What I learned from going to see a nutritional therapist

I had to go back into hospital for some manipulation under anaesthetic due to the limitations on my movement from the scar tissue after my hip surgery. I had been dutifully massaging the scar tissue on the outside but came to realise just how much scar tissue there was on the inside that was reducing my range of movement and potentially one of the causes of pain. This led me into a journey to look at what I could do with nutrition to try to help my recovery.

So, for the first time ever, I went to see someone for dietary advice – with the specific question of whether I should be taking supplements to help my healing, and if so, which ones.

Layering the different aspects

I had previously thought that nutrition was mostly common sense, but I learned a lot from the way that Saffron (the nutritional therapist) layered what I needed:

  • Starting from a well balanced diet – with 7-a-day vegetables and fruit, plus a good split at each meal of complete proteins, good fats, and wholemeal carbohydrates as well as maintaining good hydration. She also specifically asked about how often we eat fish, and especially oily fish – as apparently the British are standardly very short of the long-chain omega 3 fatty acids. The ideal is apparently at least two portions of fish per week, with at least one oily fish.
  • Then looking at my age and lifestyle to get a sense of the hormonal pressures and tensions, as well as the aging factors on all of my tissues.
  • Whether I have had any blood tests to give information on nutrient shortages. These are very useful for things like anaemia (shortage of iron) and vitamin D shortages (common in Northern Europe, especially in winter or for people who stay inside a lot).
  • Checking for any food allergies or intolerances, or specific dietary requirements. I am very lucky with the robustness of my digestive system, so it means that I can draw on most foodstuffs – I just need to be organised enough to plan the right meals, shopping, and preparation! (I am sorry – I realise that some of this advice is not going to be so helpful for vegetarians, but a nutritional therapist will work with everyone’s dietary requirements).
  • Building from there to the current medications that I am taking – and talking me through the receptors that these medications block and hence what dietary changes and vitamin supplements may be needed to reflect this. For instance, the need for extra fibre for the constipation from painkillers, sulphur if taking ibuprofen, and extra B-vitamins (B6 and B12) when taking muscle-relaxants and antidepressants.
  • Then looking at the injury and the surgeries to understand what tissues are trying to heal – in my case covering bone, joints, cartilage, muscles, ligaments, and fascia, as well as scar tissue.  She talked about the importance of protein and zinc to help the muscles and ligaments repair. So a quality protein with each meal, and a wide range of pulses, grains, seeds, and nuts for the zinc. Getting nutrients to the bone and joint is more challenging – so I will come back to this theme below.
  • From the symptoms that I am still experiencing what extra may be needed. For instance, Magnesium is the mineral involved in relaxing muscles (whilst Calcium is involved in muscle contractions), so extra Magnesium can help with the muscle spasms and cramps. Magnesium-rich foods include spinach, avocado, seeds, nuts, yoghurt, banana and best of all: dark chocolate!
  • Then we talked about inflammatory foods, vs anti-inflammatory foods. Whilst inflammation is an important process in the initial weeks after the injury and surgeries, now months down the line there is a chance that swelling and inflammation is getting in the way of healing. Hence foods can help as one of the factors that can reduce inflammation. Overall, processed foods with high fat and processed sugars are inflammatory, plus fizzy drinks and nitrates, and nitrites in processed meats like smoked bacon and ham (you can buy nitrite-free versions), and of course, mild toxins like caffeine-based drinks and alcohol. The anti-inflammatory foods include tomatoes, leafy greens, olive oil, nuts, fruits, and oily fish.

Reducing scar tissue

As I said, reducing the scar tissue internally is a big goal for me, as I think that it will improve my mobility and potentially reduce the pain.  Saffron recommended proteolytic enzymes which are supposed to help minimise and reduce scar tissue after the surgeries.  These need to be taken away from food for best impact (either 30 mins before a meal, or an hour after a meal). Natural enzymatic foods include pineapple and papaya (yum!)

Rebuilding the bone

Of all of the injury and surgical aspects, we spent a lot of time talking about how to get blood flow and nutrients to all of the damaged tissues. Obviously, the bones are one of the most difficult to reach and the only access in the joint is via the synovial fluid. This points to the importance of movement in healing, as this only happens with movement that increases both blood flow to carry the nutrients around the body, and synovial fluid movement and regeneration.

