It amazes me at how many athletes don’t take their diet seriously. High school athletes are young and full of energy with the ability to heal faster. College athletes are the same way and in most cases are not provided allowance for food. Now, for professional athletes, it baffles me to read about an athlete that doesn’t have the proper nutrition… But hey, if an athlete’s made it this far in their career, then the old saying “If it ain’t broke, don’t fix it” applies. However, let’s say it(ACL) finally broke.
Does that mean now the athlete would have to fix it? Of course, and one of the methods would be to fix their diet after ACL surgery. Aside from the obvious physical therapy, the key objective when it comes to nutrition after ACL surgery is reducing inflammation of your injured knee as well as boosting your immune system.
Your shinbone connects to your knee bone. Your knee bone connects to your thighbone. Your ligaments connect these bones to each other. The anterior cruciate ligament, or ACL, runs diagonally across the middle of your knee. It provides rotational stability while preventing your shinbone from slipping out in front of your thighbone. Athletes are highly susceptible to ACL tears. Therapy involves surgical reconstruction and physical therapy. The post-operative period necessitates optimal health and dietary practices.
Tips To Make Recovery After ACL Surgery
Recovery Timeline
Recovery after ACL surgery begins in the recovery room where a nurse will monitor your vital signs and help you manage common post-operative symptoms like pain and nausea.
Once you are stable and comfortable enough to go home (which is usually around two to three hours after surgery), you will be discharged with post-operative instructions.3 A family member or a friend will need to drive you home.
For the first two weeks after surgery, your surgeon will likely suggest the following:1
- Icing your knee regularly to reduce swelling and pain.
- Using crutches to keep weight off of the leg that was operated on.
- Wearing a special post-operative brace and use a continuous passive motion (CPM) machine (based on surgeon preference).
In terms of activity restrictions, most patients can start driving two weeks after surgery. Patients can return to work within a few days to a few weeks, depending on the nature of their job. Returning to playing sports takes much longer, usually four to six months.
Physical Needs
Your body needs more than time to recover properly and well from ACL surgery. You can aid in your recovery, and the speed at which it happens, by following your doctor’s instructions fully.
Among some of the basic recommendations:
- Taking your medications as prescribed. You will be on pain medication—often a combination of local anesthetics, opioids, and nonsteroidal anti-inflammatory drugs (NSAIDs)—after surgery. Talk to your doctor about how and when to take them and any other new medications. If you stopped medications before your surgery, be sure you are clear about when to restart them.
- Ensuring proper nutrition. Eating well after surgery can help prevent complications and improve wound healing. Nutritional guidance often includes consuming lean protein (red meat, chicken, or fish) and ensuring adequate calorie intake.
- Getting ample sleep. While you sleep, your body repairs tissues and promotes healing, so be sure to get at least eight hours of quality sleep each night. It’s best to learn and follow techniques that promote sleep rather than reaching for sleeping pills.
Psychological Needs
Stress and mild anxiety are normal after experiencing an ACL injury and undergoing surgical repair. It may also be hard to be sidelined for a bit, especially if you are used to being very active or independent.
Some people, though, experience more debilitating psychological responses after surgery. They may have an exaggerated response to actual or anticipated knee pain, or they may fear re-injury to the point that they do not return to sports activities when healed.6 Patients, especially younger athletes, may experience symptoms of post-traumatic stress disorder (PTSD)—such as sleeping problems and poor concentration—after an ACL injury.
To prevent psychological factors from impacting your emotional well-being and recovery, consider these strategies:
- Talk with your surgeon and physical therapist: Recognizing and discussing potential psychological barriers (e.g., fear of pain or re-injury) is an important first step. To address these thoughts/factors, your surgeon may recommend a physical therapy approach that incorporates cognitive-behavioral techniques.
- Use relaxation techniques: Research suggests that optimism and using guided relaxation techniques (e.g., guided imagery) can promote healing after ACL surgery. Consider using audio recordings, podcasts, or a professional telehealth instructor to help keep you calm during this stressful time.
- Ask for help: after ACL surgery, you will be less mobile and will need assistance with daily chores around the house for the first two weeks. Don’t be afraid to ask for help from your friends and family during this short-lived, but challenging time. This can reduce stress on both your body and your mind.
