November 4, 2022


The role of nutrition in injury recovery

By BIHub Team.

Nutrition plays an integral role in optimising the performance of any elite athlete. In the case of football players, nutrition is of utmost importance during training and matches and, certainly, during injury recovery.

It is worth emphasising that the nutritional aspect of elite football players is based on the premise of food first rather than supplements. In fact, in a market with an oversaturated supply of nutritional supplements, it is now more necessary than ever to provide relevant scientific evidence on any nutritional aspect, within the constraints of what is effective, practical and feasible in the football environment. The science underpinning sports nutrition is evolving rapidly and practitioners need to keep an eye out for new findings.

In recognition of these developments, the Union of European Football Associations (UEFA) issued a consensus statement, the “UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research (James Collins et al., 2020),” for which it brought together experts in applied sports nutrition research, as well as professionals working with elite football clubs and national associations/federations, on a number of relevant topics around elite football nutrition. The role of nutrition in injury recovery is one of these topics.


Nutritional needs in the rehabilitation process


The high physical demands of elite sport coupled with increasingly dynamic movements result in a high risk of injury. And when an injury occurs, teams face a unique challenge: to recover the player as quickly and safely as possible. In this circumstance, nutrition can help to optimise the rehabilitation process and aid the targeted return.

Most injuries quickly trigger inflammatory processes that cause wound healing and soft tissue and/or bone repair – the injury healing process. At this point, sufficient energy and protein intake must be ensured and deficiencies of calcium, vitamins D and C, zinc, copper and manganese, which can disrupt the initiated healing process, must be avoided.1, 2

Furthermore, as football injuries generally occur when intense muscle contractions occur, this is likely to exacerbate the level of systemic and local inflammation after the injury – a physiological response that is assumed to contribute to subsequent muscle and/or tendon unconditioning.3

While a variety of so-called ‘nutraceuticals’ (products presented as a pharmaceutical alternative claiming physiological benefits) – including phenolic compounds, curcuminoids and n3-polyunsaturated fatty acids – have been proposed as potential ways to combat the acute inflammatory process,4 it is necessary to keep doing studies on their anti-inflammatory effects in humans.


Nutrition to sustain fitness during injury


After the initial scarring and healing response, comes the rehabilitation phase, which is possibly of greatest nutritional relevance to the injured football player due to the time spent in this phase; rehabilitation requires a period (days to months) of whole body (e.g., hospitalisation/bed rest) or body part disuse (e.g., limb immobilisation), and/or reduced activity (e.g., reduced/absent training load). During this time, rapid deterioration of soft tissue and bone can be expected as a result of mechanical unloading:


  • Skeletal muscle appears to be the tissue most susceptible to disuse, with atrophy and deconditioning (e.g., reduced force-generating capacity) evident after only a few days.7


  • Bone demineralisation occurs in bone as early as one week after disuse.8


  • Although the tendon tissue appears more resistant to disuse atrophy, within about two weeks their metabolic activity and functionality are affected.9, 10


This indicates that changes in energy requirements should be monitored during rehabilitation and it is necessary to adjust energy and meal distribution to modulate the effects of deconditioning..11, 12


The importance of protein


A reduced dietary protein intake will accelerate the loss of muscle mass regardless of energy balance.13  Resistance to anabolism due to inflammation and lack of use requires specific stimuli in the form of protein boluses with sufficient leucine.14, 15

In this regard, current recommendations to alleviate muscle loss (and regain muscle) during rehabilitation include distributing16, 17 adequate amounts (20-30 g)18, 19of leucine-rich protein (≥2.5 g per meal)15 throughout the day, even before bedtime.14 It should be noted that the efficacy of such an approach is supported by (limited) laboratory data20 and applied case studies in elite athletes,21 with the resulting recommended daily protein intake of ≥1.6 g/kg body mass.22           

Collagen protein deserves separate consideration as it is very important at this stage of injury since the rate of bone collagen protein synthesis also increases in response to the provision of protein,27 with an overall positive effect on bone turnover.28 Collagen present in muscle also appears resistant to the anabolic effects of protein.27

All in all, the data available suggests that the nutritional considerations for bone and tendon rehabilitation are similar to muscle rehabilitation after injury in terms of energy balance and macronutrient intake.

It should be noted that different stages of injury call for different nutritional needs based on the stage and duration of the injury. As an example, a recent case study calculated energy expenditure of ~3100 kcal/day during the first 6 weeks of anterior cruciate ligament (ACL) rehabilitation in an elite Premier League player,31 which is close to the energy expenditure of players in full training.

