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  • Writer's pictureAnnie Bothma


- Annie Bothma, IOPN Sports Performance Nutritionist (EQF Level 7. Masters), Running Coach and Elite Marathon Runner

Injuries are multifactorial and can occur for multiple reasons, that is why almost all athletes get injures from time to time. Certain injuries may be completely out of your control, like a fall or twisting your ankle on the trails, however, others can potentially be avoided through the correct training program, adequate nutritional support, as well as enough rest and recovery.


Recovery from injury is a multi-stage process. Here is a simplified, two-stage process of recovery from injury, focusing on the physiological changes that occur during each stage:

  • Stage 1: Healing, inactivity and muscle atrophy

  • Stage 2: Rehabilitation and hypertrophy

Some factors to take into consideration when implementing and planning nutrition intervention:

  • Increased energy cost of trauma

  • Surgery

  • Stage of the healing process

  • Decrease in mobility and exercise

Stage 1: Healing, inactivity and muscle atrophy

During the initial stage of recovery from injury, the primary goal is to facilitate the healing of the damaged tissues. Here's an explanation of what happens during this stage:

  1. Healing: The body's natural healing processes begin immediately after an injury. Inflammation plays a crucial role in this phase, as it helps clear away damaged tissue and initiates repair. Depending on the type and severity of the injury, healing may involve the regeneration of cells, the formation of scar tissue, or both.

  2. Inactivity: In many cases, individuals may need to reduce or completely stop using the injured body part to avoid further damage or strain. This period of inactivity, known as immobilization, helps protect the healing tissues but can also lead to some muscle disuse.

  3. Muscle Atrophy: During periods of inactivity, muscles that are not used or loaded appropriately may undergo atrophy, which is the loss of muscle mass and strength. This can occur because the body adapts to the reduced demand placed on those muscles.

Stage 1: Nutritional Considerations

Effect of total protein intake on muscle protein synthesis (MPS):

  • Insufficient total dietary protein intake delays wound healing.

  • Required for synthesis of collagen and other proteins in the repair process.

  • Rate of muscle protein synthesis is suppressed in injured athletes.

Muscle protein synthesis (MPS) is a fundamental biological process in which the body builds new muscle proteins from amino acids, the building blocks of proteins. This process is crucial for the growth, repair, and maintenance of muscle tissue. MPS occurs when the rate of muscle protein creation exceeds the rate of muscle protein breakdown, leading to a net increase in muscle protein content.

Effects of specific amino acids on MPS:

  • The presence of all the essential amino acids can help stimulate greater MPS.

  • Leucine is a key essential amino acid for MPS. Aim for 2.5g of Leucine in your post-recovery shake or meal.

  • Bone collagen synthesis responds to increased protein intakes.

Timing of protein or amino acid intake on MPS:

  • Frequent protein feedings every 3 hours may result in greater MPS stimulation.

  • Ingestion of high biological value protein at 0.3g/kg/body weight for athletes who undertake cross-training or unilateral strength training of uninjured part can help maintain lean-body mass and avoid muscle atrophy.

Effect of protein status prior to injury on muscle loss and recovery:

  • Low protein intake prior to injury negatively influences recovery time of the injury.

  • A sudden decrease in protein intake just prior to the injury, which leads to a negative nitrogen balance, can promote greater muscle loss during injury.

  • Maintenance of energy balance is important during recovery.

  • When mobility is limited, total energy expenditure will decrease.

Most athletes tend to go into a calorie deficit to avoid weight gain, however, negative energy balance leads to decreased Muscle Protein Synthesis (MSP) and will delay recovery of the injury.

Stage 2: Rehabilitation

Once the initial healing has progressed, the focus shifts to rehabilitation and restoring function. This stage involves a gradual return to activity and strengthening the affected area:

  1. Rehabilitation: Rehabilitation encompasses a range of strategies, including physical therapy exercises, mobility work, and neuromuscular training. The goal is to improve range of motion, stability, and overall function of the injured area. Specific exercises and techniques are tailored to the type and location of the injury.

  2. Hypertrophy: As rehabilitation progresses, there's an emphasis on rebuilding muscle strength and size through targeted exercises. This stage involves resistance training and progressive overload, which challenges the muscles to adapt and grow.