Wound Care
You will most likely have two to three incision sites covered by a large bandage around your knee after surgery. It’s important to keep the bandage and the incision sites clean and dry.
While you can usually shower soon after ACL surgery, you will want to wrap or tape a plastic cover over your knee to keep the wound site from getting wet.
Be sure to contact your surgeon right away if you develop any symptoms or signs of an infection, such as:
- Fever
- Increased redness, swelling, or warmth around the incision site(s)
- Increased knee pain or skin tenderness
- Abnormal drainage from an incision site
Reduce Swelling
Swelling is part of the inflammatory response induced by the trauma of surgery. It causes joint stiffness and the muscles stop working. Swelling is treated with rest, ice, compression, and elevation (RICE).
Wear a compression Tubigrip sleeve on the knee for as long as the swelling persists, which may be weeks.
There is no such thing as too much ice in the early stages. Three to four 15 minute sessions a day is desirable. Excellent results can be obtained with the GameReady device used by professional sport teams. It can be hired through some physiotherapists.
Restore Full Straightening
Achieving a completely straight knee (referred to as extension) is actually the single most important thing following ACL reconstruction surgery. However, to get it out fully straight, you will need to have your pain under control and reduce the swelling. Do an extension stretch exercise repeatedly throughout the day.
If you are lying down or sitting, have the leg out straight with the heel propped on a pillow to gently force the knee straight. Remember that stretching exercises are a low load, long duration. Stretch and hold.
A knee that does not fully straighten causes a permanent limp.
To assess your progress from week to week, lie flat on the bed and attempt to put a hand under your knee. By the end of week six, there should not be enough room to slide your hand easily between the back of your knee and the bed. The knee should be fully straight by the end of week twelve at the absolute latest.
Get The Knee Bending
Difficulty with knee bending (or flexion) is much less common following ACL reconstruction surgery. It is very safe to bend the knee and the physiotherapist will have you onto the CPM machine day one after ACL surgery. The bending won’t come back without some gentle pushing on your part. Start with the drop and dangle exercise in my rehabilitation program.
Some people are apprehensive about damaging their reconstruction. This can be a mistake as it leads to inadequate rehabilitation and stiffness. The reconstruction is stronger than you think and won’t be damaged by forceful extension or bending in the early weeks.
Don’t Forget About The Kneecap
Kneecap pain (patellofemoral pain) is the scourge of ACL rehabilitation. Sometimes the kneecap is damaged with the original injury but more often than not, the kneecap pain is a secondary event because of tightness of the tissues on the outer half of the knee and weakness of the quadriceps which develops after ACL surgery. Medial patellofemoral glide stretches are a part of the early rehabilitation. It is also a good idea to do some ITB massage and if there is ITB tightness, use an ITB roller and do some regular ITB stretches.
What To Eat After ACL Surgery
Before delving into the list of foods to eat after ACL surgery, I would like to make a clear statement: Try to stick with an organic diet as opposed to processed foods and GMO’s( Genetically Modified Organism’s). Now, although these don’t create a noticeably negative affect on your body immediately, they’re detrimental to your health. These processed foods contain ingredients for a longer shelf life which hurt our bodies.
GMO’s have no benefits to your health. According to the American Academy of Environmental Medicine (AAEM), they urge doctors to prescribe non-GMO diets for all patients. They cite animal studies showing organ damage, gastrointestinal and immune system disorders, accelerated aging, and infertility. That’s just the beginning, which i’ll cover this topic in a separate post.
Post-op Nutrition
Since anesthesia and sedation impede the protective reflexes that keep your stomach contents from entering your lungs, your doctor will require you to fast before surgery. Some people come out of surgery feeling hungry, but others experience a complete loss of appetite. General anesthesia slows your metabolism, and the post-operative pain medications may cause nausea. Surgeons at Valletta Orthopaedics in San Diego suggest that patients begin with clear liquids and gradually progress their diets each day. If your stomach can tolerate them, nutritional shakes supply important nutrients without overtaxing your digestive system.
