Nutrition Strategies & Tips for Successful Injury Recovery

Check out this blog post for nutrition tips to optimize injury healing and recovery, especially if you’ve experienced a similar injury to me (fractured ankle requiring surgery).

To read about my injury and surgery experience, check out my original blog post here.

Recovery Mindset

Surgery was done! Now, it was time to focus 100% on recovery. 

As I mentioned previously, it is challenging dealing with the “loss” of your usual activities (for me I missed walking my dog, strength training, and cooking the most). Control your controllables. A growth mindset is key. One day at a time, focusing on what is in your control to get yourself recovered and strong. And nutrition is one of the main things that can help optimize your healing process.

“Recovery is now your sport.” The perfect mindset or mantra as read in the book Rebound by Carrie Jackson Cheadle and Cindy Kuzma (a great read- recommended by a client!).

This became my mission and should be the mindset of any athlete dealing with injuries. Focusing on recovering and coming back stronger gives you a mission and a purpose during a time when so much is inaccessible due to your injury or setback.

I also immersed myself in a ton of research articles on injury nutrition and recovery to ensure I was doing everything I could to optimize recovery (& learn along the way to be able to share as I am now!). Of course, there was a great deal of Netflix watching, too!

After learning so much about injury nutrition during my recovery, I’ve really nerded out on this topic and want to provide some practical and evidence-based nutrition strategies to optimize injury recovery. I hope this is information you never need, but injuries happen and injury nutrition is not talked about nearly enough! 

Of course, injuries differ and individuals are unique- so this is related to the type of injury I sustained along with surgery, but these recommendations apply to most injuries of all types/severity.

How Injuries Impact our Nutritional Needs

Let me start this list of nutrition tips by saying the most important takeaway…Now is not the time to cut calories!!!!! 

Inadequate energy (calorie) intake likely means your body is not getting enough macronutrients and micronutrients it needs to support the recovery process. Fear of weight gain and slashing calories will absolutely backfire in leading to poor recovery, which could mean long-term issues with return to normal functioning post-injury. You need to be fueling your recovery. 

What the Research Says

Energy expenditure may be increased by 15% up to 50%, depending on the type and severity of the injury. This is a fairly large range and thus, important to take your individual situation into account (such as severity of injury, location/size of bone/tissue/muscle affected, surgical and/or fracture recovery, immobilization, and more). This increase in energy expenditure is related to an increase in basal metabolic rate (BMR).

While you may not be moving much, your body is working hard to repair and heal whatever injury you’re recovering from. To repair damaged muscle/bone/tendon damage, you need building blocks to do so, and food is what you need to nourish and support that process. If you deal with chronic injuries, this could be a sign of long-term underfueling, and I’d recommend you seek the support of a sports/performance Dietitian (like me!). 

Adequate energy/calorie intake

Remember, recovery is your sport and you need fuel to recover! 

If your diet is well-balanced and full of nutrient dense foods, but you are still under-fueled (aka eating below your caloric maintenance level), you are not optimizing your recovery. This is step one. 

If you’re under-fueled, you are doing yourself a disservice to be able to recover and rebuild from your injury, potentially leading to more time on the sidelines and potentially with long term pain or complications. Make sure you’re eating regular meals, listening to hunger/fullness cues (although pain may impact this), and having adequate balance/variety is key for success! And of course working on that recovery mindset, too. 

If you struggle with under-fueling, not knowing how to adequately fuel (for recovery or for general fitness/life), or with your nutrition mindset- this is what I help my clients with in my signature Balanced Fueling Nutrition Program– more info here if you’re interested in learning more! 

The key to nutrition during recovery is focusing on a well-balanced diet with mostly whole/nutrient-dense foods to aid in the recovery process. Here’s more information on several important macro- and micronutrients that specifically support recovery & how to incorporate them into your meals/snacks.

Role of Macronutrients

Protein– Arguably the most important macronutrient for the recovery process is protein. Protein needs are higher for athletes and also increase with injuries. Getting enough protein from your diet will provide essential building blocks (amino acids) that support the healing process in our bone, muscle, and joint tissues. 

How much?

I typically recommend anywhere between 1.5-2.2 grams of protein/kg of bodyweight daily (or about 68-100g protein per 100 lbs. of bodyweight per day) . Generally, protein needs would be on the higher end of the range for severe injuries, surgery, among other variables including health conditions/medical history, etc.

Where to find it?

Look for proteins like seafood, chicken, turkey, lean beef/pork, low-fat dairy products (milk, greek yogurt, cottage cheese), eggs, soy/tofu, quinoa, edamame, beans/lentils, and protein powders/shakes. Many products these days also have added protein such as waffles, breads, wraps, etc.- check the label to know for sure!

