August 1, Nutrition. Physical Muscle preservation for injury recovery inmury and after immobility can help patients restore muscle strength. Prsservation Diagnostic Imaging All-natural weight loss Doctors Forms Hospital Affiliations Coverage Make a Payment Contact OrthoCare ASAP. Google Scholar Frankenfield D. Cookies configuration. Foods rich in omega-3 fatty acids, nitric acid, collagen, and vitamin C may help improve healing while strengthening the damaged tissues. Get essential fatty acids.

Muscle preservation for injury recovery -

The article selection process was given by the title analysis, which should contain the two MeSH search terms, then the selection of articles by abstract reading and complete reading of relevant papers according to the following eligibility criteria.

The selection criteria for articles were 1 literary reviews and clinical trials, 2 reviews and original research made in the last 25 years — , 3 written in English, Spanish, or Portuguese, and 4 including muscle injury or related to high performance athletes, any sports discipline, or immobilized patient healthy men or women after an ambulatory, immobilization process, or bed rest in injury situation.

Figure 1 shows the search methodology and selection of articles for each DeCS and MeSh term with the total number of articles analyzed for this review. A sport injury requires a particular nutritional intake, according to the degree of immobilization, the decrease in physical activity, and the degree of muscle mass loss, its strength and function [ 14 ].

In this sense, it is crucial to keep in mind the recovery stages of the muscle injury and how the nutritional process can determine the times of regeneration and return to the sports activity. These stages are classified as destruction-inflammation, repair, and remodeling phase [ 4 , 7 , 8 , 15 ].

At first, there is an inflammatory response through the first 4 to 6 days, which is modulated by inflammatory mediators like cytokines and growth factors transforming growth factor TGF , platelet-derived growth factor PDGF , vascular endothelial growth factor VEGF , epidermal growth factor, and fibroblast growth factor FGF that allows a vasodilatation and the migration of immune system cells e.

This inflammation continues several days, depending on the severity, and it is an important step for the healing process [ 16 ]. In this initial phase of the muscle injury, there is a reduction of the physical activity or complete immobilization, which is mandatory and beneficial for two purposes, the speed of the recovery as well as it fosters a most complete recovery; after this process it is recommended the active rehabilitation [ 7 ].

The proliferation phase starts around the fourth day and 2 weeks after the injury and it consists in the formation of new capillaries through the production of nitric oxide NO via endothelial NO synthase in response to hypoxia, causing vasodilation and increased blood flow to the site of injury [ 8 ], in the case of the muscle occurs with proliferation and differentiation of satellite cells and generation of new myofibers to replace those that were injured [ 15 ].

The remodeling or maturation phase usually begins 1 week after the injury and can continue for 1 year or more. In that case, fibronectin is the initial component in the extracellular matrix that forms a preliminary fibrous scar during this phase of wound healing. This formed scar has two key functions: as a template for collagen deposition and as a platform for cell migration and cell growth [ 17 ].

In the muscle, the maturation of the regenerating myofibers includes formation of a mature contractile apparatus and attachment of the ends of the regenerated myofibers to the intervening scar by newly formed myotendinous junction [ 7 ].

According to all physiological stages of the recovery process, the proliferative stage is important in the increase of collagen matrix and fibroblast synthesis; moreover, in the remodeling stage the increase in the production of collagen type II [ 14 ], both could determine the energy consumption that must be considered to avoid caloric restrictions which are frequent in this type of situation.

The energy expenditure depends on the degree of inflammatory response, more than the extent of tissue injury, which is the determinant of hypermetabolism [ 17 ].

In a study made in nine healthy volunteers, it was assessed the changes in the lean body mass LBM and the Leucine rate of appearance protein synthesis in 14 days under different physical activity levels, ambulatory and bed rest conditions, subjects received an eucaloric diet and a hypocaloric diet [ 18 ].

