No one likes to be injured. But given the nature of the continuous repetitive movement required to train and take part in endurance sports, and the very often extreme environment these sports are undertaken in, the chances of an injury occurring are pretty high. 

In this article I will be referring to musculoskeletal injuries (skeletal muscle, bones, tendons, and ligaments) incurred as a result of physical activity. 

The role of nutrition strategies in injury can be both a preventive measure and an important part of the rehab process. There are specific nutrition strategies an athlete can follow after an injury that have been shown to improve recovery, thus reducing time spent away from training and activity, attenuating loss of fitness, and preserving sanity levels! 

Poor nutrition practices can almost certainly increase risk of injury and will slow recovery, prolonging nonparticipation in the activities we enjoy. 

The Dangers of Low Energy Availability

Chronic low energy availability (LEA) is a major determinant for increasing the risk of an injury occurring. The drive to restrict food intake over a significant period of time in an effort to keep body weight down compromises bone health, which can result in poor bone density and an increased risk of bone fractures. LEA has also been shown to weaken tendons and ligaments. Underfueling for the effort required can also lead to poor recovery and increased fatigue, increasing the risk of illness and an injury occurring as the result of a mistake such as a fall. 

While you are injured, despite physical activity levels likely to be reduced compared to normal, it is important to avoid overly restricting energy/food intake. The aim is to meet energy requirements, providing your body with the energy and nutrients it needs to fully heal. Meeting your energy needs will also slow muscle mass loss and tendon mass loss and function. If deficiencies in energy and protein occur via a reduced food intake during the early phase of an injury, wound healing is impaired and muscle mass and tendon function loss are exacerbated. 

Regardless of the time point of your injury, it is paramount first and foremost to eat a healthy diet that provides sufficient energy and nutrients. This will prevent unnecessary weight loss and nutritional deficiencies (e.g., calcium, iron, copper, zinc). The opposite is also true: the temptation to comfort ourselves with alcohol and palatable sugary and fatty foods, resulting in body fat gain, should also be avoided. 

Protein

Muscle mass loss starts to occur within as little as 36 hours following inactivity. In an attempt to preserve muscle mass, protein should be kept at habitual intakes (I recommend Uphill Athletes consume 1.4–1.6 g/kg/BW), and for some a higher protein intake of 2 g/kg/BW may be necessary. Protein intake should be spread evenly throughout the day at 4-hour intervals as meals (~0.3 g/kg/BW) and snacks. This protein should come from good-quality protein sources that provide the essential amino acids required for muscle mass (e.g., animal proteins such as meats, fish, dairy, and eggs and complete plant proteins such as tofu, Quorn, hemp, and quinoa). 

Hydration

Keep up good hydration. This improves blood flow to and from the site of injury for repair or wound healing. 

Alcohol

Avoid or at the very least limit alcohol in the early stages of any injury as it has been shown to impair wound healing and delay recovery time. 

Anti-inflammatory Foods/Supplements

During the early phase of an injury occurring, you actually want the inflammatory response to take place (i.e., swelling, redness, bruising), so consider holding off on the intake of anti-inflammatory/antioxidant supplements such as curcumin or any touted high-strength antioxidant supplement. 

However, a diet rich in antioxidants and anti-inflammatory foods is recommended. Ensure plenty of green leafy vegetables, berries, brightly colored fruits and vegetables, foods rich in polyphenols (dark chocolate, green tea, nuts, seeds), and omega-3-rich foods such as oily fish and mono- and polyunsaturated fats (e.g., nuts, seeds, avocado, olive oil). 

Nutritional Supplements

• Hydrolyzed Collagen/Gelatin: Consume in doses of 10 g of hydrolyzed collagen per day or 15 g of gelatin combined with 50 mg vitamin C 30–60 minutes before exercise. This may lead to increased collagen production, thickened cartilage supporting tendon and ligament function, and a potential reduction in joint pain. Can be used as a preventative measure to support collagen and tendon health as well as improved recovery from injury. 

• Omega-3 Fats: Doses shown to support recovery from an injury are high at 5 g of omega-3 oils  (DHA/EPA) per day. (One salmon steak provides approximately 2 g omega fish oil.) Therefore it is recommended to include omega-3 oils on a daily basis from oily fish or an algae omega-3 supplement as a supportive measure. 

• Curcumin: Curcumin is poorly absorbed by the body when ingested by itself. The combination of curcumin with piperidine from black pepper is known to increase the bioavailability of curcumin. Recommended amounts are approximately 5 g per day, consumed for a minimum of eight weeks before improvements, if any, are experienced. Curcumin is known for its anti-inflammatory effects. Curcumin can cause gastric distress side effects.

• Vitamin D: A deficiency in vitamin D has been shown to increase the risk of fractures 3.5-fold and impair immune function. Therefore, it is recommended to check vitamin D levels and supplement if required to both prevent injury and aid recovery from an injury. 

• Multivitamin/Antioxidants: Supplementation of micronutrients in amounts above the recommended daily intakes do not further reduce inflammation to enhance recovery. Ideally micronutrients and antioxidants should be consumed via foods (as recommended above). 

• Tart Cherry Juice: Tart cherry juice exerts anti-inflammatory/antioxidant effects and can be strategically used to alleviate pain during exercise for those who suffer from a chronic injury. Preloading with tart cherry juice (specifically from the Montmorency cherry) twice per day four days before your chosen event could reduce pain experienced during exercise. 

• Creatine Monohydrate: Taking a creatine supplementation during rehabilitation or return to training and activity may be beneficial in supporting the regeneration of muscle and strength gains.  A typical side effect of creatine supplementation is weight gain, mainly in the form of water retention.

Nutrition interventions to prevent or support recovery from injury should be with a food-first approach. Then add in the use of nutritional supplements where appropriate. Nutrition strategies will be individual and depend on the level of injury sustained, the extent to which it inhibits physical activity, and the time point at which the injury occurred. 

The good work of nutrition never stands alone. The influence of nutrition on injury and recovery is strengthened by diligent rehabilitation and recommended rest, followed by good nights of sleep. 

References and Further Reading

• Tipton, Kevin D. “Nutritional Support for Exercise-Induced Injuries.” Sports Medicine 2015;45:93–104. 
• Maughan, Ronald J., et al. “IOC consensus statement: dietary supplements and the high-performance athlete.” British Journal of Sports Medicine 2018;52:439–455.
• Close, Graeme L., et al. “Nutrition for the Prevention and Management of Injuries in Track and Field.” International Journal of Sport Nutrition and Exercise Metabolism 2019;29:189–197. 
• Wall, Benjamin T., et al. “Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics.” European Journal of Sport Science 2015;15:53–62. (Epub 2014 Jul 16)