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Nutrition and Performance in Sport

Christophe Hausswirth

Chapter 2. Nutrition, sport and health

Topic 5. Muscle and tendon pains

Amélie Fosse, Christophe Hausswirth, Axel Heulin, Yann Le Meur, Véronique Rousseau, Eve Tiollier et École Lenôtre

Texte intégral

Questions and answers

Key points
Exercise commonly produces acid components in the body; it is thus recommended that athletes eat alkaline foods to preserve optimal muscle function.
When athletes are injured and need to take time off, their diet must include nutrients such as vitamin D, zinc, copper, calcium and silica, to promote tissue healing.
Some foods are known to possess anti-inflammatory properties, including essential fatty acids such as omega-3 and vitamin K.
Branched-chain amino acids have beneficial effects on the muscle pain experienced after bodybuilding exercises.
To limit exercise-induced tissue lesions, a combination of vitamins C and E is recommended. Both of these vitamins are available in food.

Can musculoskeletal pain be increased by an inappropriate diet?

1Musculoskeletal pain is above all linked to strain injuries without anatomic lesions and should resorb after 2 to 12 days. These strain injuries include simple microlesions, causing aches, and contractures of longer duration. A balanced diet can obviously contribute to the development of quality muscles and connective tissues, and hydration helps to flush out poorly vascularized tissues, such as tendons. It also optimizes metabolic exchanges and helps to eliminate uric acid crystals or cholesterol which may have accumulated. In practice, athletes must drink regularly to preserve the functionality of their tendons. This is also valid when tendinitis has already developed.

Can an acidic diet injure tendons and muscles?

2In itself, exercise stimulates the production of protons (H+ ions), which leads to an increase in blood acidity. This acidity negatively influences muscle activity. Therefore, it is largely accepted that any exogenous intake neutralizing protons will be beneficial for sports performance. This applies to intake through eating and/or drinking. Specific acidity indicators are available for food (PRAL, Potential Renal Acid Load, see Fact sheet No. 14 Supplements, 395) and it is best to refer to these when you want to adopt a more neutral or alkaline diet. A climate of metabolic acidosis promotes the formation of uric acid crystals, which are prejudicial to muscle tissues and tendons. An alkaline diet is therefore recommended. Fruit and vegetables – in view of their position on the PRAL chart – are recommended in this context. Although they may taste acidic, this kind of food induces the production of significant quantities of citric and malic acid, which are particularly alkalizing. Hydration with fluids containing bicarbonate, such as many sparkling waters, also contributes to increasing the buffering capacity and, consequently, reduces blood acidity. In addition, it has been shown that regular consumption of sodas, cheeses and red meat has a negative impact on blood acidity levels.

How can trace elements contribute to the prevention of injuries and/or pain?

3Given that iron, zinc and copper interact and compete for the same carrier during intestinal absorption, an excessive consumption of one of these minerals can lead to a deficit in another. For instance, excessive iron intake will decrease zinc absorption, while an excess of zinc will decrease copper absorption.

4Zinc contributes to stabilizing various proteins which are required to build up the athlete’s muscles. Copper is involved in collagen and elastin synthesis, which are essential components in healthy tendons and muscles. Through its contribution to various linkage systems, it forms “biochemical bridges” between proteins. Thus, it makes an essential contribution to the cohesion of various tissues and indirectly prevents some exercise-induced microlesions. These two trace elements also activate various inflammatory proteins. These processes are activated in case of trauma and copper and zinc are taken up to facilitate healing. It is thus particularly recommended that athletes include sources of both zinc (meat, eggs, dairy products) and copper (liver, cereals, legumes) in the diet to prevent lesions, or even to establish a reserve that could actively contribute to controlling inflammatory reactions in case of injury.

5Silica represents another essential architect of our tissues. It has been considered a trace element since 1992, when it was discovered to play a particular role in connective tissue, arteries, skin, bone and cartilage. It is present in large amounts in our connective tissue and is necessary to the formation of certain proteins, as well as to healing. A silica deficiency leads to growth disorders and weakening of the tissues. In athletes, silica is used to combat pains due to inflammation of the joints and tendons, and during recovery after fractures. Silica is present in the earth, and a moderate amount leaches into some mineral waters, vegetables, such as cabbage, garlic or onion, and it is also found in cereals, fruit and vegetables.

6Although calcium and vitamin D appear necessary for repairing bones after fractures, vitamin C and vitamin A also play an essential role in recovery from injuries. Vitamin C, for example, is an essential element of the synthesis of some amino acids necessary for collagen formation. According to a recent American study, vitamin K – which is contained in broccoli, cabbage, parsley, spinach and rapeseed oil – can also be considered as an anti-inflammatory, useful in the treatment of chronic phenomena. This beneficial effect is particularly marked when vitamin K is associated with slightly increased vitamin D intake.

7Despite all their potential benefits, there is no need to consume an excess of micronutrients during recovery from injury.

