Mythbusting: Nutrition doesn't matter in physical therapy

Most athletes do not have too much trouble honing in their nutrition as they prepare for a new season or when they are in the midst of a competitive season. In fact, as they get deeper into their season other important factors of training and recovery fall in line as well - sleep, additional training sessions, stress management, etc. But what happens if the athlete gets hurt? What happens when they go from training and competing at high intensities for 10-15 hours per week to being sidelined and facing a significant reduction in physical activity? It is completely understandable for athletes facing a season ending injury to lose motivation and to lose steam on all of the positive behaviors that were leading them to success. Some examples may include neglecting a sleep schedule, indulging in comfort foods, and skipping individual workouts. In our collective experience treating athletes of all levels, a common thought amongst injured folks is just letting time do all the healing, and while that is a very legitimate thought process, our philosophy is that the entire scope of health and wellness ought to be considered regardless of our injury status.

We have mentioned this countless times, but the best ways to optimize your physiological recovery is to prioritize sleep, nutrition, stress management, and regular physical activity. It’s obvious why these things matter when we’re healthy, but at Headquarters Physical Therapy we believe that these things matter as much, if not more, when injured. Why? Because an injured athlete’s priority is recovery. While we could go on about the benefits of maintaining a good sleep schedule and stress management routine while injured, we’re going to spend a little more time in this blog going into why we feel that nutrition is such an important part of a good physical therapy plan of care.

Overuse injuries

All injuries are a result of an overload of stress on a part of the body that the body cannot tolerate or is not adequately prepared for. This overload can occur in the blink of an eye, such as an ACL tear, or over the course of weeks and months. These injuries that occur over a lengthier time frame, are typically referred to as “overuse injuries”. Some common examples are tendinitis or tendinopathies, general knee pain, low back pain, tennis elbow, and plantar fasciitis. Now, while pain is a much more complex phenomenon than workload vs. work capacity, for the sake of simplicity, we’re going to focus primarily on the effect that the ratio of tissue load to tissue tolerance has on us as athletes.

Let’s take the example of a long distance runner preparing for the Portland Marathon. A typical endurance training program will be focused on building endurance by gradual increases in weekly mileage, or volume. On top of the increase in running volume will likely be an increase in running intensity via speed intervals. Needless to say that this all results in more caloric expenditure over time. As we have mentioned on more than one occasion, athletes need adequate caloric intake to meet the recovery demands of their rigorous training demands. Injuries that seem to occur “out of nowhere” and without any obvious trauma can oftentimes be traced back to an increase in physiological demand without sufficient recovery to match. Before we continue with this point, we do have to make a note that there are times in an individual’s life where caloric intake will actually need to be lower than the amount required to meet physical activity demands. Typically, these times are saved for moments of necessary weight loss, such as cutting weight before a wrestling or weightlifting competition. However, for a competitive athlete, these instances are fairly short periods of time and usually do not occur during the most fatiguing times of their training programs. So going back to the runner preparing for the Portland Marathon, if this particular athlete does not continue to monitor their caloric intake in relation to their increasing physical demands, the likelihood that they develop an injury such as tendinopathy, knee pain, or stress fractures of the hip and/or foot.

Post-operative muscle growth

Not all surgeries result in muscle atrophy. However, there are some surgeries that are characterized by notable loss of muscle tissue. A common example of this is the atrophy of the quadricep following an ACL reconstruction surgery. Obviously, quadricep hypertrophy is the main priority in this situation, and while muscle and weight gain will require a caloric surplus, we at Headquarters Nutrition would see this scenario differently. First, as much as we encourage consistent and challenging training to the rest of the athlete’s body, the truth is training volume and intensity are likely to reduce to some degree in the initial stages of rehab, and a spike in caloric consumption may ultimately result in unwanted weight gain. It is important to consider during this phase of physical therapy the value of preventing as much muscle loss as possible, and doing as much as possible to actually increase the muscle tissue development of the affected leg. A key aspect of nutrition to achieving this goal is to maintain, if not increase, protein consumption. Second, caloric intake should be maintained at an appropriate level to prevent unwanted weight gain, as that would be counterproductive to maintaining the fitness levels necessary to minimize injury risk as the athlete transitions from rehabilitation towards return to sport. Our recommendations for protein consumption would be 1.6-2 grams of protein per kilogram of bodyweight, whether injured or not. However, most individuals we work with tend to lack adequate protein intake and when they strive to increase their daily protein count have a difficult time doing so without adding excessive calories and saturated fats.

Before continuing, we do have to say that the conversation of weight loss vs weight gain and how the two might impact injury risk or rehabilitation is an extremely delicate one that will vary from person to person. It is important to discuss with your medical provider, physical therapist, and nutritionist or sports dietitian regarding an appropriate plan moving forward. Fortunately, at Headquarters Physical Therapy and Headquarters Nutrition we offer two out of the three services under the same roof.

Bone stress injuries

Bone stress injuries (stress reactions and stress fractures), common in the feet, shins, and hips, are typically a result of repetitive impact stress without sufficient recovery. Bone remodeling occurs under a principle called Wolff’s Law - when weight-bearing stress is applied, the cells that lay down new bone are more active than the cells that break up bone. The end result of weight-bearing stress via resistance training is improved bone density and increased resilience to impact related injuries. This is why we believe it is so important for runners to integrate resistance training into their running programs in an intelligent manner. However, in addition to resistance training, a good nutrition plan that maintains adequate caloric intake, daily protein count, and sufficient hydration serves to assist in the recovery of the athlete and provide the necessary tools to maintain bone density.

Keep in mind that bone density is not just important for athletes, but is also increasingly important for just about everybody as they age. Osteopenia and osteoporosis are risk factors in the aging person. Weakened bone density can increase the likelihood of a fracture, which can then place the individual at risk of losing independence with daily functions. There is strong evidence to suggest that resistance training and sound nutrition are fantastic ways to minimize this complication in individuals with both osteopenia and osteoporosis.

So whether your goal in physical therapy is to become more active, remain active, or get back to doing what you love after injury a good nutrition program will only serve to enhance the physical activity methods you and your physical therapist agree upon. If you are looking for the best place in Portland, Oregon to have both services, then connect with one of our physical therapists or our sports nutritionist now.