Injury Nutrition and Supplementation: How to Get Back in the Game Sooner
Written on August 9, 2012 at 9:01 pm, by Eric Cressey
Today’s guest blog comes from nutrition expert, Brian St. Pierre.
About three weeks ago, I broke part of my tibia while playing in a rugby tournament. Fortunately, my break isn’t too bad (though it is rather rare), as I only broke the bottom portion of the tibia, not the entire bone.
I got tackled on the final play of the game, and while we went on to score, giving us a chance to tie. Unfortunately, we missed the kick, and even more unfortunately, my ankle everted excessively. This eversion caused huge strain on my tibiocalcaneal ligament (the white one in the photo below), which is so damn strong that instead of spraining, it simply broke the bone where it attached to my tibia.
The worst part is that 1 in 6 of these breaks require surgery. I am young, fit and healthy, so I am hopefully not the “1,” but I still felt it was in my best interest to do everything I could to decrease the surgery odds.
Injuries are a part of the game; whether that game is rugby, baseball or just being a recreational exerciser – they can happen to all of us. While prevention is always the goal, once injury occurs, what can we do about it? A lot, actually.
You see, the body has a very organized recovery process. First is the coagulation phase which lasts 1-2 days. An inflammation phase follows, lasting up to 5 days post –injury. Third is the migration phase, which lasts from day 4 to 21 days post injury. Finally, the remodeling phase lasts from day 5 up to 2 years post injury.
With this in mind, we can use appropriate nutrition and supplement choices to improve the recovery process. The goal with an injury is to manage inflammation by controlling swelling and pain, and to assist with the remodeling phase to stimulate tissue growth (in my case, bone).
The trick is to not completely eliminate inflammation, as some is necessary for proper recovery, but too much can increase tissue damage and lengthen the recovery time. Here are some strategies for modulating inflammation:
1. Eating appropriate fat-dense foods.
Focusing consumption on plenty of extra virgin olive oil, various nuts, avocados, ground flax, chia seeds and wild fatty fish or fish oil. Fish oil is a must here, with a good goal being 3-9g of total fish oil per day.
In this same vein, it is even more important to minimize inflammatory promoters such as industrial vegetable oils – corn, cottonseed, safflower, soybean, sunflower, etc and especially trans fats.
2. Including specific foods and supplements.
Curcumin at 1-2g/day.
Garlic
Bromelain 500-1000mg/day or 1 cup pineapple/day
3. Using NSAIDs appropriately.
NSAIDs do help with managing inflammation, but they also can hinder appropriate healing, in addition to many other possible side effects such as GI distress, bleeding, etc. They are best reserved for the inflammation phase of recovery only.
In addition to managing inflammation, it is also important to note that injuries increase our resting metabolic rates by 15-50%. In my case it is probably closer to 15, in the case of severe burns covering large amounts of the body, then it approaches 50%. As such, we need to consider the extent of the injury when we decide how to plan out nutrition to optimize tissue repair.
While overall calories needs will be higher than your needs if you were not injured, they are not as high as your needs are if you are healthy and training hard. In my case I was still able to lift 4x/wk with some modifications, but I was no longer able to walk the dog everyday for two miles, and my overall movement decreased, so my intake reflected that.
In addition, having some vitamin or mineral deficiencies can also inhibit healing and recovery. These deficiencies include vitamins A, Bs, C, and D, as well as copper, iron, magnesium, manganese, zinc and calcium.
Additionally, some micronutrients may actually speed healing (though some are more specific to wounds than bone): vitamins A and C, copper and zinc are examples.
With all of that in mind, what did I actually do with my nutrition and supplementation to ensure a good recovery?
I actually increased my already substantial fruit and vegetable intake to help ensure adequate vitamin and mineral status, as well as providing anti-inflammatory phytonutrients and compounds.
I will also note that I have been experimenting with a BSP version of intermittent fasting (meaning I am not a slave to it, I do it on days when it fits my schedule, and don’t do it on days when it doesn’t, and I don’t worry if I only fast for 14 hours instead of 16 either).
Wake @ 5:30am – 12oz black coffee
7:00am – 12oz black coffee
7:30-8:30am – train
10:00am – Breakfast
• 5 whole pasture-raised eggs in 1 tsp grass-fed ghee
• ½ cup mixed peppers and onions
• large handful organic spinach
• salt and pepper to taste
• ½ cup old fashioned oats cooked with a little unsweetened vanilla almond milk
• 1 banana, sliced
• 1 tbsp organic milled flax
• cinnamon to taste
• 1 smoothie made of 2oz POM, 1 cup organic whole yogurt, ½ scoop vanilla protein, 5g creatine, bunch of blueberries and strawberries
2:00pm – Lunch
• 1 Ezekiel wrap
• 2 tbsp extra virgin olive oil pesto
• large handful or two of organic spinach
• 1 chicken breast
• ½ 100cal pack wholly guacamole
• 12 baby carrots with other half of guac
• 1 organic apple
• (when uninjured I have another cup of yogurt, another half scoop of protein, a few slivered almonds, and some chopped strawberries here, but I intentionally dropped this knowing my needs were less)
6:00pm – Dinner
• 3 cups organic mixed greens
• 4 baby carrots
• ½ cucumber
• ¼ cup black beans
• ½ cup brown and wild rice
• a few croutons
• 2 tbsp expeller pressed canola oil ranch dressing
• 10oz grass-fed lean sirloin
• 1 glass wine or 1 Coors Light
• 3 squares Green & Black’s Organic 85% Cacao chocolate (1/4 serving)
• 1 serving mixed dried fruit
Supplements:
• Innate Response One Daily 2x/d
• 1g Curcumin 2x/d
• 500mg Vitamin C 2x/d
• 2000IU Vitamin D on weekdays
• 3g fish oil 2x/d (total of 3.6g EPA and DHA)
• 1 probiotic daily
• 3 ZMA 4x/wk
In advance, I’ll answer some of the questions I know will come up.:
1. I am only taking vitamin D on weekdays because I get plenty of sun on the weekends, and in fact I was only taking it a few days a week prior to the injury since I was walking the dog each afternoon and it has been a gorgeous summer.
2. I am taking the vitamin C merely because we had some kicking around the house; they were about to expire and I figured it wouldn’t hurt.
3. I don’t normally take ZMA, but I figured I would get a bottle for the extra zinc and magnesium, just for the next 5-6 weeks or until it runs out. I only take it on the nights before I train, as I tend to feel groggy if I take it every night.
4. I will only take the supplements in these amounts for four weeks. After that it returns to multi just once, 500mg curcumin, and 2g fish oil (1.2g EPA/DHA).
5. I will also not that I did take 800mg of ibuprofen 2x/d starting on day 3 of recovery, after the coagulation phase, and then only took for three more days, or until the inflammation phase was complete.
Conclusion
Don’t let an injury come between you and your health and fitness goals. As Eric has written, you can always train around an injury, and there are steps you can take to provide your body with the materials it needs to heal as rapidly and completely as possible.
Have you employed any nutritional or supplementation strategies to assist your recovery from an injury in the past? I’d love to hear your experiences in the comments section below.
About the Author
 Brian St. Pierre is a Certified Sports Nutritionist (CISSN) and a Certified Strength and Conditioning Specialist (CSCS). He received his degree in Food Science and Human Nutrition with a focus in Human Nutrition and Dietetics from the University of Maine, and he is currently pursuing his Master’s degree in Human Nutrition and Dietetics from the same institution. He was the Nutritionist and a Strength and Conditioning Coach at Cressey Performance in Hudson, MA for three years, and is now a coach with Precision Nutrition. Brian authored the Show and Go Nutrition Guide, the accompanying nutrition manual to Eric Cressey’s Show and Go Training System.
With his passion for seeing his clients succeed, Brian is able to use his knowledge, experience, and energy to create highly effective training and nutrition programs for clients of any age and background. For more information, check out his website.
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August 9th, 2012 at 9:42 pm
Brian,
Good to see your article and so much good information in this article of yours! I have a couple of questions for you.
– Innate Response: have you noticed a difference when you switched to a whole-foods based multi-vitamin? Also, what about any herbal additives in Innate Response? There was a recent article at PN about the risks of herbal supplements.
– What brand of vitamin D supplement do you take and how often do you get tested?
– What is a good cooking oil, coconut or canola? Canola seems to have gotten a bad rep recently.
Thanks in advance.
August 9th, 2012 at 10:00 pm
Great article..thanks! Quick question…why the coors light/glass of wine with dinner?
