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1/9/2014 Injury Considerations I mmo b iliza tio n L o ss o f musc le ma ss o Nourishing the De c re a se in stre ng th o De c re a se in musc le func tio n o Me ta b o lic impa c t o f immo b iliza tio n Injured Athlete Ne

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SLIDE 1

1/9/2014 1

Nourishing the Injured Athlete

Ma ure e n Na mko o ng , MS, RD Dire c to r, Nutritio n a nd F itne ss E ve ryda y He a lth Inc . E AT A Ja nua ry 2014

Overview

  • Hig h-le ve l re vie w o f the he a ling pro c e ss
  • Co nside ra tio ns during he a ling a nd re ha b ilita tio n
  • Nutritio na l ma na g e me nt o f the injure d a thle te
  • Spe c ific nutrie nts o f inte re st
  • F
  • o ds to disc o ura g e during injury
  • E

me rg ing a re a s

  • F

ina l ta ke a wa y re c o mme nda tio ns

Process of Healing

  • I

nfla mma tio n

  • I

nitiatio n o f the he a ling pro c e ss

  • Cle a r the site o f b a c te ria a nd c e llula r de b ris
  • Ang io g e ne sis
  • Pro life ra tio n
  • De po sitio n o f the fib ro b la st a nd c o lla g e n ma trix
  • Oste o b la st fo rma tio n a nd c a rtila g ino us c a llus
  • Gro wth o f ne w c a pilla ry ne two rks
  • Re mo de ling
  • Cyc le o f b re a king do wn, re b uilding , a nd o rg a niza tio n
  • Oste o b la st/ o ste o c la st a c tivity
  • Simulta ne o us pro te in synthe sis a nd de g ra da tio n
  • Ne t re sult – hype rme ta b o lic sta te & pro te in ne e ds

Injury Considerations

  • I

mmo b iliza tio n

  • L
  • ss o f musc le ma ss
  • De c re a se in stre ng th
  • De c re a se in musc le func tio n
  • Me ta b o lic impa c t o f immo b iliza tio n
  • Ne g a tive ne t musc le pro te in b a la nc e
  • Ana b o lic re sista nc e
  • Amino a c ids
  • De c re a se in insulin se nsitivity
  • Bo ne c o lla g e n synthe sis do e s re spo nd to inc re a se d a mino a c id le ve ls
  • De c re a se in a c tivity

Considerations During Rehabilitation

  • Ana b o lic sta te
  • I

nc re a se musc le

  • I

nc re a se stre ng th

  • I

nc re a sing a c tivity

The Impact from a Nutrition Perspective

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SLIDE 2

1/9/2014 2

Nutritional Consideration

  • Inc re a se d b a sa l me ta b o lic ra te
  • All pha se s o f he a ling re q uire e ne rg y
  • 15-25% inc re a se
  • De pe nds o n the se ve rity o f the injury
  • Cha ng e s in a c tivity
  • Immo b ilize d limb
  • No t pa rtic ipa ting in spo rt
  • E

ne rg y ne e ds will de pe nd o n a c tivity le ve l o f the a thle te

  • ME

T va lue o f c rutc h wa lking = 5.0

  • ME

T va lue o f wa lking fo r ple a sure = 3.5

  • Sta g e o f re ha b ilita tio n
  • Inc re a se d re q uire me nt fo r pro te in
  • Mic ro nutrie nts
  • Go a ls o f re ha b ilita tio n

Nutrition Management

  • Minimize c a ta b o lism
  • Me e t pro te in ne e ds
  • Me e t e ne rg y ne e ds
  • Ba la nc ing a c t
  • I

ndividua lize d

  • K

e e p pro te in fro m b e ing use d a s e ne rg y

  • E

nsure mic ro nutrie nts a re a de q ua te

  • Co nside r who is a t hig he st risk
  • Ma lnutritio n will impe de the he a ling pro c e ss

How to Calculate Calories

He a lthy I njure d

Basal Metabolic Rate Activity Factor Total Energy Expenditure Basal Metabolic Rate Activity Factor Stress (injury) Factor Total Energy Expenditure

