Soreness, pain, and injuries are a regular part of the sport of gymnastics. As most that are familiar with the sport know and understand, it's a high intensity, dangerous sport. It's almost to be expected that every gymnast has their own laundry list of things they've gone through. Yet, the statistics are still shocking!
A 2019 survey of NCAA athletes even found that 77% of NCAA gymnasts had sustained a major sport-related injury prior to college!
OOF!
And that doesn't even take into consideration those that had multiple major injuries or the majority of gymnasts that don't even make it to that level or stay in the sport that long...
Double OOF!
Did you ever think that maybe this sport didn't have to be this way?
There are many, many factors that go into this astonishing injury rate. But, did you ever stop and wonder how many injuries are are actually "expected" and how many of these injuries are potentially preventable?
And yes, there are many reasons why a gymnast may get injured or get stuck in the injury cycle compared to others. But, as a Registered Dietitian for gymnasts, there is a common theme I see over and over again...under fueling.
How does under fueling impact the likelihood of injury?
In the world of sports, under fueling is often referred to as RED-S, or Relative Energy Deficiency in Sport. This is a very serious syndrome with a growing body of research about the condition itself and its symptoms that leads to harmful effects across every system in the body. (If you've heard of the female athlete triad before, RED-S is similar, but has been expanded upon to incorporate all of the negative effects that are also associated with low energy availability that can apply to all athletes).
Energy availability is the difference between the energy (calories) taken in (through eating) and the energy used through every day activities and exercise each day. The energy that's left (available) is what your body then can use for all of its essential functions: like breathing, digestion, growth and development, hormone function, transportation of oxygen and nutrients in the blood, the immune system, and more.
When energy availability is low, the body does not have enough to support exercise and everyday activities and basic body functions, and has to make compromises. RED-S affects every single system in the body, which is why it's so serious.
When the body does not have enough available energy, it will start to adapt. The body will actually slow or even shut down many functions to save energy to make sure it has enough for absolutely essential functions (like breathing). One of the most well-studied consequences of low energy availability is the down regulation of hormones (specifically Estrogen), which leads to bone weakening and bone loss (aka the Female Athlete Triad). This makes under fueled gymnasts more susceptible to bone related injuries, such as breaks, fractures, stress reactions, OCD lesions, and more.
Additionally, in times of low energy availability, we see what is referred to as the "Recovery Gap". This gap between the energy coming in and the energy the body needs to rebuild, repair, and recover from training or injury causes the body to stay in a state of "un-repair". Food makes up the building blocks that the body uses to build, grow, recover, and repair. Without enough food and enough of the right nutrients (read building blocks) this doesn't happen and the likelihood of all types of injuries skyrocket and can significantly slow and impair the recovery process.
This is not only important for older, high level gymnasts, but for young, beginner gymnasts as well. Adequate and appropriate nutrition is a crucial piece of building a strong foundation for the body - strong bones, strong muscles, strong tendons, strong ligaments. IF the body does not have adequate nutrition during the early, formative years of growth and development, it is likely that the body part will not be able to withstand the years of load, pounding, wear and tear.
Are gymnasts really just *clumsy*?
Under fueling can also have a major impact on focus, cognitive performance, and skill. This means that when the brain does not have adequate fuel during a workout, a gymnast is more likely to lose focus, have a slower reaction time, and make silly mistakes.
It's no coincidence that injuries are most likely to occur at:
The end of practice or the end of a long week
A higher intensity training phase (like competition season or at the end of a long camp)
A rapid spike in workload (return from vacation, finally getting cleared from injury)
Around the time of puberty (ages 11-15, especially around major growth spurts and other developmental milestones)
With added pressure (to get certain skills, perform at high expectations, look a certain way...)
For gymnasts, the recovery gap widens from two situations: insufficient intake, or increased output (or a combination of both).
Insufficient energy or nutrient intake can be intentional or unintentional and may stem from:
A sudden change in diet (going keto, vegan, even "clean eating" or just trying to eat healthier)
A change in schedule (like going back to school)
A food allergy or medical diagnosis
Medications that blunt appetite
Disordered eating or an eating disorder
An increase in energy demands can stem from:
An increase in time spent in the gym (extra hours per day, extra days per week)
An increase in intensity of workouts (more conditioning, cardio, hard landings, full routines)
An increase in stress
Prioritized recovery phase (during and after illness or injury)
Additionally demands on your time and energy
Phases of rapid growth and development
So, what can I do to help support my recovery and break out of the injury cycle?
