Tissue repair after injury: How nutrition helps you heal faster

As we have had the London Marathon a couple of weeks ago there may be a few stiff, sore and aching muscles. Some may have picked up more significant injuries and are trying to nurse themselves back to health. Musculoskeletal injuries are not only painful and inconvenient, but they can also lead to long term loss of optimal function, susceptibility to further injury and reduced activity, which can have additional metabolic consequences.

Maintaining strength, fitness, flexibility along with optimal nutrient intake is essential for prevention of certain injuries, although sometimes they are completely unavoidable. Following an injury, nutritional support can be fundamental to optimising repair, reducing recovery time and helping to protect against further damage. In this blog we look at mechanisms that are involved in injury recovery and hence nutritional interventions to get people back on their feet.

Soft tissue injuries

Soft tissue (e.g. muscle, cartilage, ligament and tendon) injuries, particularly strains and sprains, are the most common type of injury in sports. While specific percentages vary depending on the sport, study, and population, a significant majority of sports injuries are soft tissue-related, often exceeding 60% in certain sporting leagues.¹

The recovery from soft tissue injuries can be a slow process, particularly in ligaments and tendons which have a poor blood supply and therefore delivery of repairing nutrients is challenging. It is also often difficult to fully rest them to allow the healing process.

Soft tissue repair happens in several phases:²

Phase 1

• The initial response to an acute injury is inflammation, and haemostasis, the aim being to control cellular damage and blood loss, clear debris from the site, and try to prevent and control invading bacteria. This phase may last up to 4 days from the time of injury and includes vasoconstriction to eventually stop bleeding and form a clot. The injury may look red and swollen during this phase and feel warm to touch. During this time, it is important to limit movement around the injury to prevent further damage and inflammation.

Phase 2

• Proliferation. New blood vessels are formed, fibroblasts produce collagen, wound edges start pulling together and the wound is covered in a new layer of epithelial tissue. This process may start around day 3 after injury and continue for up to 2-3 weeks.

Phase 3

• Remodelling. Collagen and other proteins become more organised in structure, and a stronger type II collagen replaces type I. This phase can take up to 2 years to be complete. Scar tissue may be only 70-80% as strong as previous tissue.

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Bone injuries/fractures

Injuries to bones are generally fractures, meaning that new bone needs to be formed. While a fracture may appear to be a more serious injury, if the break is simple then repair and recovery can be a faster process than soft tissue. However severe breaks can result in other tissue damage and therefore need additional healing time and support.

Bone repair also happens in stages:³

Stage 1:

• Reactive phase inflammation. Bleeding from the fractured bone and surrounding tissue causes the fractured area to swell. This is similar to the inflammation phase experienced in soft tissue injury.

Stage 2:

• Soft callus formation. Pain and swelling decrease. The site of the fracture will stiffen, with new bone forming. New bone is weaker than uninjured bone, it is also not complete and cannot be seen on x ray.

Stage 3:

• Hard callus formation. New bone begins to bridge the fracture during this phase, covering the incomplete soft callus. This bridge can be seen on x-rays.

Stage 4:

• Bone remodelling. The fracture site remodels itself, correcting any deformities that may remain as a result of the injury. This final stage of fracture healing can last several years

Nutrition plans to support injury should include:^4,5

Support immune function

The immune system is essential for protection from infection, signalling repair mechanisms, adding repair and clearing debris.

Aid issue repair

It is essential to provide optimal levels of all nutrients to ensure adequate availability of building block for soft tissue. Protein, collagen and nutrient cofactors are essential for rebuilding damaged tissue and vitamins D and K, calcium, magnesium and boron are essential nutrients for the formation of bone⁶.

Reduce chronic inflammation

The initial damage will create inflammation leading to pain and swelling in the affected area. This is an important initial process in activating immune recovery mechanisms, however over the long term it can cause tissue damage, limit movement or prolong pain. Interventions to ameliorate inflammation are important.

Reduce oxidative stress

Elevated levels of oxidative stress will drive both inflammation and tissue damage, hence inhibiting recovery and repair. Both oxidative stress and inflammation activate of MMPs (matrix metalloproteinases), which contribute to the breakdown of collagen and hence suppress recovery. Providing antioxidants can help to reduce the oxidative burden.⁷

Support mitochondrial function

Essential for energy production, the health of the mitochondria can have a significant impact on cellular energy and therefore the ability to repair. Mitochondria are also important for supporting muscle health and function and therefore recovery and growth of muscles. Additionally, if mitochondria are dysfunctional, they can create additional oxidative stress which further drives damage.

Support cardiovascular function

Development and generation of new blood vessels as well as delivery of nutrients to the site of injury is essential for the repair process. Therefore, cardiovascular health needs to be supported when considering repair processes.

Nutritional support for musculoskeletal injuries:

Protein⁸

Proteins are fundamental structural components of all cells and tissues and are required for repair. During phase 2 of repair when new tissue is being created and laid down, protein requirements increase. Depending on the type of injury, large amounts of protein may be lost each day.