Can targeted nutrition help some tissues to heal faster?

8An inadequate protein supply will obviously affect healing time and significantly increase inflammation. Like some trace elements, proteins are very useful in the tissue healing process. Thus, consuming leucine, which is contained in milk, has a well-known effect, not only increasing muscle mass during resistance training and slowing protein degradation, but also activating signalling pathways which can, themselves, elicit anabolic stimuli during immobilization or involuntary rest periods following injury. Some recent data show that an amino acid-rich diet promotes recovery after an operation for a hip fracture. Compared to placebo drinks containing no proteins, drinks containing some branched-chain amino acid (BCAA) mixtures showed beneficial effects on delayed onset muscle soreness (DOMS) after bodybuilding exercises involving concentric contractions. In addition, it has been observed that myoglobin concentrations decrease after the ingestion of BCCA, suggesting that these nutrients help to reduce muscle damage. Some very recent Japanese studies involving joggers who committed to an intense training protocol over three days confirm this. In these studies, repeatedly consuming drinks containing BCAA decreased the feeling of muscle fatigue, decreased DOMS and reduced concentrations of muscle damage indicators. Although there is no evidence that performance is enhanced, all of this still contributes to preventing strain-related injury.

Should energy intake be significantly reduced during sick leave?

9During immobilization or sick leave due to an injury, it is essential to adapt energy intake to requirements. The first step, for athletes, is to reduce the number of calories absorbed. However, depending on the type of injury and its severity, the healing phase has a cost and a low-calorie diet is not necessarily recommended. In addition, an injury and/or fracture makes it necessary to employ unusual modes of locomotion, which can consume large amounts of energy during exercise. So as to avoid losing too much weight and prevent muscle atrophy, it is recommended that a diet containing both carbohydrates and proteins be maintained. Protein synthesis is more efficient if carbohydrates are present, as confirmed in a recent study showing that a diet where calorie intake was decreased by 80% for ten days was associated with a 19% decrease in protein synthesis. This reduction in protein synthesis contributes most to the loss in muscle mass.

10In practice, it is therefore preferable to gain 1 or 2 kg of body weight during sick leave, rather than drastically reducing calorie intake through an unusual diet, which could slow healing or protein synthesis.

11To limit the reduction in muscle mass during healing, some suggest creatine supplementation to maintain muscle properties. However, although a recent study shows that creatine supplementation for seven days contributed to maintaining maximal strength in the upper limbs, the results are not so clear-cut when it comes to strength in the lower limbs.

12Alcohol should be avoided during recovery from injury and immobilization: indeed, it has been shown that excessive ethanol intake can accelerate the reduction in muscle mass during this rest phase, as it significantly decreases protein synthesis.

What nutrients are recommended during recovery from injury?

13One of the key objectives during recovery from injury is to avoid creating eating disorders or deficiencies, which would otherwise prolong the sick leave. During the injury phase, the role of carbohydrates and proteins is important, as is the role of lipids. Like other nutrients, there is no need to increase the amounts of fat ingested during a rest period. However, after injury an increase in essential fatty acid (EFA) requirements has been reported, thus a low-EFA diet could create deficiencies. The most important fatty acids in recovering from injury are omega-3s, which have anti-inflammatory properties. It is highly recommended that these omega-3s be obtained though food (salmon, tuna, herring, rapeseed oil, walnut oil, soy, cabbage, spinach, etc.) and that care be taken to ensure that they are not destroyed during cooking. Current studies show that omega-3 supplements help to decrease chronic inflammation and arthritis. Because of this, fish oils are the subject of various scientific studies where they have been found to relieve persistent inflammation. In contrast, omega-6 fatty acids (sunflower oil, grape seed oil, meat and most industrial products) should be limited as they promote inflammatory phenomena. To enhance the anti-inflammatory effect, the omega-6/omega-3 ratio should be kept low (a ratio of five to one is recommended for a balanced diet).

14A very recent Chinese study emphasises the importance of fish oil: apparently, it maintains muscle mass and limits atrophy caused by immobilization or a period of reduced activity after an injury.

How important are antioxidant foods in preserving muscle cells?

15It seems that muscle microlesions can be prevented, at least partially, by monitoring your nutritional status and/or taking antioxidant-rich supplements. Several studies have shown that muscle damage is more extensive in people with vitamin E deficiency due to greater damage to the lipid membrane in this population. This leads to an increased prevalence of tissue lesions during exercise and degradation of membrane lipids. However, even if vitamin E deficiency could favour the appearance of muscle lesions during training, the capacity of vitamin E supplementation to prevent exercise-related damage in athletes with adequate levels of this vitamin remains to be seen. In fact, it seems essential to maintain a balanced diet, including sufficient vitamin E (which can be found in sunflower oil, hazelnut, pistachio nuts, walnuts, avocados, etc.) to preserve cellular integrity and avoid damage to muscles and tendons.

