May 9, 2018Eat to Heal
When an athlete is injured, their whole routine gets turned upside down as they transition to the long, arduous road of rehab. Nutrition must play a key role in this journey, both to promote healing and ensure the athlete returns to activity in peak shape.
I started to work with “Kelly,” a high school soccer player, one week after she suffered an isolated tibia fracture midway through her sophomore season. At the time, she was scheduled to be in a long leg cast for four weeks, using crutches to get around, before switching to a walking boot for another six weeks.
Kelly came to see me at her parents’ urging, so she wasn’t very comfortable with the idea of seeing a dietitian. As a result, our initial visit moved slowly. I started by discussing the basics of nutrition for injured athletes. I explained that there are three phases of healing — inflammation, proliferation, and remodeling — and described what each one entailed. To promote a successful progression through each of these phases, I also covered the importance of increased intake (focusing on protein), as well as micronutrients such as vitamins A, C, and D; calcium; and zinc.
After that, I got a general idea of what Kelly’s diet had been since her injury. Based on a rundown of her typical daily meals, I determined that she was under-fueling, consuming inadequate protein and spacing it incorrectly throughout the day, and eating too many refined carbohydrates. In addition, she wasn’t eating enough vegetables, which meant she was at risk for being deficient in micronutrients.
Armed with this information, I set two goals for Kelly’s nutrition plan while she was injured. First, I wanted to educate her on the importance of keeping her calorie and protein intake high to aid in healing and tissue-building. This took some convincing. Kelly feared that increasing her calories while she was inactive would cause her to gain weight, leaving her in even worse shape when she returned to play.
To put Kelly at ease, I explained why her body needed the additional calories and protein for healing. Plus, I pointed out that she was using crutches to get around, which required much more energy than normal walking and would burn enough calories to keep her from gaining any unwanted weight.
Furthermore, I encouraged Kelly to look at her new nutrition plan as a way to establish good fueling habits that would benefit her in the years to come. She aspired to play soccer in college, so I emphasized that it was the ideal time to start training and eating for muscle growth. This helped Kelly see beyond her injury and helped her buy in to what I was suggesting.
Once she was on board, we discussed changing her diet to increase her calorie and protein intake. When making adjustments to an injured athlete’s meal plan, the ideas and strategies should come from them, as this makes the changes seem more achievable and realistic. With Kelly, we started by looking at her current routine one meal and snack at a time. Then, we determined if there was room to easily add a protein- and/or calorie-rich food that she enjoyed.
For instance, before we started working together, Kelly regularly skipped breakfast. But we brainstormed a few high protein and calorie options that she was excited about, including nonfat Greek yogurt with cereal; a hard-boiled egg, toast with peanut butter, a small piece of fruit, and glass of low-fat milk; and a homemade smoothie made of nonfat Greek yogurt, frozen berries, and peanut butter.
We also came up with a list of grab-and-go protein- and calorie-rich meals and snacks that Kelly could eat in a pinch. Some of her favorites were a pre-made protein shake and fruit or a high-protein meal bar with fruit.
My secondary goal with Kelly was to better space her protein intake throughout the day — she struggled with eating too little protein at some meals and too much at others. Our bodies are in a constant state of breaking down and rebuilding tissues, and it is essential to continuously supply protein for these processes. If we don’t consume enough protein, we end up breaking down more tissues than we build. In Kelly’s case, this would prevent her leg from healing properly and regaining muscle strength.
When recovering from her injury, Kelly necessitated 1.2 to 1.5 grams of protein per kilogram of bodyweight per day. Therefore, at 125 pounds, she needed roughly 70 to 85 grams daily or 15 to 20 grams at each meal and snack.
We worked together to build a list of protein-rich foods and appropriate serving sizes that would meet these requirements. Once we came up with a bunch of options, we re-evaluated the list by considering how easy and enjoyable the foods would be for Kelly. If she thought they were too challenging to prepare or bring to school, they were cut from the list.
These two goals proved to be a lot for Kelly to focus on at once. Adding more would have definitely been too much for her. So although I had also hoped to concentrate on increasing her micronutrient intake with real food, I added a multivitamin to her routine instead.
After my initial meeting with Kelly, her follow-up sessions centered on analyzing what worked, what didn’t, and what we could add to her routine as she progressed through rehab. The biggest challenges for Kelly were finding breakfast and snack options that fit into her schedule. For example, she loved homemade smoothies for breakfast but rarely had time to make them in the morning before school. Therefore, we decided pre-made shakes were a better breakfast option for Kelly during the week, and she could save her homemade smoothies for the weekends.
For snacks, we had to find options Kelly could prep quickly and keep in her locker to eat between classes. We discovered that items like hard-boiled eggs took too much prep, while Greek yogurt was too difficult to eat at school. However, half a turkey and cheese sandwich, a handful of almonds, or a snack bar all worked well.
As Kelly moved forward with rehab and her metabolic demands for healing decreased, her activity slowly increased, keeping her weight in a steady state. To be sure her body composition remained constant, we monitored her weight and how her clothes were fitting. Four months post-injury, Kelly was cleared for sport-specific activity, and she returned to full activity at five months.
My advice to anyone working on a nutrition plan for an injured athlete is to always factor in how they are handling the setback emotionally, as the connection between food and emotional health is very strong. Like Kelly, some athletes may be fearful of gaining weight while they are sidelined and want to restrict calories, not realizing the cost to their healing. Others may take the opposite approach — eating through their emotions and making poor food choices. In either circumstance, engaging the injured athlete by addressing their nutritional state, giving them some control over the situation, and educating them on the impact nutrition has on their return to play can help to overcome these emotional challenges.