August 9th, 2012 at 10:00 pm
Diet looks alright, but there are a lot of suggestions here, with minimal references as to whhy to do it. Vitamin D is key, but the other 2 biggest factors to heal bone are likely vitamin K2, prefereably MK4 version. And avoiding grains altogether appears to allow bones/teeth the greatest chance to heal and recover. IMO, anything good for the teeth should extrapolate nicely to the bones (which we can’t see as easily).
http://wholehealthsource.blogspot.com/2010/12/dr-mellanbys-tooth-decay-reversal-diet.html
http://wholehealthsource.blogspot.com/2009/04/images-of-tooth-decay-healing-due-to.html
August 9th, 2012 at 10:37 pm
I appreciate this article Brian.
As a chiropractor specializing in Active Release Technique, I see a lot of acute/chronic injury patients.
I often recommend a fish oil dosage of 5g and to stick to the “Paleo” method of eating to increase vitamins/minerals and decrease inflammatory foods. So thank you for reaffirming my advice.
I’m curious if you have any knowledge with proteolytic enzymes such as serrapeptase for injury recovery?
August 9th, 2012 at 10:38 pm
Or is being a “proteolyic enzyme” the purpose of the bromelain?
August 10th, 2012 at 1:12 am
Interesting article, Brian. I have just incurred an injury myself so useful information!
Thanks
August 10th, 2012 at 4:44 am
Brian, GREAT article my man, thank you!
August 10th, 2012 at 6:07 am
I’m suprised that you didn’t mention collagen or
hyulronic acid to augment your armada of supplemental vitamins and nutrients.
August 10th, 2012 at 7:08 am
Do you really recommend a multivitamin if you cannot identify any nutritional deficit in your lifestyle? I eat a pretty varied diet and whenever I go to the doctor’s for blood work, all tests come back optimal. It doesn’t seem necessary for me to go with a vitamin by anything I can identify in my life.
Also, I want to give a big thumbs up to fish oil, especially for its properties as an anti-inflamitory. I have eczema (which is itself just inflamation of the skin) and fish oil is a natural supplement which manages to hold any skin break outs at bay. I’ve also seen a connection between fish oil and cholesterol. In my case, this certainly seems to be relevant because I have extremely low cholesterol–to the point doctors say ‘oh wow, good job.’ Fish oil is one supplement I think is well worth it.
August 10th, 2012 at 7:57 am
Huge dose of good fish oil and curcumin I use in 2-3 grams for very inflammed patients. Great advice. Also, take a big teaspoon of coconut oil daily and after hard workout shower up and rub coconut oil on whole body after drying with towel.
August 10th, 2012 at 9:00 am
Great article keep it up. Looking at your meals it appears that you already eat sufficient protien. Do you subscribe to the philosophy of increased protien during healing or post op for those that are normally in the .8 to 1gm. per K or in my view increase temporarily to 1-2 per pound?
J
August 10th, 2012 at 9:15 am
Know what else helps? Bone broth. I fed my boyfriend bone broth after his recent ankle surgery. I can’t know if he would have healed just as well without it, but I like to believe it contributed to his relatively smooth healing.
Get some pastured beef bones (lots of marrow) from a farmer or from the local Whole Foods, and put them in a big pot with onions, carrots, etc. and herbs such as thyme and/or bay leaf. There are plenty of solid recipes online. Add a few tablespoons of apple cider vinegar (important for breaking down the bone), cover everything with water, and then simmer the snot out of that business — for at least 18 hours, up to 3 days. Strain all the solid pieces out of it, and let it cool in the fridge for 24 hours. The fat will rise to the top – save that fat for cooking (since it is from healthy animals). You’ll be left with gelatinous broth.
The minerals (calcium, magnesium, etc) are SUPER bioavailable, and you’ll get all the building blocks for repairing your connective tissue.
August 10th, 2012 at 9:33 am
Thanks for an informative article. You mentioned something new to me about NSAIDS. Please provide information/links as to why NSAIDS slow down the healing process. I can’t find any info to support this on “normal” sites like WebMD and I trust Cressey et all implicitly and would like to share this with our kids.
August 10th, 2012 at 10:58 am
Hi Brian;
I really enjoy your nutrition based articles. I myself am currently taking Vitamins D,A,E and fish oil caps as well as following a solid nutrition plan to help ease the pain and inflammation from arthritis. Although it is not an injury per se, with the amount of pain I am in at times it sure feels like it could be an injury. I find that the supplementation and the sound nutrition keep me mobile and ready for my daily workouts.
August 10th, 2012 at 11:54 am
I have a question about your recovery, actually.
