Dietary supplements are widely used to enhance performance and body composition during training programs.

Clinical experience tells us that as soon as someone gets injured, they immediately stop taking any form of supplementation [1].

Most people think that the use of these performance-enhancing supplements is not required after they are injured. They believe that the benefits of using supplements won’t occur until they are totally recovered from their injury and back to their normal training program.

The intent of this article is to highlight the potential of supplements after injury so trainers can better advise their clients in the use of supplements during the rehabilitative phase.

We will look specifically at the use of two supplements, whey protein and creatine, in regard to their promise during the rehab phase of training after sustaining a musculoskeletal injury.

Protein supplementation during musculoskeletal rehab

Typically, musculoskeletal injury occurs due to a deficiency of muscles and tendons. As such, rehabilitation focuses on the prescription of exercise to facilitate synthesis and maturation of newly constructed muscle tissue.

It should go without saying that not having enough protein in the rehab phase may delay regeneration of muscle tissue.

For example, a muscle injury caused by a strain or tear involves destruction of muscle tissue cells, followed by resynthesis and production of new muscle tissue cells. We know the consumption of protein and amino acids enhances muscle protein synthesis (build new muscle proteins) and is apparent in both younger and older skeletal muscles [2].

Therefore, rehabbing an injury should include rest, rehabilitation and nutrition.

This ensures that the formation of new muscle cells are optimized and a positive protein balance occurs, allowing effective muscle tissue repair [3].

Injured? There are benefits from keeping up your protein supplementation during rehab

Preliminary evidence shows that appropriate protein supplementation during rehabilitation training delivers better results. In a nutshell, this means a greater degree of muscle synthesis and strength [4].

It’s important to note that these improvements resulted from the use of carbohydrate with the high amount of protein. This likely provides sufficient insulin to enhance the protein synthesis process [5] and is why the combination of nutrients may be more effective than protein on its own [6].

The recommended intake of 20-25 g of whey protein after exercise [7] is also the amount warranted in the rehabilitation period, post injury, to sustain positive net protein balance supportive of rehabilitative exercise.[8]

It’s important to note that without adequate protein, exercise of healing muscle tissue will most likely lead to a negative net protein balance, thus causing a decrement in tissue repair. [9] In simple terms- you won’t be recovering from your injury. Read more about protein for rehab here Protein for faster recovery

Creatine supplementation during musculoskeletal rehab

The benefits of creatine supplementation in a healthy population undertaking resistance training are clear and well documented in the scientific literature. These benefits include improvements in muscle size and strength [10], increases in anabolic hormones, a reduction in catabolic hormones [11], and improvements in physical performance and body composition [12].

In comparison there isn’t as much research regarding creatine’s potential during musculoskeletal rehab.

Benefits of creatine during rehab

Most research available utilizing creatine during rehabilitation used an immobilization protocol on subjects. This means that they were not able to utilize a part of their body (e.g. legs, arms) during the experiment.

This research showed that a group of immobilized subjects consuming creatine had a 10% increase in a glucose transport protein found primarily in striated muscle (skeletal and cardiac). The group without creatine had a further reduction of 10% in this glucose transport protein [13]. Read more about Creatine for Type 2 diabetes

The study concluded that using creatine supplements both increased the level of this protein in muscle tissue during rehab and prevented further reductions. These results indicated creatine use during rehabilitation can enhance the muscle tissue’s ability to create energy efficiently, and may prevent muscle fatigue.

This means that the use of creatine during rehab will enhance the muscle’s ability to make ATP. ATP is basically the energy currency that our muscle cells use to contract and do work. In addition, creatine use will prevent muscle fatigue when exercising due to this enhanced energy efficiency in muscle cells.

Another study immobilized subjects for 2 weeks and followed this with a 10-week exercise rehabilitation program supplemented by either creatine or placebo (carbohydrate) [14]. Results showed that during the immobilization period; both groups saw an equal detriment to muscle size and strength. What was interesting is that the creatine group showed a more rapid recovery in both muscle size and strength during the rehabilitation phase.

Although there isn’t as much evidence available in this population; the research available indicates the benefits for beginning or continuing a cycle of creatine and protein supplementation during a period of immobility post injury and through the rehabilitation phase.

Take home points

• A common misconception is thinking that because exercise intensity is not “high enough” during rehabilitation that supplements provide no benefit.

• The current evidence demonstrates that utilizing protein and creatine supplementation enhances the recovery process during rehabilitation from musculoskeletal injury.

• It’s clear that the physical state of soft tissue (muscle and tendon) in times of injury and immobility is deficient for muscle tissue repair and development.

• Preliminary evidence suggests protein and creatine supplementation counteracts these deficits in muscle tissue repair and improves synthesis of new muscle proteins.

• Looking at the bigger picture instead of just the intensity of rehab training sessions tells us that continuing supplementation is in our best interest. Trainers should use this as an opportunity to discuss continuing supplementation regimes during the rehabilitation period.

• I recommend that the creatine cycling strategy recommended by Dr. Cribb be utilized during a post injury rehabilitation period.

You can find the most up to date scientific information on these and other supplements in the MP Level 1 Metabolic Nutrition On-line Certification.

Dr. Paul Henning is leading scientist at the Military Performance Division, United States Army Research Institute of Environmental Medicine. Paul's an avid bodybuilder, lives the MP lifestyle and is a proud member of the MP Team.  To read more from Dr Henning click here

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