help improve or maintain muscle mass during injury [8–10].

Conclusion

In conclusion, during injury recovery, energy and protein intake and the quality of carbohydrates and fats should be monitored to support recovery. Different supplements (e.g., creatine, omega-3, HMB and protein) may also be used to improve recovery, particularly by supporting muscle mass.

Author

Lucas Jurado Fasoli – PhD in Biomedicine (UGR). Dietitian-Nutritionist. Postdoctoral researcher at the Joint University Institute of Sport and Health and the Department of Physiology, University of Granada.

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References

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[3]       Frankenfield D. Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice 2006;21:430–7.

[4]       Bodine SC. Disuse-induced muscle wasting. Int J Biochem Cell Biol 2013;45:2200–8.

[5]       Hespel P, Op’t Eijnde B, Leemputte M Van, Ursø B, Greenhaff PL, Labarque V, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol 2001;536:625–33.

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[7]       McGlory C, Calder PC, Nunes EA. The influence of omega-3 fatty acids on skeletal muscle protein turnover in health, disuse, and disease. Front Nutr 2019;6:144.

[8]       Deutz NEP, Pereira SL, Hays NP, Oliver JS, Edens NK, Evans CM, et al. Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults. Clinical Nutrition 2013;32:704–12.

[9]       Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al. IOC consensus statement: Dietary supplements and the high-performance athlete. Br J Sports Med 2018;52:439–55. https://doi.org/10.1136/bjsports-2018-099027.

[10]      Wilson JM, Fitschen PJ, Campbell B, Wilson GJ, Zanchi N, Taylor L, et al. International Society of Sports Nutrition Position Stand: beta-hydroxy-beta-methylbutyrate (HMB). J Int Soc Sports Nutr 2013;10:6. https://doi.org/10.1186/1550-2783-10-6.