While proper nutrition won't prevent every single injury, adequate fueling is essential for strong bones, tendons, and ligaments. It may be a key to make you less susceptible to future injuries, decrease the severity of an injury, or shorten recovery times (all of which will keep you in the gym this competition season).
Here are 3 ways a gymnast can use nutrition to help support healing and recovery:
1. Eat Enough Carbs, Proteins, AND Fats
Adequate energy availability is characterized by eating at least 45 calories per kilogram of lean body mass (or about 20.5 calories per pound of lean body mass) daily. For most gymnasts, this can be achieved by eating 3 meals and 2-4 snacks daily utilizing a performance plate and incorporating a performance nutrition strategy.
Carbohydrates are a gymnast's #1 source of energy. So much so, that they make up anywhere from 50-70% of your total energy intake (and about 3/4 of your plate). These foods are essential for fueling your workouts and recovery.
Carbs (for short) come from many different foods, including:
Grains (like bread, rice, pasta, oats, quinoa, etc.)
Starchy vegetables (like potatoes, squash, corn, etc.)
Non-starchy Vegetables (like carrots, tomatoes, broccoli, spinach, etc.)
Plant-based proteins (like nuts, seeds, beans, and soy)
Fruit (like apples, bananas, berries, melons, etc.)
Dairy (like milk and yogurt)
IF you are not eating enough carbs, it is very difficult for you to eat enough overall energy. If you're not eating enough energy from carbs, the body will have to pick and choose what functions it prioritizes. More often than not, breathing > recovery.
Protein is the body's building blocks. It helps to build everything from new cells to muscles (and everything in between). You can't expect an injury to heal without the materials it needs.
Most gymnasts need about 1.6-2.0g of protein per kg of body weight (or about .7-.9g of protein per pound) to support the body's functions as well as the demands of training and recovery, PT, or injury healing.
While eating enough protein each day is crucial for gymnasts, more is not necessarily better. Research has shown that there is a limit of how much protein can be utilized at one time, meaning it's ability to support the body is capped. Therefore, it’s not ideal to eat 100% of your day's protein in one sitting. Instead, try spreading protein evenly throughout the day, including protein foods (like meat, poultry, eggs, dairy, nuts, seeds, beans, legumes, and soy) at most meals and snacks throughout the day. For most gymnasts, meals should incorporate about .4-.5g of protein per kg of body weight and most snacks (other than those during a workout) will incorporate about .2g of protein per kg.
Fats are another essential energy source for the body (most gymnasts will get approximately 20-30% of their overall energy needs from fat). There are 2 main types of fats found in foods: Saturated and Unsaturated. As a gymnast, you want to strive to get most (~80%) of your dietary fat from unsaturated sources, as they are not only a a good source of energy but they are anti-inflammatory, which are essential for healing and recovery.
Unsaturated fats can be easily found in foods including:
Fish
Nuts / Nut butters
Seeds
Avocados
Olives
Plant oils (like olive oil, avocado oil, grapeseed oil, etc.)
Gymnasts recovering from injury should especially focus on Omega-3 fats, which are mostly found in fatty fish like salmon and tuna. Try including these 2-3 times per week, or if you do not eat seafood, you may benefit from a fish oil supplement with DHA + EPA.
Foods with saturated fats are more pro-inflammatory. These are most often found in animal foods (like beef, poultry, pork, full-fat dairy), butter and foods made with butter, and coconut, as well as fried foods. These foods are fine to include (as most gymnasts rely on them for protein), so strategize when you can.
When preparing meals or snacks:
Choose unsaturated cooking oils, like olive oil, avocado oil, or grapeseed oil
Choose lean cooking methods like grilling, baking, steaming, or broiling
Opt for leaner cuts of meat (like poultry vs red meat, chicken breast or thighs vs wings or legs, beef or pork tenderloin vs rib or shoulder cuts)
2. Incorporate Antioxidant Rich Foods
There are more than 25+ major vitamins and minerals that your body needs to stay healthy. And while I'm not saying all of them come from fruits and vegetables, these foods are some of the most nutrient dense, meaning they have a lot of nutrients like these vitamins and minerals.
When it comes to fruits and vegetables, I always encourage my gymnasts to "eat the rainbow". This is because many of these vitamins and minerals are similar within color groups (ex. the nutrition is similar in blueberries, blackberries, and cherries). If you eat the same fruit or vegetable every day, you could be missing out on the potential benefits of others.
