So I really hope the time never comes where you have to use the information which is about to follow.
One of my old clients dropped me an email to say she was due to undergo knee surgery and wanted to sign back up with me if there was any useful information or strategies for optimal recovery from injury.
Yes, there certainly are guidelines you can follow which can help optimise recovery. Nutrition is just one piece of the puzzle here, and as we go on you’ll see that the rehab you get from your specialist/physio team plays a massive role in fully recovering and getting back to full strength and function.
Full and optimal recovery has several components. Look after ALL of them.
I’m delighted Lou signed back up, and between the nutritional guidelines and the support from her medical team I believe she has given herself the best possible path back to full fitness following the surgery.
It was a really cool learning process for me as well. I enjoyed researching the content and it’s great to have contact with the client throughout their recovery.
Here we go…
The first thing I want to do is to make it clear that this is specifically to do with orthopedic/musculoskeletal injuries, which is basically to do with muscle or bone (ligaments and tendons fall into the category also). Just think of it as some kind of sports related injury that occurs like a bone break or ligament tear and not something like heart surgery or anything to do with the organs for example.
A sport or training related injury happens and then there is possibly some kind of period of immobilisation. These are the guidelines for optimising recovery as far as nutritional strategies go in this specific set of circumstances.
Another thing to consider is the fact that even though someone may suffer an injury which is labelled and diagnosed, for example some kind of cruciate ligament tear, the recovery time between people will always differ in some way. An injury can be labelled the exact same between 2, or even 10 people, but everyone’s recovery time will be slightly different depending on several factors. You can talk about things such as age, fitness level and other stuff that will seem obvious, but one factor that’s almost impossible to measure is that some people just seem to heal more quickly than others.
Here’s a great slide from Caleb Burgess showing how much of a variance in recovery time there can be for some of the injuries relevant to this article.
Recovery time depends on the injury and it depends on the individual. There are different factors which affect it, but as far as nutrition goes and doing your rehab as prescribed you’ve got two factors you can directly control which will influence your recovery time and the quality of your recovery.
As much as it sucks, it was great to have Louise actively applying the guidelines and I am sure she will make the best recovery possible. Also, I broke my wrist playing soccer around 10 years ago and it required surgery. I didn’t have any of these guidelines and I definitely remember doing very little of the work the physio gave me.
For months my wrist would give me grief and especially so in the cold weather. It was only when I got in to fitness and started resistance training (lifting weights) that the pain disappeared. It took time but eventually it felt back to normal, but I was quite lucky that I strengthened it up so much through weight training.
The difference between life long chronic wrist pain and being pain free is a pretty big deal. If you get injured please follow the guidelines your medical team and physio give you, and if you need nutritional support reach and contact me.
To get in to things it’s best to work our way through the whole process of the injury occurring and what actually happens in the body on the road to recovery.
What are the processes that occur when you get injured and begin to heal? What are we looking to support and what are we trying to avoid?
Learning about how the body reacts to injury will help you understand why the nutritional guidelines are set the way they are. Fully understanding how food can support the healing and recovery process, and understanding the negative outcomes if you DON’T do the right things will…make you do the right things.
What We Are Trying To Avoid.
The main problem with any kind of big injury is immobilisation. A bone break, surgery, or any other serious injury that causes you, or a limb, to be immobilised causes problems. The problem is the loss of muscle mass and of function of the injured area.
Muscular atrophy is the loss of muscle mass and this most commonly occurs when a person suffers temporarily disabling circumstances. Substantial muscle loss can occur in as little as 5 days.
The image is a good visual representation of what you don’t want to happen. You don’t want any kind of muscle loss whether you’re an athlete or even if you just train recreationally.
You’ll see as we work through the example of my client that medical teams try and get you back on your feet/moving/doing rehab as quickly as possible to aid the healing process and to minimise loss of function.
