Nutrition for tendon & ligament repair

Evidence based nutrition strategies to help support the preparation for and recovery from surgery
Learning Outcomes
• Background and context of the injury
• Pre-operation and literature
• Creatine
• Strength and nutrition working together
• Operation time
• Road to recovery
• Nutrition literature
• Importance of recovery
• 8 weeks post op
• Case study from rugby
• Cross education?
• Cost for supplements
background
HOW did the injury happen?
ACUTE PHASE CHRONIC PHASE (10 MONTHS)

• Game of football on 4g grass with moulded studs • Initially, was not aware of the damage so I carried on with life
• This was followed by a workout in the gym at work • Would train, swelling would occur, would rest and let it go down
• Part of the workout was a set of pull ups which I completed. On the • Start to train again which included:
final set, drop to the ground ready to run over to the Watt Bike.
• Running
• POP
• Strength
• Injury sustained but I was not aware of the damage caused
• Golf
• Skiing, snowboarding
• At 10 months post-op, I decided to get a MRI scan done
• FULL ACL RUPTURE AND MENISCUS TEAR CONFIRMED
FULL ACL RUPTURE AND MENISCUS TEAR
PRE-OPERATION
THINGS TO CONSIDER BEFORE THE OPERATION DATE
What literature is there?
Creatine

A double-blind trial was performed in young healthy volunteers (n=22). A

cast was used to immobilize the right leg for 2 weeks. Thereafter the

subjects participated in a knee-extension rehabilitation programme (3

sessions week−1, 10 weeks). Half of the subjects received creatine

monohydrate (CR; from 20 g down to 5 g daily), whilst the others

ingested placebo (P; maltodextrin).

STRENGTH AND NUTRITION
• BIG FOCUS ON CARDIO TO IMPROVE BODY COMPOSITION
• BIG FOCUS ON HYPERTROPHY OF LEGS
• DAY BEFORE THE OPERATION – GVT, RDL, BACK SQUAT, DEADLIFTS
Operation time
PREPERATION OF OVERNIGHT ‘CARE PACKAGE’
IN THE HOSPITAL
• Arrive nil by mouth, including fluids 4 hours prior to the op
• Nutrition X Hydration tablets
• Nutrition X Protein bars
• Nutrition X Repair Shots
• Enhanced Recovery Sports Drink
• Hand Wash
• Creatine
• Fish Oils
Pre-Op Post-Op
THE ROAD TO RECOVERY
CHALLENGE ACCEPTED
ACUTE stages
15

Immobilisation
Major changes after 6 h:

- Lack of muscle use to reduced protein synthesis

- Initiates process of muscle atrophy

First week: Strength loss of 3-4 % per day

- Reduced size (atrophy)

- Neuromuscular activity (most loss coming from
-
physical atrophy)
Reversible effects on type 1 and type 2 fibres

- Cross-sectional area , cell contents degenerate

- Type 2 is affected more than type 1 Streaming z disks
REHAB STAGES
56.5 cm 51.5 cm

4 WEEKS POST
NUTRITION STRATEGY
WHAT DATA DID I HAVE?
• Previous DXA scans
• Previous RMR measurements
• If no RMR then Cunningham equation
• RMR + 500-750 ish kcal
• Individual nutrition plan written
ANY PREVIOUS LITERATURE?
ANY PREVIOUS LITERATURE?
5.1 kg 5.8 kg 0.7 kg
How things then changed!
How things then changed!
Leg DXA Results
ANOTHER POTENTIAL MECHANISM?
AN EXAMPLE FROM RUGBY PLAYERS
POST-MATCH RECOVERY
ITS VERY IMPORTANT FOR RECOVERY
• we have shown that if CHO is not optimally ingested in the first hour post-exercise, muscle
glycogen is not fully restored 48 hours later despite a high CHO diet (Bradley et al., 2017)

• The suggested CHO intake is to have approximately 1g.kg-1 per hour for 3 hours post exercise,
i.e. for a 90 kg player they would need 90g immediately post game, then a further 90g at 1 hour
and 2 hours post game.
Recent data on professional rugby players in the English Premiership

Suggests that the physical collisions associated with rugby match play increase the requirement for CHO in the hours and days after a match

Av. increase in RMR after match play

of ~231 kcal·d at GD + 1, a 10% increase
from GD − 1.