The British Nutrition Foundation recommends a daily protein intake of 0.75g/kg body weight for healthy adults and there have been suggestions for differing protein amounts depending on the type of injury.⁹

Collagen^10–12

Collagen is the most abundant protein in the body and helps compose the extra-cellular matrix. Over 20 different types of collagen have been identified in humans, the most abundant being types I, II and III which make up 80% of the body’s collagen. In repair phases 2 and 3 collagen is produced and laid down.

Supplementation with type hydrolysed 1 collagen has been shown to be supportive for soft tissue repair such as from tendon and ligament injuries. While type 2 collagen is effective in support cartilage and protection from joint degeneration.

MSM¹³

MSM – contains high levels of sulphur which are important for maintaining normal connective tissue. MSM has also been demonstrated to have anti-inflammatory, chemoprotective and antioxidant activities. In a pilot study MSM (3 g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events.

Micronutrients

Vitamins A, B, C, and D as well as the minerals calcium, copper, iron, magnesium, manganese, and zinc are all important for injury recovery. 

Vitamin C

Vitamin C has multiple influences on repair processes as it supports multiple aspects of the immune system but is also involved in collagen production, attenuating oxidative stress and supporting immune function:

Studies have shown ^4,5,14

• Vitamin C has an anabolic effect on cartilage.
• Vitamin C is useful for pain relief particularly of the musculoskeletal system, and vitamin C deficiency is associated with higher incidence of pain.
• Vitamin C has analgesic properties in some clinical conditions, thus potentially mitigating suffering and improving patient quality of life.

Vitamin D

Vitamin D is essential for calcium absorption and hence to help support bone mineral density. It is also essential for immune modulation and low levels are associated with increased inflammation. The prevalence of vitamin D deficiency is increased among patients with connective tissue disease. (Active form as vitamin D3).⁶

Vitamin K

A coenzyme associated with the formation of osteocalcin, a major non-collagenous protein incorporated in bone matrix during bone formation. (Active form for bone health as vitamin K2).⁶

Calcium

An essential component of bone, requires vitamin D3 and K2 for absorption and transport.⁶

Magnesium

Magnesium is a major element which aids in bone growth. It is necessary for the proper functioning of muscles and also regulates the metabolism of calcium. Also involved in cartilage synthesis and inhibits inflammation.^5,6,15

Manganese

The saying goes ‘clicky knees more manganese’! Its role includes scavenging free radicals through as a cofactor for superoxide dismutase and supporting bone and collagen synthesis.¹⁶

Zinc

Zinc is required for the production of over 200 enzymes including those required for wound healing, antioxidant function, cell replication and tissue repair. It also has antioxidant capability and a role in immune cells such as macrophages, T cells and B cells. ¹⁷

Copper

Copper cofactor for superoxide dismutase antioxidant and well as for collagen and cartilage synthesis. ¹⁸

CoQ10 (Ubiquinol)

Utilised as a carrier in complex II of the electronic transfer chain in the mitochondria, essential for energy production. CoQ10 also has antioxidant properties and is found in high concentrations in heart. It therefore plays an essential role in cardiovascular function as well as in normal energy production, all of which are essential for repair mechanisms.⁴

B vitamins

Are essential for normal energy production within the cell as well as for normal function of nerve cells which will play a role in repairing tissue.⁵ Additionally, B vitamins can support circulation and therefore support nutrient delivery to injury site.

Natural anti-inflammatory nutrients

Inflammation itself is a useful and necessary part of healing, therefore rushing to combat inflammation in the first instance may be counterproductive. However, for longer term recovery, once the inflammatory phase is over, further support may be required in order to keep ongoing and/or chronic inflammation under control.

Omega 3 fatty acids ^4,19,20

Increasing sources of omega 3 from oily fish and/or a supplement containing EPA is recommended as EPA is converted into anti-inflammatory prostaglandins in the body. The ability of omega-3 fatty acids to interfere with arachidonic acid metabolism is at the heart of their proposed anti-inflammatory effects.

Dosages of between 1-3g of omega-3 fatty acids daily have been shown to improve repair time to blister injury, however most of the benefits in wound healing were in the group who had taken fish oil for 4 weeks prior to injury. This may support the case for regular daily consumption of fish or an omega-3 product for overall health and to support tissues in the event of injury.

Boswellia²¹

Boswellia has been shown to be useful in both acute and chronic pain management. Clinical trials show increased pain tolerance in inflammatory disorders , with as little as a week to occur.  As well as reducing inflammation it is thought that Boswellia’s mechanism of action on joints also includes the prevention of glycosaminoglycans ( – a component of cartilage) degradation and improved blood supply to joint tissues.

Curcumin^22–24

Curcumin has been shown to help in the management of exercise-induced inflammation and muscle soreness, thus enhancing recovery and performance in active people.

One of its mechanisms of action is inhibiting Cox-2 enzymes, which produce inflammatory prostaglandins. The major therapeutic actions of NSAIDs are primarily enacted by their ability to block certain prostaglandin synthesis through the cyclooxygenase enzymes (COX-1 and COX-2) inhibition.

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Last updated on 14th May 2025 by cytoffice