Nutrition for injured athletes in soccer

Sports Nutrition
Sports Nutrition

Nutrition – injured soccer players

Injuries are an unfortunate aspect of physical activity – regardless of the level of participation. An injury may strike any individual from those exercising for health and enjoyment up to the elite athlete. Injuries usually occur when the athlete is engaged in training or competition for their sport. Activities such as running, sprinting, jumping and kicking increase the physical demands placed on the body above that at rest and thus acutely increase the risk of injury.

The incidence of outdoor soccer injuries is among the highest of all sports, particularly for adult male players. An elite soccer team with 25 players in the squad can expect about 40-50 injuries each season. Half of the injuries will be minor, causing absences of less than a week, but as many as six or seven will be severe injuries causing absences of more than four weeks. The incidence has been described to be around 24.6 and 34.8 per 1,000 match hours, and 5.8 to 7.6 per 1,000 training hours.

Almost one-third of all injuries in professional soccer are muscle injuries. The majority (92%) of injuries affect the four major muscle groups of the lower limbs: hamstrings, adductors, quadriceps and calf muscles. A team of 25 players at elite level can expect about 15 muscle injuries each season with approximately two weeks missed for each injury.

Muscle injuries represent almost one-third of all injuries in football. Strategies involving hydration, diet, sleep and cold water immersion have been reported to be effective with regard to their ability to counteract the mechanisms associated with muscular fatigue.

Recovery strategies – aimed at reducing acute inflammation from muscle damage and speeding the rate of inflammation removal are prevalent in professional soccer settings. Sleep and other methods for recovery are also important.

Body composition must be assessed at the time of injury, specifically, total BM, lean mass and fat mass. Changes in body composition during injury typically involve increased body fat and decreased lean mass from an early stage. These changes are not always reflected in BM, as BM may increase, decrease or stay relatively constant depending on the ratio of lean and fat mass change.

Body composition is important for elite soccer players. The body fat percentage for professional soccer players has been reported to be 10.6 ± 2.1%.

Body composition varies during preseason – a general decrease in abdominal fat mass and increased lean mass in the legs are generally observed. Conversely, during a long period of injury an overall decrease in lean mass is noted, with more marked changes in muscle atrophy and fat deposition in the injured region or segment.

The energy intake of the athlete should match the daily energy demands. For example, the energy cost of soccer is approximately 1300-1500 kcal for a 90’ game, depending upon playing position, tactics and body composition of the player – the amount of energy required may be adjusted to reflect the lean body mass (in kg) of the individual athlete.

An insufficient energy intake does not cover energy required for performance, training and daily living activities.

It has been reported that energy intakes below 30-35 kcal/kg lean body mass accentuate fatigue, immune-suppression and the predisposition to injury. Furthermore, low-energy diets in which calories are not consumed via a variety of foods typically have low nutritional quality.

Insufficient energy intakes combined with poor dietary choices increase the risk of players being deficient in nutrients such as vitamins B or C and minerals like Iron, Calcium, Magnesium, Zinc and Selenium. Interestingly, inadequate plasma vitamin D concentrations have been observed during the winter months in top-level soccer players.

Low vitamin D may affect bone metabolism and has been associated with alterations in strength and muscle components. Therefore, vitamin D status may be a consideration in injury prevention.

Unfavourable lipid profiles due to excesses in the diet of trans-fat, saturated fat and excessive Omega-6 fat from vegetable oils should be avoided. Instead, players are encouraged to regularly eat foods, such as oily llsh, for a source of Omega-3.

Some scientists reported that the injury rate increases according to hours of soccer exposure. However, the risk of injury is significantly increased when games overlap training with less than 72 hours between them. In this circumstance, it is necessary to emphasize optimal nutritional recovery strategies. Specifically, the restoration of muscle glycogen after exercise can be achieved by ingesting approximately 60 g of carbohydrates per hour during the first 2-3 hours.

Protein intake is recommended immediately post exercise (0.3 g/kg BM, -20-25 g), together with appropriate volumes of fluid to rehydrate.

Some studies suggest the use of nutritional anti-inflammatory aids such as the flavonoids quercetin or melatonin.

Nutritional interventions should be coordinated with the different phases of the recovery process to optimize the healing process. From this point of view, injury can be classified in two distinct phases: the immobilisation phase and the functional recovery phase.

During these phases muscle wasting and atrophy are commonly observed. Therefore, the main objectives are reducing inflammation and increasing anabolic stimuli.

Leucine – is an essential amino acid found in greater amounts in proteins of high biological value (whey protein). The ingestion of three grams of leucine, isolated or contained in protein, is capable of activating MPS (muscle protein synthesis)  in muscle resistant to insulin.

Food also offers a good source of leucine – for example: 3g of leucine can be found in 25-30g of whey protein, 140g of chicken or 170g of fish.

The catabolite of leucine, beta-hydroxy beta-methylbutyrate ingested at three grams per day, has also been reported to be an effective supplement in the activation of MPS. Finally, the ingestion of four grams/day of Omega-3 fatty acids may act synergistically with leucine, increasing protein synthesis.

Functional recovery phase:

This phase is characterized by progressive hypertrophy and functional recovery. In long-term injuries this phase can be subdivided into regeneration, functional recovery and reconditioning:

  • Regeneration phase – in this phase the exercise workout is focused on non-injured muscle groups. General guidelines include adjusting calories to lean mass and controlling carbohydrate intake, choosing low GI (Glycemic Index) foods such as vegetables and legumes. Protein intake is prioritized after exercise (20-25 g/ serving). Interestingly, this phase may benefit from creatine supplementation. Creatine has been suggested to help with the recovery of muscle mass after immobilization when supplemented individuals are compared to non- supplemented individuals. An easy way to achieve this is to incorporate creatine into any protein drinks that the player is ingesting at the time.
  • Functional Recovery – this phase involves a progressive return of the athlete to their field of play. The greater energy expenditure, as training volume and intensity increases, requires an increase in daily carbohydrate intake to about 3-5 g of carbohydrate/ kg BM. Appropriately formulated carbohydrate sports beverages are typically ingested during and after exercise, to help meet player fuel and fluid. After exercise, recommendations for protein are maintained.
  • Reconditioning (Alternative Training Phase) – in this phase previous recommendations, in line with optimal nutrition practice for the player, should be adapted to ensure, and help support, full recovery.


  • Demands placed upon professional athletes are growing because of increased fixture schedules with less recovery periods between training and competitive match play, resulting in an increased risk of injury.
  • Appropriate nutrition should be used during exercise to avoid fatigue.
  • Recovery strategies are commonly used in an attempt to regain performance faster and reduce the risk of injury.
  • The assessment of body composition is important for elite athletes, while abdominal fat is a good predictor of musculoskeletal injury and can be used as a monitoring tool during recovery of musculoskeletal injury.
  • Nutrition is among the key recovery strategies in professional sport and interventions for recovery should focus on adequate energy intake to meet the macro and micronutrient needs via foods or appropriate supplementation.
  • During injury, MPS is reduced by inactivity and, as a result, the muscle should be stimulated, in concert with the ingestion of suitable quantities of protein with high biological value.

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