Research has shown that, following a knee replacement, muscle loss is about 1% per day in adults > 65 years old, with decreases up to 18% in the quads/ hamstrings after just 6 weeks. And in healthy young men, total thigh muscle volume can decrease by 5.5%(0.66 lb) after 7 days of disuse. Good nutrition can help combat this loss and help rehab work more efficiently and effectively after surgery.
HOW MUCH DO YOU NEED?
Needs can vary based on the complexity and invasiveness of your surgery, as well as your nutrition and fitness status prior to surgery, but this can give you an estimate.
Calories: dependent on weight, height, age, activity level, and severity of injury/surgery
• injuries and surgeries increase energy needs as much as light to moderate exercise 6-7 days per week does, so intake should not decrease drastically from sport to rehab
• A general estimate is 16-20 kcal per pound of bodyweight
Protein: 2.0-3.0 grams per kg bodyweight
Carbs: 3.0-5.0 grams per kg bodyweight
• About 55% of total calories- - more than this can lead to high blood sugar, which
reduces healing and immune function
• A high carb diet reduces muscle loss
compared to a high fat diet due to carbs protein-sparing effect
Fat: 0.8-2.0 grams per kg bodyweight
• Important for would healing
• 2 grams per day of monounsaturated fat,
and 10 grams per day of polyunsaturated
Fiber: dependent on age, sex, and GI conditions, but in general, aiming for 25-38 grams per day is helpful for bowel health
• Too little and too much fiber can both increase constipation symptoms
Fluids: 64 oz per day, or an amount that keeps urine a light yellow color throughout the day and first thing in the morning
IMPORTANT CONSIDERATIONS:
Calorie needs are high even though physical activity decreases The body requires a significant amount of calories to heal from surgeries and rebuild stronger tissues during rehab. The increased stress hormones and surgery-related insulin resistance makes it harder for the body to use all of the calories you eat, which can raise calorie needs even further.
Getting adequate protein can help improve recovery time
Our body requires a certain amount of calories and protein to maintain and grow muscle. After surgery, muscle loss will happen due to increased stress and demand on our body's energy reserves. This muscle loss can be minimized fi you provide your body with enough protein, though, and this can improve recovery from surgery.
Add calorie-dense foods if you experience loss of appetite
Loss of appetite is common after surgery due to medication and decreased activity levels. When this happens, try to eat small, frequent meals with calorie dense foods such as those high in fat
(oil, avocado, nuts, seeds, nut butter), full fat dairy (cheeses, milk, cream, protein powders, meal replacement drinks, eggs), and carbs like potatoes, granola, dried fruit, refried beans, hummus, &crackers.
Try bland foods and frequent, small meals if you have nausea
Nausea can be a side effect from medications and can make it hard to get enough to eat. In these cases, try to eat bland foods such as Greek yogurt, potatoes, applesauce, bananas, white bread, protein drinks, crackers, oatmeal, rice, pudding, milk, and bone broth.
Use fiber, fluids, and supplements to help reduce constipation
Pain medication can cause constipation after surgery, which can be uncomfortable and make it harder to eat. Getting adequate fiber and fluids, and/or adding supplements like psyllium or kefir can help relieve constipation symptoms.
Add supplements to help decrease muscle loss
Getting adequate protein and calories from food is the most important step for reducing muscle loss, but adding supplements like essential amino acids ( E A s ) , creatine monohydrate, HMB, and
omega-3 fatty acids can help even further. These supplements can also improve our body's ability to build muscle.
GENERAL TIPS:
Eat soon after surgery a n d get enough protein in for the remainder of the day)
Energy stores are low after surgery due to the required fasting from food and the high levels of stress on the body. Getting food, especially high protein food, soon after surgery can reduce the stress on the body and improve recovery.
Space your protein intake throughout the day
Research has shown that evenly distributing protein intake
throughout the day (about 0.3 grams of protein per kg of bodyweight every 2-3 hours) can maximize muscle growth a n d minimize muscle loss.
Have a snack/meal before and after physical therapy
Your body needs extra energy to perform all of the exercises in rehab. The more energy it has ready access to, the more work you can do, and the faster recovery will go. Quick carbs work best before exercise. After rehab, your body needs energy to recover and repair muscle tissue, so having a snack or meal high in carbs and protein within 2 hours will help you recover more efficiently and effectively.
Include plenty of fruits and vegetables each day
Fruits and vegetables provide antioxidants, vitamins, minerals, a n d other nutrients that reduce inflammation, improve energy levels, & increase efficiency of body functions.