16Associated with vitamin E, β-carotene and vitamin C help to prevent oxidative damage to membranes. Although we do not currently have enough evidence that vitamin C can play the role of a powerful antioxidant, the efficiency of the synergy between vitamin C and vitamin E has been proven. In this synergy, vitamin E acts as a major antioxidant and vitamin C regenerates vitamin E. Most of the time, athletes who train regularly in intensive exercise have a low antioxidant vitamin or trace element status, they are thus considered to be a high-risk population. However, as is often the case, it is better to favour the intake of antioxidants through food rather than as multivitamin/mineral supplements, the benefits of which are often questioned.

Practical applications

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1. On a daily basis

Make sure you are well hydrated at all times during the day

17 Stick to a hydration plan during training and at other times of the day (See Fact sheet No. 10 Hydration, p. 342)

Check the colour of your urine Image 10000000000000F80000003206E44984.jpg

18 If you tend to suffer from muscle pains, drink bicarbonate-rich sparkling water after training: Label: HCO3–> 1000 mg/l (See Fact sheet No. 15 Specificity of the woman [Calcium], 409)

Maintain an appropriate protein intake

Image 10000000000000230000001D2DE2E3D0.jpg If you tend to be stiff after training sessions with a high level of muscle sollicitation (bodybuilding, strength sports, combat sports, speed sports, etc.)

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Eat some fruit and vegetables at every meal to:

19 Neutralize acidity (alkaline food)

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20 Take advantage of their antioxidants

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2. Injury requiring sick leave

Stick to a generally balanced diet

21(See Fact sheet No. 11 A Balanced Diet, p. 358)

22 Decrease your energy intake while maintaining a positive energy balance:

23 To meet your vitamin and mineral needs, you must consume more than 2000 calories per day

24 Monitor your weight and keep it stable. During a long sick leave, some muscle wasting is inevitable; this leads to weight loss

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25 Vary your food to benefit from all the micronutrients favouring healing

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26 Favour foods with an anti-inflammatory action

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Cut out alcoholic drinks Image 100000000000007B00000032D8895CA7.jpg


Gourmet platter

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Photo credit: Thibaut Ruggeri.

Salmon tartare, smoked salmon, three mini blinis, horseradish yoghurt sauce, yoghurt and chive sauce, toast, lamb's lettuce and beetroot salad, vegetable sticks

27Serves 1

28Preparation time: 30 minutes

29Cooking time: 30 minutes

Difficulty: Image 10000000000000510000001FE146C630.jpg


31■ 50 g raw salmon

32■ 5 g capers

33■ 10 g shallots

34■ 3 g snipped dill

35■ 5 ml lemon juice

36■ 10 ml olive oil

37■ Salt, pepper

38■ Mild chilli pepper

39■ 50 g smoked salmon

40■ 3 mini blinis

41■ 3 half-slices of toast

42■ 20 g lamb's lettuce

43■ 40 g cooked beetroot

44■ 50 g carrots

45■ 50 g celery

46■ 5 g mustard

47■ 5 g strawberry vinegar

48■ 10 ml rapeseed oil

49■ 1 Greek yoghurt

50■ 5 g grated horseradish

51■ 10 ml lemon juice

52■ 10 g chives

53■ Salt, pepper

54■ Half a lemon

55■ 2 dill stems

56Cut the salmon into small cubes. Snip the shallot and dill. Crush the capers. Mix all these ingredients together, season with the lemon juice, olive oil, salt, pepper and chilli. Present in a shot glass.

57Wash the vegetables. Peel the carrots and celery, cut into thin sticks.

58Place in a glass.

59Wash and dry the lamb’s lettuce. Dice the beetroot. Set aside. Mix 75 g of Greek yoghurt with the horseradish. Season.

60Mix the rest of the yoghurt with the lemon juice and chives. Season.

61Put the sauces in small ramekins.

62Make the vinaigrette by beating the mustard, vinegar and rapeseed oil together to form an emulsion.

63Place the smoked salmon, lamb’s lettuce and diced beetroot on a large plate. Dress with the vinaigrette. Add the salmon tartare, sauces, vegetables, mini blinis and toast, making it look attractive. Decorate with half a lemon and sprigs of dill.

64Chef’s note

65This dish is not only good for preventing pains, but also has properties which should assis in recovery from injuries. It contains up to four times the Dietary Reference Intake (DRI) for vitamin D, and half the DRI of calcium. It also provides essential fatty acids, especially omega-3, which have an antiinflammatory action. This meal also covers half the DRI for vitamin K.

66It is rich in antioxidant vitamins, which can help prevent muscle microlesions (it covers all the DRI for vitamin A and 40% of the DRI for vitamins E and C).

67As this platter is rich in lipids, it should be served with a light starter (raw vegetables) or a light dessert (fruit).

68Nutritional analysis per person

Energy (Cal)

Carbs (g)



Lipids (g)

Protein (g)




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