In the results, it was found than resting energy expenditure REE relative to LBM did not differ significantly between the ambulatory and bed rest conditions during the eucaloric and hypocaloric diet [ 18 ]. Hypocaloric nutrition led to the greatest wasting of LBM in bed rest conditions; however, in the ambulatory group the same nutrition allowed a significantly higher leucine deposition rates within the total body protein protein synthesis.

The negative energy balance conditions can lead to a rapid loss of LBM and that such catabolic effects can be prevented, at least in the short term, through a moderate level of physical activity [ 18 ]. Another research from Biolo G et al. in made in 19 healthy men, different physical inactivity conditions and energy intake were evaluated: at first ambulatory adaptation condition all subjects with the same energy intake and after 5 weeks of bed rest, under high energy balance HEB and lower energy balance LEB.

As a result of this, the HEB and muscle atrophy were associated with the activation of systemic inflammatory response and antioxidant defenses in stress conditions; for example, in the increase of glutathione synthesis, myeloperoxidase concentrations, significant changes glutamate-cysteine ligase enzyme and the rate of glutathione turnover [ 19 ].

In relation to body composition, most of the subjects who gained more body fat mass especially in the HEB group suffered the greatest loss of skeletal muscle and body free mass. Exceeding caloric intake above the calorie recommendations that athletes normally consume may have negative effects on body composition increase in fat mass due to reduced physical activity without any benefit in physiological responses to a sports injury.

Main nutritional recommendations related to energy consumption, protein, antioxidants, and probiotics in sports muscle injuries. The periods of immobilization following a muscle injury, especially at week one and two, the rate of muscle protein synthesis decreases if the 10 days of disuse are exceeded with a small or no contribution in muscle catabolism [ 20 ].

However, some research also suggests that reduced mobility decreases the sensitivity of skeletal muscle to anabolic properties of amino acids [ 20 ].

Within the anabolic resistance, there is a cascade of metabolic reactions, including an interaction between the reactive oxygen species produced by the immobilization and the signaling pathways of IGF-1, the latter pathway is inhibited by the high reactive oxygen species ROS production to insulin resistance [ 21 ].

A positive balance in protein consumption is necessary for the repair of muscle damage produced by exercise [ 22 ]. The same happens when there is an injury that implies a reduction of physical activity of the athlete, but in this opportunity the protein consumption must be according to the reduction of the fasting synthesis rate [ 9 ] and the reduction of muscle protein synthesis in response to protein intake [ 20 ], due to the reduction of the ability of myofibrillar proteins to respond to amino acids in immobilization [ 23 ].

In that sense, in 12 healthy young men in 14 days of knee immobilization were measured the protein synthesis after protein intake before and after a period of disuse the immobilization period led a significant decrease to an 8. Beyond these results, in the context of sports performance, it should be kept in mind that the level of physical activity is important to maintain a normal response in postprandial protein synthesis at muscle level and that it will also change according to age [ 24 ], in the case of high-performance athletes, although there is no evidence of anabolic resistance in lesions, it is clear that the adaptations induced by physical activity play a major role in delaying or reducing the effects of anabolic resistance to the consumption of protein.

Due to the above several studies document the different degrees of muscular atrophy by disuse depending many times on the duration of the injury or the immobilization phase, it has been shown that in 1 week of immobilization in 10 healthy young males in energy balance, there is a reduction of muscle mass in 3.

A significant increase in angiogenic markets like HIF-1α protein expression was observed following bed rest but without changes in skeletal muscle capillary density, measured by immunohistochemistry [ 25 ]. Based on the concepts above, nutritional strategies that could be used during immobilization and recovery to overcome this anabolic resistance, should be given from two main approaches: the first is to provide more anabolic factors and improve amino acid availability, i.

Regarding the recommendation of protein consumption during the period of muscle disuse, it should be taken into consideration that in healthy adults the muscle tissue responds to a dose of protein of 20 to 25 g, which maximizes the response of muscle protein synthesis MPS in both fasting and exercised muscle [ 16 ].

