Functional Training Zones

Healing is Optimized with Proper Nutrition

The body eventually heals on its own. However, providing correct nutrients may enable the body to heal faster and more efficiently.

Sue Falsone PT, MS, SCS, ATC, CSCS
Director of Performance Physical Therapy, Athletes' Performance

Amanda Carlson MS, RD
Director of Performance Nutrition and Research, Athletes' Performance

Just as a plant needs sunlight and water to flourish, the human body cannot function at optimum capacity without the proper chemical and nutritional environment. Many body systems must intertwine and play a part to heal an injury. Biomechanical changes can affect tissue stress and strain. The nervous system provides sensory input and output to help movement patterns develop. A bioneural component is the basis for motor learning and motor control.

The biochemical component, which is often difficult for rehab professionals to harness, may be one of the most important factors in tissue health. It is important to understand the role nutrition and supplements can play in allowing an athlete's body to recover from injury. When working with athletes, it is critical to review the importance of a healthy overall diet, which is necessary to supply vitamins and minerals for normal body function and tissue repair.

Remember the phrase "food first, supplement second." A nutritional supplement is just a nutritional supplement. It is not a magic pill that can miraculously heal injuries. However, in times of physiologic stress or injury, it may be difficult to meet the body's nutritional needs through food alone. The combination of a nutrient-rich diet and supplementation creates an ideal physiologic environment for healing. Encourage athletes to adhere to general dietary guidelines in times of good health and during healing, such as the following:

• Maintain adequate caloric intake, and remember to consider changes in activity level.

• The body needs a sufficient amount of calories to maintain function and support repair.

• Focus on eating whole foods, such as fruits, vegetables and whole grains, instead of junk food and refined carbohydrates.

• Avoid fried foods and fat condiments, which add calories without adding nutritional value.

• Focus on lean protein sources, such as fish, poultry, lean cuts of red meat, eggs and nonfat dairy products.

• Maintain protein intake that's equivalent to 1.0-1.5g/kg/d

• Eat a rainbow diet. This simple tip stresses the importance of a diet that is consistently full of colorful fruits, vegetables and whole grain, and that includes lean protein sources.

Introducing Supplements

Despite efforts to maintain a healthy diet, athletes still have trouble meeting daily nutritional requirements. This is where dietary supplements and micronutrient supplements can play a role. When an athlete is injured, it is even more important that the body has the tools it needs to absorb important components for healing.

Among the most common sports injuries are sprains and strains. While healing occurs on a continuum, rather than in distinct separate steps, it is important for clinicians to understand the process that soft tissue goes through in order to repair itself. The three stages are inflammation, proliferation (scar formation), and scar maturation. The stage of healing dictates the best treatment for a recovering athlete. The type of therapeutic environment, which includes modalities, therapeutic exercise and soft tissue mobilization, will have a significant impact on the strength of the scar that forms and on the overall outcome.

Sprains, strains, and acute joint traumas require a reduction of inflammation and healing of the tendon or ligament. A protease mixture of bioflavonoids, curcumin, ascorbates, glucosamine and chondroitin, and a vitamin/mineral/antioxidant mixture are the most effective supplements for these processes. The combination of these vitamins, minerals and enzymes may have an anti-inflammatory effect and speed the rate of healing.

Curcumin has strong antioxidant and anti-inflammatory properties, and vitamin C is involved in the synthesis of collagen, proteoglycans, and other organic components of the intracellular matrix. It is also a powerful tissue antioxidant and immune system booster. By stimulating articular cartilage regeneration and slowing osteoarthritic deterioration, glucosamine and chondroitin can further speed the rate of healing following injury.

The optimum external sources for enzymes, antioxidants, flavonoids and organic sulfur are raw and living foods that are not processed, dried, cooked or preserved. Cooked food is virtually absent of enzymes and may reduce the presence of antioxidants, flavonoids and sulfurs. Athletes should take enzymes 30 minutes before meals, because they are catalysts for most biological and chemical reactions in the body.

Wound Healing

Nutrition and supplements can also affect wound healing. Surgical incisions, diabetic ulcers and other wounds need an optimal healing environment. Wounds that do not heal properly pose a risk of infection and scar formation.

Most clinicians are familiar with a patient whose post-surgical incisions seem to be "scarred down," or adhered to the tissue beneath it. Tissue healing for an external or internal wound requires a balance of tissue strength and mobility.

Tissue repair responds to the stress placed on it. Cross-friction massage, progressive stretching and strengthening lead to tissue remodeling, which should establish a strong, mobile scar.

Injured skin has an increased metabolic demand and special nutritional requirements. If these requirements are not met, healing may be hindered. Several nutrients may improve healing time and wound outcome, mainly vitamin A, vitamin C, zinc, glucosamine and protein. In addition to the action of vitamin C outlined above, vitamin A may enhance early inflammatory phase of wound healing and support epithelial cell differentiation.

Zinc is required for the synthesis of DNA and protein, and for cell division. Glucosamine enhances hyaluronic acid production in the wound, while protein prevents delayed healing and complications from surgery.

The Bottom Line

Creating an optimal physiologic environment that promotes tissue regeneration and repair is the goal during healing. Start by examining one's overall diet, then address deficiencies to make food choices as nutrient-dense as possible.

The next step is to explore supplementation strategies. There is evidence that these vitamins, minerals and enzymes are critical to different physiologic actions in the body. However, additional extensive double-blinded clinical trials with well-defined outcome measures will be able to evaluate safety, efficacy and potential drug interactions. Nutritional interventions in these cases are still considered alternative and most protocols have not been validated.

The body eventually heals on its own. However, providing correct nutrients may enable the body to heal faster and more efficiently. When treating injured athletes, a faster return to the playing field is the name of the game.



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References

1. Lipello, L. (2003). Glucosamine and chondroitin sulfate: Biological response modifiers of chondrocytes under simulated conditions of joint stress. Osteoarthritis and Cartilage, 11, 335-342.
2. Priebe, D., McDiarmid, T., Mackler, L., & Tudiver, F. (2003). Do glucosamine or chondroitin cause regeneration of cartilage in osteoarthritis? Journal of Family Practice, 52, 237-239.
3. MacKay, D., & Miller, A. (2003). Nutritional support for wound healing. Alternative Medicine Review, 8, 359-371.