Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation

Abstract

Nutritional interventions are not commonly a standard of care in rehabilitation interventions. A nutritional approach has the potential to be a low-cost, high-volume strategy that complements the existing standard of care. In this commentary, our aim is to provide an evidence-based, practical guide for athletes with injuries treated surgically or conservatively, along with healing and rehabilitation considerations. Injuries are a normal and expected part of exercise participation. Regardless of severity, an injury typically results in the athlete's short- or long-term removal from participation. Nutritional interventions may augment the recovery process and support optimal healing; therefore, incorporating nutritional strategies is important at each stage of the healing process. Preoperative nutrition and nutritional demands during rehabilitation are key factors to consider. The physiological response to wounds, immobilization, and traumatic brain injuries may be improved by optimizing macronutrient composition, caloric consumption, and nutrient timing and using select dietary supplements. Previous research supports practical nutrition recommendations to reduce surgical complications, minimize deficits after immobilization, and maximize the chance of safe return to play. These recommendations include identifying the individual's caloric requirements to ensure that energy needs are being met. A higher protein intake, with special attention to evenly distributed consumption throughout the day, will help to minimize loss of muscle and strength during immobilization. Dietary-supplement strategies may be useful when navigating the challenges of appropriate caloric intake and timing and a reduced appetite. The rehabilitation process also requires a strong nutritional plan to enhance recovery from injury. Athletic trainers, physical therapists, and other health care professionals should provide basic nutritional recommendations during rehabilitation, discuss the timing of meals with respect to therapy, and refer the patient to a registered dietitian if warranted. Because nutrition plays an essential role in injury recovery and rehabilitation, nutritional interventions should become a component of standard-of-care practice after injury. In this article, we address best practices for implementing nutritional strategies among patients with athletic injuries.

© by the National Athletic Trainers' Association, Inc.

Figures

Figure 1

Physiological and metabolic demands after injury can be addressed with key nutritional targets; elevated caloric demand, increased protein, glucose regulation with complex carbohydrates, and essential fatty acids should be considered. In addition, based on the evidence, specific dietary supplements may mitigate the negative effects of surgery and immobilization and support faster healing. Abbreviation: HMB, β-hydroxy-β-methylbutyrate.

Figure 2

Before surgery, increasing the carbohydrates in the diet, particularly from complex sources and proteins, is beneficial. The night before surgery should include a well-rounded meal with slow-releasing carbohydrates and proteins. Two to 4 hours before surgery, a clear liquid consisting of a high molecular weight starch (HMS) and essential amino acids molecular-weight essential amino acids (EAA) is recommended.

Figure 3

Injury and surgery result in a significant stress response, which highlights the potential for nutritional support. The demand for glucose and amino acids increases, which initiates a hormonal response resulting in a catabolic environment, leading to large losses in lean body mass. Adapted from Demling.

Figure 4

Identifying energy needs during injury and rehabilitation is a key first step. Metabolic needs increase to account for basic metabolism and the increased energy demands of wound and injury healing. Abbreviations: FFM, fat-free mass; RMR, resting metabolic rate.

Figure 5

Energy needs and quality of calories should be evaluated postsurgery and during recovery. A diet consisting of complex carbohydrates, high-quality protein, and high-quality fats is advised. For example, create a plate with a 30-g serving of complete proteins paired with a complex whole grain. Then add fresh fruits and vegetables in a variety of colors to help provide antioxidants to enhance recovery, control inflammation, and provide important micronutrients. Abbreviations: ACL, anterior cruciate ligament; CHO, carbohydrates; PRO, protein; RMR, resting metabolic rate.

Figure 6

The timing of macronutrient ingestion throughout the day is particularly important, with special attention to nutrition before and after therapy. Abbreviations: CHO, carbohydrates; EAA, essential amino acids; EPA/DHA, eicosapentaenoic acid/docosahexaenoic acid; HMB, beta symbol-hydroxy-beta symbol-methylbutyrate; rehab, rehabilitation; RSB, rehabilitation supplement blend.

Figure 7

Third-party testing companies provide a seal or stamp for approved products. Look for these logos on applicable dietary supplements.

Figure 8

An overview of key micronutrients that have been shown to enhance healing and recovery.