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.
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.
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 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 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.
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.