When there is a sports injury situation with immobilization or reduced physical activity, it is likely that the amount of protein in each dose needed to stimulate MPS increases. About this, the currently International Society of Sport Nutrition ISSN position stand establish, according to reviews about protein intake and timing in exercise that an ingestion of a protein dose of 20—40 g 0.

In a research made in 19 middle age healthy adults to response to leucine LEU and placebo supplementation CON , all subjects passed over two process, at first an ambulatory phase 1—4 days both groups with the same diet and without supplementation and then the bed rest 14 days.

Although these are short-term effects, because the leucine effects on lean mass are only during the first 7 days of the 14 days protocol, in the final 7 days the rate of loss of lean mass in the LEU group was similar to that in the CON group [ 29 ].

Participants in the whey protein group had significantly greater improvements in knee extension strength in the operated limb and non-operated limb compared with the control group and improvement in functional activities of daily life [ 30 ].

Whey protein supplementation can be essential for the maintenance of muscle strength during a period of postoperative immobilization along with an active rehabilitation process, it can also mitigate the increase of physiological markers of muscle damage such as creatine kinase CK and lactate dehydrogenase LDH [ 31 ], and contribute to the recovery of the skeletal muscle after exercise and injury.

According to the intake recommendations in injured athletes, it should mitigate muscle loss during a period of negative protein balance [ 16 ], so the recommendation should be 1.

The recommendations of protein intake from the International Society of Sport Nutrition ISSN position stand, 1. In agreement with the last Position in Nutrition and Athletic Performance from Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine, in cases of energy restriction or reduction of physical activity as it happens as a result of an injury, the increased protein intake of up to 2.

This recommendation could be used in the nutritional approach of the injured athlete without the need to provide less or more protein than this recovery process implies, still there is no evidence or clinical trial related to athletes male or female in any sports disciplines or according the type of injury and the physiological specificities of the recovery process.

Sport-related damages and injuries favor free radicals and ROS production and other inflammatory molecules [ 35 ]. Under normal physiological conditions, the endogenous antioxidant defense can remove or neutralize these detrimental molecules.

Oxidative stress, produced when there is an imbalance between free radicals and the endogenous antioxidant defense, can cause lipid peroxidation, DNA damage, and activation of stress-sensitive signaling pathways, which contribute to inflammation maintenance, symptoms of injury e.

In the case of athletes who were immobilized or with reduced physical activity of a specific limb due to sport-related injuries, oxidative stress contributes to muscle atrophy by increasing the expression of components of the proteasome proteolytic system.

For instance, ROS can activate a group of proteases, known as caspases, that degrade proteins and it may trigger apoptosis [ 38 , 39 ]. In order to attenuate oxidative stress and their consequences abovementioned, the intake of antioxidant nutrients has been considered as a concern by athletes [ 16 ].

Some micronutrients, such as vitamins A β-carotene , C ascorbic acid , and E α-tocopherol , trace minerals as zinc, copper, manganese, selenium, and plant-derived polyphenols are known as antioxidant nutrients that play an important role on redox balance along with the endogenous antioxidant defense [ 37 ].

They act by preventing ROS and free radicals formation, and behave as scavengers or proton donors in order to regenerate or repair oxidative damages Powers et al. Besides that, vitamin C is important for recycling the α-tocopherol from oxidative reactions.

Vitamin E, as well as polyphenols and β-carotene, has an important role in the conversion of ROS and free radicals to less reactive forms, at cellular membrane, contributing to restrain lipid peroxidation.

In addition, the minerals act as co-factors of the superoxide dismutase SOD and glutathione peroxidase GPX , two important enzymes from the endogenous antioxidant defense [ 37 ].

Studies that demonstrated positive outcomes after antioxidants supplementation were mostly performed in sedentary, physically active individuals or elderly people after acute exercise [ 41 , 42 , 43 , 44 ].