Hypertrophy is the process of muscle cells increasing in size, leading to increased muscle mass and strength.

Physical changes during the rehabilitation stage

  • Recovery of muscle takes longer during rehabilitation.

  • Muscle size and strength is slower to build than to lose.

  • Overall energy expenditure is likely to increase during this phase.

  • Requires an increase in MPS for optimal remodeling and rebuilding of the injured limb.

  • Resistance exercise will lead to an increase in MPS.

Goals during the rehabilitation stage

  • Support muscle growth

  • Increase strength

  • Regain full range of motion

  • Most important nutritional consideration is meeting energy and protein requirements!


Maintain a Balanced Diet and Consume Enough Calories

Ensure you're getting a balanced intake of carbohydrates, protein, and healthy fats to support overall health and recovery. Avoid being in a calorie deficit, since a negative energy balance will decreased MSP and will slow down the recovery process.

Increase Your Protein Intake

Protein is essential for tissue repair. Increase your protein intake to aid muscle recovery. Good sources include lean meats, fish, dairy, and plant-based options like beans and tofu.

Don't Cut the Carbs

Carbs provide energy. Adjust your intake based on your activity level and injury severity, but don't neglect them completely. Studies have shown CHO is important for the decrease of immunosuppression observed after exercise. CHO ingestion pre, during and post-exercise may lead to less risk of illness and injury.

Include Ant-inflammatory Foods

Some injuries result in inflammation. Incorporate anti-inflammatory foods like lots of colorful fruit and vegetables have antioxidant components which can help decrease inflammation in the body.

Examples of antioxidant rich foods:

  • Blueberries

  • Strawberries

  • Carrots

  • Tomatoes

  • Pineapple

Anti-inflammatory compounds:

  • Herbs and spices

  • Turmeric

  • Garlic

  • Green tea

  • Cinnamon

  • Oregano

  • Cumin

  • Clove

  • Basil

→ For therapeutic doses, best taken in supplement form

Include Plenty of Vitamins and Minerals in Your Diet

Ensure you're getting enough vitamins and minerals from whole foods like grains, fruits and vegetables.

Key Micronutrients for Injuries:

  • Calcium & Vitamin D - important to optimize the bone formation

  • Zinc, Vitamin C, Vitamin A, Vitamin E - aids wound healing.

  • Magnesium - plays a role in glucose metabolism, acts as an electrolyte, and affects protein synthesis.

  • Vitamin C - aids collagen synthesis.

Stay on top of your Hydration

Staying hydrated is critical for injury prevention and recovery. Water supports tissue healing and helps maintain joint health.

Consume more Omega-3 Fatty Acids

These can help reduce inflammation and aid recovery. They also have Immune-modulatory properties.

Reported to:

  • Reduce muscle soreness

  • Improve oxygen & nutrient delivery

  • Reduce inflammation

  • Increase muscle synthesis

Omega-3 rich foods

  • Mackerel

  • Tuna

  • Salmon

  • Flaxseeds

  • Chia seeds

  • Walnuts

Timing Matters

Consider timing your meals around your training or rehabilitation sessions. Pre-workout and post-workout nutrition can be critical. Some nutritional strategies to help you recover faster form injuries.

Avoid Fasted Training

Fasted training may increase your injury risk. Inadequate fueling can compromise the body's ability to absorb shock and support optimal movement patterns. Fatigue, impaired muscle function, and decreased coordination resulting from fasted training may increase the risk of injuries during exercise, such as strains, sprains, and stress fractures.


Supplements can be beneficial to support recovery from an injury, but it's essential to consult with a healthcare professional before adding any new supplements to your routine. They can assess your specific needs and ensure supplements won't interact with any medications or medical conditions you have.

That said, here are some supplements that are commonly considered for injury recovery:

Protein Powder

Whey or plant-based protein supplements can aid in muscle repair and recovery, especially if your dietary protein intake is insufficient.


One potential mechanism through which creatine may contribute to injury prevention is through improving muscle strength and power. By increasing phosphocreatine stores in the muscles, creatine supplementation can enhance the ability to generate rapid and forceful muscle contractions. This can be beneficial in activities that involve quick movements, jumps, or sudden changes in direction, as it may help reduce the risk of muscle strains or tears. Additionally, creatine has been shown to have potential benefits in reducing muscle damage and inflammation associated with intense exercise. This may aid in post-exercise recovery and potentially lower the risk of overuse injuries.

