What Can I Eat to Recover from Injury?

Friday, February 14, 2014 | By Chris Burnham

What Can I Eat to Recover from Injury?

You’ve been hard at work in preparation for the upcoming season. You’ve set your goals, gone to the gym, and put in the miles. Then, the unthinkable happens. A little irritation in your knee, hip, or ankle starts. At first you choose to ignore it, but soon you are limping around the house and struggling to make it up the stairs. Visions of your season start slipping away. You start to wonder if you will ever run or ride-pain free again.

You’re sidelined by injury. An endurance athlete’s worst nightmare.

When overuse injuries start, the typical, and best, immediate prescription is the RICE method: Rest, Ice, Compression, and Elevation. However, what’s missing from the acronym is one more important but oft-neglected component to recovery: nutrition. By paying close attention to your diet during the healing process, you can expedite your recovery and get back on track sooner.

Stages of Injury

First, some background on the anatomy of an injury. There are three distinct phases to soft tissue injuries:

1. Inflammation (1 to 4 days)

Regardless of the type of injury, there is typically a disruption of the nutrient-rich blood flow and oxygen which results in cellular death. In an attempt to clear out the dead cells and start the creation of new cells, the body initiates the inflammatory response. This process is usually characterized by pain, swelling or bruising, redness or heat.

2. The Proliferative Phase (4 to 21 days)

After the dead and damaged cells have been removed, the inflammation will start to subside and new vasculation will have been laid down. That new vasculature will provide oxygen and nutrients to start rebuilding tissue. This new tissue is often called scar tissue. Athletes can often start very light exercise in this phase, but should stop if inflammation returns.

3. Injury Remodeling (21 days to 2 years)

Eventually, the scar tissue formed in the proliferative phase will be replaced with type I collagen, which is much stronger and will restore the injury site to at least 80% of its original strength. During this phase, the athlete can start to resume activities to help the scar tissue become more functional.

Caloric Intake

During these phases our nutritional needs will vary. Initially, it is not uncommon for an athlete to try and turn the “lemon” of getting injured into “lemonade” by cutting calories to lose weight, but this often delays healing. When injured, our body actually has an increase in energy demands. Resting metabolic rates are often 15 – 50% higher after a sports injury depending on the severity of the injury. Reducing caloric intake during these times can drastically delay healing1. A good rule of thumb is make sure you are getting in 20% more calories than your resting metabolic rate. This is often less than when an athlete is training, but more than the sedentary baseline intake.

Omega-3 Fats

After the initial 1 – 4 day inflammation period, it may be good to emphasize omega-3 fat intake and eliminate or drastically reduce omega-6 fats. There is growing evidence that reducing omega-6 fats and including more omega-3 fats can be extremely beneficial in reducing inflammation and promoting wound healing2. Omitting vegetable fats that are rich in omega-6 fats, and increasing fish oil (or algae sources of omega-3 supplements) can dramatically help the healing process. A good goal early on in the inflammation process is to achieve a 3:1 to 1:1 ratio of omega-6 to omega-3 fats. Beyond the omega-6:omega-3 ratio, it has been shown that consuming monounsaturated fats (found in nuts, seeds, and olive oil) may also reduce inflammatory enzymes3.

Protein

Protein needs are also elevated during the proliferative phase and after to allow the body to start forming new tissue. The current clinical recommendation for injured athletes is to get in 1 gram of protein per pound of lean body weight. It may also be beneficial to include an amino acid supplement containing glutamine and arginine, as these have shown to speed up the healing process in the body4.

Glucose

Glucose is needed for wound healing but is less critical than the above nutrients. Ideally, eating unprocessed carbohydrates to achieve micronutrient intake and keep blood sugars level is all that is required. All phases of recovery will benefit from Vitamin A, C, Copper, and Zinc and should be prioritized in food choices during periods of injury. Foods that are often high in these micronutrients are also high in flavonoids (plant chemicals that often function as pigment in fruits and vegetables) that can lead to a more pronounced anti-inflammatory response. Look for dark fruits and vegetables to increase your flavonoid and micronutrient intake.

Herbal Supplements

Herbs can also be beneficial in managing inflammation and helping healing. Turmeric is a great addition to an athlete’s diet during periods of injury, to control inflammation. Garlic has also been shown to be beneficial to in inhibiting inflammatory enzymes as well, although you may require a supplement to reach effective dosing5.

