Injuries can quite literally stop a runner in his or her tracks. Recent research suggests that half of sports injuries lead to an average of three weeks without training or competing. Consequently, for a runner eager to return to the streets and trails, any intervention that can increase healing and decrease down time is important.
Cross-training, physical therapy and biomechanical assessments are well-established aspects of the treatment process, but often overlooked is the role of nutrition in the recovery from injury. Dr. Keith Baar, a researcher at the University of California, Davis, believes that nutritional support is a critical element of recovery.
“A greater understanding of the role of nutrition in healing has evolved in the past three to five years, with much of that coming from studies dealing with the recovery of muscle strength and return to play in elite athletes after ACL surgery,” says Dr. Baar. In one such case study, by following an injury-specific nutritional program, the athlete displayed half of the muscle atrophy in the immobilized leg that was expected. Since a return to running after injury is often dictated by the rate of muscle function, maintaining muscle size and strength may significantly hasten recovery.
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In fact, a 2015 review article in the journal Sports Medicine concluded, “Nutritional support may be crucial to lessen the length of time and reduce the negative aspects of reduced activity and immobilization, as well as to support the return to activity and training.”
According to Dr. Baar, the recommendations can be divided into the role of nutrition in the recovery of two different structures—collagen-based tissues, and muscle tissue. Collagen—the principal component of tendons, ligaments and cartilage—is characterized by a relatively poor bloodflow, making the delivery of potential nutrients all the more difficult. “When nutrients are designated for tendons or ligaments, the increase in blood flow during exercise is the optimal time for absorption,” says Baar.
Exercise also signals the tendon to briefly increase its absorption of important nutrients. Working backwards, in order for the collagen-building nutrients to be floating in the blood stream ready for absorption, meals need to be consumed approximately one hour before exercise.
Baar names four important amino acids—lysine, hydroxylysine, hydroxyproline, and proline—as those that have shown the greatest promise in building collagen. Lysine, an essential amino acid found in meat, cheese and eggs, may play a particularly important role in the health of bones, connective tissue and skin.
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While both scientific and clinical studies have indicated that these amino acids may actually strengthen ligaments and tendons, no long-term research has been carried out to determine the preventative effects of nutritional interventions.
Facilitated by a better blood flow, nutrition may play an even greater role in the growth and recovery of muscle tissue. Amino acids, the building blocks of muscle protein, are readily delivered to muscles and consequently, an adequate daily protein intake may be essential in maintaining muscle mass during injury. Studies show that in periods of inactivity, healthy muscle tissue atrophies at approximately 0.5 percent per day. For a runner that has had surgery or suffered serious injury, two to three weeks of immobilization can lead to a loss of 10 percent of muscle mass. As muscle strength declines at approximately three times the rate that muscle tissue is lost, it doesn’t take a mathematician to realize that extended periods of inactivity can result in big losses in strength.
Without a focused exercise effort—possibly months of rehabilitation—these losses are frequently never recovered, perhaps forever influencing injury risk and performance.
Baar stresses that these recommendations aren’t just for those that have been injured—they also apply to those recovering from hard exercise sessions, a time when muscle breakdown also occurs. “To repair the muscle damage that occurs after hard exercise, a good, well-timed nutritional support program emphasizing leucine-rich proteins is very important.” Sadly, for those that love a post-workout beer or Chardonnay, excessive alcohol (more than 4 drinks) can impair muscle recovery.
Owing to the observation that muscle recovery is ramped up during two different time periods, 18 and 48 hours after exercise, those runners attempting to optimize muscle recovery should aim to ensure that recovery foods include leucine rich foods (egg whites, chicken, tuna, turkey, dairy products).
While indicating the importance of particular nutrients during the recovery from injury, the author of the Sports Medicine review article, Dr. Kevin Tipton of the University of Stirling, emphasizes balanced nutrition. “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.”
The article recommends the following guidelines for those that wish to optimize recovery.
- Deficiencies of energy, protein and other nutrients should be avoided.
- Alcohol is best avoided as it may impair recovery, wound healing and inflammation.
- Following an injury, an inflammatory response is initiated and while excess inflammation may be harmful, given the importance of the inflammatory process for wound healing, attempting to drastically reduce inflammation may not be ideal for optimal recovery.
- Energy balance is critical. Higher protein intakes (2–2.5 g/kg/day) seem to be warranted during immobilization. This can be broken up into 4-6 small meals/day.
- At the very least, care should be taken not to reduce the absolute amount of protein intake when energy intake is reduced.
- There is promising, albeit preliminary, evidence for the use of omega-3 fatty acids, branched chain amino acids (including leucine) and creatine to counter muscle loss and enhance hypertrophy.
- The overriding nutritional recommendation for injured exercisers should be to consume a well-balanced diet.