Effective Nutrition for Injury and Rehabilitation

Fresh Food

An often overlooked aspect of recovering from an injury is nutritional intake.

This post will look at nutritional needs for injury from a broad perspective including:

  • Energy needs during reocvery from injury
  • Macronutrient needs during recovery
  • Micronutrient needs during recovery

A future post will explore effective supplementation for pain and injury, but as always, it’s important to start with the “big rocks” first.

Before we go into further details, you need to understand the difference between pain and injury.

Injury occurs when tissues are stressed beyond their tolerance, resulting in damage as either a partial or full rupture of the tissue. Injuries usually fall into one of two categories: acute/traumatic, chronic/overuse. Whether soft or hard tissue is involved, each injury undergoes an acute inflammatory phase followed by a rebuilding phase. Both the inflammatory and rebuilding phases can benefit from targeted nutritional approaches.

Pain is the unpleasant feeling we experience, often, but not always, in response to an injury. We can also experience pain without injury, so just having pain is not an indicator you need to modify your nutrition.

To know whether you are suffering from pain resulting from and injury, or simply “non-specific” pain, you can ask yourself a couple of simple questions:

  1. Was there a traumatic incident that could have caused the injury, and did the pain start after this?
  2. Is this a new pain? (recurring pain is typically non-specific, or less associated with injury)
  3. Are there obvious signs of inflammation – redness, swelling, heat?

Answering yes to one or more of these questions could indicate an injury. If you are unsure, it’s best to seek out a medical professional for a diagnosis.

Energy Needs During Injury

As you can imagine, an injury results in an increase to our energy needs, as the body increases metabolic activity to repair the damaged tissues.

Most textbooks calculate an increase of approximately 20% on top of your energy needs, if you are sedentary and eating at maintenance (not gaining or losing weight).

If you are already highly active, you will actually end up eating less than normal, as being highly active would require eating greater than 20% above maintenance intake.

You don’t have to track your intake exactly, but rather be mindful that if sedentary, you will need to increase your energy intake during an injury, whereas if you are highly active, you will need to decrease it, but not all the way to your baseline maintenance intake.

Macronutrient Needs During Injury

Macronutrients are the three different constituents of food: protein, fat and carbohydrate (alcohol is also considered a macronutrient, but it should be obvious that it isn’t good for injuries or recovery).

Depending on your current diet, you may benefit from changing the macronutrient ratio of your diet.


For someone eating a fairly average diet, when injured, an increase in protein intake is beneficial. The recommended protein intake is 0.8 g/kg of body weight, whilst the recommended intake for an injury is 1.5-2.0 g/kg, double the baseline. If you are already consuming a high protein diet (as is common among athletes), you don’t have to change anything.


The amount of fat you consume in response to an injury isn’t as important as the types of fat you consume.

Recall that after injury there is an inflammatory phase. This is when the body increases blood flow to the effected area, breaking down the damaged tissue to prepare it for rebuilding.

If the inflammatory phase is prolonged and/or too extreme, healing can be delayed. This is the reasoning behind applying ice and compression to acute injuries.

Different kinds of fats can be either pro or anti-inflammatory. Thus it makes sense to limit your intake of pro-inflammatory fats during an injury.

There are 3 kinds of fats: saturated , monounsaturated and polyunsaturated. Dieticians generally recommend your total fat intake is evenly divided amongst the 3.

Certain types of polyunsatured fats, omega-6 fats, are pro-inflammatory. Typical western diets are already high in omega-6 fats, so they should generally be reduced, even more so during an injury. Common sources of omega=6 fats are flax seeds, hemp, canola, safflower (and their oils), commercial dressings and many nuts.

At the other end of the scale, omega-3 fats have an anti-inflammatory effect, and can be increased during injury. The best sources of omega-3 fats are marine oils (fish oils) and algae. Many people do not eat adequate amounts of  fish to get enough omega-3 fats, so it is commonplace to supplement. However, the quality of fish oil supplements varies highly, with many brands using low quality sources, along with poor transport and storage methods, which mean that it is unlikely that you are getting what you pay for. In fact, if the oils have already oxidised, then you are actually taking something that is likely causing your health harm*.

It is important to understand that whilst reducing inflammation slightly can accelerate healing, reducing inflammation too much (or eliminating it) can impair healing, thus, you want to eat adequate, not surplus amounts of omega-3, especially if you are also taking non steroidal anti inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Nurofen) or diclofenac (Voltaren).


There are no specific dietary guidelines for carbohydrate intake and injury.

