Sports Physical Therapy and Nutrition

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Sports Nutrition

One of the hottest terms in the last decade: sports nutrition. Ask any exercise scientists, personal trainer, or athletic trainer, and they will say that sports nutrition has become a booming topic of interest and a huge market. Physios may be behind the curve a bit on this topic, so we thought we'd offer a nice review of sports nutrition specific to sports physical therapy practice.

For PTs, the 3 main areas of sports nutrition we should be focused on would include:

1. Recovery
2. Immunonutrition
3. Performance enhancement

Let's dive into each of these and see what PTs need to consider from a dietary perspective.

Recovery

Helping athletes rehabilitate after an injury is an important role of a sports physio -- but what about recovering from resistance training, practice, or competition? Recovering from training and competition can translate into athletes gaining more strength, playing better, and maybe even preventing injuries. PTs can help their athletes gain an edge in recovery with simple dietary changes.

Many authors and athletes alike cite the 3Rs after training; a time when rehydration, refueling (carbohydrate), and repair (3R) takes major priority.

• Rehydration protocols vary depending on the length of the event, the intensity of the exercise, and the specific athlete. Weighing in/out can help a PT guide an athlete in the best rehydration.
• Refueling carbohydrates is low hanging fruit. No seriously, fruit is likely the best carbohydrate refueling food for athletes. It's rich in carbs, good in fiber, and chock full of antioxidants, which may also help with repair. Exercise, especially resistance training, induces micro-tearing and minute inflammation, which is normal and good. However, if such damage and inflammation is unabated, it can mean more pain, reduced performance, or even injury. Fruit is likely the best functional food to help with repairing tissues, with cherries, citrus, watermelon, and berries standing out as the best.

We extensively cover the research and dosing of such fruits to optimize recovering from delayed onset muscle soreness (DOMs) and training in our third course, Specialized Nutrition for PTs (SNP).  Let's move onto the next subject: keeping athletes from getting sick!

Immunonutrition

When athletes train and compete at high volumes and intensity their immune system can become compromised. With a drop in immune system function, athletes are more prone to catch upper respiratory infections and other issues. Fortunately, nutrition can help to mitigate this drop in immune function and keep athletes training, a topic known as immunonutrition.

Several dietary factors can help improve an athlete's immunonutrition, and they are:

1. Maintaining hydration. Saliva and mucous membranes contain defensins, which help to combat infection. When a person is dehydrated these defensins cannot function as well.
2. Consume fruit! Study after study has highlighted how consuming berries, cherries, and other fruits rich in Vitamin C can help reduce infections like colds, coughs, and sinus problems.
3. Consume protein-rich foods spread throughout the day. Studies show that spreading protein-rich foods throughout the day, and especially right after training or competition, can help athletes maintain lean muscle mass. Keeping lean muscle mass on an athlete helps to mitigate a catabolic state, which can depress the immune system. Protein-rich foods does not mean meat; in fact, consuming plant-based sources of protein can be just as effective as animal-sources of protein!
4. Maintain carbohydrate status. Long competitions and training bouts can deplete glycogen stores and stress the immune system. Repleting carb stores should be done during training and competition and most definitely immediately after exercise.
5. Supplements. From probiotics to colostrum, a wide range of supplements offer conflicting data on boosting an athlete's immune system. We dive into this debate further in our online continuing education courses for rehabilitation professionals and PTs.

Let's move on to our last section, which is a major topic in any locker room or sidelines!

Performance Enhancement

Most athletes are looking for an edge in training and competition. They often seek the guidance of the team strength coach, personal trainer, head coach, or other fellow athletes. Some of these team members may pass-along how certain nutrients, supplements or other foods can help boost performance. This information can be evidenced-based, but often it may be just a fad or obtained from poorly researched sources like social media or the internet. A sports PT can help clear the air and provide excellent patient education when he or she is well-informed on dietary performance enhancement. 

We cover an extensive supplement and dietary review of the evidence for performance enhancement in our 3rd course; to cover the entire content here would take consider space and times. Let's outline some highlights of this data:

1. Similar to the immunonutrition data, protein consumption is important to enhancing performance. Probably the premiere article for performance enhancement and protein would be the Schoenfeld et al meta-analysis on protein timing post-workout. This article refuted the need for "timing" protein to optimize muscle mass or strength. It appears that consumption of 5-6 meals/snacks with at least 20 grams of protein showed promising results for many athletes wishing to gain lean muscle mass and strength. 
2. Training under varying amounts of carbohydrate availability may help athletes push through difficult bouts of competition. The exact methods of "training low" vs "training high" depends on the athlete and the sport.
3. Two "supplements" that stand out within the literature are caffeine and creatine monohydrate. Caffeine can help reaction times, boost power performance, and increase weight lifted. Caffeine can be ingested as a pill, gum, or beverage, such as tea or coffee, which may other positive health benefits. Creatine monohydrate also shows very promising data: it can boost power output in athletes, increasing sprint time and weight lifted. Adding this supplement into an athlete's regime is fairly cheap and has minimal side effects
4. Functional foods are another hot topic for athletes. Nitrates in beets, arugula, and fennel have been shown to increase nitric oxide compounds in the body. Such compounds can promote vasodilation and improve perfusion of muscle tissues; increasing the blood flow is likely why athletes that use these functional foods have better endurance, sprint velocities, and lower fatigue rates.

Conclusion

Understanding functional foods, supplements, and solid sports nutrition can help sports physical therapists better help their athletes recover and perform. From boost their immune system after a hard competition to recovering from training session, sports physios have a role in educating their athletes and also knowing when to refer an athlete to a sport dietician or team physician. 

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!

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Learn about the Top 5 Functional Foods to Fight Inflammation and Pain in Physical Therapy. 

Keywords: nutrition, diet, continuing education, sports, online, athlete, SCS, PT, physical therapy, learning, physio, athletic training, rehab

Disclaimer: The above article is written as opinion piece and does not convey specific legal, medical, and/or practice act advice.