Ideally, try to eat regular meals and snacks to space out protein intake throughout the day to help ensure you’re eating enough. Adequate protein can help to reduce muscle protein breakdown (inevitable part of the process) and support maintenance of other muscle mass. Protein should be in every meal and snack!

Carbs– You may need a bit less than you would during normal training regimen (if you regularly participate in endurance or strength sports of any kind). However, most athletes are under-fueling (especially in the carb department), so you may or may not need to adjust this from your baseline intake. Largest differences would be seen in individuals following relatively higher carbohydrate intakes (50-65% calories) such as endurance athletes or high-level strength and sport athletes.

Your body still needs carbs. USDA guidelines recommend about 45-65% of your calories coming from carbohydrates. Tune in to your own hunger/fullness and focus on high-fiber carbs like quinoa, sweet potato, or whole grain rice/pasta. Fiber will help to keep you full/satisfied, and can help ease constipation (common during recovery especially if you’re taking pain medications). Limiting added sugars will help you prioritize nutrient-dense foods and reduce inflammation.

Fat– Recommendations per usual and/or may increase from baseline. USDA guidelines recommend ~20-35% calories from fat for the general population. Focus on those heart-healthy fats (those containing omega-3s) such as salmon or other fatty fish, flax or chia seeds, and walnuts, for their anti-inflammatory benefits, which supports the healing process.

Role of Micronutrients

Eat your color! Add color to your plate whenever possible. Aim to make about half of your plate fruits and veggies (color) to make sure you’re getting important micronutrients that aid in general health but also support the healing process. Fruits & vegetables also provide fiber, antioxidants, phytonutrients, and anti-inflammatory benefits. Frozen fruits & veggies are a great convenient option that require little to no prep work!

Fill up with fiber: Fiber helps support digestive regularity, which is particularly of concern during injury recovery given limited mobility and potential opioid medications that can lead to constipation. Fiber also helps w/ satiety (keeping you full) in addition to regulation of blood sugar (sustained energy for hours). Add fruits, veggies, whole grains/complex carbs, beans/legumes, and nuts/seeds for a fiber boost!

Vitamin C: Vitamin C has antioxidant properties that help to combat oxidative damage (more oxidative damage = more muscle breakdown); Vitamin C also aids in collagen formation, building connective tissue, healing tendons, ligaments, and surgical wounds, making it an essential nutrient for wound healing. Add citrus fruits, berries, tomatoes, peppers, greens, melon, raw cabbage, potatoes, and kiwis for vitamin C!

Zinc: Zinc is another wound healing rockstar! Zinc is a mineral that is involved in over 100 processes in the body, including aiding in protein synthesis, wound healing, and cell division. Add oysters, beef, pork, chicken, fortified cereals, beans and legumes for more zinc.

Vitamin D: Important for bone formation/healing and calcium absorption. Add fortified milk or butter, fortified cereals, fatty fish, and egg yolks. Consider supplementation if necessary (ask your doctor before taking!) and try to get some sunlight if you can! Eating enough magnesium can support healing as well as magnesium converts vitamin D to its active form in the body.

Calcium: Important for bone formation/building new bone and with muscle contraction. Add milk, cheese, yogurt, soy products, greens (kale, collard greens, broccoli, mustard and turnip greens), and almonds.

Vitamin A: Assists in collagen formation, helping wounds and tissue damage heal, supports growth and maintenance of skin. Add carrots, sweet potatoes, dark yellow or leafy green vegetables, milk, cheese, egg yolks, or liver

Omega 3s: Omega-3 fatty acids offer anti-inflammatory benefits that help to reduce oxidative stress and can mitigate muscle loss during periods of immobilization. In addition

Top 10 Nutrition Tips for Recovery

#1 One day at a time!

#2 Prioritize nutrient-dense foods (such as high protein, healthy fats, color)

#3: Eat your color/fruits/veggies!! 

#4: Adequate fiber and fluids

#5: Convenience foods are your friend(frozen; pre-made; family; Instacart for grocery delivery

#6:  Fuel Your Soul (listen to music, tv shows/movies, stay positive, self-care)

#7: Rest & Sleep

#8: Consider supplements – ask your doctor! (vitamins, magnesium)

#9: Get Support/Ask for Help

#10: Listen to your body (hunger/fullness cues; permission to eat/honor needs; listen to body when easing into more movement post-surgery)

Loving this info? Be sure to check out the RhoDe to Fueling Better podcast (Episode 13) where I talk about my injury and give more tips for the road to injury recovery!

