Nutrition For the Management of Injuries

We all suffer from the odd sports injury such as a pulled calf or an ankle sprain, sometimes from a more serious injury such as a torn cartilage or a fracture, but can nutrition impact on the speed of recovery from these injuries? First let’s establish what happens in the acute phase of an injury before we talk about what the nutritional management could be. Let’s say you were out jogging and you slip and sprain your ankle. This causes you pain and you have to hobble home. In the acute phase there will be some bleeding within the ligament that you have just sprained and normally people apply ice to the area to stop the internal bleeding and reduce the swelling. This bleeding phase can last for the first few hours after an injury. Depending on how much bleeding you have will determine how bruised the ankle would be, sometimes there will be no obvious bruising, but you will still have had some internal bleeding.

The next phase is classified as the inflammatory phase which can last a number of days. In this phase special immune cells migrate to the area of damage and start to clean up the mess. It is during this inflammatory phase that there is residual pain and swelling and where certain nutritional principles can be applied as we will discuss. The next phase is called the proliferation phase which can start a few days after the injury and last for between 1-2 weeks. In this phase special secretory cells such as fibroblasts start to lay down new collagen to replace that which was damaged when you sprained your ankle, initially this collagen is weak and immature. The lasts phase is called the remodelling phase which can last for months after an injury. In this phase the new immature tissue that has been laid down by the fibroblasts is matured and strengthened to give the once injured ligament some functional strength and stability again.

So let’s go back to the inflammation phase and consider what nutrition can do to help us. If you are an elite athlete who consumes a certain number of calories per day to fulfil your training and performances needs you will probably need to eat slightly less. As you will not be training for a few weeks, you probably don’t need those excess calories, especially from carbohydrates and if you do continue to eat those carbohydrates as you did prior to injury you might find you put on a little bit of body fat, which is in itself not a good idea as excess body fat can contribute to inflammation in the body – but I digress. Beyond that there are certain anti-inflammatory food and nutrients that can help to reduce the pain and swelling in the acute stage of an injury.

Let’s first consider fat intake. Fats get a bad rap, people avoid them and think that if they eat fat they are going to get fat or have a heart attack. However, fats have the ability to either create or reduce inflammation in the body. Fats that create inflammation in the body belong to omega 6 family, foods like vegetable and plant oils such as corn, sunflower, safflower and rapeseed oils. Foods that can reduce inflammation in the body belong to the omega 3 family, foods such as fish, fish oils, flax seeds and walnuts. So it stands to reason that reducing omega 6 rich foods and increasing omega 3 rich foods in the acute stage of an injury should help to reduce pain and inflammation. Besides that a diet high in trans-fats, omega 6 rich vegetable oils, and saturated fat is also bad for the cardiovascular system.

To balance your intake of good and bad fats increase your intake of fish, fish oils, olive oil, nuts, avocados and ground flax seeds each day. Reduce your intake of diary, red meat and white meat. Consider also taking a fish oil supplement during these first few days after an injury. 3 grams a day might do spread throughout the day.

There are also a number of herbs and phytochemicals found in plants that help to manage inflammation. These include the spice turmeric, ginger, garlic, bromelain and flavanoids. Curcumin is the anti-inflammatory active ingredient in turmeric which is used in curry powder. So eating a homemade curry would therefore be a good idea during the acute phase of an injury using curry powder, ginger and garlic.

Bromelain is found in pineapple that has anti-inflammatory and analgesic effects. It also acts as a digestive enzyme and if taken away from food it can help to “digest” and breakdown the inflammatory soup that occurs around an injury. So perhaps you could have a few slices of pineapple for dessert after the home made curry. Dark chocolate, green tea, berries, red wine, and apples are high in anti-inflammatory flavanoids so it makes sense to snack on berries with nuts and seeds (remember the nuts and seeds contain the healthy fats), drink green tea and have the occasional bits of dark chocolate and a glass of wine during this acute injury phase.

After the first few days of eating this anti-inflammatory diet to reduce the pain and swelling from your injury you could manipulate the diet slightly to allow for the physiological needs of the proliferation phase. During this phase the fibroblasts are laying down new collagen and it is important to provide your body with the “raw material” to make this new collagen. Collagen is a type of protein found in connective tissues including bone, tendons, ligaments and skin. It is made from the amino acid lysine, proline and hydroxyproline and the enzymes that power the conversion of the foods into body tissues are vitamin C dependent, thus we need to eat foods rich in vitamin C.

Conventional wisdom would suggest that oranges and orange juice are the best sources of vitamin C but this is not the case. Foods such as broccoli, cabbage, peppers, tomatoes and kiwi fruit are better sources. We could go one step further in this proliferation phase and think about the type of connective tissue we are trying to effect. For example if we are trying to improve the healing of bone injuries would could think about getting more vitamin D from liver, butter and dairy and foods rich in vitamin K which include the green leafy vegetables. These vitamins help stimulate bone formation. If we are trying to repair muscles we need to think about the branched chain amino acids and perhaps supplement them in the form of a branched chain amino acid supplement a protein shake or simply dairy products. Joint tissues such as articular cartilage are made from proteoglycans which are protein and sugar compounds that include sulphur. So if we are thinking about repairing cartilage we could use nutrients such as glucosamine and chondroitin in supplement form as well as food rich in sulphur foods like eggs, broccoli, cabbage, leeks and onions. The sulphur is what makes these foods quite smelly.

Notice the common thread with this type of nutrition is that it is rich in animal proteins and vegetables which should make up the majority of the diet, with the addition of small amounts of fruits, nuts, seeds and some whole grains to create balance and provide fibre and antioxidants.

The last thing to think about when recovering from an acute injury is hydration. We often only think of hydration, or actually dehydration in terms of performance. However considering that most of your body is made of water it now seems obvious to make sure you are adequately hydrated when recovering from an injury. Most of the muscle and cartilage is water that is locked into the tissue by the protein and proteoglycan content, even bone is up to 25% water. So consider drinking 1 to 2 litres of plain water a day depending on how much you weigh (this can include green tea, a coffee and a protein shake after your rehab exercises) but avoid alcohol (except the odd glass of red wine that contains flavanoids) soda AND diet soda drink and fruit juice.

So now we can see that with a little bit of though and diet manipulation we can enhance our bodies innate ability to heal itself though certain foods and nutrients.

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