Given the metabolic demands of the tissues/wound recovery process, the most significant nutritional issue during rehabilitation is perhaps to remain as close as possible to energy balance, and therefore to avoid drastic reductions in nutrients intake.




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8  Rittweger J, Winwood K, Seynnes O, et al. Bone loss from the human distal tibia epiphysis during 24 days of unilateral lower limb suspension. J Physiol 2006;577:331–7.

9  de Boer MD, Maganaris CN, Seynnes OR, et al. Time course of muscular, neural and tendinous adaptations to 23 day unilateral lower-limb suspension in young men. J Physiol 2007;583:1079–91.

10  Dideriksen K, Boesen AP, Reitelseder S, et al. Tendon collagen synthesis declines with immobilization in elderly humans: no effect of anti-inflammatory medication. J Appl Physiol 2017;122:273–82.

11  Biolo G, Agostini F, Simunic B, et al. Positive energy balance is associated with accelerated muscle atrophy and increased erythrocyte glutathione turnover during 5 wk of bed rest. Am J Clin Nutr 2008;88:950–8.

12 Paddon-Jones D, Sheffield-Moore M, Urban RJ, et al. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. J Clin Endocrinol Metab 2004;89:4351–8.

13  Stuart CA, Shangraw RE, Peters EJ, et al. Effect of dietary protein on bed-rest-related changes in whole-body-protein synthesis. Am J Clin Nutr 1990;52:509–14.

14 Mathews NM. Prohibited contaminants in dietary supplements. Sports Health


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16 Cohen PA, Travis JC, Keizers PHJ, et al. Four experimental stimulants found in sports and weight loss supplements: 2-amino-6-methylheptane (octodrine), 1,4-dimethylamylamine (1,4-DMAA), 1,3-dimethylamylamine (1,3-DMAA) and 1,3-dimethylbutylamine (1,3-DMBA). Clin Toxicol 2018;56:421–6.

17 Geyer H, Braun H, Burke LM, et al. A-Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance– Part 22. Br J Sports Med 2011;45:752–4.

18 Geyer H. Adulterated nutritional supplements and unapproved pharmaceuticals as new sources of doping substances for fitness and recreational sports. In: Ahmadi N LA, Göran S, eds. Doping and public health. London, UK: Routledge, 2016: 64–70.

19 Thevis M, Krug O, Piper T, et al. Solutions Advertised as erythropoiesis-stimulating products were found to contain undeclared cobalt and nickel species. Int J Sports Med 2016;37:82–4.

20 Maughan RJ, Shirreffs SM, Vernec A. Making decisions about supplement use. Int J Sport Nutr Exerc Metab 2018;28:212–9.

21  Bradley PS, Sheldon W, Wooster B, et al. High-Intensity running in English FA premier League soccer matches. J Sports Sci 2009;27:159–68.

22 Snijders T, Res PT, Smeets JSJ, et al. Protein ingestion before sleep increases muscle mass and strength gains during prolonged Resistance-Type exercise training in healthy young men. J Nutr 2015;145:1178–84.

23  Smith GI, Atherton P, Reeds DN, et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr 2011;93:402–12.

24  Deutz NEP, Pereira SL, Hays NP, et al. Effect of ®-hydroxy-®-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults. Clin Nutr 2013;32:704–12.

25  Adams CM, Ebert SM, Dyle MC. Use of mRNA expression signatures to discover small molecule inhibitors of skeletal muscle atrophy. Curr Opin Clin Nutr Metab Care 2015;18:263–8.

26 Wall BT, Morton JP, van Loon LJC. Strategies to maintain skeletal muscle mass in the injured athlete: nutritional considerations and exercise mimetics. Eur J Sport Sci 2015;15:53–62.

27  Babraj JA, Smith K, Cuthbertson DJR, et al. Human bone collagen synthesis is a rapid, nutritionally modulated process. J Bone Miner Res 2005;20:930–7.

28  Townsend R, Elliott-Sale KJ, Currell K, et al. The effect of postexercise carbohydrate and protein ingestion on bone metabolism. Med Sci Sports Exerc 2017;49:1209–18.

29  Farup J, Rahbek SK, Vendelbo MH, et al. Whey protein hydrolysate augments tendon and muscle hypertrophy independent of resistance exercise contraction mode. Scand J Med Sci Sports 2014;24:788–98.

30  Shaw G, Lee-Barthel A, Ross ML, et al. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr 2017;105:136–43.

31 Anderson L, Close GL, Konopinski M, et al. Case study: muscle atrophy, hypertrophy, and energy expenditure of a premier League soccer player during rehabilitation from anterior cruciate ligament injury. Int J Sport Nutr Exerc Metab 2019;29:559–66.





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