Connectivity of injuries

If you ask any hardcore scientist whether we can reduce the chance of injuries and improve injury rehab outcomes by eating better, they would probably just review the literature and respond with a conclusive ‘no’.

Within the confines of modern double-blind placebo-controlled scientific trials, to prove that by repetitively eating a certain food we can impact our musculoskeletal integrity, can be incredibly difficult, which is why not many sport scientists or sports medics are thinking that way.

However, if we, as my mother would say, use a bit of ‘applied common sense’, the musculoskeletal implications of a healthy diet are blooming obvious. To start with, we should note that connective tissue forms the basis of the fascia, tendons, ligaments, cartilage and bone, plus the structure that binds muscles together. When we then view what connective tissue is made up of, the nutritional importance becomes more obvious. The matrix of connective tissue is made of collagen fibres, elastin fibres, fluid, migrating immune cells, stem cells and carbohydrates called ‘GAGs’ (glycosaminoglycans). Connective tissue is therefore not a mechanical device that simply becomes overloaded by excessive strains placed upon it - it is a living, breathing system that runs throughout the body in complex matrices, as described by Thomas Myers in Anatomy Trains.

To sharpen our focus in this short blog, let’s discuss collagen in more detail.

Collagen is the structural unit of connective tissue and is the most abundant protein in the animal world, constituting more than 30 per cent of the total protein of the human body. It is found in muscles, tendons, ligaments, skin, bone, cartilage, blood vessels, and the gut. Nutritionally, it is made out of the amino acids proline, glycine and lysine, and it is widely known that vitamin C is vital for the cross-linking of collagen fibres. Deficiency of vitamin C can result in distorted, non-functional accumulation of scar tissue.

Recent genetics research into the collagen 1A1 and 5A1 genes has revealed that some individuals are more susceptible to tendon and ligament injuries due to the make-up of their collagen. This information should be used to inform training and prehabilitation (rehabilitation before the injury happens) strategies, but it should also be an added incentive to be more choosy about nutrition choices.

For collagen health, well-absorbed dietary proteins are extremely important - as noted, the amino acids proline, lysine and glycine are required. This is yet another reason why athletes should ensure a sufficient intake of protein in their diet; it is also notable to mention that digestion and absorption are incredibly important here, so issues of hypochloridia (low stomach acidity) may have musculoskeletal consequences. Additionally, nitric oxide, which requires the amino acid arginine for synthesis, is important for blood flow and collagen synthesis. Nitric oxide is normally up-regulated following injury, but if inhibited for some reason, tendon healing has been shown to be reduced. Modern beetroot juice research should also be considered because beetroot, along with many other common vegetables, has been shown to be high in nitrates and therefore beneficial for purposes of vasodilation and blood flow through rehabilitating tissues.

As noted, vitamin C is needed for the structural strength of collagen and has consequently been used to treat many collagen disorders. Vitamin C, along with vitamin E and other antioxidants, is also essential to buffer the consequences of oxidative stress, which is likely to be prevalent during injury. Foods high in vitamin C include bell peppers, broccoli, papaya, strawberries, pineapple, kiwi fruit and citrus fruit.

If you enjoy your smoothies, hydrolysed collagen is a useful addition, and research interests have intensified in recent years. A poster presentation at the 2017 South African Sports Medicine Association conference revealed that oral supplementation of a particular hydrolysed collagen product may accelerate the clinical benefits of a well-structured calf strengthening programme in patients with chronic Achilles tendinopathy symptoms.

And to close, I’m going to mention a food that Rachel and I enjoy bringing into our winter soups, stews and curries - stock or bone broth. Rachel wrote an excellent article on this subject in FSN magazine last year, so you can Click here to read further on this incredibly interesting topic. 

With regard to nutrition and musculoskeletal health, what I haven’t expanded on is inflammation and oxidative stress, both processes integral to training, recovery and injury, and which have well-proven links to our food choices. Let’s therefore embrace our food when it comes to injury and recovery.

This blog is an extract of Ian’s longer article ‘The connectivity of injuries’, previously published in Total Sports Nutrition. Click here to see the full article. 

This blog also forms a preview of some of the material covered in the Musculoskeletal lecture in Module 1 of the Certificate of Integrative Sports Nutrition course