Nutrition For Injury Recovery: Post-Operative Nutrition Strategies To Optimize The Recovery And Healing Process

By Paige Canfield, MS, RD, LDN

Unfortunately, injuries happen in all sports settings and can keep athletes off the field for quite some time. Focusing on nutrition is an often overlooked component of injury recovery. Athletes who neglect nutrition during rehabilitation may have a lengthened recovery timeline and a tougher time returning to play.




When an injury occurs, a sports dietitian should be consulted as soon as possible to design a nutrition recovery plan (Harmon & Ayesta, 2018). Different injuries require different nutritional interventions. However, the goals of nutrition intervention remain the same regardless of the type of injury sustained: support muscle protein synthesis, preserve muscle mass, maintain energy balance, and prevent increased body fat (Harmon & Ayesta, 2018).

Macronutrient Needs

Often, when athletes get injured, they believe they do not need as many calories because they are not as physically active. However, this is a misconception; energy needs are still reasonably high in order to support the healing process. It is critical for athletes to meet estimated energy requirements after injury in order to avoid loss of lean muscle mass and impaired wound healing (Smith-Ryan et al., 2020). Athletes should prioritize complex carbohydrates, increase consumption of protein, and include essential fatty acids to reduce weight gain and enhance recovery (Smith-Ryan et al., 2020).

Carbohydrates

Even in an injured state, athletes still need carbohydrates as a fuel source. If sufficient carbohydrates are not consumed, the body taps into protein for energy, resulting in a loss of lean mass. In fact, post-operative athletes may need up to 3-5 g/kg of complex carbohydrates daily during rehabilitation (Thomas et al., 2016). Filling up around ¼ of a plate with complex carbohydrates at each meal (3x daily) can help athletes meet their recommended carbohydrate needs. Post-operative athletes should focus on complex carbohydrates (whole grains, fruit, vegetables) and limit simple carbohydrates (sports drinks, candy, refined grain products such as white bread and crackers). Complex carbohydrates are digested at a slower rate which better controls blood sugar levels to support healing, and offer a wide variety of vitamins and minerals when compared to simple carbohydrates (Smith-Ryan et al., 2020).

Protein

Protein has many roles, including its cruciality for wound healing as well as muscle repair and rebuilding (Evans et al., 2014; Demling, 2009). Post-operative athletes have higher protein needs of at least 1.6 g/kg/day and up to 3.0 g/kg/day (Tipton, 2015). Here is an example of how to calculate the low end of protein for a 160 lb athlete:

160 lb / 2.2 = 72.7 kg x 1.6 g/kg = 116 g of protein

It is vital for athletes to consume around 3 grams of leucine per serving of protein (Tipton, 2015). This amino acid is responsible for jump starting muscle protein synthesis (Nicastro et al., 2011). Animal proteins such as chicken, beef, fish, and whey protein all have a high leucine content. Additionally, edamame, navy beans, tofu, and tempeh are examples of plant-based protein sources with sufficient amounts of leucine to initiate muscle protein synthesis, if consumed in appropriate amounts. Spreading protein intake throughout the day (20-40 g protein every 3-4 hours) by consuming protein with all meals and snacks can help reach estimated protein needs and maintain lean muscle mass (Smith-Ryan et al., 2020).

Fat

Post-surgical athletes often have a prolonged inflammatory response which hinders healing (Smith-Ryan et al., 2020). Thus, athletes should aim to consume 0.8 to 2 g/kg/day of dietary fat to aid in reducing inflammation (Demling, 2009). However, not all dietary fats are created equal. For post-surgical athletes, unsaturated fats such as monounsaturated and some polyunsaturated fats should be prioritized because they have anti-inflammatory effects. Foods such as avocados, olive oil, fatty fish like tuna and salmon, nuts, and seeds are all high in unsaturated fats and can easily be incorporated in the diet. For example, add a handful of nuts to Greek yogurt or add slices of avocado to a sandwich. Saturated fats from processed meats, fried and greasy foods should be limited because they cause increased inflammation in the body.

Hydration

Not only is hydration after surgery essential in reducing the likelihood of surgical complications, but hydration also supports blood flow and nutrient delivery to the surgical site to improve recovery. Plus, many individuals often experience constipation after surgery due to medications such as opioids and a lack of mobility. To avoid post surgical constipation and promote wound healing in post-operative athletes, it is vital to drink plenty of hydrating fluids such as water and milk throughout the day with a daily ounce goal equal to body weight / 2 (ex: 160lb / 2 = 80 oz minimum). It is worth noting that alcohol is inflammatory and causes dehydration so should be avoided post-operatively, regardless of age.

Dietary Supplements & Micronutrients

Incorporating dietary supplements and some specific micronutrients into the recovery plan can enhance the rehabilitation process. Creatine, omega-3 fatty acids, vitamin D, and calcium are a few supplements that have scientifically been shown to boost recovery. When recommending dietary supplements to athletes, make sure to choose third party tested supplements to ensure purity, safety, and appropriate dosing. Look for the NSF Certified for Sport logo on dietary supplements as pictured below, which is the only third party certification that encompasses purity, safety and verified dosing.

Creatine Monohydrate

Creatine is a fuel source produced by the body, utilized in skeletal muscle and the brain. Creatine can also be consumed through animal proteins such as meat, chicken and fish (Branch, 2003). When coupled with exercise, creatine is one of the most effective ergogenic aids to improve exercise performance and enhance lean body mass (Buford et al., 2007). During immobilization, creatine supplementation has shown to have a positive impact on retaining muscle size and strength as well as enhancing bone remodeling (Smith-Ryan et al., 2020). A loading dose of 20 g (4 x 5 g daily) for 5 days is recommended during and after immobilization. Once the 5-day loading phase is completed, then a dosage of 3 to 5 g per day is recommended for maintenance of creatine stores (Kreider et al., 2017). Athletes can also forego a loading phase and instead take 5 g of creatine daily.