Injury Recovery Meal Ideas

• Cereal w/ frozen fruit + high protein milk
  • Aim for high fiber/high protein cereal option
• Greek yogurt + frozen fruit + granola + nut butter
• Tuna or salmon packet + minute rice + handful of greens + kimchi/sriracha, avocado 
• Pre-made tuna/chicken/egg/bean salad; pre-made green/veggie salads
• Air fryer salmon with potato/rice + frozen veg
• Chopped up fruit/veggies
• Recovery Smoothie: protein powder and/or greek yogurt + milk + frozen fruit + banana or oats + chia/flax seeds (plus other optional add-ins: spinach/greens, collagen, spices like cinnamon or turmeric, nut butter). Check out my building a balanced smoothie post for ideas.
• Frozen fruits/veggies (steam in bag, cauliflower)
• Favorite Products: core power protein or protein powder, orange juice, fortified cereal, frozen fruit, frozen veggies, frozen chicken, frozen meals, canned soup, greek yogurt, Chobani complete drinks, pre-cooked chicken, salmon/tuna packets, minute rice

Must Have Items for Recovery

• Ice packs: These are going to be your best friend during injury recovery. Ease pain, swelling and inflammation with ice packs, my personal favorite was ice packs that wrap around the ankle or injury site to give the most relief! Remember RICE: rest, ice, elevation, compression
• Book: Rebound by Carrie Jackson Cheadle and Cindy Kuzma
• If taking pain meds: magnesium citrate supplement (can help reduce constipation, check with your doctor first!)
• High-volume reusable water bottle – stay hydrated!
• Help & support

Items for Ankle/Foot/Lower Extremity Surgery

Ankle elevation pillow: I bought this on a whim after my injury and wasn’t sure whether or not I’d use it, but I used this while sleeping and nearly every day during the days leading up to surgery and for several weeks post-surgery.

Shower sleeve: While in a cast pre/post surgery, you need to keep it dry while showering. I think it took one shower with a trash bag wrapped around my leg while waiting for this to arrive. This made it much easier and did not leak!

Shower chair: Well worth it for ability to relax and avoid pain and fall risk while showering pre/post op. It’s truly a must. Don’t skip this!

Sweatpants: I live in leggings so I had to get some wide leg sweatpants that fit over the cast/boot during recovery. Leggings were way too tight for several weeks due to swelling. Go with wide leg if you have a cast/boot!

Hospital/non-skid socks: the last thing you want to do is slip and fall and further injury yourself. Socks with grips/non-skid are a great idea along with comfortable/secure shoes.

Compression stockings: I was required to wear stockings (provided by the surgery center) for 2 weeks post-surgery and then a few weeks later I purchased some additional ones which seemed to help. I did have to wait for swelling to come down before they were able to get over the ankle. Check with your doctor first!

Other tips:

-Have a solid nightstand or coffee table setup w/ your essentials nearby (extra long phone charger, water bottle, pen/paper/journals, makeup bag, vitamins/medications, journal/books/magazines, laptop, headphones, snacks, etc.). You’ll want everything you need because moving around is super uncomfortable for a few weeks!

-Books/podcasts/crosswords/sudoku are great ways to keep your mind occupied depending on how much mental energy you have or pain levels. Netflix is also a great option! I watched Prison Break and worked on my social media (@balanced.fueling) content creation (and eventually this blog!) to keep me occupied.

-Track your medications & supplements (written or in notes on phone) if necessary, especially if taking pain medications. Time sort of blends together when you are just sitting around pre/post surgery when mobility is limited. It’s also easy to forget when you are in pain, uncomfortable, or distracted. I kept track in the notes section of my phone to make sure I was staying on schedule.

-Keep a recovery journal to celebrate wins along the way! I tried to post my recovery journey as much as possible on my instagram and while journaling on my own.

Thank you so much for reading! Stay tuned for future posts on my recovery journey including my experience with physical therapy, slowly walking without crutches and boot, to getting back into workouts, more PT, and where I’m currently at!

In the meantime, make sure you’re connected with me on Instagram @balanced.fueling and check out the RhoDe to Fueling Better podcast which I co-host and debunk diet myths and give practical nutrition tips!

References: 

Tipton, K. Nutritional Support for Exercise-Induced Injuries. Sports Med (2015) 45 (Suppl1) :S93–S104.DOI 10.1007/s40279-015-0398-4. PMID: 26553492

Smith-Ryan A, Hirsch K, Saylor H, Gould L, Blue M. Nutritional Considerations and Strategies to Facilitate Injury Recovery and Rehabilitation. J Athl Train (2020) 55(9). 918-930. PMID: 32991705

Rosenbloom C. Eating for Strength and Recovery After Sports Injury. 2018. Academy of Nutrition and Dietetics. Link to article.

Nutrition for Healing. 2009. Hospital for Special Surgery. Womens Sports Medicine Center. Link to article.