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Can Nutrition Aid in Injury Rehab?
Toolbox: Unfortunately, the timing to talk about cycling injuries is quite good, with major injuries to Chris Froome and even our own Toolbox Editor Dr. Stephen Cheung. What’s the role of proper nutrition during the recovery and rehabilitation process? How should your diet be modified during this time?



Over the past few weeks, we have been witnessing a considerable number of crashes in the pro peloton affecting many riders. One of them was Chris Froome who suffered multiple serious injuries and broken bones after crashing at 55kmph on a recon of stage four of the Criterium du Dauphine. Estimates for recovery range from 6-12 months.

Another injury in late May was our own Toolbox Editor Dr. Stephen Cheung, who broke and dislocated his foot while rock climbing in late May. He’s on crutches with no weight bearing allowed for 8 weeks, with progressive rehab over an additional couple of months.


Dr. Stephen Cheung and his editorial assistants

So, how can nutrition help Chris and Stephen optimize their roads to recovery in all the stages they must go through now?

On this article we will focus on muscle and bone injures, going through the latest evidence based knowledge available on how nutrition can be of any help.



Nutrition for muscle injuries
(for a visual summary, check out the end of this article)

An important thing to consider is that research on prevention and treatment of muscle injuries is scarce. Which means that many popular food lists and eye-catching Instagram infographics with “the 10 best foods for healing” are based on nothing.

So, what do we actually know and where should we be putting our attention?



1. Minimize lean body mass loss
Everyone loves to talk about protein in sports. Right? It is therefore attractive to theorise that eating more protein can alleviate muscle damage or improve recovery of muscle function. But evidence so far does not support this.

But don’t get me wrong. Protein is fundamental when recovering from injuries, especially those that require immobilization of a sudden loss of mobility.

In the first 1-2 weeks of immobilization is when the greatest loss of muscle mass occurs. So, the priority right away should be to provide enough protein to preserve or at least minimize lean body mass loss. Aiming for 2-2.5g/kg of protein per day, ideally fractioning it equally throughout the day in doses of 20-40 g of high leucine foods per meal. Dietary protein sources particularly rich in leucine are milk, eggs, beef, poultry, fish and the popular protein supplements such whey and casein.

2. Adjust energy intake to reduced energy expenditure
With an injury, a reduction of mobility is very likely to happen. In the case of a cyclist, the energy expenditure can drop dramatically depending on the severity of the injury and the immobilization degree (e.g. upper body versus lower body injuries).

While this job should be performed by a registered nutritionist/dietitian using proper formulas to estimate energy expenditure, the most important aspect to retain for the average cyclist is that this reduction in energy intake shouldn’t be done by any means at the expense of reducing protein intake (as discussed before). This must be done at the expenses of reducing (not eliminating) carbohydrate and fat intake.

3. Minimize strength losses
This is where creatine joins the party! While evidence so far only shows benefit in upper arm strength and lean body mass preservation after immobilization, considering the low price of creatine, I’d consider this a possible cost-effective strategy to take into account.

Nutrition for bone injuries
(for a visual summary, check out the end of this article)

Again, not much research here. Therefore, nutrition strategies should focus mainly on prevention:

1. Avoiding relative energy deficit (RED-S)
This is a big one and I’ll briefly summarize it bellow



2. Provide adequate calcium rich foods regularly
This may come of no surprise, as calcium deficiency is associated with increased risk of stress fractures. But before thinking right away in supplementing while recovering from a bone fracture, consider guaranteeing that you are include enough calcium-rich foods daily. Some of these foods are also high-leucine protein sources so they’re worth considering: Milk, yogurt, low-fat cheese, canned fish (aim for the fishbone) and broccoli.

3. Vitamin D status
Many athletes, including cyclists are deficient in vitamin D. This popular vitamin may play a role not only in bone health, but also in muscle regeneration capacity. Therefore, it is important to assess your vitamin D status and ensure that your serum 25(OH)D is >75 nmol/L. If you’re not able to maintain this value throughout the year, consider supplementing with 2,000–4,000 IU D3 during the winter and re-check periodically.



Of course, the best thing would be just to avoid crashing! So, stay safe out there and don’t take unnecessary risks. The road to recovery from an injury is a long one where nutrition plays a small yet important role. Beware the random advice found on social media.

Consult your doctor and especially a trained nutritionist before applying any of these strategies on your own.




About Gabriel Martins:
Gabriel Martins is a Portuguese Nutritionist with a Master's degree in Sports Nutrition. He currently lives in Spain where he works with cycling teams and integrates the research group on sports physiology at the University Camilo José Cela in Madrid. Additionally, Gabriel is the Host of Fuel the Pedal Podcast. A show where he interviews researchers, sports nutritionists and cyclists discussing topics related to nutrition and physiology.

Gabriel can be reached for comments at [email protected]. You can also follow him on Instagram, Twitter and Facebook.

 


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