Omega-3 Fatty Acids

Omega-3 fatty acids such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are essential fatty acids, meaning that they cannot be made by the body. Therefore, it is necessary to consume them through diet or supplementation. Due to their anti-inflammatory properties, omega-3s may reduce post-surgical inflammation, reduce muscle loss, and increase muscle protein synthesis (Tipton, 2015). It is recommended that post-surgical athletes consume a total of 2-4 g of DHA and EPA daily in order to reap these benefits (Smith-Ryan et al., 2020).

Vitamin D & Calcium

Vitamin D and calcium are essential for muscle function and bone health. Athletes with vitamin D deficiency (<30nmol/L of serum vitamin D, 25-OH(D)) are at risk for impaired muscle repair and decreased athletic performance (Tipton, 2015). Vitamin D is made by the body when sunlight hits the skin and ultraviolet-B rays react with provitamin D3 in the skin to spark vitamin D synthesis. Keep in mind that vitamin D levels may be lower depending on the latitude of where one lives. For example, athletes living north of 37 degrees latitude are more likely to have lower vitamin D levels due to decreased sunlight in all but summer months. Furthermore, athletes who practice indoors, wear gear or clothing that limits skin exposure, and have darker pigmented skin are also at risk for vitamin D deficiency, regardless of latitude. While it is important to take a food first approach to nutrition, there are few foods with naturally occurring vitamin D. Egg yolks, mushrooms, cheese, yogurt, fish such as salmon, sardines or canned tuna, fortified orange juice and cereals are some examples of vitamin D rich foods, but without proper sun exposure or supplementation, it is impossible to get sufficient vitamin D through food alone. Thus, vitamin D supplementation may be needed, depending on aforementioned factors. Vitamin D dosage is dependent on individual factors and should be assessed by a physician before supplementation.

Calcium and vitamin D work synergistically and unlike vitamin D, calcium needs can be met with a food first approach before turning to supplementation. The recommended daily allowance (RDA) of calcium for adults 19 and older is 1000 mg daily. Calcium rich foods include dairy products, fortified dairy alternatives, tofu, almonds, and broccoli. The table below gives examples of how much calcium is in the serving size listed.

Calcium-Rich Food Amount of Calcium (mg)
1 cup milk 300 mg
3 oz tofu 150 mg
¼ cup almonds 97 mg
1 oz cheese 200 mg
1 cup fortified orange juice 300 mg

Vitamins A, C, and E

Vitamins A, C, and E are crucial due to their role in injury recovery and wound healing (Smith-Ryan et al., 2020). Vitamin A assists in decreasing inflammation, vitamin E lowers oxidative stress leading to reduced wound healing time, and vitamin C helps with collagen synthesis, aiding in strengthening tendons and ligaments and potentially helping to decrease joint pain. Research indicates that doses of 5 to 15 g of collagen should be paired with 50 mg of vitamin C 1-hour prior to training or rehabilitation for increased collagen production (Shaw et al., 2017). Post-surgical athletes should focus on consuming foods containing vitamin A (sweet potatoes, carrots, squash), vitamin C (citrus fruits like oranges or kiwi, broccoli), and vitamin E (sunflower seeds, almonds, spinach) to support the rehabilitation process. If these foods are not consumed on a regular basis, taking a third party tested multivitamin may be warranted.

Nutrition plays a vital role in enhancing injury recovery and rehabilitation. The evidence-based nutritional strategies presented here are highly recommended for post-operative athletes to facilitate a faster and healthier recovery.


References

Branch, J.D. (2003). Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab, 13(2), 198-226.

Buford, T.W., Kreider, R.B., Stout, J.R. (2007). International society of sports nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr, 4,6.

Demling, R.H. (2009). Nutrition, anabolism, and the wound healing process: an overview. Eplasty, 9.

Evans, D.C., Martindale, R.G., Kiraly, L.N., Jones, C.M. (2014). Nutrition optimization prior to surgery. Nutr Clin Pract, 29(1), 10-21.

Harmon, R., Ayesta, A. (2018). Nutritional support for injury recovery and return-to-play. Collegiate and Professional Sports Dietitians Association. https://www.sportsrd.org/wp-content/uploads/2018/11/Nutrition-Support-for-Inury-Recovery-Return-to-Play.pdf

Kreider, R.B, Kalman, D.S., Antonio, J. (2017). International society of sports nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr. 14(18).

Nicastro, H., Artioli, G.G., Costa Ados, S. (2011) An overview of the therapeutic effects of leucine supplementation on skeletal muscle under atrophic conditions. Amino Acids, 40(2), 287-300.

Shaw, G., Lee-Barthel, A., Ross, M.L., Wang, B., Baar, K. (2017). Vitamin C- enriched gelatin supplementation before intermittent activity augments collagen synthesis. The American Journal of Clinical Nutrition, 105(1), 136-143.

Smith-Ryan, A.E., Hirsch, K.R., Saylor, H.E., Gould, L.M. (2020). Nutritional considerations and strategies to facilitate injury recovery and rehabilitation. J Athl Train, 55(9), 918-930.

Thomas, D.T., Erdman, K.A., Burke, L.M. (2016). American college of sports medicine joint position statement. nutrition and athletic performance. Medi Sci Sports Exerc, 48(3), 543-568.

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


This article was written by a Collegiate and Professional Sports Dietitian Association Registered Dietitian (RD).  To learn more about sports nutrition and CPSDA, go to www.sportsrd.org


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