The range of increased RMR was large, with individual

responses between 240 and 1000 kcal.

The greatest increases in RMR were seen in the forwards,

who underwent more physical collisions during a game at
the scrum, maul, and tackle area versus backs
WHAT DID I DO?
• 20g of creatine for the first 7 days, 5g maintenance 7 days
onwards
• High protein 3g/kg/bw, moderate carbohydrate intake 2
g/kg/bw approx.
• High intake of fruit and vegetable – rainbow a day
• Protein every 2-3 hours – alarm set
• Game ready every 2 hours – alarm set
• 4,000 IU Vit D3
• Nutrition X Repair Shot – 3 x per day CASEIN PROTEIN EXAMPLES
• Enhance Recovery Sports Drink 1 x per day
• Health Span Elite 40 Winks 1 x per day
• Fuel Hub prepared meals – 2 x per day
• Opti-Turmeric – 2 x per day
~350g yogurt ~350g cottage cheese 1 ½ pints milk Protein Yogs
30

8 x 10 (1.5h) 4 x 20g (3h) 2 x 40g (6h)

*
0.9

0.8
MPS (%/h)

0.7

0.6

0.4

0.3

0.2

1- 12 hours

Areta et al., (2013). J Physiol, 591, 2319-2331

 31

Fractional rate of MPS

n= 6
 p l e D a y
Exam
Breakfast Snack Lunch Snack Dinner Pre-Bed

Fuel Hub
3 x eggs Greek Yog Fuel Hub Enhanced Repair Shot
Mixed Berries Recovery Creatine 40 Winks
Peppers Repair Shot Milk
1 x Rye Bread Enhanced Creatine Greek Yoghurt
Repair shot Recovery Turmeric
Vit D3
Creatine
Fish Oils
Turmeric
What the world leaders currently say…
8 weeks post-op
Surgeon happy, Physio Happy
REHAB PROGRAMME DEVELOPING WELL

51.5 TO 52.5 CM
8 MONTHS DIFFERENCE
Case study from professional sport
Professional rugby player
I like to keep it player focused and engaging
SEPTEMBER 2021 FUNCTIONAL MASS SUMMARY

??? – 98.9KG FUNCTIONAL MASS PROFILE

LEAN MASS SUBTOTAL LEAN MASS LEAN MASS
LEFT LEG RIGHT LEG
(kg)

81.4kg 14.2kg 15.5kg

FAT MASS SUBTOTAL LEAN MASS LEAN MASS

LEFT ARM RIGHT ARM
(kg)

6.8kg 5.7kg 6.3kg

LEAN MASS RATIO BODY FAT PERCENTAGE

0.82 7.5%
BONE MINERAL DESNSITY T-SCORE

1.58 2.2
YOUR FUNCTIONAL MASS SUMMARY
YOUR LEAN MASS SUMMARY
For elite level rugby players, carrying excess body weight can be a disadvantage. It is important to strike the
right balance between body fat levels & lean muscle mass that allows you as an individual to be functional for
Your ratio of lean mass vs fat mass is considered to be your position. For example, a disproportionate amount of lean muscle mass vs fat mass (or vice versa) can
functional. The closer your ratio to 1 the more functional adversely affect speed, strength & endurance. In short, lean muscle mass is beneficial for rugby players,
you are. excess body fat is not.
NOVEMBER 2021 FUNCTIONAL MASS SUMMARY

?? – 102.1KG FUNCTIONAL MASS PROFILE

LEAN MASS SUBTOTAL LEAN MASS LEAN MASS
LEFT LEG RIGHT LEG
(kg)

