Nutrition for Injured Athletes I: Energy Balance

Nutrition and getting injured – my two true passions. Navigating injury is a minefield for the best of us. Not only are you in physical pain, you have the psychological hurdle of your routine thrown off. You can’t train, or move your body how you usually do. For the athlete, injury can be a huge mental challenge.

We can use nutrition and food to support our recovery.

After injury, for an athlete the goal is to achieve a return to a high-level of competition and activity. Emphasis is placed on fast and effective healing, and nutrition can help this process.

Navigating Energy Balance: Calorie Deficit or Nah?

Haters will say “it’s just calories in, calories out bro”.

And in its simplest form, for once they are correct. Spending an extended amount of time in a calorie deficit is associated with a reduction in skeletal muscle mass (RIP gainz) and reduced muscle-protein synthesis[1]. This is especially important in the acute phase of any injury, as Biolo et al. [2] demonstrated a calorie deficit significantly accelerated muscle loss in the immobilised individual. So, a calorie deficit is a big old yikes during the acute phase of injury.

Therefore, the focus should be on ensuring the athlete is at least eating to their maintenance calories. This translates to roughly 25-30 calories/kg of bodyweight, in order to reduce sarcopenia [3]. Now, age-related decline in muscle mass is different to disuse atrophy, but we can apply some of the same thinking here.

Injury is inherently catabolic – tissues and muscle are being broken down – so we want to ensure we have fuel in the tank to recover!

More Calories = Better Recovery?

You would be forgiven for assuming that you should just whack up calories to prevent muscle loss. This may hold slightly true, as the body will enter a positive energy balance (calorie surplus). However, increasing calories beyond maintenance increases fat mass [4], and doesn’t further decrease the rate of muscle loss [5].

An increase in excess fat mass isn’t beneficial for most athletes, and is typically associated with poorer athletic performance [6,7].

So, it’s not necessarily the more the better!

The New Maintenance: Eating More, Move Less

So, eating to maintenance is the buzz. This presents some challenges in itself – what is the new maintenance? For athletes, exercise and training contributes a huge amount to energy expenditure – in some cases up to twice as much as us regular plebs [8]. Athletes are used to training hard, torching calories and fuelling to allow this!

With a drop off in activity, the athlete won’t be using as much energy in their daily life. Consequentially, a reduction in calorie intake may be required to prevent excess fat gain.

It is important to note that reducing caloric intake after injury isn’t because we are concerned about fat gain – rather it is about accommodating for a reduction in activity!

Beyond Macros: Injury & Disordered Eating

It is so important also to monitor the athletes’ eating behaviours, as injury has been linked with an increase in disordered eating patterns amongst athletes[9]. Injury is linked with disturbances in body image and self-worth [10], another risk factor for disordered eating. It is so important to understand the psychological impact of injury.

Athletes tie up a huge deal of their identity in their sport, and their physical health and image is a massive part of that. When you devote hours of your life in the gym or on the pitch, to suddenly lose that is a difficult psychological storm to weather. It is important as coaches and trainers that we keep an eye out for the mental well-being of our injured athletes.

Speaking from personal experience, it is never the injury itself that is the most painful – it’s the aftermath. You question everything: will you ever get back to it? Is your health all gone to shit now? Is there even a point in doing anything about it?

My first ACL repair really was a mental challenge. There was a lot of binge-eating, and pity parties. It truly was a harrowing experience, and I was extremely fortunate to work with a great coach during my last ACL repair so that this didn’t again. We have a responsibility to our athletes, and ourselves, to ensure this is protected against.


Injury is truly awful for anyone. For athletes in particular, nutrition can be pivotal in ensuring physical and psychological health is catered for during one of the more challenging times in their career.

Overall, we want to ensure:

  • The athlete eats at least to maintenance calories
  • We account for reduced activity in calculating new maintenance calories
  • Our athletes are well-supported and monitored for disordered eating patterns following injury

This article just scrapes the surface of nutrition for the injured athletes, and the next article in the series will delve a little deeper into the role of macros and supplementation!


  1. Carbone, J.W., McClung, J.P., Pasiakos, S.M. (2012) ‘Skeletal muscle responses to negative energy balance: effects of dietary protein’, Advances in Nutrition, 3(2), pp. 119-126.
  2. Biolo, G., Ciocchi, B., Stulle, M., Bosutti, A., Barazzoni, R., Zanetti, M., Antonione, R., Lebenstedt, M., Platen, P., Heer, M., Guarnieri, G. (2007) ‘Calorie restriction accelerates the catabolism of lean body mass during 2 wk of bed rest’, American Journal of Clinical Nutrition, 86(2), pp. 366-372.
  3. Correia, M.I., Hegazi, R.A., Higashiguchi, T., Michel, J.P., Reddy, B.R., Tappenden, K.A., Uyar, M., Muscaritoli, M. (2014) ‘Evidence-based recommendations for addressing malnutrition in health care: an updated strategy from the feedM.E. Global Study Group’, Journal of the American Medical Directors Association, 15(8), pp. 544-550.
  4. Slater, G.J., Dieter, B.P., Marsh, D.J., Helms, E.J., Shaw, G., Iraki, J. (2019) ‘Is an Energy Surplus Required to Maximise Skeletal Muscle Hypertrophy Associated with Resistance Training’, Frontiers in Nutrition, 6, p. 131.
  5. Paddon-Jones, D., Sheffield-Moore, M., Zhang, X., Volpi, E., Wolf, S.E., Aarsland, A., Ferrando, A.A., Wolfe, R.R. (2004) ‘Amino acid ingestion improves muscle protein synthesis in the young and elderly’, American Journal of Physiology, Endocrinology & Metabolism, 286(3), pp. 321-328.
  6. Silvestre, R., West, C., Maresh, C.M., Kraemer, W.J. (2006) ‘Body Composition and Physical Performance in Men’s Soccer: A Study of National Collegiate Athletic Association Division I Team’, Journal of Strength and Conditioning Research, 20(1), pp. 177-183.
  7. Pilis, K., Stec, K., Pilis, A., Mroczek, A., Michalski, C., Pilis, W. (2019) ‘Body composition and nutrition of female athletes’, Roczinki Państwowego Zakładu Higieny, 70(3).
  8. Westerterp, K.R. (2017) ‘Exercise, energy expenditure and energy balance, as measured with doubly labelled water’, Proceedings of the Nutrition Society, 77(1).
  9. Rauh, M.J., Nichols, J.F., Barrack, M.T. (2010) ‘Relationships Among Injury and Disordered Eating, Menstrual Dysfunction, and Low Bone Mineral Density in High School Athletes: A Prospective Study’, Journal of Athletic Trianing, 45(3), pp. 243-245.
  10.  Drench, M.E. (1994) ‘Changes in body image secondary to disease and injury’, Rehabilitation Nursing, 19(1), pp. 31-36.

Published by Michelle Carroll

I am an online coach (MSc Sports & Exercise Nutrition, EQF Level 4 Personal Trainer, PN Level 1) and radiographer (BSc). I believe in empowering others to make better choices for their health through education. I think that the fitness industry has created a disconnect between best practices and “evidence-based” practices. I hope by chronicling my experience as a healthcare professional and my education as a fitness professional I can assist others on the path to bettering themselves.

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