The best approach to overcoming the first challenge is to add liquid protein sources in addition to regular protein-rich meals. For the second challenge, you want to prioritise protein sources that are high in protein and relatively low in fat and carbohydrates where possible.

While I would not aim to get a large percentage of your intake from supplements, adding some protein supplements can help with both of those problems. Creatine helps with building muscle and strength. It has obvious applications for longer rehab protocols. There is also research indicating that during immobilisation creatine can help with lean mass retention and reduces loss of strength.

There is not a lot of research on this topic, but it looks promising. Another study on strength gains weeks after ACL surgery found that creatine significantly outperformed placebo. It is worth highlighting that not ALL the research has shown positive outcomes.

One study measuring strength after 30 days after knee surgery found that creatine did not improve outcomes. While the evidence is not overwhelmingly positive, it is enough that I think it is worth taking creatine.

Particularly because there is minimal downside to doing so. Dosage and how to take: 20g per day for 5 days, followed by 5g per day ongoing.

This is a simplified protocol. If you want more details, check out our post on the topic. There are proposed mechanisms for how omega-3s can help due to enhancing anabolic sensitivity to amino acids as well as help from an anti-inflammatory perspective.

There is minimal research looking at fish oil and immobilisation. The research we do have is surprisingly promising. An example of this involved lower limb immobilisation for 2 weeks. The fish oil group maintained significantly more muscle than the placebo group.

Although the research looks promising, I would keep an open mind on this topic. I would not be surprised if more research came out showing it does not matter. I also heard the main author of that study on a podcast say an interesting line. A nuanced approach could involve taking fish oil leading up to and post-surgery if you have a serious injury and a surgery date planned though.

Collagen and gelatin supplementation have emerging research indicating they can help with recovery from musculoskeletal injuries. The mechanism that I propose involves the collagen peptides breaking down into amino acids, as mentioned.

But either way, collagen protein has a very different amino acid profile to other protein sources. It is a lot higher in proline, glycine, lysine and arginine than most other protein sources. We have evidence that these amino acids peak in the blood ~ minutes after consumption.

Theoretically, we can target the injured area by getting blood flow to the area with training. Even without that, some of the research looks promising anyway. There is also evidence of an increase in collagen synthesis in the body following supplementation and a targeted exercise protocol too.

In terms of the evidence, while the evidence is mixed, all the research fitting the following criteria has shown positive outcomes:.

There also is not a lot of quality research on the topic. At the moment, my interpretation of the research is that it helps. But I am watching the space closely to see if anything comes along to change my mind.

One of the most promising studies, in particular, involved a patellar tendinopathy case study. The MRI footage showed complete healing of the patellar tendon, which is exceptionally rare.

Often with tendinopathy that severe, MRI footage still shows a damaged area long after the pain has gone. Dosage and How to Take: g of collagen or gelatin, minutes prior to training.

If you have not consumed any vitamin C for the day, it makes sense to add that too. Vitamin C is required for collagen synthesis. At a population level, supplementing those things, without further context e.

dietary intake and blood levels leads to increased bone mineral density. Supplementing with calcium and vitamin D has evidence of improving fracture recovery. It is not a large benefit, but it is worth being aware of.

Adding some nuance, those who have low calcium intakes or low blood vitamin D levels would benefit significantly more from this.

A study identified that 3 months post ACL surgery, low vitamin D status was linked with lower levels of strength in comparison to those with higher vitamin D.

Vitamin D can also be relevant from an inflammation standpoint. Obviously, you could aim for a food-first approach. This would involve getting ~mg of calcium per day through food and minutes of sunlight per day.

Some people might need a bit more sun than that if they have darker skin. Dehydration increases your risk of injury—from more minimal muscle strains to serious ligament and muscle tears [9]. Proper hydration helps maintain the elasticity and health of connective tissues, boosts your immune system, and helps with inflammatory regulation [10].

Hydration needs vary drastically from one person to another based on height, weight, age, activity level, and even location people at higher altitudes or in dryer, hotter locations generally need more water. So for most, we recommend judging hydration needs based on fluid loss during exercise and urine color.

As for electrolyte intake, replacing sodium, chloride, potassium, magnesium, and calcium lost through sweat will help maintain fluid balance and muscle contraction—all of which aid in injury prevention. Opting for salty foods is a great way to get in sodium post-exercise. The foods you eat directly impact your ability to mitigate injury or recover from injury when and if it occurs.

Exact nutrient needs vary significantly from person to person and injury to injury. But, with proper nutrition, you can mitigate risk and increase the recovery rate when and if they happen. For a daily digest of all things CrossFit. Community, Competitions, Athletes, Tips, Recipes, Deals and more.

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November 13, by Ali Macy, Working Against Gravity. In Partnership With:. Enjoying Morning Chalk Up? Access additional exclusive interviews, analyses, and stories with an Rx membership. Given this, the consumption of dairy, fruits, and vegetables particularly of the green leafy kind are likely to be useful sources of the main nutrients that support bone health.