82.8kg 14.9kg 16.3kg

FAT MASS SUBTOTAL LEAN MASS LEAN MASS

LEFT ARM RIGHT ARM
(kg)

7.7kg 6.0kg 6.6kg

LEAN MASS RATIO BODY FAT PERCENTAGE

0.81 8.2%
BONE MINERAL DESNSITY T-SCORE

1.60 2.3
YOUR FUNCTIONAL MASS SUMMARY
YOUR LEAN MASS SUMMARY
For elite level rugby players, carrying excess body weight can be a disadvantage. It is important to strike the
right balance between body fat levels & lean muscle mass that allows you as an individual to be functional for
Your ratio of lean mass vs fat mass is considered to be your position. For example, a disproportionate amount of lean muscle mass vs fat mass (or vice versa) can
functional. The closer your ratio to 1 the more functional adversely affect speed, strength & endurance. In short, lean muscle mass is beneficial for rugby players,
you are. excess body fat is not.
Can training other body parts help?
Can training other body parts help?
How much will it cost
1-2 month supply to really get you going on the right track
 F RRP COST
HERE IS A BREAKDOWN O
BRAND PRODUCT REASON QUANTITY RRP
Nutrition-X Hydra+ Hydration tabs 2 £15.98

Nutrition-X Pro X bars Protein bars 3 £89.97

Nutrition-X Repair Shots Collagen shots 6 £164.94

Nutrition-X Vitamin Bundle Vit C, D, Omega, Multi 1 £54.72

Nutrition-X Gainers Bundle Whey, All in one blend, Night 1 £116.97

time protein
Drink eo3 eo3 Protein & omega 1 £71.99

Healthspan Elite Opti-turmeric Inflammation 1 £37.99

Fuel Hub Prepared meals Easy to eat 2 meals per day, 5 days £65

TOTAL - £617.56
 F MY COSTS
HERE IS A BREAKDOWN O
BRAND PRODUCT REASON QUANTITY RRP MOREHEN COST
Nutrition-X Hydra+ Hydration tabs 2 £15.98 £11.19

Nutrition-X Pro X bars Protein bars 3 £89.97 £62.98

Nutrition-X Repair Shots Collagen shots 6 £164.94 £115.46

Nutrition-X Vitamin Bundle Vit C, D, Omega, Multi 1 £54.72 SAME

Nutrition-X Gainers Bundle Whey, All in one blend, Night 1 £116.97 SAME

£117
time protein
Drink eo3 eo3 Protein & omega 1 £71.99 £64.79

Healthspan Elite Opti-turmeric Inflammation 1 £37.99 £28.49

Fuel Hub Prepared meals Easy to eat 2 meals per day, 5 £65 £45.50
days
TOTAL - £617.56 TOTAL - £500
Discount Codes which maybe useful for athletes and coaches

My Best Codes: Other good codes:

Prepped meals for home, travel or when busy Healthspan Elite supplement company
https://fuelhub.co.uk https://www.healthspan.co.uk/shop/elite-nutrition
30% Discount Code - MOREHEN30 20% Discount Code - ISN-HEJM

Nutrition X supplement company MoJu Drinks

https://www.nutritionx.co.uk https://mojudrinks.com/
30% Discount Code - JM30 20% Discount Code - MOREHENPERFORM20

High protein Elete cereal

https://eleatcereal.com High protein omega 3 drink
20% Discount Code – PERFORM20 www.drinkeo3.com
10% Discount Code Code - morehen10
 GETTING A JOB IN
professional sport:
A former student’s reflections on the ups and downs of his academic studies and early career in sport.

Dr. James Morehen

Twitter: James_Morehen
IG: MorehenPerformance

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 My journey is one of many!!

Insights, reflections and advice from practitioners working in elite sport.

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So I wrote a book about it…

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and run a community programme to help others.

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