How to Heal (from chronic or acute injury)

When I first began working with clients years ago, it didn’t take long until I realized one of the most common requests I would forevermore be receiving (along with desire for energy and performance) was help to overcome various injuries. Most runners appear to believe that injury is part of the game – if you run, you will get injured at some point. And don’t be surprised if it happens regularly – as in probably every year or even more often. These are most often chronic injuries, sometimes called “overuse” injuries (although I dislike the term “overuse injury” as I feel it distracts from the true cause of injury).

However, I do understand because I once also held that mindset. From 2002 to 2011, I sustained injury after injury, some putting me out of the game for months at a time. It all began with shin splints, then Runners Knee, and then ITB syndrome, and then that weird “who-knows-what-this-is” hip thing that put me out for 6 months. Later, more ITB, and then Achilles tendonitis, then there was that knee thing (more an acute injury because it started when I fell on the root that sticking up too far out of the ground – you know how it goes…), and finally plantar fasciitis. But so be it, this was all normal – as confirmed by various coaches, physiotherapists and doctors I had over the years.

When I began ‘eating 2 run’ in January 2012 I had a bad head cold and was just coming off plantar fasciitis. Four months later, in great health and completely injury-free, I crossed the finish line of BMO Marathon over 25 minutes faster than I’d ever run any of my previous 9 marathons. The rest is history. I started Eat 2 Run Sports Nutrition shortly thereafter and have had the absolute pleasure of helping hundreds of runners find their own way back from injury.

Chronic Injury

The above listed injuries I suffered from were all mostly chronic in nature, those which tend to creep up slowly on you until one day you realize there’s just too much pain to run through. Chronic injuries often include stress fractures (of the pelvis, femur, tibia, fibula, metatarsals or other foot bones); sacroiliac (SI) joint dysfunction; hip labral tears; facet joint syndrome; hamstring, quad or calf strains; various knee injuries (patellofemoral pain syndrome [aka runner’s knee], ITB friction syndrome, patella tendonitis); Achilles tendonitis; Achilles bursitis; tibialis posterior tendonitis; Plantar fasciitis and Morton’s neuroma, to name only a few (I actually personally developed Morton’s neuroma in May of 2017, and it haunted me up until only a few months ago – despite best intentions, following my own advice hasn’t always happened over the years).

In most of these scenarios, the body cannot keep up with the repair process required after training sessions and slowly breaks down (we can help the body keep up by ensuring optimal nutrition and rest). Biomechanical and strength issues can also be at play, typically aggravated by excess inflammation.

Acute Injury

Then there’s acute injuries – a broken bone, a sprained ankle, a sprained rib, a torn hamstring, quad or calf. Whereas chronic injuries develop slowly over time, an acute injury happens in a split second. Last January (2018), I was out for a Sunday long run, and only 7km in, I slipped on wet stairs. Within a fraction of a second I managed to land so awkwardly that my tendon pulled off a piece of bone and I effectively fractured my 5th metatarsal (in other words, I broke my foot). Years ago, November 2014, I sprained a rib in a split second during a gym workout. Nearly all runners have rolled an ankle at some point (I know I have multiple times).

The point is, acute injuries happen in a split second and you can clearly point to the cause, whereas figuring out the cause of chronic injuries can feel frustrating because there isn’t a single event that clearly led to the injury (it’s more a slow degeneration, as mentioned above).

Inflammation

Inflammation is the bodies biological response of the immune system to a number of different factors, including chronic and acute injury. It causes pain (thanks to the release of chemicals and compression of nerves in the area) and swelling. The edema (medical term for swelling) is thanks to blood and other fluids that collect around the damaged area. Running injuries can also often involve swelling of a joint, called effusion – fluid inside the joint capsule (due to torn ligaments or cartilages or broken bones) or hemarthrosis, bleeding into a joint space, which occurs in serious injuries such as ACL tears or broken bones.

