The economic burden of treating orthopedic injuries is estimated at $ 9 billion per year for 17-44 year olds. (Harlan et al. Am J Public Health 2020) Nutritional interventions are not commonly used as the standard of care for recovery from injury or orthopedic surgery. However, it is well known that good nutrition is essential for optimizing health and well-being. Nutritional requirements become magnified as individuals heal and recover from a physical injury or orthopedic surgery. For those recovering from surgery, studies have shown that nutritional strategies can reduce hospital stays, increase wound healing time, and reduce the risk of post-surgical infections. (Evans et al. Nutr Clin Pract, 2014)
During surgery or after injury, inflammation is the first step in recovery. Initially, the inflammation is essential for the protection of the area and tissue repair, which lasts from a few hours to several days. After this initial period, inflammation may be counterproductive, delaying or inhibiting recovery. Minimizing prolonged or excessive inflammation by ingesting quality foods and supplements can speed healing, thereby improving the process of physiotherapy and rehabilitation.
Postoperative and Injury Recovery Needs:
Beyond inflammation, there is immobilization or disuse following injury or post-surgical recovery. Muscle tissue begins to atrophy within 36 hours, and significant loss of muscle mass occurs within five days of inactivity and inflammation. (Reich et al. J Appl Physiol, 2010) Early physical therapy is essential to mitigate these harmful effects. Due to the strong catabolic response (tissue breakdown), there is a huge need for the right kind of calories and protein to prevent loss of lean body mass while complementing physical therapy. Preventing muscle atrophy can have a significant impact on short and long term recovery.
Nutritional needs: carbohydrates, proteins, fats and supplements:
During the recovery process, the basal metabolic rate (energy expended while resting) drops from 20% for minor injuries and surgeries to 100% for more serious bodily assaults. (Demling et al., Eplasty. 2009) Ultimately, more high-quality calories are needed, avoiding ultra-processed foods with high amounts of chemicals, sugar, salt, and unhealthy fats.
Protein: Injury and surgery increase protein requirements by up to 80%. (Kerksick et al. Sports Nutr, 2017) Protein is needed to reduce muscle atrophy and build and repair scar tissue. Recommended protein: vegetable protein, fish and small amounts of poultry, and lean meats, poultry (approximately 1 g / lb of body weight per day or 30 to 40 g of total dietary protein per meal).
Protein supplementation is a simple and effective way to ensure adequate protein intake. Whey protein (derived from eggs) is considered the highest quality protein supplement, with over 50% of amino acids (the building blocks of protein) coming from essential amino acids (amino acids that the body cannot make. ). Whey also contains high amounts of leucine, an essential amino acid for building muscle. If you are following a complete plant-based diet, you can use plant-based protein supplements, such as peas, soybeans, hemp, or rice.
Carbohydrates: Diets should focus on less carbohydrate (around 40%) or a 2: 1 carbohydrate-to-protein ratio (for example, 260 g of carbohydrate and 130 g of protein), which promotes positive changes in body composition. (Weigle et al. Am J Clin Nutr. 2005, Layman et al. Nutr Metab, 2009)
Fat: Fat is an essential source of energy for healing wounds and increasing cell growth and proliferation. Polyunsaturated and monounsaturated fats are essential for healing, especially omega-3 fatty acids, found in avocado, olive oil, fish, flax, nuts, and seeds. Omega-6 fatty acids (processed meats, fried and fatty foods, cakes and pastries, and ultra-processed foods) are pro-inflammatory and should be limited. About 20-25% (0.8-2g / kg per body weight per day) of calories should come from fat.
“Superfoods”: Superfoods are scientifically proven and should be a part of the diet of all Americans. These choice foods are loaded with copious amounts of vitamins, minerals, antioxidants, flavonoids, and phytochemicals that optimize cellular healing and recovery. Berries (elderberry, blueberry, raspberry, strawberry), Citrus fruit (oranges, grapefruit, tangerines, lemons), Other fruits (tomatoes, apples, watermelon), Leafy vegetables (spinach, Swiss chard, kale, collard greens or leaves of mustard)), Cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, collard greens, kale, kohlrabi, mustard greens, radishes and turnips), Nuts (hazelnuts, walnuts, almonds, pecans, whole grains (oatmeal, quinoa, brown rice, wheat bread), legumes (red, black, kidney beans and chickpeas, soybeans and peas), tea and coffee, mushrooms, sweet potatoes. It is recommended to have 5 to 10 servings ( the size of a palm is one serving) per day.
Creatine monohydrate (Creatine):
Based on decades of research, creatine is the most effective supplement for improving performance of intense exercise and improving muscle healing, repair and enlargement. It also improves bone health, neuromuscular function, and brain health. A recommended dose of 20g (4 x 5g per day) for five days, then 5g per day thereafter.
Omega-3 fatty acids:
Omega 3 fatty acids have anti-inflammatory properties and may help control an exaggerated inflammatory response, reduce muscle loss, and improve cell repair. Omega 3 supplementation should begin 2-4 days after an injury or surgery so as not to interfere with the important early stages of healing. (Calder et al. Br j Nutr, 2009). A recommended dose of 2000-4000 mg per day can reduce chronic inflammation and maximize protein synthesis. (Smith et al. Clin Sci, 2011)
Vitamin D is essential for the regulation of calcium and bones, but it also plays a role in innate and acquired immune regulation and skeletal muscle function. Vitamin D is produced in the skin from about 20 minutes of sunlight per day. It is also found in fortified foods such as; cheese, yogurt, orange juice and some cereals. A recommended dose of 2000-4000 IU per day. (Correia et al. Am J Clin Nutr, 2008)
Probiotics are the “good” bacteria that live in our gastrointestinal system (digestive system) and make up about 70% of the immune system. Because antibiotics are used after surgery, there may be a negative change in the gastrointestinal flora, resulting in changes in nutrient metabolism and immunity. Strands of lactobacillus acidophilus and Bifidobacterium longum have shown positive immune effects. (Maughan et al. Br J Sports Med, 2018) Probiotics can be found in yogurt or in the form of dietary supplements. A recommended dose of> 1010 colony forming units. (Smith-Ryan et al. Athl Train Day. 2020)
Other vitamins and micronutrients:
Curcumin, vitamin A, C, E, selenium and zinc have a positive effect on wound healing and inflammation control. Foods such as; kiwi, orange, strawberries, avocado, broccoli, carrots, spinach, seeds, almonds are excellent sources of these micronutrients. A multivitamin with an antioxidant formula could be used if these foods are not available.
Nutrient calendar around physiotherapy:
Synchronizing nutrients around physical therapy can help reduce muscle damage, improve recovery, and improve body composition. Three to four hours before physical therapy, consume 50-100g of complex carbohydrates, 30-50g of protein, and 15-20g of fat. Fifteen to forty-five minutes before physical therapy, take 25g of protein (whey, peas, soybeans), 5g of creatine monohydrate and 2g of fish oil. Thirty minutes after physiotherapy, have 25 g of protein (whey, peas, soy), 5 g of creatine monohydrate.
Dr Mishock is one of the few clinicians with a doctorate in physiotherapy and chiropractic in the state of Pennsylvania.
He is also the author of two books; “Fundamentals of training: essential knowledge to train the elite athlete”, “The rubber arm; Using science to increase pitch control, improve speed, and prevent elbow and shoulder injuries, ”both can be purchased on Amazon.
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