While all these recommendations are extra critical for injured athletes, they can also be extremely beneficial in avoiding injuries in the first place. Keep track of what you’re eating by keeping a food journal, and review it frequently to make sure that you are meeting your needs. If you’re proactive and include a few of these suggestions into your diet now, you may even be able to prevent that achy knee before it starts.

  1. Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr. 1979 Nov-Dec;3(6):452-6.
  2. Nutrition. 2004 Feb;20(2):243. Dietary long-chain omega-3 fatty acids and anti-inflammatory action: potential application in the field of physical exercise. Machado Andrade Pde M, Tavares do Carmo Md.
  3. Pharmacological Research. Volume 65, Issue 6, June 2012, Pages 577–583. Polyphenols and Health. “Virgin olive oil and nuts as key foods of the Mediterranean diet effects on inflammatory biomarkers related to atherosclerosis.”
  4. Bulus N, Cersosimo E, Ghishan F, et al. Physiologic importance of glutamine. Metabolism 1989; 38: 1–5. Cersosimo E, Williams PE, Radosevich PM, et al. Role of glutamine in adaptations in nitrogen metabolism during fasting. Am J Physiol 1986; 250: E622–E628. Williams JZ, Abumrad N, Barbul A. Effect of a specialized amino acid mixture on human collagen deposition. Ann Surg. 2002 Sep;236(3):369-74; discussion 374-5.
  5. Mediators Inflamm. 2013;2013:381815. doi: 10.1155/2013/381815. Epub 2013 Dec 26. Alliin, a garlic (Allium sativum) compound, prevents LPS-induced inflammation in 3T3-L1 adipocytes. Quintero-Fabián S1, Ortuño-Sahagún D2, Vázquez-Carrera M3, López-Roa RI4.

How to Ice an Injured Ankle

Jeremy Hassler March 7, 2013

You’ve just rolled your ankle. Once the cursing subsides, it’s time to focus on controlling the swelling. Here are your options to ice a sprained ankle efficiently:

Thinkstock Photo

The Classic Bag

The standard sandwich or Ziploc bag that most people reach for works fine. Fill it with ice—crushed, flaked, or pellet for the best conformity to your foot. Leave space to tie it off or zip up. Remove as much air from the bag as possible to improve the conformity of the bag and keep the temperature consistent around the ankle. Place the ice bag over the injured area and then an elastic wrap around the bag and your foot and ankle to provide compression. Ice and elevate the injured area above your heart for 20- to 30-minute sessions several times throughout the day during the first 24 to 72 hours after injury.

The Ideal Scenario

Wet an ace bandage or elastic wrap so it’s damp, but not dripping. Wrap it around your foot beginning at the base of the toes and spiraling up around the ankle and up the leg. Wrap tightly near the toes and more gently as you work your way up the leg. Lightly pinch the nail of one of your toes in with your thumb and index finger so the color in your nail disappears. If color does not return within a couple seconds, the wrap is too tight. This wet base layer improves the conductivity of the ice bag and helps prevent potential freezer burn on your skin. Place the ice bag over the base layer and wrap with a dry layer to hold the ice in place and create compression.

Ice Bag Alternatives

Slush Pack

A slush pack is a simple alternative that is created with a combination of rubbing alcohol and water. The benefits of this method are that it’s more comfortable to wear and conforms to your foot better than regular ice bags. Here’s how to make one:

  1. Combine 1 cup rubbing alcohol and 3 cups water.
  2. Pour this combo into a gallon-sized Ziploc bag.
  3. Slide this into another bag to prevent spillage.
  4. Stick it in the freezer overnight.
  5. Wrap around the injured area the same way you would an ice bag.

Water and Gel Sheets

Water and gel sheets—available at most pharmacies—can be frozen in your freezer and inserted into prefabricated wraps. Most of these products will have same guidelines as ice bags—20 to 30 minutes with elevation—but make sure to follow the directions provided. These can be put back in the freezer and reused throughout the day. If a wrap isn’t included, apply in a similar fashion to the ideal scenario described above to avoid direct skin contact.

Chemical Packs

Chemical Packs are convenient because they cool immediately without needing a freezer. Cold is produced as a byproduct of a chemical reaction in the pack. The danger of chemical packs is a potential chemical burn if the pack were to leak. The temperatures can be inconsistent and the packs cannot be reused. Follow the directions on the packaging.

Game Ready

Game Ready is the Cadillac of cryotherapy. It’s like a souped-up ice bucket that gives you control over temperature, time, and compression. The downside: It’s the priciest option. Plus, you need a physician’s script to pick one up.