Unfortunately, while inflammation and swelling are completely normal and protective mechanisms, the body often goes overboard with an excessive inflammatory response. This can potentially lead to more damage than actual healing, not to mention rigid muscle tissues which are now more susceptible to further injury. Therefore, one of the key things we can do to help heal as fast as possible is to help our bodies manage the inflammatory process. We do NOT want to extinguish all inflammation (such as NSAID’s do) because some inflammation is required for healing to take place. In fact, NSAIDs (such as Advil) have actually been shown to delay bone healing and damage the gut lining (inducing intestinal permeability and negatively altering gut bacteria, which sets us up for a wide variety of compromising health conditions). If NSAIDs are utilized in injury, usage is best restricted to the first 24-48 hours after an acute injury.

What we want to do is MODULATE the inflammation – that is, bring it down to levels where healing is able to occur as fast as possible. And therein lies the beauty of anti-inflammatory foods. Instead of extinguishing inflammation like NSAIDs do, these foods simply help to adjust and regulate the bodies innate inflammatory response so that it is more helpful to healing. It’s important to acknowledge that there are also foods that cause additional excess inflammation and must be eliminated (or at the very least, greatly reduced) for fastest healing possible. Lastly, there are certain macro and micro nutrients required when it comes to healing, as your body requires extra ‘tools’ to build and strengthen the damaged muscle/ligament/bone/nerves (depending on your injury).

Healing

What I’ve found to be true over the years is that we can absolutely quite effectively help our body to completely heal from either acute or chronic injury with an anti-inflammatory healing nutritional protocol, of which I want to share with you here today. Injuries can happen to bones (complete breaks / fractures or “stress fractures”), joints & ligaments (sprains), tendons (inflammation or degeneration), muscles (strains, pulls, tears) and nerves (inflammation or damage resulting from another injury). The healing of all these injuries stand to be greatly expedited by implementing the three strategies outlined below.

1. Eat as many anti-inflammatory foods as often as possible on a daily basis. These include:

• Turmeric (fresh or powdered) – contains over 2 dozen phytonutrients including curcumin, the strongest and most studied component shown to reduce oxidative damage sustained during exercise as well as assist in healing from inflammatory conditions. While turmeric is the most anti-inflammatory spice, ginger and cinnamon are also highly useful.
• Leafy Greens – quite simply, leafy greens are by far the most nutrient-dense food available (that is, they contain the most vitamins, minerals and phytonutrients per calorie).
• Matcha (green tea powder) – contains EGCG’s, catechins unique to green tea known to powerfully reduce inflammation, boosting recovery, preventing inflammatory conditions and building immunity.
• Cacao (raw cacao powder or nibs, 85-90% or darker dark chocolate) – rich in flavonoids that studies show can help us run faster, improve brain health and strengthen the cardiovascular system. Plus, it’s a great source of iron and magnesium – two very important minerals for runners.
• Omega-3 fatty acids are also highly anti-inflammatory however they are often utilized through supplementation of algal/algae oil or fish oil for best anti-inflammatory results. You can get ALA (unconverted form of omega-3s) from hemp hearts, chia seeds and flax seeds; and EPA/DHA (useable form of omega-3s) from cold water wild fish such as salmon and sardines.
• Tart Cherries (100% pure tart cherry juice or tart cherry juice concentrate, dried tart cherries or frozen tart cherries) – contain phytonutrients including anthocyanins and ellagic acid that studies repeatedly show help runners to recover faster and feel less sore, as well as perform better during the run. While tart cherries are most potent, all berries contain various anti-inflammatory properties.