Understanding the injury process leads us to two conclusions regarding carbohydrate intake:

  1. We need some form of carbohydrate in our diet, as glucose is required for repair.
  2. Ideally, these carbohydrates come primarily from fruits and vegetables and whole grain sources, as excessive processed carbohydrate intake can be inflammatory.

So while very low carbohydrate diets are currently popular for weight loss/management, during a time of injury it is advisable to consume adequate amounts of carbohydrate.

Micronutrient Needs During Injury

Micronutrients are vitamins and minerals found in foods. As to be expected, the needs for certain micronutrients increases with injury.

One important thing to understand, at this stage, it is not clear whether simply having adequate amounts in your diet is optimal, or whether there is benefit to be had from “megadosing” certain micronutrients during time of injury.

Here is a list of micronutrients that play important roles in recovery from injury:

  • Vitamin A: supports early inflammation, reverse post injury immune suppression and assists in collagen formation. A dosage of 10,000 IU daily for 1-2 weeks post injury is likely safe, but be aware that Vitamin A accumulates in the body and can become toxic if taken in excess. Remember to consider all dietary sources.
  • Vitamin C: enhances white blood cells the help fight infection as well as improving collagen formation during repair. It also is a powerful anti-oxidant and immune booster. Recommended dosage: 1-2 g/day during injury repair.
  • Copper: helps the formation of red blood cells and acts with Vitamin C to form elastin – part of our connective tissue. Recommended dosage: 2-4 mg/day for the first few weeks after injury.
  • Zinc: is required for over 300 different chemical reactions in the body. It also helps with DNA synthesis, cell division and protein synthesis – all necessary for tissue regeneration/repair. Recommended dosage: 15-30 mg/day during initial stages of healing.
  • Calcium and Iron: more in the preventative category, as deficiency in either or both minerals are quite common, leading to increased risk of stress fractures.

It is important to remember that these recommendations are guidelines only. For specifics, it is best to speak to a qualified practitioner well versed in nutrition (or a dietician) to tailor a diet and supplement plan specific to your injury needs. Some of the above if taken continuously can lead to toxicity, whilst others can cause interactions with other nutrients if taken in excess.


The main key to managing your recovery from injury with nutrition is to ensure you are getting adequate amounts of everything you need.

If you already eat a healthy diet and your weight is in the healthy range, it is likely you don’t have any excesses or deficiencies (it is still possible), so continuing to do what you already are is probably your best course of action, with perhaps a modification of total intake up or down as needed.

There are certain supplements that can help with injury and pain resulting from certain conditions, and we will explore those in a future post, however, in terms of this article, the majority of your nutrient needs should be met with food. If you feel you might require specific supplementation, it is best to speak to a qualified health professional (in Australia, go with an AHPRA registered professional as your starting point).


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.



(1) Berardi, J., Andrews, R., The Essentials of Sport and Exercise Nutrition, 2nd Edition, Precision Nutrition, ON

(2) Foods high in omega-6: http://nutritiondata.self.com/foods-000141000000000000000-1w.html?

*The two brands of fish oil we recommend in Australia are BioCeuticals and Metagenics. These are “practitioner only” ranges (we can order them), though you can often source them from health shops with a naturopath on staff.

Pain Science Made Simple

Scary Unkown

When the primary complaint is pain, treatment of pain should be primary. – Barrett Dorko, P.T.

At Integrative Osteopathy, one of my core practices is to empower people through education, so they feel better both in the short term, and the long term as a result of resilience and independence.

A hugely important part of this process is pain and neuroscience education.

Whilst this may sound daunting and perhaps even irrelevant to you, research shows that neuroscience (including pain science) education has a positive effect on pain, disability, physical performance as well as anxiety and stress.

In addition, not learning about pain early on can lead to the rise of chronic pain conditions later, by not alleviating the fear that is often associated with pain (consciously or unconsciously)

Considering how effective this intervention is, and the fact that pain is the number one reason people consult an osteopath in Australia, it’s a no brainer to ensure a thorough teaching about pain precedes any other treatment.

What is pain?

Any teaching about pain must start with exactly what pain is, and currently, the definition put forward by the International Association for the Study of Pain (IASP) is:

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Now that seems straight forward enough, but let’s look at it a little deeper.

What exactly does this mean though?

Pain is more than just a physical phenomenon

Most people associate pain with injury and damage, and whilst this is often a component of pain, pain is much more than damage.

This is why the word potential is used, it implies something else is at play – we don’t need tissue damage to occur in order to feel pain.

Pain is an alarm, not a damage meter. This can be one of the hardest things to grasp when first learning about pain, and will be explored in more depth later in this post.