If you struggle with soreness or soft tissue injuries (like muscles, tendons, and ligaments) then you want to prioritize the anti-inflammatory and antioxidant rich foods.Gymnasts prioritizing recovery should make it a point to meet the daily recommended intake for:
Vitamin A
When recovering from an injury or even just after a tough gymnastics practice, the body needs to go into repair mode, which often requires new cell at every level of the body to replace those damaged by the workout. Consuming Vitamin A rich foods (>600mcg) helps promotes cell growth and development. Vitamin A can be found in:
sweet potato
pumpkin
spinach
carrots
cantaloupe
bell peppers
mango
tomato
Vitamin C
An important part of the recovery and injury prevention process is repairing any damaged cells, tissues, or ligaments, as well as removing Vitamin C (>45mcg): promotes wound healing, tissue repair, and can work as an antioxidant. Vitamin C rich foods include:
citrus fruits (like oranges, grapefruit, lemons, limes)
bell peppers
cantaloupe
kiwi
cabbage
tomato
strawberries
broccoli
Brussels sprouts
Anythocyanins
Anythocyanins (no RDA) have been shown to be an antioxidant, anti-inflammatory, and promote restful sleep (another essential piece to the recovery puzzle). These flavonoids can be found in blue and purple fruits and vegetables (as well as their juices) like:
cherries and tart cherry juice
pomegranates
blueberries
blackberries
beets
purple cabbage
acai
Omega-3s
(see point #1)
3. Don't Forget About The Bone Healing Nutrients
If you struggle with bone health like breaks, fractures, or stress reactions, then you want to prioritize the bone-healing nutrients, specifically Calcium, Vitamin D, Vitamin K, and Magnesium.
Calcium
The bones are made up largely of calcium. Consuming enough calcium from foods ( >1000mg daily) can help keep bones strong, as well as supply the building blocks to repair any damage. Calcium is found in:
Dairy foods (like milk, cheese, yogurt, cheese) ---> be sure to check your non-dairy alternatives
Leafy green vegetables (like broccoli, spinach, kale)
Tofu and soy
Chia seeds
Fortified foods (like OJ)
While calcium supplementation is not often recommended, if this is something you are looking to add, look for the active form "calcium citrate" (most supplements with calcium contain calcium carbonate, which is fine as an antacid, but this is not readily absorbed for bone health and prolonged and excess intake can actually increase the risk of fractures)
Vitamin D
Vitamin D (>600IU daily) is also essential for bone health, since it promotes the calcium to be absorbed by bones. The main way our body gets Vitamin D is from the sunlight (converted by our skin), so many people do not get enough. You are at risk for Vitamin D deficiency if:
You spend most of your time indoors (like in a gym)
You are rarely exposed to direct sunlight (only getting sunlight through windows, clothes, or sunscreen-covered skin)
You live at a latitude 37 degrees or more north or south of the equator (most of the USA), where you experience all 4 seasons (and the sun is not very strong for 6 or more months each year)
You have a stomach condition, such as IBS, IBD, celiac disease
If you can, try getting 15 minutes of unprotected sun time each day. Vitamin D can be found in a limited number of foods, including
Oily fish like salmon and trout
Mushrooms
Fortified foods (like cereals and milks)
It is important for your doctor to regularly test your Vitamin D level through blood tests (in summer and winter) to determine if you should be taking a supplement, at what dose, and for how long. Prolonged, and excessive Vitamin D supplementation can have some negative health consequences (and can also increase the risk of fractures)
Vitamin K2
Vitamin K (specifically K2) plays a central role in the metabolism of calcium, which help to build and maintain bones. While Vitamin K is typically associated with leafy green vegetables, vitamin K2 (45ug/day for children, 100-300ug for teens & adults) can be found in animal foods and fermented foods, including:
Egg Yolks
Cheese (like Munster, Gouda, and Cheddar)
Chicken
Beef Liver
Butter
Sauerkraut
Fermented soybeans (Natto)
Eel
Magnesium
Magnesium (RDA of 240-410mg daily, depending on age) has also been shown to play a pivotal role in bone health and development, as it helps increase the absorption of calcium. Magnesium deficiency can impair bone structure and interfere with Vitamin D. Magnesium is found in:
Nuts (like almonds, peanuts, and cashews)
Whole grains (like whole wheat, brown rice, and potatoes)
Edamame
Spinach
Black Beans
While it is ideal to get magnesium from food sources first, if you are considering a magnesium supplement for bone health, look for the form Magnesium Glycinate.
If you or your gymnast struggles to stay healthy and perform their best during competition season, it's time to meet with a Registered Dietitian. You can learn more about Food for Fuel, High Performance Nutrition for Gymnasts and fill out the short application to book your session.
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