2. Eliminate inflammatory foods. These include: 

• Processed cooking oils – such as canola oil, soy oil, corn oil, sunflower seed oil, safflower seed oil. Choose only extra-virgin oils from monounsaturated sources, such as olive oil and avocado oil; as well as organic coconut oil and grass fed butter or ghee.
• Sugar – as in, pretty much every sweetener you can think of. Use only tiny amounts of maple syrup, honey or blackstrap molasses. Avoid all the rest, including artificial sweeteners, which negatively alter gut bacteria thereby disrupting the very centre of optimal health.
• Processed grains – such as bread (all types, gluten containing or not), pastas, crackers, cookies, muffins, pastries and donuts to name a few. Aside from the fact these items are all nutrient-poor (they do not contain many vitamins, mineral and phytonutrients per calorie), these products commonly also contain inflammatory oils and/or sugars. Additionally the starchy carbs that processed grains are can easily be absorbed and processed inappropriately in metabolically inefficient individuals (yes even if they are “whole grain”), spiking blood sugar levels, which is – you guessed it – inflammatory.
• Alcohol – ethanol is essentially a poison to all parts of the body, and while yes it has appeared in some contexts/studies to exert some positive health effects in some people, the detrimental impact of alcohol consumption on tissue repair has been long known in the medical community. And one of the latest studies to come out concluded even moderate consumption lowers lifespan. But importantly here, in the context of injury, studies show that alcohol disrupts basic signalling in the bodies healing processes and that it delays healing. The alcohol appears to interact with the damaged tissue and slows recovery. When we are talking about athletes – particularly injured athletes, there’s no question about it – alcohol is best avoided for fast and optimal recovery.
• Foods you have a sensitivity / intolerance to – I’ve had clients with sensitivities to just about every single food out there. And while ultimately the health of the gastrointestinal system must be addressed to hopefully overcome most if not all food sensitivities, when we are looking to heal the fact of the matter is that all inflammatory foods are best avoided. Any food that one is sensitive to causes the body to react with an inappropriate inflammatory response, therefore must be avoided. Most common culprits are gluten (found in wheat, rye, spelt, kamut, barley, muesli, couscous, einkorn, freekeh, gnocchi) and dairy (milk, cheese, yogurt).

3. Eat enough protein, healthy fats and vegetables.

• Protein – amino acids are building blocks for virtually all cells and tissues. When we are healing from soft tissue or bone/tendon injury, we simply must be consuming enough protein, between 1-1.5 grams per kg of bodyweight – but certainly up to 2 grams per kg of bodyweight daily is not too much. When building your menu, calculating the amount of protein required is one of the first things that needs to be done – and the menu built accordingly. Fill up the majority of protein requirements with whole food sources (such as grass fed wild meats, poultry and fish, eggs, nuts and seeds, lentils and beans), and if required round it out with a scoop of high quality whey protein or plant-based protein.
• Healthy Fats – fatty acids from quality sources are essential to building healthy cells (every single cell in our body contains fat in the membrane – without a healthy cell membrane, the rest of the cell can’t function properly), required in order to allow our body to use the fat-soluble vitamins A, D, E and K. Fats are also required to make hormones (structural components), which regulate many of the body’s functions. It’s hard to recover well and grow stronger without a healthy hormonal system. Choose from nuts and seeds (and their butters), avocado, coconut, olives (and their virgin oils), grass fed butter, dark chocolate and full fat grass fed dairy if tolerated.
• Vegetables – your body requires all sorts of vitamins and minerals to heal properly (such as vitamin D and calcium among many more), but to simplify matters I’ve found that ensuring a wide variety of enough leafy greens and veggies with each meal covers off any nutrient not received via the protein or healthy fats. Look to get 6 or more cups of leafy greens daily (Green Smoothies, Big Salads, greens in soups and soups, and so on) as well as 2-3 additional veggies with each lunch and each dinner. Bonus if you get veggies with breakfast too!

It’s also very important to get ENOUGH calories while in healing mode. Healing requires extra calories and all too often I see athletes using time injured to also reduce caloric intake in hopes of loosing excess body fat (since they can’t workout, might as well focus on weight loss – ultimately an unhelpful mindset). When determining how much to eat, healing requires extra calories – so adding 10-20% to the required number (determined by Mifflin-St Jeor formula multiplied by daily energy expenditure) will give you an approximate starting point.

