Key Topics Covered
- Maintenance calories is ideal.
- Deficit will likely slow the recovery.
- Surplus will likely gain a lot of extra body fat.
- Maintenance calories will probably be different when injured versus when you’re training. Injuries increase calorie requirements due to the healing process – although obviously this needs to be balanced with the reduced activity.
- Your calorie requirements will be based off of the severity of the injury & how much it impacts your planned and incidental exercise.
- E.g. Short term injury that takes <4 weeks vs long term injury like ACL or Achilles and what we would do differently with calories.
High Protein Intake
- Immobilisation vs non-immobilisation
- If immobilised a large portion of muscle loss occurs quickly, within 1-2 weeks.
- Current recommendations are 1.6-2.5g/kg/day for protein while injured. The upper end is most relevant for when muscle loss is most likely.
- Great paper on this titled “strategies to maintain skeletal muscle mass in the injured athlete: nutritional considerations and exercise mimetics”
- There is also the practical challenge here:
- 1) Reduced appetite due to being less active
- 2) If you are eating less calories, it is harder to get the upper end of that protein amount in
- Creatine helps build strength and muscle, so that has obvious applications for longer rehab protocols
- During immobilisation, there is research showing creatine can help with lean mass retention & reduces loss of strength
- STUDY 1: Where participants had one of their arms immobilised in a full arm cast at a 90 degree angle for almost a month – they compared their lean mass & muscle strength pre and post – the group that was taking creatine (instead of the placebo) maintained more lean mass, and muscle strength.
- The participants weren’t taking creatine beforehand, but the dosage for the study was 20g per day
- If you were consistently taking creatine leading up to the injury, you could just use the 5g maintenance dosage but if you weren’t I would do a fast loading phase (5g x 4)
- STUDY 2: One study did show significant improvements in strength due to creatine 6-12 weeks post ACL surgery – most strength markers improved by ~20%, but knee extension strength was 47% greater
- Not all of the research is promising, there are other studies showing no difference between groups as well
- But overall, I think most athletes should be taking creatine all of the time and during injury is no exception
- Fish oil can help:
- Enhance anabolic sensitivity to amino acids
- Decrease inflammation
While I’m skeptical 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.
Two studies have shown to help with the prevention of muscle loss during immobilisation. That being said, even the researchers who conducted those studies have said “I wouldn’t necessarily take fish oil year-round just in case of injury.” It is still very early days.
The fish oil recommendation is 2-4g per day.
- Episode 10 of the podcast – full episode on this PLUS a great blog post by Aidan on the website
- Useful for soft tissue or musculoskeletal injuries – Tendons, ligaments, bones and cartilage ALL contain collagen.
- These type of injuries make up for 70% of injuries in athletes, so it is really applicable to athletes.
- Recommendation: 15-25g of hydrolysed collagen powder or gelatine 40-60 minutes before training/rehab session (+ a source of vitamin C for absorption)
- Mechanism: We can’t really direct where the amino acids from the consumed collagen actually go but in theory – if we train the injured area and get more blood flow to that area while the amino acids are peaking in our bloodstream, we actually can kind of target the area.
- Research on collagen supplementation is new and still a little bit of a mixed bag of research outcomes but could be an easy win for an injured athlete.
- Note for all vegans, there isn’t a good non-animal based alternative at this time.
Vitamin D / Calcium – particularly if bone-related
- Calcium and vitamin D are no brainers, supplementing these leads to increased bone mineral density.
- Anything bone-related e.g. fractures.
- Supplementing with vitamin D and calcium does appear to improve fracture recovery although it is not a massive improvement. That being said, a sub-optimal intake would obviously be detrimental.
- Vitamin D will also help decrease inflammation
- While not specific to injuries – a systematic review on vitamin D and surgical outcomes identified that 84% of studies on the topic found a link between low vitamin D status and increased risk of poorer surgical outcomes.
- Another 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
Overall Healthy Diet
- Nutrients like magnesium, vitamin K and zinc all play a role in injury recovery.
- Potentially the antioxidants that you would get through things like fruit and veggies have a role from an antioxidant perspective
- But they are not things I personally would overly focus on. Having an overall good quality diet will help you get enough of them though.
Brumbies example of quad size being gained post ACL tear with electro muscular stimulation
Useful Links/ Resources
- Strategies to Maintain skeletal muscle mass in injured athletes
- The effect of creatine supplementation on strength recovery after anterior cruciate ligament (ACL) reconstruction
- Creatine monohydrate supplementation does not improve functional recovery after total knee arthroplasty
- Omega-3 fatty acid supplementation attenuates skeletal muscle disuse atrophy during two weeks of unilateral leg immobilization in healthy young women
- Dietary fish oil alleviates soleus atrophy during immobilization
- Calcium and vitamin d in bone fracture healing and post-traumatice bone turnover
- Vitamin D status and surgical outcomes
Relevant Blog Posts