At the last ISEH Masterclass on the 12 June attendees were treated to some insights from the ISEH's Clinical and Sports Dietitian Rick Miller into supporting the management of their orthopaedic trauma clients with nutritional strategies that could enhance their recovery:

"What is clear from my experiences is that recovery from orthopaedic trauma is a ‘chicken and the egg’ scenario.

Nutrition is fundamental to the recovery process and poor nutrition can lengthen the duration of recovery grossly and the recovery processes places demands on the body in terms of nutrient reserve. Whilst there is much information available, many sports people - both novice and elite - don’t have access to reliable and scientifically sound nutrition advice from a professional.

As a consequence they often rely on their peers, coaches or other healthcare professionals, the advice is not personalised and therefore poorly complied with. Poor compliance leads to ill informed nutrition choices and thus the recovery process is prolonged.

In the session I talked about the 4 key areas that nutrition can influence in recovery from orthopaedic trauma:

Supply - Dietary nitrates from spinach, cocoa flavonoids and the amino acid supplement L-arginine can increase blood flow to tissues, particularly those with a poor circulatory capacity such as the tendons and ligaments.

Demand - Nutrition plans should emphasise the intake of protein from high quality (animal derived) sources and fed at regular intervals to maximise protein synthesis. The other core micronutrients: Vitamin D, calcium, Vitamin B12, Phosphorus, Zinc and Magnesium - these statuses are not all easily assessed by biochemical assay - due to their principle reserves not being in the serum. Therefore detailed appraisal of the athletes nutrition choices is pivotal to making a judgement on whether to supplement or simply make more informed food choices. Attention to other wider conditions that could affect nutrient absorption - such as inflammatory bowel disease, coeliac disease or other functional bowel disorders are key in ensuring compliance.

Stimulation - As much as early mobility can stimulate the recovery process, nutrition can too expedite recovery through nutrient selection. Early research suggests the combination of vitamin C and proteins rich in proline and lysine (such as gelatine) can enhance protein synthesis in tendons and cartilage, characterised by low vascular flow. Whilst the provision of magnesium, vitamin D, calcium and vitamin K can enhance bone remodelling.

Inflammation - Whilst inflammation management is an intrinsic part of the treatment process, chronic use of non-steroidal anti-inflammatory drugs can lead to poor fracture healing (1)  and are not without side-effects, particularly gastrointestinal. Whilst the evidence base is growing, some nutrients have been shown to have a profound effect on modulation of the inflammatory cascade such as: omega-3-fatty acids(2), ginger(3) and turmeric(4).

Nutrition has a key role to play in enhancing the recovery of the client suffering from orthopaedic trauma. Whilst fundamental advice given at bedside to the clients may be sufficient in some groups but for the majority, personalised nutrition must start to take a front seat to management."

For upcoming ISEH masterclasses please see our events calendar.

For Nutrition and Dietetic referrals, please contact the ISEH on 020 3447 2800.

References
1. Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of femoral diaphysis: the influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg. 2000;82B:655-658

2. Hankenson et al. 2000 Omega-3 fatty acids enhance ligament fibroblast collagen formation in association with changes in interleukin-6 production Proc Soc Exp Biol Med 223(1):88-95

3. Rondanelli et al. 2017 The effect and safety of highly standardized Ginger (Zingiber officinale) and Echinacea (Echinacea angustifolia) extract supplementation on inflammation and chronic pain in NSAIDs poor responders. A pilot study in subjects with knee arthrosis. Nat Prod Res (11):1309-1313

4. Belcaro et al. 2010 Efficacy and safety of Meriva®, a curcumin-phosphatidylcholine complex, during extended administration in osteoarthritis patients Altern Med Rev 15(4):337-44