Omega-3 Fatty Acids
Controlling inflammation is an essential part of the healing process. Research scientists at Purdue University in Indiana found that omega-3 fatty acids, found in certain types of fish, assist in post-injury collagen formation and control inflammation. Fish such as herring, salmon, sardines’ mackerel, lake trout and albacore tuna are high in omega-3 fatty acids. Adding these food items to your post-operative diet has some serendipitous side benefits. The American heart Association advises that omega-3 fatty acids prevent heart disease, and specialists at the University of Maryland Medical Center state that they also prevent mood swings and depression.
The four- to six-month period of post-surgical reduced activity impedes cardiovascular fitness, and previously active patients may suffer from depression resulting from lack of exercise. Adding fish to your diet may minimize depression as well as the loss of benefits associated with aerobic exercise.
Antioxidants
Nutrients and enzymes called antioxidants combat the substances that cause tissue damage. After ACL surgery, pro-inflammatory molecules called cytokines induce muscle dysfunction, causing muscle atrophy. The antioxidants vitamin C and vitamin E modulate the activity of these cykotines. Researchers at the Linus Pauling Institute speculated that since leg strength is associated with vitamin C content in the bloodstream, vitamin C and vitamin E supplementation may hasten the healing process by reducing inflammation and promoting strength. They gave one group of ACL surgery patients 400 IU of vitamin E and 1,000 mg of vitamin C.
The other group received a placebo. After three months, the antioxidant group showed greater strength gains than the placebo group. While these results sound encouraging, physicians are of mixed minds about the use of supplementation. Valletta, for example, warns that supplements after ACL surgery may upset your stomach. Citrus fruits are rich in vitamin C, and wheat germ and grains have large amounts of vitamin E.
Vitamin E – Helps minimize oxidative stress and inflammation of your knee after surgery which helps for greater strength gains of the muscles around your knee.
What to Eat – Tofu, Spinach, Almonds, roasted sun flower seeds, avocados, fish ( rainbow trout), olive oils, broccoli.
Vitamin C – When you consume both vitamin E and C, they work together as a team almost immediately to help minimize the inflammation and increase strength in your knee following ACL surgery. According to the Linus Pauling Institute( Micronutrient Research for Optimum Health), greater gains in leg strength after ACL surgery were associated with higher plasma vitamin C levels…suggesting that vitamin C aids muscle strength recovery from ACL surgery.
What To Eat After ACL Surgery – Fruits, vegetables – broccoli, bell peppers, cauliflower, and berries.
Vitamin A– Speeds the product of collagen, which is a vital protein in your ACL, meniscus and other ligaments and tendons.
What To Eat After ACL Surgery – Sweet potato, carrots, kale, squash, romaine lettuce, prunes, dried apricots, Cantaloupe melon, sweet red peppers, blue fin tuna, mango.
Zinc– Helps maintain a strong immune system.
What To Eat After ACL Surgery- Seafood (oysters), spinach, chia seeds, flaxseed, nuts ( almonds, pecans), chicken.
Flavonoids – Help to reduce swelling by protecting cells from oxygen damage, blood vessels from rupture or leakage, and enhancing the power of your vitamin C.
What To Eat After ACL Surgery- Apples,blueberries, strawberries, tomatoes, onions, cabbage, black beans.
Fiber – Helps your body the important nutrients previously mentioned by allowing fluid motion through your digestive tract in order to optimize the benefits you will gain from said nutrients.
What To Eat After ACL Surgery- Caulifower, broccoli, cabbage, berries (raspberries), leafy greens (romaine lettuc, spinach), celery, squash, kidney beans, white mushrooms, oranges.
Weight Control
Weight gain is inevitable if you continue your training diet in the post-surgical period, according to the American Dietetic Association. The added weight puts additional strain on your knee. Fortunately, within about four weeks, your physical therapist increases the intensity of your rehabilitation sessions, so you start burning more calories. Pedaling on a bicycle to regain range of motion and walking on a treadmill to monitor your gait are two important aspects of ACL rehabilitation. Increase your caloric intake only after your activity level increases.
The American Dietetic Association recommends eating foods with low fat but high nutrient content. Spinach, turnips and mangoes are rich in vitamin A, important for cell growth. Baked potatoes, cabbage, tomatoes and cantaloupe offer non-citrus alternatives for vitamin C. Seafood and almonds have a high zinc content, which aids in wound healing.
