Nutritional Strategies for Enhanced Healing

Unfortunately, minor injuries are par for the course in sport and exercise. In my experience, the most common cause of sports-related injuries are running, football (soccer to our American friends) and poor lifting technique, as opposed to “high-risk” activities such as CrossFit or combat sports. Over half of all sports-related injuries are severe enough that they take more than three-weeks before training can resume (Jacobsson et al., 2014). Injuries may take a few days to several months to fully recover, depending on the extent of the damage. So anything that can be done to enhance healing should be encouraged.

From a nutritional standpoint, there are two things to consider to reduce injury recovery time. (1) Establish an environment that supports rapid cell regrowth and (2) minimise muscle atrophy. In other words, create an anabolic state. Follow the same nutrition protocol that would be put in place for increasing muscle size and strength.

Meeting daily caloric requirements is essential to aid repair. This is not the time to be in calorie deficit. But there is a calorie sweet-spot. Aim to maintain a calorie balance, so not a deficit nor surplus. “Calorie neutral”, as it were. A study published in the American Journal of Clinical Nutrition warned that a calorie surplus actually accelerates muscle loss during healing due to an increased inflammatory response (Biolo et al., 2008), so should be clearly avoided. Physical activity is likely to be compromised during the recovery period but, perhaps surprisingly, resting calorie expenditure increases between 15% and 50% depending on the severity of the injury (Frankenfield, 2006). Both factors should be taken into account when calculating calorie needs.

A recent British study from the University of Birmingham examined the effect of protein intake on muscle atrophy (Mettler et al., 2010). Participants consuming a high protein diet (2.3g/kg/bodyweight) lost just ~20% of the muscle incurred by the control group eating a more modest protein intake (1g/kg/bodyweight). These deleterious effects were more pronounced following a sudden reduction of habitual protein intake post-injury. Insufficient protein increases inflammation, accelerating muscle loss. Thus, the recommended protein intake during recovery is 2-2.5g per kg bodyweight (Tipton, 2015). Due to the suppressed anabolic response during recovery, protein serving sizes will need to increased to match the same anabolic effect prior to injury.

Deficiencies of key micronutrients should be addressed. However, there’s no evidence of supraphysiolgical doses (exceeding natural levels) bestowing any additional benefits. Zinc, calcium, vitamin A, vitamin C and vitamin D have a proven association with enhanced wound healing. The Journal of Evidence-Based Complementary and Alternative Medicine reported that low vitamin D status impairs strength gains post knee surgery (Barker et al., 2011). Sufficient calcium and vitamin D is a prerequisite for optimal bone formation following fracture, whilst vitamin C has benefits for collagen production. One obvious “nutrient” that should be minimised is alcohol. Alcohol blunts the hypertrophy response to exercise, which would be counterproductive during the rehabilitation phase of healing (Parr et al., 2014).

Written by ACA Contributor Jason Jackson

Jason’s career began in 2008 when he joined an experienced personal training team at a Virgin Active health club in Northwest London. By 2012 Jason had become an accredited strength and conditioning coach, giving him the necessary credentials to work with professional athletes. Jason spent a season at Brentford Football Club, before a further two-years conducting research at the Saracens’ human performance lab.

In 2017 Jason became a Master of Science in sport nutrition. For his thesis, Jason spent two-years conducting a systematic review of over 100 testosterone studies. In addition to the well-documented physical effects on muscle mass and body fat, Jason examined testosterone’s significant influence on cognitive performance and wellbeing. Jason then integrated his findings into a unified strategy to successfully reverse the age-related decline in testosterone.

Jason is a registered nutritionist with SENr, the performance-orientated division of the British Dietetic Association. In his role as educator, Jason delivers seminars on performance and wellbeing at corporate accounts across the City of London. Clients include All Saints, RBS and exclusive high-end members club The Ned. The number one trainer in Virgin Active’s 20-year history, Jason wrote the book (literally) on nutrition strategy for the company.

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REFERENCES

1. Barker, T., Martins, T.B., Hill, H.R., Kjeldsberg, C.R., Trawick, R.H., Weaver, L.K. and Traber, M.G., 2011. Low vitamin D impairs strength recovery after anterior cruciate ligament surgery.Journal of Evidence-Based Complementary & Alternative Medicine, 16(3), pp.201-209.

2. Biolo, G., Agostini, F., Simunic, B., Sturma, M., Torelli, L., Preiser, J.C., Deby-Dupont, G., Magni, P., Strollo, F., di Prampero, P. and Guarnieri, G., 2008. Positive energy balance is associated with accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 wk of bed rest–.The American journal of clinical nutrition, 88(4), pp.950-958.

3. Frankenfield, D., 2006. Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice, 21(5), pp.430-437.

4. Garthe, I., Raastad, T., Refsnes, P.E. and Sundgot-Borgen, J., 2013. Effect of nutritional intervention on body composition and performance in elite athletes. European journal of sport science, 13(3), pp.295-303.

5. Jacobsson, J., Timpka, T., Kowalski, J., Ekberg, J., Nilsson, S., Dahlström, Ö. and Renström, P., 2014. Subsequent injury during injury recovery in elite athletics: cohort study in Swedish male and female athletes. Br J Sports Med, 48(7), pp.610-611.

6. Mettler, S., Mitchell, N. and Tipton, K.D., 2010. Increased protein intake reduces lean body mass loss during weight loss in athletes. Medicine & Science in Sports & Exercise, 42(2), pp.326-337.

7. Parr, E.B., Camera, D.M., Areta, J.L., Burke, L.M., Phillips, S.M., Hawley, J.A. and Coffey, V.G., 2014. Alcohol ingestion impairs maximal postexercise rates of myofibrillar protein synthesis following a single bout of concurrent training. PLoS One, 9(2), p.e88384.

8. Tipton, K.D., 2015. Nutritional support for exercise-induced injuries. Sports Medicine, 45(1), pp.93-104.

9. Wall, B.T., Dirks, M.L., Snijders, T., Senden, J.M., Dolmans, J. and Van Loon, L.J., 2014. Substantial skeletal muscle loss occurs during only 5 days of disuse. Acta Physiologica, 210(3), pp.600-611.
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