Of the more specific issues for the athlete, undoubtedly the biggest factor is the avoidance of low energy availability, which is essential to avoid negative consequences for bone Papageorgiou et al.

In athletes, this poses the question of whether the effect of low energy availability on bone is a result of dietary restriction or high exercise energy expenditures. Low EA achieved through inadequate dietary energy intake resulted in decreased bone formation but no change in bone resorption, whereas low EA achieved through exercise did not significantly influence bone metabolism, highlighting the importance of adequate dietary intakes for the athlete.

Evidence of the impact of low energy availability on bone health, particularly in female athletes, comes from the many studies relating to both the Female Athlete Triad Nattiv et al.

A thorough review of these syndromes is beyond the scope of the current article; however, those interested are advised to make use of the existing literature base on this topic. That said, this is likely to be an unrealistic target for many athlete groups, particularly the endurance athlete e.

This target may also be difficult to achieve in youth athletes who have limited time to fuel given the combined demands of school and training.

In addition, a calorie deficit is often considered to drive the endurance phenotype in these athletes, meaning that work is needed to identify the threshold of energy availability above which there are little or no negative implications for the bone.

However, a recent case study on an elite female endurance athlete over a 9-year period demonstrated that it is possible to train slightly over optimal race weight and maintain sufficient energy availability for most of the year, and then reduce calorie intake to achieve race weight at specific times in the year Stellingwerff, This may be the ideal strategy to allow athletes to race at their ideal weight, train at times with low energy availability to drive the endurance phenotype, but not be in a dangerously low energy availability all year round.

Moran et al. The development of stress fractures was associated with preexisting dietary deficiencies, not only in vitamin D and calcium, but also in carbohydrate intake. Although a small-scale association study, these data provide some indication of potential dietary risk factors for stress fracture injury.

Miller et al. Similarly, other groups have shown a link between calcium intake and both bone mineral density Myburgh et al.

Despite these initially encouraging findings, there remain relatively few prospective studies evaluating the optimal calcium and vitamin D intake in athletes relating to either a stress fracture prevention or b bone healing.

For a more comprehensive review of this area, readers are directed toward a recent review by Fischer et al. One further consideration that might need to be made with regard to the calcium intake of endurance athletes and possibly weight classification athletes practicing dehydration strategies to make weight is the amount of dermal calcium loss over time.

Although the amount of dermal calcium lost with short-term exercise is unlikely to be that important in some endurance athletes performing prolonged exercise bouts or multiple sessions per day e.

Athletes are generally advised to consume more protein than the recommended daily allowance of 0. More recently, however, several reviews Rizzoli et al. Conversely, inadequacies in dietary intake have a negative effect on physical performance, which might, in turn, contribute to an increased risk of injury.

This is as likely to be the case for the bone as it is for other tissues of importance to the athlete, like muscles, tendons, and ligaments. Despite this, there is a relative dearth of information relating to the effects of dietary intake on bone health in athletes and, particularly, around the optimal diet to support recovery from bone injury.

In the main, however, it is likely that the nutritional needs for bone health in the athlete are not likely to be substantially different from those of the general population, albeit with an additional need to minimize low energy availability states and consider the potentially elevated calcium, vitamin D, and protein requirements of many athletes.

Tendinopathy is one of the most common musculoskeletal issues in high-jerk sports. Jerk, the rate of change of acceleration, is the physical property that coaches and athletes think of as plyometric load.

Given that the volume of high-jerk movements increases in elite athletes, interventions to prevent or treat tendinopathies would have a significant impact on elite performance. The goal of any intervention to treat tendinopathy is to increase the content of directionally oriented collagen and the density of cross-links within the protein to increase the tensile strength of the tendon.

The most common intervention to treat tendinopathy is loading. The realization that tendons are dynamic tissues that respond to load began when the Kjaer laboratory demonstrated an increase in tendon collagen synthesis, in the form of increased collagen propeptides in the peritendinous space 72 hr after exercise Langberg et al.

They followed this up using stable isotope infusion to show that tendon collagen synthesis doubled within the first 24 hr after exercise Miller et al.

Therefore, loading can increase collagen synthesis, and this may contribute to the beneficial effects of loading on tendinopathy.

Recently, combining loading with nutritional interventions has been proposed to further improve collagen synthesis Shaw et al. Nutrition has been recognized as being essential for collagen synthesis and tendon health for over years.

The two sailors given the oranges and lemon recovered within 6 days; however, the relationship between the citrus fruit and scurvy continued to be debated for over years. In , Jerome Gross showed that guinea pigs on a vitamin C deficient diet did not synthesize collagen at a detectable level Gross, , making the molecular connection between vitamin C and scurvy.

The requirement for vitamin C in the synthesis of collagen comes from its role in the regulation of prolyl hydroxylase activity Mussini et al.