Thus, if athletes do not present nutritional deficiencies, antioxidant supplementation may favor oxidative reactions and blunt important pathways for positive exercise adaptations, recovery, and wound healing [ 45 , 46 , 47 ].

For instance, a mixture of antioxidants supplementation mg of vitamin C, mg of α-tocopherol, 30 mg of β-carotene, 2 mg of lutein, mμg of selenium, 30 mg of zinc, and mg of magnesium did not offer protection against exercise-induced lipid peroxidation and inflammation, which may hinder muscle recovery in athletes [ 48 ].

Also, vitamin A supplementation decreased anti-inflammatory interleukin IL and heat shock protein 70 expression [ 49 ]. A meta-analysis did not find a significant protection against either exercise-induced lipid peroxidation or muscle damage after vitamin E supplementation [ 53 ].

Likewise, polyphenol-rich plant supplements have small effects in increasing antioxidant capacity, but countermeasure effects on exercise-induced oxidative stress and inflammation [ 54 ].

A majority of studies have supported that antioxidant supplementation does not enhance antioxidant capacity in non-nutritional deficient athletes [ 45 , 55 , 56 , 57 , 58 , 59 ]; however, a critical approach is necessary for athletes who have undergone sport-related injuries.

On the other hand, athletes that have received nutritional intervention via food intake have shown higher levels of total antioxidant capacity and endogenous antioxidant activity SOD and GPX compared to the ones who do not follow this intervention [ 60 ].

Also, the Mediterranean diet, characterized by high consumption of monounsaturated fatty acids from olives, fruits, vegetables, and whole grains, low consumption of red meat and moderate use of red wine can enhance antioxidant defenses and improves the lipid oxidation [ 62 , 63 ].

Pingitore et al. Omega 3 fatty acid n-3FA has also been considered in the context of nutritional support for sport-related injuries due to its anti-inflammatory and immunomodulatory properties [ 10 ].

For instance, omega 3 fatty acid supplementation has also shown capable of attenuate oxidative biomarkers in athletes who had undergone knee surgery [ 64 ]. Fish oil intake could play a role in the amelioration of muscle loss with disuse favoring protein synthesis response in both young and older adults [ 65 , 66 ].

Nevertheless, other studies have found high fish oil consumption may play an inhibitory role on muscle mass recovery [ 67 ] and wound healing [ 8 ]. Cold-water dwelling fish e. In addition, some micronutrients are important in various aspects of wound healing, including muscle disuse.

For example, calcium and vitamin D are essential for bone shaping whereas vitamin C is necessary for collagen formation [ 16 ]. Vitamin A contributes to collagen synthesis and may revert the corticosteroids-induced inhibition in wound healing [ 8 ].

Furthermore, ubiquinone, also known as coenzyme Q10 CoQ10 , plays an important role as an essential electron carrier in the mitochondrial respiratory chain. As mentioned previously, careful consideration of the use of antioxidants and anti-inflammatory nutrients supplementation is necessary given the importance of the ROS-mediated physiological signaling and inflammatory response for positive adaptations and wound healing [ 70 ].

Studies have demonstrated that athletes, without micronutrients deficiency, present a higher total antioxidant capacity, increased antioxidant enzymes activity SOD and GPX , and higher plasma levels of ascorbic acid vitamin C and α-tocopherol vitamin E compared to sedentary individuals [ 71 , 72 ].

Indeed, antioxidant nutrients are important for antioxidant defense system, exercise recovery, and sports performance; however, the appropriate dose of nutrients consumption for injured athletes has not been established, and the individual nutritional status and oxidative biomarker levels have to be considered before supplementation recommendation [ 73 , 74 ].