The recommended maintenance dose is 3-5 g of creatine daily. The most common type of creatine and the one most studied is creatine monohydrate. That’s the type you want to look for in any supplement you choose. It is also the most affordable.


Fibrous protein found in connective tissues of the body, e.g. tendons, ligaments, cartilage, bones, teeth. Type II collagen main purpose is the treatment of joint pain and arthritic conditions.

Collagen synthesis is important for:

  • Promoting the healing of connective tissues, such as tendons and ligaments.

  • Wound healing.

  • Formation of scar tissue.

→ Take 15 g collagen 45-60 minutes prior to doing your rehab with a source of vitamin C for the maximum benefit.

Omega-3 Fatty Acids

Fish oil supplements, rich in omega-3s, have anti-inflammatory properties that may help reduce inflammation and support overall recovery. You can also get it from your diet.

Glucosamine and Chondroitin

These supplements are often used to support joint health and may be beneficial for injuries involving joint damage or cartilage wear and tear.

Vitamin C

Vitamin C plays a crucial role in collagen production, which is essential for tissue repair. A vitamin C supplement may be beneficial if your dietary intake is insufficient.

Food first approach: Good sources include citrus fruits, berries, mango, kiwi, red pepper and tomatoes.

Calcium and Vitamin D

If your injury involves bone damage, calcium and vitamin D supplements can support bone healing and strength.

Food first approach: Good food sources include yogurt, milk, cheese, dark leafy greens, salmon and sardines with bones.

Turmeric or Curcumin

These supplements have anti-inflammatory properties and may help reduce pain and inflammation associated with some injuries.


Derived from pineapple, bromelain supplements may have anti-inflammatory effects and help reduce swelling.


Magnesium can support muscle function and relaxation, potentially aiding in muscle recovery and preventing cramps. Magnesium supplement may be beneficial if your dietary intake is insufficient.

Food first approach: Good sources include Dark leafy greens, whole grains, dark chocolate, nuts and seeds, avocados.

Remember that supplements should complement a well-balanced diet and not replace it. Also, their effectiveness can vary from person to person, so it's crucial to consult with a healthcare professional to determine which, if any, supplements are suitable for your specific injury and recovery needs.


  • Make sure you meet your energy requirements.

  • Stay well hydrated.

  • Increase your protein intake.

  • Don't cut out your carbs completely, even if you are moving less.

  • Ensure you're getting sufficient vitamins and minerals, especially vitamin D (for bone health), calcium (for bone and muscle function), and magnesium (for muscle function).

  • Increase antioxidant rich foods in your diet.

  • Consume omega rich foods like fatty fish and nuts on a regular basis.

  • Consider if certain supplements can help support your recovery and healing process.

  • Avoid fasted training and time your nutrition to support your training and rehab.


Whether we like it or not almost all athletes experiences injuries or niggles that interrupt their training from time to time. It almost part of the game of sports and comes along with the pursuit of discovering your personal limitations. Through trial and error you will find the right amount of volume and intensity that your body can handle and hopefully find your sweet spot along the way. Working with a coach can be helpful to help you manage your training load and create a program that suits your physical needs and goals.

If you would like to work with me one on one to nail down your nutrition as an endurance athlete or you need a running coach to help you prepare for your upcoming race, please click on the link below to learn more about the services I offer.

Contact me at to set up a consultation today.



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  • Craig Sale, Kirsty Jayne Elliott-Sale, "Nutrition and Athlete Bone Health," Journal of Sports Medicine, 2017

  • Graeme L. Close, Craig Sale, Keith Baar, Stephane Bermon, Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes, International Journal of Sport Nutrition and Exercise Metabolism, 2019

  • Keith Baar, Minimizing Injury and Maximizing Return to Play: Lessons from Engineered Ligaments, Sports Med, 2017

  • Benjamin T. Walla, James P. Morton, & Luc J. C. van Loona, Strategies to maintain skeletal muscle mass in the injured athlete: Nutritional considerations and exercise mimetics, European Journal of Sport Science, 2014

  • Ronald J Maughan, Louise M Burke, Jiri Dvorak, IOC consensus statement: dietary supplements and the high-performance athlete, Consensus statement, 2018

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