Comparison of Recommendations

Healthy State Injur ed State

  • E

ne rg y Ne e ds

  • 1.8 mo de ra te a c tivity
  • 2.3 ve ry he a vy physic a l a c tivity
  • 30 kc a l/ kg F

F M

  • Pro te in Ne e ds
  • 1.2 -1.4 g / kg fo r e ndura nc e
  • 1.2 -1.7 g / kg fo r stre ng th
  • F

a t

  • 20 – 35% c a lo rie s
  • Ca rb o hydra te s
  • 7 – 8 g / kg
  • E

ne rg y Ne e ds

  • 1.0 – 1.2 Mino r surg e ry
  • 1.1 – 1.3 Ma jo r surg e ry
  • 1.25 – 1.3 L
  • ng -b o ne fra c ture
  • 30 – 35 kc a l/ kg
  • Pro te in Ne e ds
  • 1.0 – 1.5 g / kg initia l injury
  • 1.2 -1.7 g / kg re ha b
  • F

a t

  • 20 - 30% c a lo rie s
  • Ca rb o hydra te s
  • 7 – 8 g / kg

Female 5’6”, 135 lb, 20 y/o

Healthy State Injur ed State

  • Ca lo rie s
  • 2600 - 3350
  • Pro te in
  • 74 – 105 g ra ms
  • Ca lo rie s
  • 2450 - 3050
  • Pro te in
  • 74 – 105 g ra ms

Male 6’0”, 190 lb, 20 y/o

Healthy State Injur ed State

  • Ca lo rie s
  • 3750 - 5000
  • Pro te in
  • 104 - 147
  • Ca lo rie s
  • 3500 - 4300
  • Pro te in
  • 104 – 147
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SLIDE 3

1/9/2014 3

Specific Nutrients

Ho w so me mine ra ls, vita mins, a nd a mino a c id s pla y a ro le in he a ling

May be helpful in healing

  • Zinc pla ys a ro le in immune func tio n, pro te in, a nd c o lla g e n

synthe sis, c e llula r pro life ra tio n, a nd wo und he a ling

  • Vitamin C func tio ns in the synthe sis o f c o lla g e n c o nne c tive

tissue pro te in, a c ts o n fib ro b la st pro life ra tio n, c a pilla ry fo rma tio n, a nd ne utro phil a c tivity

  • Vitamin A stimulate s the immune syste m, e nha nc e s wo und

he a ling b y stimula ting e pithe lia liza tio n, a nd inc re a se s c o lla g e n d e po sitio n b y fib ro b la sts

  • Glutamine c ritic a l fo r the synthe sis o f fib ro b la sts, e pithe lia l c e lls,

a nd ma c ro pha g e s, e sse ntia l fo r g luc o ne o g e ne sis, a nd impo rta nt in stimula ting the infla mma to ry re spo nse

  • Ar

ginine sub stra te fo r pro te in synthe sis, c o lla g e n de po sitio n, a nd c e llula r g ro wth

  • Calc ium e sse ntia l fo r no rma l b o ne struc ture
  • Vitamin D fa c ilita te s the a b so rptio n o f c a lc ium

Food Sources

  • Zinc – me a t, live r, e g g s, a nd se a fo o d
  • Vita min C – c itrus fruit, g re e n ve g e ta b le s, to ma to e s,

a nd po ta to e s

  • Vita min A – live r, ye llo w ve g e ta b le s, g re e n le a fy

ve g e ta b le s, e g g s, a nd milk pro duc ts

  • Ca lc ium – milk, yo g urt, a nd c he e se
  • Vita min D – sun e xpo sure , fo rtifie d fo o ds – milk a nd

c e re a ls

What to Avoid During Injury

  • L
  • w-de nsity fo o ds
  • Hig h-sug a r
  • Hig h-fa t
  • Alc o ho l

How does all of this translate?

