American Diabetes Association Phoenix

Nutrition for Injury Recovery

By Ellen K. Chow, MS, RD, CSSD, CD

According to the National Institute of Health, sports injuries are broadly defined as being a direct result from participation in sports. Common occurrences include sprains and strains, compartment syndrome, knee injuries, Achilles tendon injuries, shin splints, fractures, and dislocations(1). Almost all can be classified as either acute or chronic.

An acute injury is one that can usually be traced back to a specific incident, causing immediate pain and often swelling; for example, a twisted ankle or a broken bone. It also includes wounds from surgical procedures, which create short-term damage to tissues. A chronic injury, however, may or may not have a distinct origin, it develops slowly, is persistent and long lasting. It may also be recurring and is usually accompanied by dull pain, aches, or soreness.

When an injury occurs, the body leaps into action to start healing, which involves the inflammatory response. In short, it is our immune system’s mechanism to get rid of unwanted materials, including dead cells and tissues. Inflammation can be coupled with redness, tenderness, swollen tissues, and sometimes drainage. This healing process may take minutes to weeks for external injuries, and anywhere from hours to years for an internal or one that is related to chronic conditions. During this process, new cells are generated to form new tissues.

Imminent acute injury. Photo courtesy of Wheels in Focus Photo courtesy of Wheels in Focus

Imminent acute injury.

Macronutrients refer to carbohydrates, protein, and fats. They provide energy in the form of calories as well as essential components for tissue regeneration. While all of the macronutrients can be metabolized to provide energy, in general, carbohydrates act as the most direct and ready source. Proteins are the major building blocks for new muscle tissues. Fats form cell membranes, signaling molecules, and provide a concentrated, secondary source of energy after carbohydrates. In addition, water is a crucial component of healing. Even though it does not provide energy, it bathes cells and allows all biochemical processes to take place. Water also helps to eliminate waste and toxins through sweat, urination, and fecal excretion.

All nutrients other than the aforementioned macronutrients are referred to as micronutrients. These include vitamins, minerals, enzymes, phytochemicals, and more. Antioxidants are macro or micronutrients that protect cells and DNA from free radicals’ oxidation damages, which is an unavoidable part of the inflammation response and recovery process. Some of the antioxidants are vitamin A, C, E, selenium, and Co-enzyme Q10. By nature, antioxidants attract free radicals in order to neutralize them. Excessive levels of antioxidants can result in a “pro-oxidative” state, where there is an increase in the production of free radicals.

Injuries frequently limit physical activities or even result in immobilization. This lack of exercise leads to negative protein balance and reduced energy needs. However, inflammatory response and wound healing increases basal metabolism — the amount of energy expended at rest while awake — as much as a 10 percent. According to British researchers who studied nutrition in people with exercise-induced acute injuries, when both factors are taken into consideration, athletes may not always require an intentional increase in calories or proteins intake(2). Depending on the anticipated duration of recovery or immobilization, muscle mass and basal metabolism may be measured and incorporated into a recovery nutrition plan. Fortunately, for short-term recovery, typically under a month, ample but moderate protein and caloric intake, similar to that of a light exercise day should suffice. If possible, adding progressive resistance exercises to the daily recovery routine would promote positive protein balance and muscle reconditioning. Maintaining intake at a high level, such as that during active training phases, may cause unwanted weight gain.

Regarding micronutrients and antioxidants, research is limited on optimal intake, especially when individual metabolism and training level play a significant role. Even though it has been documented that intense exercise increases oxidation, it was also observed that the body of a trained athlete has the ability to increase antioxidation activities to counter potential damages. Researchers at Ohio State University recommended that:

• Optimal antioxidants needed should be individualized;

• Proportional increase of multiple nutrients can be more effective than megadosages of a single nutrient supplementation;

• Injury recovery and performance should not be the only objective, as long-term well-being should also be a priority(3).

Injured athletes should maintain calorie and protein intake adequate for basal metabolism plus the amount required for effective recovery while avoiding the additional hundreds or thousands of calories associated with active training. Different types of injuries require different treatments. In a study involving nearly 150 athletes, liquid collagen hydrolysate appeared to significantly improve joint pain compared to a placebo4. However, it is unlikely to produce the same effect in a repeated stress fracture. Consult your physician, pharmacist, and sports dietitian before significantly implementing/increasing any dietary supplement intake; the quality of those over-the-counter products vary greatly.

Cycling may or may not be the only sport you enjoy. If participating in multiple sports or if weight training is part of your exercise routine, a small or unknown injury can be compounded by other activities, making it difficult to pinpoint the problem, and therefore treatment. If you’re injured, especially if it limits daily activities, seek medical care as soon as possible.

References:

1. National Institute of Health, Types of Sports Injuries. http://www.niams.nih.gov/Health_Info/Sports_Injuries/default.asp

2. Nutrition for Acute Exercise-induced Injuries. Tipton, KD., Annals of Nutrition and Metabolism 2010; 57 Suppl 2:43-53.

3. Dietary antioxidants for the athlete. Atalay M. et al., Currrent Sports Medicine Reports 2006 Jun; 5 (4):182-6.

4. 24-week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Clark, KL., Current Sports Medicine Reports, 2008 May; 24 (5):1485-96.

Ellen Chow is a Seattle-based sports and wellness nutritionist. She works with athletes of all ages and extensively with athletes who have stable cardiovascular and metabolic diseases. Ellen can be contacted at www.endgamenutrition.com.

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