Drink fluids after eating (not before)
Fluids can increase feelings of fullness even when they're not providing much nutrition. Because energy needs are so high during recovery from surgery, it's best to eat until full and then to drink fluids. This helps you to avoid underfueling.
About 7-10 days after surgery, start to increase intake of anti-inflammatory foods
Inflammation is a helpful process early on after a trauma like surgery or a n injury. It protects the injured tissue and brings important cells to help with healing. Because of this, you shouldn't focus on eating a diet high in anti-inflammatory foods right after surgery. After 7-10 days, this inflammation is less helpful, so adding in anti-inflammatory foods like those high in omega-3s and antioxidants can be beneficial.
SUPPLEMENTS:
Can be rapidly absorbed and used by muscle. Note, these are different than branched-chain amino acids (BCAAs) Research has shown that taking 20 grams of E A s twice daily during post-op rehab helped reduce loss of leg muscle. You can get the most benefit from E A s when taking them before exercise (or physical therapy).
Creatine is stored in muscle and provides energy to muscle. It can help to better maintain muscle and strength during immobilization, improve muscle recovery from exercise, a n d increase muscle size. After a surgery/injury ,it's recommended to take four, 5 gram doses each day for 5 days, and then a single 3-5 gram dose every day following that.
HMB (beta-hydroxy-beta-methylbutyrate)
Can potentially increase repair rates of muscle and tendon and reduce muscle loss, specifically during high stress periods and immobilization (e.g. injury s u r g e r y . Recommended intake is 2doses of 15. grams per day(3.0 grams total).
Probiotics/Prebiotics
Improving the gut microbiome can help make stools easier to pass while still taking pain medications. It also can strengthen our immune system and improve both protein µnutrient absorption in the gut. Look for supplements containing .L acidophilus and B. longum. Store them in the refrigerator and take them on an empty stomach.
Omega-3 fatty acids help to decrease inflammation in the body. If using a supplement, make sure that it contains DHA and EPA, and don't start taking it until 7-10 days after surgery.
Beetroot Juice
Beetroot increases blood flow, decreases inflammation, and can improve muscle strength and endurance. Recommended d o s a g e is 70-140ml taken a few hours before physical therapy exercises. Adding beetroot juice after exercise can also help decrease soreness. Dosage can go up to 250ml when used
for this purpose.
Plays a role in bone and immune health, as well as muscle function. Inflammation causes levels to decrease, so after an injury or surgery, deficiency is common. Ensuring levels are adequate can help improve strength recovery.
Vitamin A
Improves wound healing by helping new skin cells to form and collagen to be laid down. Also acts as an antioxidant to decrease inflammation. Ex- sweet potato, pumpkin/ squash, carrots, spinach.
Vitamin E
Can reduce muscle breakdown, decrease inflammation, and improve immune system function. Ex- sunflower seeds, almonds, apricot, avocado, spinach
Maintains and builds collagen and helps improve healing.
NUTRITION AROUND PT
This eating pattern is helpful for the entire duration of PT, but is most important during the first 6-12 weeks after injury or surgery when tissue stress is ongoing.
Meal ( 3 - 4 hours Pre-pT):
• Complex Carbohydrates: 50-100 grams
• whole grains, vegetables, whole fruit • Protein: 30-50 grams
• Fat: 15-20 grams
Snack (15-45 min Pre-PI):
• Quick Carbohydrates: 30 grams
o fruit, cereal, white bread/rice, jam, crackers, granola, potato, tortilla
• Whey / Essential Amino Acids: 25 g r a m s
• Creatine Monohydrate: 5-10 grams
• HMB: 1.5 grams
• EPA/DHA supplement: 2-3 g r a m s
Snack OR Meal (<30 min Pre-PT):
• Whey / Essential Amino Acids: 25 g r a m s
• Creatine Monohydrate: 5-10 grams
• HMB: 1.5 grams
PROTEIN DISTRIBUTION
How to evenly distribute protein throughout the day to maximize muscle growth and minimize muscle loss (example: 180 grams protein/ day):
• Breakfast: 30 grams of protein
• Morning Snack: 20 g r a m s of protein
• Lunch: 30 grams of protein
• Pre-Rehab Exercises: 25 grams of whey or
EAAs (+ carbs, creatine, HMB, and EPA/DHA)
• Post-Rehab Exercises: 25 grams of whey or
EAAs (+ carbs, creatine, and HMB)
• Dinner: 30 grams of protein
• Evening Snack: 20 grams of protein
