This article is not medical advice and should not be taken as such. This is basic, generalised information which you might speak to your medical professional about when recovering from injury.
The 10 Point Plan for Recovering from Injury
Listen to your medical and rehab practitioners. Injuries will vary and may warrant individualised treatment.
Ask your practitioner if & how you can continue to train. Even if one body part can’t be moved, try to train uninjured body parts. As soon as movement of the injured area is allowed, follow your rehab program. Don’t get lazy or skip sessions!
Avoid nutritional deficiencies by maintaining a varied, whole food-based diet with plenty of plants. This will be effortless if you already have good habits in place. 5 servings of veggies and 2 pieces of fruit per day is a great start.
Aim to maintain your body weight. You might burn less energy if training less, however, you might burn more energy at rest due to the recovery process. Changes in your food/drink intake will be individual but start with consistency and react to average weight changes.
If reducing energy intake, start with a reduction in more processed, indulgence carbs & fats (chips, choccy, cakes, sweets, sugary drinks & alcohol).
Continue eating at least the same amount of protein, even if you reduce the amount of total energy you are consuming. Consider increasing protein up to 2-2.5 grams per kilogram of your body weight, per day. Yes...that’s a lot.
Continue eating varied whole food sources of carbs and fats. Vitamins, minerals, fibre and fatty acids are important so think potatoes, whole grains, legumes, avocado, nuts/seeds, olives, olive oil and oily fish.
Continue your intake of Omega-3 fatty acids through your usual method. It might be oily fish like salmon or fish oils, vegan sources like flaxseeds or algae. If you know you consume some, just keep doing what you are doing.
Continue making sleep hours a priority.
Continue taking your daily 5mg dose of creatine or consider starting.
(The word “continue” is used frequently in the 10 Point Plan for Recovering from Injury. This is an intentional prompt for anyone who does not currently consider these habits.)
There are 2 stages of rehabilitation from injury:
Wound healing
Recovery
Wound healing has 3 steps:
Inflammation
It begins the recovery process, occurs pretty much straight away and lasts from a few hours to several days.
It is a normal and necessary part of the process. It is to be encouraged and elimination or reduction of inflammation may not be optimal for recovery.
For most healthy individuals, excessive or prolonged inflammation is unlikely to be a concern.
(1)(2)
2. Proliferation
Scar tissue forms and acts as a ‘glue’.
3. Remodelling
Scar tissue breaks down and the injured area is re-formed.
The way the injured area is remodelled will largely depend on movement so do your rehab exercises! (1)(2)
The 3 stages of wound healing all require significant energy and may actually increase your energy expenditure at rest by 15-50%.
So whilst you might move less, these necessary stages might actually mean the reduction in your total “Calories burned” is less than you expect. (1)(2)
Immobilisation Stage of Recovery
Most injuries will result in immobilisation during the wound healing stage.
Eg - not being able to move the joint, being in a cast etc.
Muscle and strength losses are a reality of immobilisation and the aim of the game is to try and reduce this as much as possible through any movement possible and nutrition.
This might sound a little complicated - the immobilised area will likely be less sensitive to Muscle Protein Synthesis (MPS). We want MPS, it helps us maintain and grow muscle.
We want more MPS than muscle breakdown to result in a positive protein balance so that we don’t lose muscle.
This is much harder when unable to move an area of the body.
In normal conditions, we stimulate MPS with about 20-25 grams of protein in a meal.
However when immobilised, this dose might not do the job, so we should increase protein per meal above 25 grams.
If you have no idea how much your protein portions weigh or how much they contain, just make sure you don’t decrease the portions and if the injury means you have more time to learn it would be a good time to research a bit about your usual food intake and how that relates to Calories and grams of protein.
(2)(3)(4)(5)
Recovery Stage of Recovery
We are talking about the “cast coming off” and it’s time to get moving.
We are aiming to build back the strength and muscle mass of the injured area.
Recovery is likely to take significantly longer than wound healing, particularly in cases involving immobilisation, so be patient, do your rehab, build the strength and muscle back within the guidelines you are provided by your rehab practitioner. (2)(6)
Training when Recovering from Injury
When the all-clear is given to re-commence movement, actually do what is prescribed. Don’t get lazy with your rehab!
If possible, safe and medically approved, train everything that’s not injured. This can stimulate MPS (remember, we want to do this as much as possible).
Use the injury as an opportunity to work on weaknesses.
If you know your upper body isn’t strong and you injure a knee, this time is an opportunity. Look for the positives and use the time wisely.
Ask your rehab practitioner about the “cross-over effect” of training the uninjured/opposite limb in an attempt to maintain strength in the injured limb/area.
Eg you injure your right arm, so you train the left and potentially may help maintain some strength in the injured arm. (1)(2)(7)
Nutrition when Recovering from Injury
There we have a summary of the recovery process. Let’s take a look at the role nutrition can play.
“Ultimately, a balanced diet with sufficient energy, ample carbohydrate, protein and micronutrient intakes is always the best approach.” (1)
Nutritional Deficiencies when Recovering from Injury
The number 1 consideration is not letting injury derail your nutrition.
You might be down about getting injured but wallowing in mountains of chocolate and pools of vodka will likely extend the length of your rehab and risk health complications.