A d a y in the life thro ug h fo o d

Typical Intake ‐ Female

  • Bre a kfa st
  • Who le whe a t b a g e l, c re a m c he e se , yo g urt & fruit smo o thie with spina c h

a nd o ra ng e juic e

  • Sna c k
  • Apple , a lmo nds, c ra c ke rs
  • L

unc h

  • T

urke y sa ndwic h with le ttuc e a nd to ma to , c a rro t stic ks, o ra ng e , pre tze l ro d, a nd spo rts drink

  • Sna c k
  • Hummus, ve g g ie stic ks, a nd a pita
  • Dinne r
  • Sa lmo n, spina c h, winte r sq ua sh, b ro wn ric e , a nd milk
  • Sna c k
  • Gra ha m c ra c ke rs, pe a nut b utte r, stra wb e rrie s
  • T
  • ta ls
  • 2800 c a lo rie s, 435 g CHO, 112 g Pro
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SLIDE 4

1/9/2014 4

Typical Intake ‐ Male

  • Bre a kfa st
  • Who le whe a t b a g e l, c re a m c he e se , ha rd b o ile d e g g , yo g urt a nd fruit

smo o thie with spina c h, pe a nut b utte r a nd o ra ng e juic e

  • Sna c k
  • Cle me ntine , a lmo nd s, c ra c ke rs
  • L

unc h

  • T

urke y sa ndwic h with le ttuc e , to ma to , a nd c he e se , c a rro t stic ks, a pple , pre tze l ro d, a nd spo rts drink

  • Sna c k
  • Yo g urt, g ra no la , a nd spo rts drink
  • Dinne r
  • Chic ke n b re a st, who le whe a t pa sta with re d sa uc e , b ro c c o li, winte r sq ua sh,

a nd sa la d with dre ssing

  • Sna c k
  • Ce re a l, milk, a nd pe a r
  • T
  • ta ls
  • 3900 c a lo rie s, 600 g CHO, 172 g Pro

What Are We Still Learning?

So me E me rg ing T

  • pic s

Emerging Information

  • Supple me nta tio n with immo b iliza tio n
  • Pro te in supple me nta tio n
  • Bra nc he d-c ha in a mino a c ids
  • L

e uc ine

  • Ome g a -3
  • Cre a tine

Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans

  • He spe l, e t a l.
  • Do ub le -b lind tria l
  • Me tho ds
  • 22 yo ung he a lthy vo lunte e rs
  • Ca st wa s use d to immo b ilize the rig ht le g fo r two we e ks
  • Ha lf the sub je c ts re c e ive d c re a tine mo no hydra te – 20 g do wn to 5g da ily
  • Sub je c ts pa rtic ipa te d in a kne e -e xte nsio n re ha b ilita tio n pro g ra m
  • Me a sure d the c ro ss-se c tio na l a re a o f the q ua dric e p with NMR ima g ing
  • Me a sure d ma xima l kne e e xte nsio n po we r with iso kine tic dyna mo me te r
  • Ne e dle b io psy ta ke n fro m the va stus la te ra lis we re e xa mine d fo r

myo g e nic re g ula to ry fa c to rs

  • Re sults
  • Ora l c re a tine supple me nta tio n stimula te s musc le hype rtro phy during

re ha b ilita tio n stre ng th tra ining

Jo urna l o f Physio lo g y (2001) 536.2

The Effect of Creatine Supplementation on Strength Recovery After ACL Reconstruction

  • T

yle r, e t a l.

  • Do ub le -b lind, pro spe c tive , a nd ra ndo mize d c linic a l

tria l

  • Me tho ds
  • 60 pa tie nts we re ra ndo mize d into pla c e b o a nd c re a tine
  • 20 g / da y fo r the first 7 da ys the n do sa g e wa s re duc e d to 5g / da y
  • F
  • rma l re ha b ilita tio n b e g a n a t 1 we e k
  • Qua dric e ps a nd ha mstring stre ng th a nd po we r we re me a sure d

iso kine tic a lly. Hip fle xo r, a b duc to r, a nd a dduc to r we re me a sure d with a ha ndhe ld dyna mo me te r prio r to surg e ry, a t 6 wks, 12 wks, o r 6 mo nths a fte r surg e ry.