This article is dealing with injury, but think more broadly about things and whether someone isn’t immobilised because of injury, maybe they are inactive by choice. The same principles apply here, muscle mass and function suffer through inactivity.
Use it or lose it.
Loss of muscle mass negatively affects strength, strength is one measure of longevity (stronger, fitter people generally live longer).
A reduction in function means you’re less likely to be mobile. A loss of strength and mobility usually compound each other into a downward spiral. Your quality of life can suffer, you can be more likely to fall and if you do fall you’ll be more likely to break something.
This is just something to keep in mind for people around you that you care about.
Back on track and let’s assume we are all here as active people who are trying our best to offset any loss in muscle mass or function.
The Journey From Injury To Recovery.
The following image lays out the journey from the initial injury until recovery in terms of the healing process.
You can see things are broken down into phases. Once the injury occurs the body springs into action and begins the wound healing process.
Wound healing itself is broken down into 3 phases – inflammation, proliferation and remodelling. The final phase is recovery. This is when the person is no longer immobilised.
Each injury will be different, and the time scale of the different phases depend on the severity of the injury. Lyle McDonald goes in to more detail on this in his brilliant resource ‘Optimal nutrition for injury recovery’.
An example of my client’s situation was an ACL reconstruction. Louise went in and got the op done, stayed overnight, and was home the next day with rehab exercises to work on immediately. The first physio appointment post-op is 7-10 days later and then a follow up with the consultant after 14 days.
Full recovery from ACL surgery can take up to 6 months and there’s several progress checks within that time frame.
Each injury is different, but let’s look at the phases of wound healing and then I’ll discuss what can be done to support recovery from the injury as a whole.
Wound Healing – Inflammation, Proliferation and Remodelling.
Once the injury occurs the body moves straight into wound healing mode. The first step here is inflammation.
Inflammation is the body’s response to tissue damage. It’s important to distinguish between inflammation in response to an injury and chronic inflammation through bad lifestyle choices. Acute inflammation in this scenario is a good thing, the body is initiating tissue repair and clearing out any dead cells and damaged tissue. Without inflammation here the injury wouldn’t heal.
When you think of inflammation being a negative thing it’s chronic inflammation that can lead to disease states. Being obese increases the risk of chronic inflammation, but it can also be caused by auto-immune disorders. The ins and outs of it are beyond the scope of my knowledge but just remember when it comes to injuries and healing the acute type isn’t bad.
Once inflammation subsides proliferation will occur. This is the rapid reproduction of cells and a good way to visualise it is picturing when you’ve had some kind of a cut and it fills in as it heals. It’s the process of scar tissue formation and this leads in to remodelling.
Once the injury has healed through profileration reclaiming range of motion and fully recovering from the injury becomes the priority. The remodelling phase is where that scar tissue that has formed is shaped. This is a vital time for sticking to the rehab programme you have been given and making sure the work all gets done.
Once you’re back on your feet so to speak, it’s the recovery phase. Again, how long this takes depends on the severity of the injury.
How Nutrition Can Support Recovery From Injury.
The right nutritional guidelines may help lessen recovery time from the injury, reduce any negative effects of being immobilised, and help maintain body composition over whole process from the initial injury to full recovery.
There’s a great quote from the Kevin Tipton paper which is listed in the references at the bottom of this article.
‘The single most important nutritional consideration during reduced muscle activity and/or immobility is to avoid nutrient deficiencies. Deficiencies of energy, vitamins, minerals and macronutrients – particularly protein – will impair wound healing and exacerbate loss of muscle and tendon mass and function.
Whereas healthy exercisers and athletes are unlikely to suffer from malnourishment, choices made during recovery from an injury need to be carefully considered to optimise recovery and return to training.’
References and Source Material:
Lyle McDonald – Optimal Nutrition For Injury Recovery.
Bojan Kostevski – Nutrition When Recovering From Injuries.
Kevin Tipton – Nutritional Support for Exercise-Induced Injuries (2015).