Nutrition for Injury Recovery and Rehab

When it comes to recovering from an injury, nutrition is a useful tool that is often overlooked. Prioritizing nutrition for healing can assist in maintaining lean mass and reducing inflammation. To do this, athletes must achieve adequate energy and nutrient intake to promote muscle preservation and healing. This article will discuss how to calculate energy needs when injured, macronutrient needs, and nutritional strategies for optimal healing. These recommendations are based on the latest research published in the Journal of Athletic Training. 

It is important to note that these are general guidelines, and I always recommend working with a sports dietitian to determine the best individualized approach for you.

Energy Needs

When injured, athletes tend to believe they should be reducing their calorie intake since their training level has decreased, but that’s not necessarily the case. An athlete's metabolic rate will increase to support the injury-healing process. The amount the metabolic rate increases will depend on the severity of the injury. An athlete must have adequate energy intake to avoid increased muscle loss and prolonged healing.

Calorie needs can be estimated by using the equation below. This is the same way an athlete would typically calculate energy needs, but adds a stress factor component to account for the additional energy needed to heal from an injury.

Energy Needs = Resting Metabolic Rate x Activity Level x Stress Factor

Resting Metabolic Rate: The gold standard for determining an athletes resting metabolic rate is indirect calorimetry, which often can be difficult for athletes to access. The most reliable and convenient way to determine RMR is the Cunningham equation, but note that you must know the athlete's body fat % for this equation. If you do not have access to the athletes body fat %, you can use this calculator here as a starting point.

Consistent consumption of nutrients throughout the day will preserve lean muscle mass and promote muscle protein synthesis. Athletes need to prioritize nutrition around training sessions, as carbohydrates and protein availability around these sessions can result in greater strength, functionality, and lean mass.

Carbohydrates: 3-5 g/kg body weight. This will increase as activity increases.

Carbohydrates play an essential role in the recovery process as a source of energy, and they can negate muscle breakdown if the body is in a catabolic state. An athlete should aim to meet this need in the form of complex carbohydrates such as whole grains, fruits, and vegetables. Complex carbohydrates provide a variety of micronutrients and fiber, which assist in the rehabilitation process.

Protein: Recommended 2.0 – 3.0 g/kg bodyweight. No less than 1.6 g/kg bodyweight.

After an injury, protein needs are increased to support wound healing, tissue rebuilding, and glycemic control. If this is not met nutritionally, the body will begin to break down muscle to meet amino acid needs. Aim for 20-40 grams of protein at each meal.

The amino acid leucine is especially important during recovery as it is primarily responsible for stimulating muscle protein synthesis. An athlete should aim to consume 3 grams of leucine per serving of protein. Focusing on consuming high leucine foods, including fish, poultry, tofu, edamame, eggs, may help aid the recovery process.

Fat: .8 – 2 g/kg body weight. Prioritize unsaturated fatty acids.

Monounsaturated and polyunsaturated fats should be prioritized during recovery for their anti-inflammatory effects. Good sources include avocado, fish, olive oil, nuts, and seeds. Saturated fats found in processed meats, fried and greasy foods, and vegetable oils can have a pro-inflammatory impact and should be limited. 

Nutrients to Prioritize

Anti-Inflammatory Foods

Foods that can help fight inflammation include fruits, vegetables, whole grains, nuts, seeds, fatty fish, and some spices such as turmeric and ginger. Prioritizing foods that are rich in antioxidants, especially vitamin A, C, and E can help reduce inflammation. These vitamins have antioxidant properties that assist in wound healing and decreasing oxidative stress. Vitamin C also plays a critical role in collagen synthesis that has an essential role in tendon, ligament, and bone health. Athletes should aim to meet the RDA for these vitamins to support recovery.

Calcium

Calcium plays a vital role in our bone structure and function and can be especially important for those who have a history of or may be at risk of bone related injuries. Athletes should aim to consume the RDA (1000 mg) of calcium to support bone health. Some calcium rich food sources include dairy products, tofu, edamame, chia seeds, canned salmon, and fortified non-dairy beverages.  

Vitamin D

Vitamin D is needed for calcium regulation and bone health but also is involved in skeletal muscle function and immune regulation. Insufficient levels of vitamin D may inhibit recovery from an injury. An individual may require supplementation if they are deficient in vitamin D, but levels should be assessed and discussed with a physician or dietitian before a supplement is started. Athletes should aim to consume foods rich in vitamin D to maintain sufficient levels. Foods rich in vitamin D include fish, egg yolks, cheese, fortified cereals and fruit juices. 

Dietary Supplements

Here are a few dietary supplements that have evidence to show they may positively impact the recovery process. It is important to note that no dietary supplement will better support recovery than consuming a diet that meets your energy, macronutrient, and micronutrient needs. An athlete should always work with a sports dietitian when considering a dietary supplement to ensure safety and effectiveness.

Creatine 

Creatine is a molecule naturally produced in the body and a majority is stored in your body's muscles as phosphocreatine. Phosphocreatine is used to fuel short, high intensity exercise. It is one of the most highly researched ergogenic aids and there is evidence to show it can improve high intensity exercise and positively impact lean muscle mass. Creatine may help preserve lean muscle mass during immobilization and help stimulate muscle growth during rehabilitative strength training.

If an athlete is interested in supplementing with creatine, it is important to choose a product that holds NSF Certified for Sport or Informed Sport certifications to ensure safety of the product. For more on creatine, read this article.

Omega-3 Fatty Acids (Fish Oil)

As previously mentioned, omega-3 fatty acids have a strong anti-inflammatory effect and can help reduce chronic inflammation caused by injury. There are three primary omega-3 fatty acids: alpha-linoleic acid (ALA), eicosapenaenoic acid (EPA), and docosahexaenoic acid (DHA). It may be difficult for some athletes to consume the recommended 2 grams of omega-3 fatty acids daily, and supplementation may help obtain that amount. There is inconsistent data in the literature, but omega-3s may also help reduce muscle loss during injury and immobilization.

Essential Amino Acids (EAAs)

EAAs are a way to provide essential amino acids that can be quickly absorbed and utilized by the muscle. This can produce a greater anabolic response than protein from dietary sources or whey protein supplements because it is a more concentrated and readily available form. There is evidence to show that consuming EAAs can help preserve lean muscle mass. EAAs should not replace consuming high-quality, whole-food sources of protein.

Article by: Dana Norris, MS, RD, Eleat Nutrition Intern