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Injury Rehabilitation: Why is Nutrition Ignored?

posted 24 Sep 2010, 08:45 by Mpelembe Admin   [ updated 24 Sep 2010, 08:48 ]
Every sport has its own list of most common injuries from
strains, tears, dislocations, fractures and overuse. The
common first-aid protocol of rest, ice, compression and
elevation with the use of anti-inflammatory medication is
the usual approach to an injury. The nutritional protocol
frequently calls for a reduction in caloric intake,
especially if the athlete is unable to train. Yet nutrition
plays a vital role in injury rehabilitation from limiting
the damage caused by chronic inflammation to actively
promoting tissue healing and improving recovery times. As
such, can any athlete ignore the role nutrition could play
in his or her injury rehabilitation?

Inflammation and NSAIDs

Anti-inflammatory medication is frequently used to deal with
inflammation caused by injury. However, NSAIDs do have
side-effects, especially with long-term use. These are used
regularly by athletes, including adolescent athletes, with
the majority of these users not recognising the possible
toxicity or adverse effects of these drugs, especially on
athletes subjected to intermittent dehydration. Considering
the documented deleterious side effects of NSAIDs, the use
of enzymes and diet could prove to be viable alternatives.

Inflammation and Enzymes

Enzymes have been reported to moderate the inflammatory
cycle and up-regulate the healing process. Their use is
suggested for bruising, sprains, strains, fractures, low
back pain, dental surgery, arthritis and post-surgical
trauma and recovery. The anti-inflammatory action of these
enzymes, which is thought to inhibit the arachidonic
cascade, is also associated with increased tissue
permeability, facilitating resorption of oedema and
accelerated restructuring of the damaged tissue.

Enzymes are protein compounds capable of accelerating a
change in its substrate by catalytic action. Proteolytic
enzymes catalyse the hydrolysis of proteins and various
protein end products. In order for proteolytic enzymes to
work, they must be absorbed in an active form from the
gastrointestinal tract. However, the intestinal absorption
of enzymes has been a matter of scientific controversy for
many years as enzymes are proteins, it is believed that if
taken orally they are denatured by hydrochloric acid in the

The intestinal absorption of un-degraded proteins, in
particular proteolytic enzymes, has been noted for many
years with research dating back to the 1960s. More recent
studies have shown that the intestinal transport of
un-degraded, non-denatured proteins (often enterically
coated) can take place to a small but significant extent and
that these enzymes can decrease the recovery time of
injuries. In addition, it has been suggested that because
different enzymes have different targets of activity,
different modes of action, and different absorption rates,
the use of a combination of enzymes is thought to be more
efficacious than singular use.

Moreover, proteolytic enzymes appear to be safe at high
doses and when taken long-term. However for best results,
they require compliance as they have to be taken 2-4 times a
day on an empty stomach. The only known contraindications are
for those on blood thinning medication, and allergies to
compounds in the enzyme combination preparation.

Inflammation and Diet:Fatty Acids

Pro-inflammatory signals are mediated by metabolites of
arachidonic acid (AA), an omega-6 polyunsaturated fatty acid
(PUFA). To mitigate inflammation through dietary intervention
requires a reduction of AA and increased intake of
eicosapentaenoic acid (EPA), an omega-3 PUFA.

Various studies on the effects of a diet low in AA in
conjunction with the supplementation of fish oil have been
shown to ameliorate the clinical signs of a number of
inflammatory and autoimmune diseases in humans, and in
particular rheumatoid arthritis. The beneficial effect of
EPA, the active ingredient in fish oil, was found to augment
by the reduction of dietary AA intake. EPA and DHA from fish
oil are thought to be more biologically potent than omega-3
from flaxseed oil.

Inflammation and Diet:Vitamins and Minerals

Numerous vitamins and minerals are involved in wound healing
of which only a few will be reviewed.

Vitamin A plays a role in each stage of wound healing. It
enhances the early inflammation phase, increasing the number
of monocytes and macrophages.

Vitamin C is necessary for the hydroxylation of proline and
consequently the synthesis of strong collagen. Vitamin C is
also involved as an antioxidant in the scavenging of free
radicals and it enhances iron absorption.

Vitamin E, as a lipid-soluble vitamin, accumulates in cell
membranes where it protects polyunsaturated fatty acids from
peroxidation by free radicals. Vitamin E has an
anti-inflammatory action by inhibiting phospholipase-A2
activity and consequently the production of prostaglandins
which are chemical mediators of the inflammatory response.

Marginal deficiencies of zinc are common due to our soil
being zinc depleted. Moreover, there is growing evidence
that zinc deficiency occurs even when micronutrient intake
appears to be adequate. Zinc deficiency results in delayed
closure of wounds, a decreased tensile strength of collagen
and increased susceptibility to recurring infection. Zinc
deficiency also decreases taste acuity which may lead to
decreased food intake. There is an apparent decrease in
serum zinc during wound healing with a greater concentration
in wound tissue, in surgical patients.


The body's metabolic rate increases during times of repair:
the increases correlating to the severity of the injury. As
such, the nutritional protocol during injury should be for
increased, and not decreased, caloric intake. If activity
level has dropped considerably due to the injury, the
increase in BMR from injury is often cancelled by the
decrease in activity level.  Caloric intake should therefore
remain more or less the same as when active. The USRDA for
protein increases from 0.8g/kg to 2 - 4g/kg to support wound
healing. However, the increased caloric requirement is not
simply for quantity but for a particular quality of
nutrients that assist and promote repair and recovery. To
ensure optimum repair and reduced recovery time, comply with
the following:

1. eat regularly; especially if the injury is severe, basal
metabolic rate can increase by up to 20%
2. eliminate all junk food
3. eliminate all refined and processed foods and especially
all refined sugar
4. avoid all saturated fats i.e. pro-inflammatory foods,
found in pork products (ham, bacon, salami, sausages, pate)
and fatty red meats such as lamb
5. instead have fish, chicken (without the skin) and extra
lean cuts of red meat (limit red meat intake to twice a
6. increase fruit, vegetable, legume and pulse intake
7. use an omega-3 oil (never heat the oil as it is prone to
8. ensure that protein intake remains high i.e. 1.0 -
9. the use of proteolytic enzymes is best administered under
the supervision of a qualified nutritionist.

©2010 Corpotential, All Rights Reserved.

About the Author:

If you would like to read the complete article with
references, go to

Kathryn Bistany is a Sports Nutritionist and Managing
Director of Corpotential which is based in London, England.
For one-to-one nutrition consultations, go to: