Injury Nutrition in Acute Musculoskeletal Injuries
By Henry Mercier, ATC
Remember when your Mom or Dad harped on you to eat the last bit of vegetables or chicken at dinner before going to play? Did they emphasize it more after a sprained ankle or fractured arm? Maybe they should have. Evidence shows that nutrition can play a vital role in the recovery process of an injury.
When a muscle, ligament, or bone is acutely injured the general recommendations are to rest, limit swelling via the RICE protocol, and immobilize as needed to prevent further damage. The primary reason for this is the body needs to recover from the stress of the injury. Immediately after the initial injury, the inflammatory process begins and the body is in need of many nutrients for healing. However, because we’re recovering from injury and, therefore, not expending as much calories as we used to, we tend to decrease our intake of food. This is especially concerning when injuries result in immobilization or muscle disuse. Mixing this situation with decreased food intake (and likely decreased protein intake) is a recipe for muscle atrophy – something that all workers, athletes, and anyone trying to return to play or work wants to avoid as it can lengthen the rehabilitation process. In fact, immobilizing an injured joint contributes to muscle atrophy at approximately 0.5% per day with the most loss occurring 1-2 weeks post injury1,3. Research suggests that 150-400g of muscle tissue can be lost by a single immobilized leg during this time4 along with a decline in local insulin sensitivity2. A decrease in insulin sensitivity can alter the effectiveness of the transportation of glucose (sugar molecule) from food into our cells for energy. Given this information, it would be prudent to suggest that even disuse of a joint/muscle as opposed to full immobilization for the purpose of recovery may still lead to muscle atrophy. These outcomes are not to be taken lightly as they can prolong one’s rehabilitation process and ultimately the return to work or play.
So, how could I minimize this muscle atrophy? Does this mean I have to eat more? Won’t I gain weight that way since I’m not exercising as much? Not necessarily. First, one could still train or exercise, not synonymous terms, other aspects of their body that are not injured. Generally, this would be a good idea after some recovery time as opposed to the day after an injury. Second, instead of eating more, consider changing your macronutrient levels. In other words, alter the ratio of protein, carbohydrate, and fat you take in per day in favor of protein. This does not mean you need to eat an extra five pieces of steak at dinner. It could simply be having two to three handfuls of nuts and seeds between breakfast and lunch and a yogurt between lunch and dinner.
One last question to consider is: why protein? Protein is important for injuries because it plays a vital role in healing through the formation of collagen. Collagen is a sticky substance that forms a scar around your injured connective tissue. The building blocks of collagen are specific amino acids, like all other proteins. Three amino acids in particular characterize collagen: proline, glycine, and hydroxyproline5. Luckily, these are nonessential amino acids, which means we make them. Nonetheless, that does not mean we can’t support our bodies with that production process through food.
So, consider nutrition to be an adjunct to physical therapy to assist in the recovery process to allow you to keep doing what you love!
- Glover EI, Phillips SM, Oates BR, et al. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. ResearchGate. 2008;586(Pt 24):6049-6061. doi:10.1113/jphysiol.2008.160333.
- Richter EA, Kiens B, Mizuno M, Strange S. Insulin action in human thighs after one-legged immobilization. ResearchGate. 1989;67(1):19-23.
- Wall BT, Loon LJ van. Nutritional strategies to attenuate muscle disuse atrophy. ResearchGate. 2013;71(4):195-208. doi:10.1111/nure.12019.
- Wall BT, Dirks ML, Snijders T, Senden JMG, Dolmans J, Loon LJC van. Substantial skeletal muscle loss occurs during only 5 days of disuse. ResearchGate. 2013;210(3). doi:10.1111/apha.12190.
- Lodish H, Berk A, Zipursky SL, Matsudaira P, Baltimore D, Darnell J. Collagen: The Fibrous Proteins of the Matrix. 2000. https://www.ncbi.nlm.nih.gov/books/NBK21582/. Accessed January 8, 2017.
Stating and explaining the exact amount of protein you may need is beyond the scope of this post as it is dependent on multiple factors such as the individual and kind of injury. If you would like more information, check out the following: https://www.nata.org/practice-patient-care/health-issues/nutrition.