Injuries are frustrating, whether they are short-term or long-term. When you are injured, the number one thing you want to do is recover from it as quickly and as well as you can.
While nutrition obviously is not the main factor in this, it can certainly play a role in improving outcomes.
This post will cover some things to focus on during the process while highlighting strategies that can help facilitate a quicker recovery.
Calories
This section will likely be the largest section in this post, so it will be split into sub-headings. If what to do with your calorie intake while injured is not of interest to you, then I encourage skipping down to the sections where I discuss other strategies.
Avoid the Temptation to Cut Calories Dramatically
The first temptation a lot of athletes have when they get injured is to cut calories significantly. Often you feel as though because you cannot make progress in other areas, shifting that focus towards fat loss can be another outlet for progress.
While I understand where this thought process comes from, I would argue that most of the recovery process should be spent consuming enough calories to maintain your weight.
Recovery is a process that benefits from having some additional calories. Being on low calories can slow down the healing process.
Since you are not able to train certain areas effectively, the combination of low calories and a lack of training stimulus can speed up muscle loss.
Staying at maintenance calories provides a balance between minimising both fat gain and muscle loss.
Fuel the Rehab Process
Another aspect to consider is that you will likely be undertaking a rehab protocol that involves you aiming to get stronger and build muscle in certain areas.
It is more difficult to build muscle and strength in a calorie deficit.
Having more calories can directly speed up injury recovery while also helping you indirectly by fuelling muscle growth.
Consider Periodising Nutrition for Longer Rehab Processes
If you are an athlete who has an injury that will take 6+ months to rehab, it could be worth periodising your calorie intake.
Directly after the injury when the risk of muscle loss is the greatest, it can make sense to stick near maintenance calories at the start. This is to try to reduce the amount of muscle that is lost.
Then as the pain is decreasing and the rehab process is ramping up, you might want to consider a calorie surplus.
For example, if you need to gain a certain amount of quad or calf size or strength, this will be a lot easier and quicker to do in a calorie surplus.
At the end of the process though, you want to be near your peak body composition for your sport, if possible.
Since body fat will likely have increased a bit with this approach due to a combination of the reduced training stimulus and the calorie surplus phase, it likely makes sense to have a phase in a calorie deficit.
As mentioned previously, you do not want to spend much of the rehab process in a deficit. But the overall goal is to return to sport as effectively as we can, and that likely requires a certain body composition.
Challenges With Managing Calorie Intake
There are a few challenges with managing your calorie intake while injured.
One is that your calorie expenditure is likely lower due to being less active. This means that maintenance calories will be a bit lower than they previously were.
This is another reason why people have a temptation to dramatically cut calories.
In most cases, the decrease in calories required to achieve maintenance calories is less than expected. But it is still a factor worth considering.
Another aspect is that you might now be at home more often and have more time and access to food than you previously did.
The combination of these things can make it difficult to avoid accidentally overconsuming calories.
One tool I would consider using to manage this if it is an issue is volume eating. This concept involves eating a larger volume of lower-calorie food.
Basically, it might make it easier to consume an appropriate amount of calories since you get to eat more food for the same amount of calories.
Protein
Protein helps with many aspects of injury recovery
- It can help reduce the amount of muscle lost in the early stages.
- It can help speed up the increase in muscle and strength which can be beneficial in a rehab process.
- It can help with managing appetite if that is an issue, and you are struggling with accidentally overconsuming calories.
Immobilisation vs Non-Immobilisation
When an athlete who trains hard takes a break from training, it typically takes ~3 weeks before muscle loss is measurable.
This is reassuring if you have got an injury where you are still able to move the affected area a bit.
Unfortunately, if a limb is immobilised after an injury/surgery, muscle loss occurs surprisingly quickly. There is research on ACL surgeries showing that quad size decreases by about 20% in as little as 1-2 weeks.
Since getting the quads strong and balanced between sides is an important rehab outcome, any steps that can be taken to minimise that muscle loss in that phase is crucial.
One of these steps is high protein intake.
The current recommendation for protein intake during injury recovery is 1.6-2.5g/kg/day.
The upper end of this range is particularly relevant when the risk of muscle loss is at its highest, such as during immobilisation.
This is quite a high intake. From another perspective though, I view this as a huge opportunity.
The average athlete who is injured does not get anywhere near this level. You could significantly improve your recovery outcomes by doing this thing.
Practical Challenges with Protein Intake While Injured
There are two main challenges that can occur with trying to achieve that target.
- What if your appetite has declined due to being less active?
- If you have a smaller calorie budget due to being less active, it is hard to get towards the upper end of the target without overshooting your calorie needs.
The best approach to overcoming the first challenge is to add liquid protein sources in addition to regular protein-rich meals.
For the second challenge, you want to prioritise protein sources that are high in protein and relatively low in fat and carbohydrates where possible.
While I would not aim to get a large percentage of your intake from supplements, adding some protein supplements can help with both of those problems.
Creatine
Creatine helps with building muscle and strength. It has obvious applications for longer rehab protocols.
There is also research indicating that during immobilisation creatine can help with lean mass retention and reduces loss of strength. There is not a lot of research on this topic, but it looks promising.
Another study on strength gains 6-12 weeks after ACL surgery found that creatine significantly outperformed placebo. Most strength outcomes improved by about 20%, but knee extension strength in particular showed a 47% increase.
It is worth highlighting that not ALL the research has shown positive outcomes. One study measuring strength after 30 days after knee surgery found that creatine did not improve outcomes.
While the evidence is not overwhelmingly positive, it is enough that I think it is worth taking creatine. Particularly because there is minimal downside to doing so.
