Sport

Nutrition During the Injury Recovery Process

Date 22.10.2020

Author

maq

Topics

The overall goal of the nutritional approach to the injury should aim to shorten the time the athlete is sidelined from sports and get them back to the “playing field” in the best possible condition. From here, we could set priorities that will depend on the type of injury, but fundamentally, they prioritize minimizing muscle tissue atrophy and the functional consequences that this period brings.

Therefore, during the first weeks of disuse, minimizing atrophy and other changes produced during this stage should be a priority to prevent the athlete from regressing during this time. But how quickly do you lose muscle mass? When we look at some studies that have examined the quadriceps evolution during disuse through computed tomography, the pattern is striking: in five days you tend to lose almost 5% of the cross-sectional area, more or less 1,5% of lean mass. In addition, there is also a strength loss of 10% in the same period. If this continues over time, by two weeks the losses will be quite significant. Therefore, nutrition should be acting from the very first moment of injury.

I find the study by Boer et al. in 2007 interesting, where they look at what happens with muscle protein synthesis in the immobilized leg. Protein synthesis tends to decrease during 10 days and then stabilizes. This is accompanied by a loss of muscle cross-sectional area. But as I was saying above, the effects are not limited to muscle; the tendon is also affected. Protein synthesis decreases continuously, and tendon stiffness also decreases. This is important because tendon function depends, at least in part, on adequate stiffness.

It is important for you to know that the muscle ultimately decreases its protein synthesis due to a reduction in sensitivity to anabolic stimuli such as those coming from the amino acids that make up proteins. This is known as anabolic resistance. Wall et al., in their study published in 2015 in Am J. Physiol. Endocrinology, took 12 young men and after immobilization with a cast for five days on one leg, looked at what happened when they were given a bolus of 25 g of whey protein. When muscle protein synthesis was compared between the control group and the immobilization group, the immobilized leg responded 50% less compared to the non-immobilized leg.Therefore, it is important that you consider this since if you stay here and only add protein, this will probably have little influence on repairing that decrease in protein synthesis in the immobilized muscle.

Again, the interesting thing is that we work as a team with the rehabilitator. A few years ago Dirk et al. (2014) published in Acta Physiologica an article where it was observed that the use of neuromuscular electrical stimulation for 40 minutes, twice a day, was enough to minimize the loss of muscle cross-sectional area. However, I said minimize. In fact, years later Dirk et al. published another study where they analyzed strategies to combat muscle disuse in humans focusing on neuromuscular electrical stimulation and protein.Although electrostimulation reduced muscle mass loss more than taking protein alone, the effect was additive when both strategies were applied. Therefore, they ensure a stimulus to the muscle – if possible – and a higher protein intake of 2 g would be appropriate to address this early phase of injury and atrophy. Here it is important to choose quality proteins that typically have high amounts of leucine and distribute them, if possible, evenly throughout the day.

Omega-3 fatty acids can be a good ally in recovery; however, they have certain limitations. Although they can increase muscle protein synthesis and reduce muscle mass loss, large amounts are required and also an intake for at least 2-3 weeks prior to the injury, the time needed for them to be incorporated into the muscle fiber membrane. However, you cannot predict when your athlete will get injured, which would lead you to have to give them continuously in a preventive manner throughout the year, and believe me, 5 g per day can be quite expensive for some athletes or clubs. But I think it would be good to add them directly after the injury or even prophylactically in certain important events. Therefore, keep in mind that fish oil can be effective, but it requires time and high doses to saturate the membrane of the muscle fiber.

Creatine can also be added to your toolbox to prevent muscle loss. In a study published in 2009 in the Journal of Strength and Conditioning Research, Johnston et al. took a group of 7 young men who were subjected to a crossover protocol during arm immobilization and received either a placebo or 20 g of creatine per day (4 x 5 g per day). The results showed a significant reduction in muscle mass with creatine intake; furthermore, the study data even show a slight increase, possibly associated with the creatine loading. Similarly, an attenuation of strength loss with creatine supplementation could be observed.

Finally, some micronutrients such as vitamin D should be evaluated and maintained at optimal levels. This vitamin has been seen to be involved in muscle regeneration and, therefore, can be a good ally during the recovery from an injury. In addition, other nutrients such as the polyphenols present in fruits and vegetables can be very interesting for controlling a possible excess production of free radicals during the acute phase of the injury, which can contribute to a greater loss of muscle mass.

To finish, keep these ideas in mind

Consume quality protein (about 2,3 g/Kg of body weight per day) distributed in several meals throughout the day with the same amount, if possible, of protein.
Do not forget to monitor total energy intake. The injury period is not as low in energy expenditure as was thought. If intake is low, this can favor the loss of muscle mass.
The polyunsaturated omega 3 fatty acids present in some foods such as oily fish are interesting. The necessary doses are high, so strategically you can supplement along after the injury or during important events.
Creatine can help the injury recovery process. Although more evidence is needed, its use seems advisable.
Monitor vitamin D levels and, if they are insufficient, consider supplementation.
Include fruits and vegetables rich in polyphenols. These are interesting not only in general for health but also during periods of injuries.