For this, researchers have suggested that food intake within the Recommended Dietary Allowance RDA recommendations [ 75 ] seems to be a safer source of antioxidants and n-3FA balanced and varied meals as well as fruit and vegetables , and it can guarantee an optimal antioxidant status. Moreover, natural foods can also confer multiple biological effects due to its nutritional composition [ 45 , 46 , 47 ].

Probiotics are defined as live microorganisms that confer a health benefit on the host when administered in adequate amounts [ 76 ], currently in the sports science, the probiotics elements are recommended accounting their benefits related to health status of athlete [ 77 , 78 ].

The supplementation with probiotics has been investigated in several endurance sports, like running, cycling, and swimming, in individual sports tennis, karate or alpinism , and in team games rugby and football [ 79 ].

Though the number of studies in thematic be limited, and the evidence mass be related to use of probiotics linked to upper respiratory infection and symptoms [ 80 ], recently some articles target the possible link between probiotics use muscle damage and repair [ 11 , 12 , 13 ].

Although some authors propose a fast effect in muscle repair from probiotic use, these evidence refers to resistance training and in addition to other nutritional supplements that have direct influence in the protein synthesis e.

It is known that probiotics are capable to interact with gut associated lymphoid tissue GALT immune cells improving the efficiency response and the intestinal permeability parameters.

It is possible that by indirect way probiotics can contribute to muscle repair process, via immune cells activity neutrophils and macrophages number and function , lowering the time spent with repairing process. However, from a scientific perspective, studies in experimental models with purpose to investigate the action of probiotics in muscle tissue are required to confirm this hypothesis, after these clinical studies are recommended to investigate the applicability of the results.

In an event of injury involving immobilization and reduction of physical activity, it is important to avoid the anabolic resistance of muscle and the increase of the reactive species of nitrogen and oxygen, producing the proteolysis of the skeletal muscle.

In accordance with the above, the recommendation of protein intake in the injured athlete should be adjusted from 1. The injured athlete must maintain a balanced diet with an adequate supply of antioxidants and anti-inflammatory compounds, the consumption of the Recommended Dietary Allowance RDA or the Adequate Intake AI , through food high consumption of fruits, vegetables, and both animal and vegetal sources of omega 3 fatty acids could improve the inflammatory response, which is a normal response within the process of recovery of injured tissue.

It is necessary to carry out clinical studies with injured athletes and determine directly how the consumption of nutrients and elements such as probiotics can influence the recovery processes of injured athletes, according to the literature there is little research in this area of sports nutrition.

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Sports injury and illness incidence in the Rio de Janeiro Olympic Summer Games: a prospective study of 11 athletes from countries. Br J Sport Med. Bengtsson H, Ekstrand J, Hägglund M.

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J Physiol. Head for the bench and carve your torso instead. Hitting the weak muscle hard at this stage risks undoing all that work, so stay off the 1RM attempts for a while and start training the offending body part as gently as you can.

While some muscle wastage will be inevitable, keeping it light promises an easy road to recovery. By: Matt Evans: Photography: Getty;.

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The remaining volunteers received either blood flow restriction alone, or in combination with muscle stimulation twice a day, five days a week. The researchers discovered that the combination of blood flow restriction and muscle stimulus preserved muscle mass more effectively compared to both the control group and blood flow restriction alone.

Although the technique did not prevent a loss of muscle strength, the results offer an exciting development in the field of injury rehabilitation.

In fact, the lab is working on a patent for an apparatus that would allow physiotherapists to easily treat their patients using blood flow restriction and muscle stimulation together. Burr and his team are eager to examine the use of blood flow restriction and muscle stimulation in other applications as well, such as diabetes management.

Burr hopes to demonstrate that the approach can help lower high blood sugar in diabetics with reduced mobility, by mimicking the effects of light exercise. In the meantime, Burr is busy fielding calls from the likes of the Toronto Raptors, the Toronto Maple Leafs, and even an English Premier League soccer team.

This study was funded by the Natural Sciences and Engineering Research Council and the Canada Foundation for Innovation.

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