Dosage and how to take: 20g per day for 5 days, followed by 5g per day ongoing. This is a simplified protocol. If you want more details, check out our post on the topic.
Fish Oil
There are proposed mechanisms for how omega-3s can help due to enhancing anabolic sensitivity to amino acids as well as help from an anti-inflammatory perspective
While I’m sceptical of the enhancing anabolic sensitivity to amino acids part since we don’t see it leading to better muscle growth or prevention of loss of lean mass under other circumstances, there still is some promise.
There is minimal research looking at fish oil and immobilisation. The research we do have is surprisingly promising.
An example of this involved lower limb immobilisation for 2 weeks. The fish oil group maintained significantly more muscle than the placebo group.
Although the research looks promising, I would keep an open mind on this topic. I would not be surprised if more research came out showing it does not matter.
I also heard the main author of that study on a podcast say an interesting line. He said, “while the research is interesting, it is not at a stage where I would be taking fish oil year around in case of an injury.”
That line stands out to me since he has literally dedicated part of his career to this topic.
A nuanced approach could involve taking fish oil leading up to and post-surgery if you have a serious injury and a surgery date planned though.
Best case scenario, it helps. Worst case scenario it does not really do much.
Dosage: 2-4g fish oil per day, if choosing to take it.
Collagen or Gelatin Supplementation
Collagen and gelatin supplementation have emerging research indicating they can help with recovery from musculoskeletal injuries. This covers around 70% of injuries.
Some common criticisms of collagen supplements are:
- The collagen peptides break down into amino acids. How is this different to consuming more protein in general?
- A large percentage of the body is made up of collagen. How do we know it goes to where we want it to go?
- The evidence is mixed.
The mechanism that I propose involves the collagen peptides breaking down into amino acids, as mentioned. Some sources have reported that ~10% of collagen peptides remain intact anyway though.
But either way, collagen protein has a very different amino acid profile to other protein sources. It is a lot higher in proline, glycine, lysine and arginine than most other protein sources.
We have evidence that these amino acids peak in the blood ~40-60 minutes after consumption. Theoretically, we can target the injured area by getting blood flow to the area with training. Even without that, some of the research looks promising anyway.
There is also evidence of an increase in collagen synthesis in the body following supplementation and a targeted exercise protocol too.
A Look at the Evidence
In terms of the evidence, while the evidence is mixed, all the research fitting the following criteria has shown positive outcomes:
- 15g or more of collagen protein
- Timed before rehab sessions
- Alongside vitamin C
There also is not a lot of quality research on the topic. At the moment, my interpretation of the research is that it helps. But I am watching the space closely to see if anything comes along to change my mind.
One of the most promising studies, in particular, involved a patellar tendinopathy case study. The MRI footage showed complete healing of the patellar tendon, which is exceptionally rare. Often with tendinopathy that severe, MRI footage still shows a damaged area long after the pain has gone.
Dosage and How to Take: 15-25g of collagen or gelatin, 40-60 minutes prior to training. If you have not consumed any vitamin C for the day, it makes sense to add that too. Vitamin C is required for collagen synthesis.
Calcium and Vitamin D
Calcium and vitamin D supplementation can be helpful if there is anything bone related.
At a population level, supplementing those things, without further context (e.g. dietary intake and blood levels) leads to increased bone mineral density.
Supplementing with calcium and vitamin D has evidence of improving fracture recovery. It is not a large benefit, but it is worth being aware of.
Adding some nuance, those who have low calcium intakes or low blood vitamin D levels would benefit significantly more from this.
At a minimum, it is important to avoid low calcium and vitamin D.
Beyond just fractures though, vitamin D might help further.
A study identified that 3 months post ACL surgery, low vitamin D status was linked with lower levels of strength in comparison to those with higher vitamin D.
Vitamin D can also be relevant from an inflammation standpoint.
Dosage and How to Take:
Obviously, you could aim for a food-first approach. This would involve getting ~1000mg of calcium per day through food and 10-30 minutes of sunlight per day. Some people might need a bit more sun than that if they have darker skin.
From a supplemental perspective, if taking both, a supplement containing around 1200mg calcium and 1000IU vitamin D is often the gold standard. Since calcium absorption is a bit limited in a single sitting, it is even more beneficial to split the dosage and have at both morning and night.
If just supplementing vitamin D, 1000IU is the most commonly recommended dosage. But if you have low blood levels, you could go a bit higher than that and address it quicker. I sometimes recommend as high as 10,000IU per day for short periods of time, for those who are deficient.
Overall Healthy Diet
Having an overall healthy diet makes sense during injury recovery.
We know that other nutrients like magnesium, antioxidants, vitamin K and zinc all play a role in injury recovery.
But they are not things I personally would overly focus on individually. Having an overall good quality diet will help you get enough of them though.
Practical Summary
Nutrition can play a role in injury recovery. Nailing your nutrition could shave some time off the recovery process and improve the odds of an effective recovery.
Poor nutrition could dramatically slow down recovery though, particularly for longer rehabs.
A lot of rehab protocols involve increases in muscle size and strength in certain areas. Imagine trying to do that with a low protein intake and on low calories.
Or alternatively, if consuming excess calories, it can make returning to sport at the same level lot harder.
As a quick summary, some key areas to investigate addressing are:
- Appropriate calorie intake. This might involve periodising it over the course of the recovery process.
- Aiming for 1.6-2.5g/kg protein per day.
- Consider supplementing with creatine, fish oil, collagen, calcium and/or vitamin D, based on whatever is relevant for your situation.
- Consume a good quality overall diet to cover all the little details that matter and can help with recovery a bit.