Continue with a base of protein and plants consuming mostly whole-foods.
If you maintain healthy habits which supported you pre-injury, deficiencies will be unlikely and supplementing vitamins and minerals is unlikely to provide any additional benefits. (1)(2)
Continue getting at least the 5 Fists of Fortitude (5 serves of veg/salad) and Fortitude’s 300 (300 grams of fruit / 2 medium pieces) per day.
Maintaining Energy Balance when Recovering from Injury
Now is not the time to try and improve body composition.
Depending on your level of activity before the injury and during recovery, you might need to reduce your energy intake.
This reduction might be less than you expect, as you might burn up to 50% more energy at rest during wound healing.
If using crutches, at least initially, you might burn 2-3x more energy than walking.
Both reduced energy intake and excessive energy intake can reduce MPS! (we don’t want that).
It’s going to be nearly impossible to predict how much you should reduce your food and drink intake.
You need energy for recovery and to train in any way you can, however, you also don’t want to increase body fat too much.
Keep things as consistent as possible and the easiest aim is to keep your average weight stable.
If you notice your average weight increasing, reduce your intake, starting with refined carbs and fats (chips, choccy, lollies).
If you are playing things smart, your alcohol consumption is going to be close to 0 so that might be all the reduction you need (more on this below)
(1)(2)(9)(10)
Protein when Recovering from Injury
At the very least, maintain your current level of protein intake. Reductions in usual protein intake can lead to muscle loss.
If tracking your intake (Counting Calories/ macros), don’t look at protein intake as a percentage. If it’s a percentage and you drop your energy intake, absolute protein intake will reduce - we do not want this.
Calculate grams of protein per kilogram of your body weight which you are trying to maintain.
Usually, it may be 1.4 - 2 grams per KG of body weight per day.
During injury recovery, up to 2 - 2.5 grams of KG of body weight per day may be helpful.
It’s likely to be beneficial to spread your protein intake out across the day, about 4-6 meals, in a pattern which you can consistently maintain. So making protein intake a bit more of a “bodybuilding plan”.
Protein intake per meal of 20-25 grams when healthy is likely enough to stimulate MPS (good), however more is likely needed during recovery.
Splitting 2 grams per kg across 4 meals for an 80kg human is 40 grams per meal.
If you split your protein intake across your meals and work it out to be 25 grams or less, you might find it more helpful to reduce the number of meals in order to get more protein per meal.
Consuming above these recommended protein levels may not further assist recovery and may ‘eat in’ to your carbs and fats Calorie ‘budget’ and increase the risk of nutritional deficiency.
If these recommendations seem confusing, the time you have during injury might be a great chance to get some nutrition coaching and learn more about this.
(2)(3)(4)(5)
Carbs when Recovering from Injury
Carbs help fuel training and we want to train anything and everything that’s possible (and safe).
Nutritional benefits still matter (remember we want to avoid deficiencies), so whole food sources of carbs (potatoes, sweet potatoes, whole grains, beans/legumes) also give us micronutrients (vitamins, minerals, fibre).
If reducing energy intake from carbs, reduce the Calorie dense, more refined options that often are mixed with fats. Our indulgence foods (chips, chocolates, sugary drinks, cakes).
(1)(2)
Fats when Recovering from Injury
As with carbs, aim to maintain whole food intake and variety (oily fish like salmon, avocado, olives and olive oil, nuts/seeds).
It’s probably not necessary to increase Omega-3 above your usual intake.
There is limited evidence to suggest the benefits of more for recovery.
Again, it’s a chance to check in with what you usually do.
If you (or your new coach) work out that you are not consuming much Omega-3 it will be a good opportunity to add some.
However, if you already consume some, just keep doing what you are doing.
Remember that aiming to reduce inflammation during wound healing may not be a good idea.
There is some research that fatty acids are needed during the recovery so even though you might be worried about weight gain, it’s probably not a good idea to make an immediate, large reduction in your fat intake.
(1)(2)
Sleep when Recovering from Injury
Maintaining quality sleep during recovery should also be a priority.
Inadequate sleep (less than 7 hours per night) has been linked with reduced MPS (bad) and loss of muscle mass. (8)
Supplements when Recovering from Injury
Whilst creatine hasn’t demonstrated consistent benefits in minimising muscle loss during immobilisation, it is often helpful for recovery - increasing muscle mass and strength.
As mentioned previously, supplementing a varied whole food diet with additional vitamins and minerals is unlikely to be beneficial.
If you have an identified nutritional deficiency, supplementation is probably already encouraged by your medical practitioner so continue in that case.
Unless you work out that your protein intake is well below the recommendations, additional amino acids or leucine may not be useful however evidence at this stage is mixed and evolving.
(1)(2)(6)
Alcohol when Recovering from Injury
Alcohol can impair MPS (bad) and is almost certainly a major contributor to accelerated muscle loss during injury.
Alcohol has Calories.
It could slow down recovery whilst leading to increasing your body fat.
Alcohol has also been found to impact sleep quality (even 1-2 standard drinks).
Excessive alcohol intake during immobility should be avoided and in reality, alcohol intake should be minimal during recovery from injury if an “as fast as possible” recovery is desired.
(1)(2)(9)(10)
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