I know it is entirely possible to design a meal plan that encompasses all of the above in a thoroughly delicious and enjoyable manner. I know this, because I do so on a regular basis with really great feedback (from clients) and also because I personally went through a complete dietary revamp last year after breaking my foot. While there’s always more to learn, I’ve come out the other side of my broken foot injury with greater health and strength than ever before (so much so, I’ve decided to run a 200 miler this September!).

Additionally, and most amazingly, after over 1.5 years of suffering from Morton’s neuroma (remedied only through wearing shoes with a very wide toe box – TOPO’s, which allow the toes to splay), I can now wear any shoe I want with zero Morton’s neuroma pain. I’m still in awe. The human body is amazing – it always wants to heal. If given the right tools, it does appear to do just that. I believe ditching all alcohol back in November was what flipped the switch for my Morton’s (although interestingly my intake previous to that was very conservatively moderate)… But I digress.

Supplements

While I prefer to focus on using whole foods to manage inflammation, simply due to effectiveness, there are a few key supplements that I’ve found nicely round out the above dietary measures (but please let me be clear – they probably won’t appear to do much of anything if used instead of the aforementioned strategies – they are to be used alongside the above dietary suggestions). They are as follows:

• Curcumin (a strongly anti-inflammatory polyphenol): for all injuries.
• Omega-3s EPA/DHA, in liquid form (essential fatty acids – our body cannot make these, we must obtain them from food or supplements): for all injuries (algal oil or fish oil).
• Natural egg membrane (naturally occurring glycosaminoglycans and proteins essential for maintaining healthy joint and connective tissues): specifically for joint issues.
• Silicon as Choline-stabilized orthosilicic acid (triggers the production of collagen in the body): specifically for bone breaks or stress fractures.
• Collagen (a non-essential amino acid that provides strength and structure to tissues such as bone, tendons, skin, hair and nails): specifically for bone or tendon injuries (bovine grass fed sourced) – although getting collagen from food sources is just as good if not better, and Bone Broth is the best food source.
• Vitamin D3/K2 (more info here).

Other Inflammatory Factors 

I’d be remiss if I didn’t also mention that I’ve seen in clients (and even personally experienced) a complete adherence to the above three dietary strategies plus supplements, yet frustratingly little progress is made. That is a clear indication that excess inflammation is coming from a non-nutritional stressor). Other areas that can cause excess inflammation and must be addressed are as follows:

• Inadequate sleep: 7-9 hours of restful sleep is required by all adults each night – this is crucial for the body to heal. Not getting enough sleep is extremely stressful to the body.
• Inadequate stress management: any job, life, family, career, school, financial or other major life stress has the potential to initiate an inappropriate inflammatory response. Ultimately, you feel in control of your life and live in a proactive manner instead of a reactive one.
• Negative mindset / emotions: life can be hard and can feel particularly rough in times of injury. However, wallowing in despair does little to help you heal faster (I totally tried this last year for a month – ya no, it didn’t work). In fact, studies now show us that negative emotions cause a cascade of stress hormones to flow through the body non-stop, and that causes a lot of unchecked inflammation – of which you now know to be highly detrimental to the healing process.

Being injured and unable to run is certainly not a place any of us runners ever wants to find ourselves in – I understand that deeply having just gone through it myself. And while I strongly believe that our nutritional strategy can fend off many probable injuries by building a strong and healthy body, ultimately none of us is superhuman and chances are we will all encounter an injury or two in our lifetime. The good news is that there’s a high probability that healing will occur much faster than ‘normal standards’ simply by following the anti-inflammatory nutritional protocol above.

I can say with certainty that if you break a bone in January, you can still run your fastest 100 miler to date in October – only 9 months later 😉

To deliciously healthy food and stronger faster running… Cheers,

Sarah Cuff, R.H.N.
Holistic Sports Nutritionist
Founder Eat 2 Run Sports Nutrition
CSNN Sports Nutrition Instructor

*Please note: the above information does not replace the advice of your doctor or sports therapist and should be individualized to suit your personal requirements as well as used in conjunction with appropriate medical care, physiotherapist exercises and/or any other care required.