Were you able to maintain your RoM in that ankle after recovery? Were you able to regain most of your strength in that ankle, e.g. are you able to complete a single leg standing calf raise with the injured ankle through full range of motion?
I ask because i had a similar injury with my calcaneofibular ligament years back and have constant issues with it.
August 10th, 2012 at 2:34 pm
Great contribution; thanks, Kristin!
August 12th, 2012 at 1:31 pm
Thanks a lot forth is article. Came at the right time for me . I am a wrestler currently recovering from lacerated flexor tendons in my finger.
August 13th, 2012 at 3:35 pm
Great article Brian! Setting your body up in a HEALING MODE allows you to recover faster than using NSAIDs.
I would recommend adding ginger to mix (supplement or naturally). Ginger is a natural meat tenderizer and has proteolytic enzyme that breaks down protein similar to bromelain and curcumin . This would promote healing, reduce inflammation, and minimize scar tissue.
Drinking chamomile tea helps too because it relaxes the body, muscles, and nerves. When you are relaxed and rested your body heals faster. Good luck!
August 14th, 2012 at 8:35 am
Gaurav,
Thanks for the kind words. I wouldn’t say I ever “notice” much from my multivitamin, though that is not why I take one. In the Innate Response One Daily without Iron that I recommend there are no herbals in it, so I am not sure what you are referring too. I take Carlson’s vitamin D, I get tested once yearly. Canola is ok, though I would get expeller pressed. I prefer to cook with grass-fed butter, extra virgin olive oil or some coconut oil myself. I generally don’t cook above medium heat though.
James,
Because I enjoy it! Plus one drink a day is not going to cause any negative consequences, and may even provide some benefits.
Mike,
Blog posts don’t generally come along with a bunch of references. Are there any in particular you are looking for? I failed to mention that I am taking K2 MK4 right now as well, about 300mg per day. Stephan would probably not state that it is necessary to avoid grains, and in the research that you are citing they fed the subjects some grains! (I am a big reader of Stephan’s)
Dr. Chris,
Can’t say I have much on that one. The bromelain simply has a little research behind it is all.
Zach,
Thanks!
Constantine,
I generally do yes, simply as an insurance against deficiency. Which is why I prefer the IR one mentioned in the article, as it is food-derived and generally only provides 100% of vitamins and minerals, not mega-doses, which are rarely necessary.
John,
I subscribe to the philosophy of increased protein all the time! If you aim for ~1g/lb (give or take a little bit), you should be pretty set for whatever life throws at you.
Kristin,
You are not the first to mention that! Krista Scott-Dixon suggested that to me as well.
Ted,
Elder CL, Dahners LE, Weinhold PS: A cyclooxygenase-2 inhibitor
impairs ligament healing in the rat. Am J Sports Med 2001;
29(6):801–5.
Cohen DB, et al: Indomethacin and celecoxib inhibit rotator cuff
tendon-to-bone healing. Am J Sports Med 2006; 34(3):362–9
Mehallo CJ, Drezner JA, Bytomski JR: Practical management: nonsteroidal antiinflammatory drug (NSAID) use in athletic injuries. Clin J Sports Med 2006; 16:170–4.
Erik,
I am just over 3 weeks post-injury, so it is hard to say!
August 14th, 2012 at 9:17 am
Well if your aim is to limit omega6, then why do you recommend nuts and avocados? You can easily go overboard.
FYI it seems that most injuries (except for broken bones and rheumatitis) don’t even feature inflammation – at least according to Paul Ingraham
saveyourself.ca/articles/repetitive-strain-injuries.php
August 24th, 2012 at 10:14 am
Hi Brian,
cheers for another great wee article. Just a quick question. Do you have any opinion on coffee and or black tea intake during recovery from Acute or chronic bone and or connective tissue injuries? I have heard some rattlings about phytic acid and tannin content and such in black tea and coffee effecting bone growth and mineral absorbtion. Should either be avoided during healing and would adding milk to either lessen any possible negative effects? Thanks
September 15th, 2012 at 6:08 am
Thank you so much for your knowledge. I’ve sprained my ACL in my knee and needed all of this info 😀
April 15th, 2014 at 7:09 am
All this stuff seems to make sense, I just wish there was more evidence that these supplements actually play such an important role. Some people don’t take any supplements and heal up just find from bone and tendon injuries. I can only say from my own experience of being on and off omega 3’s that they do help manage the inflammation and increase blood flow to the injured area. But I haven’t noticed much difference from any other supplements. Coming from a nasty Achilles tear injury.