Pain is an emotional experience

If you have ever experienced pain, you will likely recall not being yourself, you may have been “short” with people, or become more introverted, or demonstrated any number of changes to your normal demeanour.

That’s the emotional part.

Every person’s pain is unique

We commonly use words like sharp, dull, throbbing, aching, burning, stabbing and shooting to describe pain.

This helps communicate each pain experience in a more “universal” manner, allowing clinicians and patients alike to identify certain attributes of pain, potentially helping with diagnosis or coping.

However, what this doesn’t allow for is the uniqueness of pain.

The use of the word experience in the above definition, suggests the individual nature of pain.

We all feel differently and what we feel depends on many factors – our genetics, our current situation in life and our cultural upbringing are just a few of the contributing factors to how we experience pain.

Pain is an output of the brain

Understanding the broadness of pain and the fact that pain is not reflective of tissue damage, the next step is to grasp the concept that pain is an output of the brain, rather than an input to the brain.

To understand what this means, let’s use a simple analogy.

On a computer, we can use a mouse or keyboard to provide an input. This input is then processed, and then, depending on the program in operation, and output is displayed.

Currently, I’m typing in a word processor, which means when I hit the “w” key, w appears on the screen. However, if I were playing a game, that “w” key might move my character in a certain direction.

Same input, different output.

When it comes to pain, we experience it when our brain decides, unconsciously, that the sum of information it is processing is “dangerous” and we realise this danger consciously – the feeling of pain.

Regarding the inputs to the brain, there are 3 main sources (in no particular order):

  1. Cognitive (thoughts)
  2. Affective (emotions)
  3. Physical (messages from the nerves)

What’s interesting, is that only one of the three inputs is regarding the status of the body.

If the sum of all this information is perceived as “dangerous”, then we experience pain, changes to movement and posture, a heightened stress response etc.

So really, pain is a broader part of the nervous’s systems operations to keep us safe. Though sometimes it goes wrong, for the most part, it’s a pretty good system. If it wasn’t, we wouldn’t be here today.

Nociception and pain

We are really diving deep into this pain stuff now, but this is quite an important part of the pain experience.

Nociception is simply the reporting from the peripheral nerves to the central nervous system (brain and spinal cord) on the status of the tissues.

There are 3 main kinds of nociceptors:

  1. Thermal (reporting on heat/cold)
  2. Chemical (reporting on chemical irritation, like inflammation)
  3. Mechanical (reporting on tension and compression)

There is always some nociception occuring, that is so our brain knows what’s happening with our body. However, this doesn’t necessarily turn into pain.

When nociception reaches a certain threshold, then the nerves fire faster, which can alert the brain to something happening. It doesn’t mean there is damage – but only that there is more stimulation of those nociceptors.

This only becomes pain, if, when combined with the other inputs mentioned above, your brain decides the information means “danger”.

Acute versus chronic pain

Acute pain is a completely normal response to dangerous stimuli. It usually follows some form of tissue irritation, which may or may not include damage to the tissues.

This is the pain we experience when we bump into something, strain a muscle or cut ourselves. It serves a protective purpose – alerting us to the incident and getting us to change our behaviour accordingly, so we do no further harm. It usually subsides when healing has taken place – often before (think of a cut, it doesn’t hurt all the time, only in the beginning).

For some people, pain does not resolve after the acute phase, and it becomes chronic pain, which is a problem in and of itself.

Chronic pain occurs due to changes in the nervous system, which make it more sensitive.

Whilst too deep a topic to cover in a short section, the most important thing to grasp about chronic pain is that the longer it has been present, the less correlation there is with tissue damage, and the more sensitive the nervous system has become.

Chronic pain is manageable, but it needs a very different approach to acute pain.


Pain can be thought of as an alarm bell. A highly sensitive alarm bell that often rings for no reason and sometimes keeps ringing despite people cutting of its power supply.

Understanding the complexity underpinning the pain experience is an important step to resolving or managing pain, and one that pays long term dividends.

This post can only touch on the basics of pain, but it is enough to give you an overview of the main components.


This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.



Burke, S.R., et al, A profile of osteopathic practice in Australia 2010-11: a cross sectional survey, BMC Musculoskeletal Disorders 2013, 14:227 [http://www.biomedcentral.com/1471-2474/14/227]

Louw, A., et al,  The effect of neuroscience education on pain, disability, anxiety and stress in chronic musculoskeletal pain, Arch Physical Med Rehabilil, 2011 Dec;92(12):2041-56 [http://www.ncbi.nlm.nih.gov/pubmed/22133255]

Melzack, R. and Katz, J. (2013), Pain. WIREs Cogn Sci, 4: 1–15. doi: 10.1002/wcs.1201