  • Re sults
  • Pa tie nts do no t b e ne fit fro m c re a tine supple me nta tio n during the first 12

we e ks o f re ha b ilita tio n a fte r ACL re c o nstruc tio n

AJSM, Vo l 32 No .2 2004

Take Away

  • E

nc o ura g e a thle te s to c o ntinue the ir no rma l inta ke

  • Hig h q ua lity pro te in, who le g ra ins, fruits, & ve g g ie s
  • Ca re fully wa tc h tho se a t mo st risk
  • I

f yo u ha ve c o nc e rns spe a k with yo ur te a m die titia n a nd/ o r do c to r

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SLIDE 5

1/9/2014 5

Thank You

na mko o ng .m@ g ma il.c o m ma ure e n@ e ve ryda yhe a lthinc .o m

References

  • Co llins, Na nc y. "E

stima ting Ca lo ric Ne e ds to Pro mo te Wo und He a ling ." Advanc e s in Skin & Wo und Care 15.3 (2002): 140-41. Wo undjo urnal.c o m. We b . Ja n. 2014.

  • He spe l, Pe te r, Be rt Op't E

ijnde , Ma rc Va n L e e mputte , Birg itte U rso , Pa ul L . Gre e nha ff, Va le ry L a b a rq ue , Ste ve n Dyma rko wski, Pa ul Va n He c ke , a nd E rik A. Ric hte r. "Ora l Cre a tine Supple me nta tio n F a c ilita te s the Re ha b ilita tio n o f Disuse Atro phy a nd Alte rs the E xpre ssio n o f Musc le Myo g e nic F a c to rs in Huma ns." T he Jo urnal o f Physio lo g y 536.2 (2001): 625-33. We b . De c . 2013.

  • Ma ha n, L

. K a thle e n., a nd Sylvia E sc o tt-Stump. Krause 's F

  • o d, Nutritio n, & Die t T

he rapy. Phila de lphia : W.B. Sa unde rs, 2000. Print.

  • "Po sitio n o f the Ame ric a n Die te tic Asso c ia tio n, Die titia ns o f Ca na da , a nd the Ame ric a n Co lle g e o f

Spo rts Me dic ine : Nutritio n a nd Athle tic Pe rfo rma nc e ." Jo urnal o f the Ame ric an Die te tic Asso c iatio n 109.3 (2009): 509-27.

  • Shils, Ma uric e E

. Mo de rn Nutritio n in He alth and Dise ase . Ba ltimo re : Willia ms & Wilkins, 1999. Print.

  • Smith, Go rdo n I

., Philip Anthe rto n, a nd Re e ds Do minic . "Ome g a -3 Po lyunsa tura te d F a tty Ac ids Aug me nt the Musc le Pro te in Ana b o lic Re spo nse to Hype rinsulina e mia –hype ra mino a c ida e mia in He a lthy Yo ung a nd Middle -a g e d Me n a nd Wo me n." Clinic al Sc ie nc e 121.6 (2011): 267-78. We b . De c . 2013.

  • T

ipto n, K e vin D. "Nutritio n fo r Ac ute E xe rc ise - I nduc e d I njurie s." Annals o f Nutritio n & Me tabo lism 57.Suppl 2 (2010): 43-53. 22 F e b . 2011. We b . De c . 2013.

  • T

ipto n, K e vin D., a nd L uc JC Va n L

  • o n. "Die ta ry Stra te g ie s to Atte nua te Musc le L
  • ss during Re c o ve ry

fro m I njury." Ne stle Nutritio n I nstitute Wo rksho p Se rie s. Vo l. 75. Ba se l: K a rg e r, 2013. 51-61. Print.

  • T

yle r, T . F . "T he E ffe c t o f Cre a tine Supple me nta tio n o n Stre ng th Re c o ve ry Afte r Ante rio r Cruc ia te L ig a me nt (ACL ) Re c o nstruc tio n: A Ra ndo mize d, Pla c e b o -Co ntro lle d, Do ub le -Blind T ria l." Ame ric an Jo urnal o f Spo rts Me dic ine 32.2 (2004): 383-88. We b . De c . 2013.

  • Wa ll, Be nja min T

., a nd L uc JC Va n L

  • o n. "Nutritio na l Stra te g ie s to Atte nua te Musc le Disuse

Atro phy." Nutritio nal Re vie ws 71.4 (2013): 195-208. We b . De c . 2013.