As vitamin C is consumed in the hydroxylation reaction, and humans lack the l -gulono-γ-lactone oxidase enzyme required for the last step in the synthesis of vitamin C Drouin et al.

Even though a basal level of vitamin C is required for collagen synthesis, whether exceeding this value results in a concomitant increase in collagen synthesis has yet to be determined. Therefore, currently, there is no evidence that increasing vitamin C intake will increase collagen synthesis and prevent tendon injuries.

Like vitamin C, copper deficiency leads to impaired mechanical function of collagen-containing tissues, such as bone Jonas et al. However, the beneficial effects of copper are only seen in the transition from deficiency to sufficiency Opsahl et al.

There is no further increase in collagen function with increasing doses of copper. This sequence allows collagen to form the tight triple helix that gives the protein its mechanical strength. Because of the importance of glycine, some researchers have hypothesized that increasing dietary glycine would have a beneficial effect on tendon healing.

Vieira et al. The authors repeated the results in a follow-up study Vieira et al. Another potential source of the amino acids found in collagen is gelatin or hydrolyzed collagen.

Gelatin is created by boiling the skin, bones, tendons, and ligaments of cattle, pigs, and fish. Further chemical or enzymatic hydrolysis of gelatin breaks the protein into smaller peptides that are soluble in water and no longer form a gel.

Because both gelatin and hydrolyzed collagen are derived from collagen, they are rich in glycine, proline, hydroxylysine, and hydroxyproline Shaw et al. As would be expected from a dietary intervention that increases collagen synthesis, consumption of 10 g of hydrolyzed collagen in a randomized, double-blinded, placebo-controlled study in athletes decreased knee pain from standing and walking Clark et al.

The decrease in knee pain could be the result of an improvement in collagen synthesis of the cartilage within the knee since cartilage thickness, measured using gadolinium labeled magnetic resonance imaging, increases with long-term consumption of 10 g of hydrolyzed collagen McAlindon et al.

The role of gelatin consumption in collagen synthesis was directly tested by Shaw et al. In this randomized, double-blinded, placebo-controlled, crossover-designed study, subjects who consumed 15 g of gelatin showed twice the collagen synthesis, measured through serum propeptide levels, as either a placebo or a 5-g group.

Furthermore, when serum from subjects fed either gelatin or collagen is added to engineered ligaments, the engineered ligaments demonstrate more than twofold greater mechanics and collagen content Avey and Baar unpublished; Figure 1.

Even though bathing the engineered ligaments in serum rich in procollagen amino acids provides a beneficial effect, this is a far cry from what would be seen in people.

However, these data suggest that consuming gelatin or hydrolyzed collagen may increase collagen synthesis and potentially decrease injury rate in athletes. Citation: International Journal of Sport Nutrition and Exercise Metabolism 29, 2; These and other nutraceuticals have recently been reviewed by Fusini et al.

Interestingly, many of these nutrients are thought to decrease inflammation, and the role of inflammation in tendinopathy in elite athletes remains controversial Peeling et al. Therefore, future work is needed to validate these purported nutraceuticals in the prevention or treatment of tendon or ligament injuries.

Although injuries are going to happen in athletes, there are several nutrition solutions that can be implemented to reduce the risk and decrease recovery time. To reduce the risk of injury, it is crucial that athletes do not have chronic low energy availability, as this is a major risk factor for bone injuries.

Cycling energy intake throughout the year to allow race weight to be achieved, while achieving adequate energy availability away from competitions, may be the most effective strategy. It is also crucial for bone, muscle, tendon, and ligament health to ensure that there are no dietary deficiencies, especially low protein intake or inadequate vitamin C, D, copper, n-3 PUFA, or calcium.

This highlights the importance of athletes having access to qualified nutrition support to help them achieve their goals without compromising health. If an injury does occur, one of the key considerations during the injury is to ensure excessive lean muscle mass is not lost and that sufficient energy is consumed to allow repair, without significantly increasing body fat.

It is crucial to understand the change in energy demands and, at the same time, ensure sufficient protein is consumed for repair, especially since the muscle could become anabolic resistant.

In terms of tendon health, there is a growing interest in the role of gelatin to increase collagen synthesis. Studies are now showing that gelatin supplementation can improve cartilage thickness and decrease knee pain, and may reduce the risk of injury or accelerate return to play, providing both a prophylactic and therapeutic treatment for tendon, ligament, and, potentially, bone health.

Where supplementation is deemed necessary e. Last but not least, more human-based research is needed, ideally in elite athlete populations, on the possible benefits of some macro- and micronutrients in the prevention or boosted recovery of injured athletes.

Given that placebo-controlled, randomized control trials are exceptionally difficult to perform in elite athletes no athlete would want to be in a placebo group if there is a potential of benefit of an intervention, combined with the fact that the time course and pathology of the same injuries are often very different , it is important that high-quality case studies are now published in elite athletes to help to develop an evidence base for interventions.

All authors contributed equally to the manuscript, with each author writing specific sections and all authors editing the final manuscript prior to final submission.

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