ACL rehab: Phase 3, home time, and the first 4-6 weeks
There is a lot to be said here about getting into a good routine and sticking to it. Once I was home, I set out a regimented plan of attack regarding specific feeding times and supplement schedules to help reduce the swelling as quickly as possible from a nutritional point of view.
Having previously had many Dual X-ray Absorptiometry (DXA – body composition assessment) scans as a student, I had access to data which would help me build an individualised nutrition strategy regarding total energy and macronutrient (carbohydrate, fat and protein) intake.
I used the commonly cited Cunningham equation ((lean body mass x 22) + 500) to work out my predicted resting metabolic rate (RMR). However, if you do not know your lean body mass or have access to finding it out, then you can use the following equation: RMR (kcal.day-1) = 1254 + (9.5 x body mass in kg). In simple terms, this equation is working out how many calories you normally burn in a 24-hour window. It does this by multiplying 9.5 x your body weight + 1254. so for me this would be 9.5 x 73kg = 693.5, then add 1254, so 693.5 + 1254 = 1947.5. Therefore my RMR is approx. 1947 calories per day.
My RMR is the total amount of calories I would need to maintain normal physiological function in a rested state. For me, this is around 1900-2000 kcal per day. However, considering my body had just come out of an operation, I knew it was going to take more calories than my RMR suggested, to support the fact my body was working overtime to recover, repair, and rebuild the soft tissue around the knee.
This is brilliantly shown in a case study on an English Premier League football player who, following an ACL operation, had a similar total energy expenditure to non-injured, fully active football players. The authors of this study said this similarity was due to the injured player working overtime to help repair and recover his body – pretty cool, huh?
It was therefore important I provided my body with ample calories from good-quality sources of nutrition rather than poor ones. For example, lots of fresh protein (i.e., oily fish, lean white meats, etc.), fruits, and vegetables, rather than sugary, fatty and pro-inflammatory foods.
The increase in calories mainly came from protein, as I tried to maintain a total intake of around 3g per kg of body weight (approx. 210g). When I was awake, I maintained protein distribution throughout the day to every 2-3 hours (i.e., 20-30g of protein, consumed every 2-3 hours), in line with key literature. You may laugh, but for the first few days, I set my alarm for every three hours to remind me to down my next source of protein. After a few days, my internal alarm was set, and I had formed a habit that had stuck well. This habit-forming was born from inspiration from reading Atomic Habits by James Clear – a brilliant book, and I would highly recommend it to anyone reading this blog.
Another supplement I added was vitamin D3. As I had my operation in October (Autumn time in the UK), and I was pretty much immobile, so my access to daily sunlight was limited. I had a good guess I was not going to see much sunlight for a few weeks, and even if I did, the sun was not going to be strong enough to give me a natural dose of vitamin D3. That’s why I opted for the supplement throughout the winter months and took one tablet per day for the next six months. If you are interested in reading a little more about vitamin D3, there is some great information here.