When Tough Guys Get Hurt.

The strategic and practical role of nutrition for recovery from injury in professional rugby

25th September

Daniel Davey MSc, BSc, CSCS, NEHS

Presentation outline

• That hurts – common injuries in rugby, phases of treatment and typical recovery times

• Getting better – developing nutritional strategies and helping players adapt

• These work – supplements for specific sports injuries

• Make me better – why tough players make tough patients and how they can be helped

Objective

• Achieve specific nutrition needs

• Enhance muscle sparing/Limit atrophy

• Support the healing process

• Offer specific nutrients for injuries to specific tissue types.

• Care for the athlete

Common Rugby Injuries

• Muscle / tendon tears – 40% - 2-10 weeks

• Ligament injuries – 30% - 2-6 weeks

• Concussion – 12.5% - 2 – 12 weeks

• Fractures / dislocation – 9% - 6-14 weeks

• Superficial / non structural injuries – 10%

Match play injury risk in rugby is 74%, a percentage which is higher than both Gaelic football and soccer.

Fractures are the most common injuries in young players

What an athlete should avoid during injury

• Large losses of lean mass

• Significant increase in body fat

7 days

Nutrition process following injury for our athlete’s1. Injury occurs

2. Athlete attends medical

3. Medical meeting with S&C / Physio / Nutritionist

4. Timeline for key monitoring events and return to play

5. Group meeting with player – Nutrition resources provided

6. Nutrition meeting with player

7. Weekly follow up meeting

8. DXA scan / fitness testing to measure readiness to train

9. Player returns to full training

10. Player available for selection

Return To Play

Nutrition for optimum recovery from injury

Nature of Injury & time frame of injury

MuscleProtein - 4-6 hits

HMB - 3g daily

Various Nutrition / Supplement Strategies

BoneVitamin D – 10,000 IU weekly

Calcium - 1500 mg CA2+ per day

Tendon / LigamentCollagen – 15g daily

Gelatine10g collagen + 50 mg

Vit. C per session

Return To Play

Foods: Moderate CHO, high in fibre, quality protein, lots of essential fats & antioxidants

Foods: Low CHO intakes (fruit), high in fibre, quality protein, essential fats & antioxidants

Foods: CHO introduced around training, lower protein and fat intake to moderate amounts

Energy requirements during injury• BMR – Increased – initially

• Energy demands higher than when sedentary but still not as high as when training

– Typical 5’10 male athlete requires an average 2100 when sedentary, > 3000 calories daily during training and roughly 2500 during the early stages of injury

• Adequate energy intake is required to meet energy requirements –inadequate energy intake can impair healing and result in loss of lean mass

Carbohydrate

Pre operative nutrition

• Carbohydrate loading – anti catabolic affect

• Reduces hospital stay

• Assist with maintenance of muscle mass

• Daily protein intake 1.7–2.5 g kg body mass may be required to support muscle mass maintenance during disuse

• This should be achieved by the regular (4–6 times daily) consumption of adequate amounts (20–35 g) per meal

• BENJAMIN T. WALL1 , JAMES P. MORTON , & LUC J. C. VAN LOON1 1 NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands, 2 Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK

Practical Nutrition Recommendations For Limiting Muscle Mass Loss When Injured

”Limb immobilisation following injury leads to rapid muscle loss and declines in functional capacity” BENJAMIN T. WALL1 , JAMES P. MORTON2 , & LUC J. C. VAN LOON1

Muscle loss is most profound during the first 1–2 weeks of limb immobilisation.

• During this time athletes should aim to limit muscle loss during this time to improve the rate of recovery.

• Muscle loss during disuse is primarily attributed to a decline in muscle protein synthesis rate and the development of anabolic resistance to dietary protein intake.

quality protein sources with a high leucine content

Of particular relevance is the time-course of muscle atrophy, with the

first 1–2 weeks showing the greatest relative loss of muscle

mass. During this period, 150–400 g of muscle tissue can be lost from a single, immobilised leg (Wall, Dirks,

Snijders, et al., 2013)

Breakfast:Cereal & milk

Snack:Fruit & seeds

Lunch:Soup & ham sandwich

Pre-training:Banana & yoghurt

Post-training:Protein shake, two chicken breasts & rice

Snack:Handful of mixed nuts

Breakfast:Porridge, milk & three boiled eggs

Snack:Berries & nuts in yoghurt

Lunch:Chicken salad with rice

Pre-training:Turkey sandwich on oat bread

Post-training:Pork chops & potatoes

Snack:Protein shake

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Even protein distribution

Fats & Essential Oils

Essential for providing energy as well as the development of vital hormones involved in the recovery process

Eat at least 2 of these healthy fats each day:

Avocadoes, olive oil, mixed nuts, fatty fish (such as salmon), flax seeds, and flax oil

Functional foods that support recovery

Functional foods and nutrient considerations

• Why functional foods work – inflammation?

• The aim is to control the inflammatory response but not fully suppress it – Certain amount of inflammation required for adaptation

• Pain reduction

• Non toxic and Less side effects compared to medication

Anti-inflammatory foods

Supplements that support recovery

• Branched Chain Amino Acids (BCAAs)– During rehab and early phase of injury

• Whey protein

• Probiotics – if antibiotics used

• Glutamine – 10 g daily

• Glucosamine 1500 mg daily

• HMB – 3 g daily

• Collagen – 15g daily

Food, what I recommend?

• Garlic– 4 g of garlic cloves / 600-1200 mg

• Turmeric– Curcumin is the active ingredient

• Ginger

– 1 large piece

• Multivitamin – 1 daily

Managing body composition

Influencing factors

• “Grace” period?

• Food choices – avoiding processed foods

• Energy intake

• Macro nutrient intake recommendations

Alcohol consumption during injury

• Increased stress hormone and inflammation levels

• Reduction in testosterone, growth hormone and other anabolic

hormones

• Increased recovery time from injury

• Calorie surplus

• Increased fat storage

• Dehydration

Your Energy & Macronutrient Targets• 2 g of protein per kg daily 104 x 2 = 208g – >30 g per meal (800 calories)

• Training days 4g of carbohydrate per kg = 400g (1600 calories)

• Healthy fats 90g - (800 calories)

• Total calories on training days = 3200 – 3000 depending on exercise intensity

• These targets should be achieved in 6 meals – 3 main meals and 3 snacks

Putting it all into practice

The information matters least –

Encouragement and support matters most

• Set clear goals and targets

• Regular support and engagement

• Communicate with fellow staff on player morale and motivation

• Inclusion on squad events and tasks

• Player accountability

Resources / Support for athletes

Physical

Meal plans

Cooking sessions

Supplement plans

Psychological

Books / podcasts

Daily support

Activities

Summary recommendations for injured athletes

1. Food intake must be altered during each stage of recovery from injury

2. Appropriate levels of calories, energy is critical in the immediate phase post injury

3. Herbs and phytochemicals should be used for the 2-4 weeks after the injury to manage inflammation

4. Appropriate supplements can support recovery and help control inflammation

5. Athletes require clear targets and regular support and encouragement