The nutritional advice is to bring bone broths into my diet – using them instead of stock.  She counselled that it might seem weird to begin with but that you can get bones from butchers – they just give them away (I think that they normally assume they’re for a dog…) https://wholefully.com/bone-broth/

Normally your body will synthesise the necessary building blocks itself for bone synthesis and (to a certain extent) repair but it does get more difficult as we get older and we have less of the ‘whole’ ingredients in our diet such as animal skin (like on chicken etc), marrow, offal etc.  So this is where a supplement may be easier. 

Dealing with continued inflammation

Turmeric has become one of the anti-inflammatory supplements of choice for athletes. There is a lot of discussion about the format, and whether it is needed to be activated with black pepper or not. There is not a clear answer. The focus is probably best on getting one with sufficient amounts of the curcuminoids that create the reduction in inflammation. It needs to be taken with omega-3s for impact, which given the frequency really means using a good quality supplement.

More that we could have talked about

I have to admit that there was so much more that we could have talked about – and maybe I should go back in a few weeks once I see the impact of a few changes.

For instance, many people say that having had 7 general anaesthetics, rebuilding the gut fauna with a good probiotic is a priority to ensure good absorption of nutrients.

In summary

I came away with a much clearer view of what I should be doing in my base diet and the things that I should be eating more of and the things to avoid. I also finally answered the debate that I had been having with myself about supplements – and decided that the extra demands of this recovery phase meant that a few specific supplements would really help me.

But more than this, it was a real wake-up on the complexity of nutrition and how everything works together. It has been a great insight at this stage of injury, medication etc. But when life changes again, I think that there is a real value from getting expert insight on the body’s nutritional needs and how to meet them effectively. I really hope to be back to sport and when I start training would definitely go back again, plus at different physical lifestages as hormones change, or lifestyle changes. I had not previously realised the benefit that one can get and I would recommend it to others.

The skinny on scar tissue

Scar tissue sounds like one of those things that you can do very little about. But actually it is a little more complex than that!

Scar tissue is laid down in the key ‘proliferative’ phase of healing and then remodels during the maturation phase of healing. If you want to read more on this, read my blog ‘How do you heal after invasive surgery?’ http://www.injuredathlete.co.uk/how-do-you-heal-after-invasive-surgery/

This image is my simple visualisation of the haphazard scar tissue on the left, and then how it settles into the correct structure after remodelling on the right. This gives a sense of why the scar tissue feels tight, solid and lacks the usual movement and elasticity of the remodelled tissue on the right.

A simple demonstration symbolising the multi-directional aspect of scar tissue on the left, and the linear nature of remodelled tissue on the right.

But not everyone lays down scar tissue in the same way!

It transpires that different people lay down scar tissue in different ways, and therefore can get more complications from the adhesions and slower remodelling.

How can you know if you are one of those people?

It is probably difficult to know, if you have never had any surgery before, but a couple of signs that would be worth looking at are:

  • Do you still have lots of scars from cuts and grazes from your childhood? Or have these faded away now?
  • When you have had cuts or grazes over the last few years, has the mark (both in texture and colouring) lingered for a year or more?
  • And if you have had surgery, did the scar fade to an almost invisible light white line within 6 months or linger on?

If you are on the longer ranges, you could be someone who lays down stickier scar tissue and takes longer for it to remodel into the usual tissue, with usual movement and function.

What can you do about this before surgery?

If you already suspect this before your surgery, do talk over with the surgeon your previous healing and the types of movement and sport that you want to be able to return to. The choices that they make can really change your scar tissue – and counterintuitively, sometimes a larger scar can mean less scar tissue.

And if you are having keyhole (or arthroscopic) surgery, so not underestimate the scar tissue. If you can imagine, it is like a sticky rope of scar tissue that goes from the point of entry to the point of surgery. And that can be quite a distance. In areas like the hop there are lots of different muscles, tendons, ligaments and bone for it to stick to and in the abdomen there are also organs.

Straight after the surgery

As soon as the surgery is complete, the surgeon and physiotherapists will often get you moving through as much of the range of movement as you can. This is to gently tear the sticky scar tissue off things that it should not be sticking to and is especially important with joint mobility.

As soon as the wound has sealed up, there are four things that you can do to help the scar tissue to start to remodel:

  1. Massage it for 5 minutes at a time, using your finger tips and moving in all directions with as much pressure as feels comfortable. Remember that the surgery will have cut through 7 different layers of tissue and they each need to remodel.
  2. Rub in some Vitamin-E based oil, such as Bio Oil to help the process
  3. Protect it with a high factor sun protection cream if you are going out in sunshine, as it will burn really easily and this will damage the healing (as well as discolouring it)
  4. Keep drinking lots of water and eating a good high protein diet, so that there is lots of collagen for the body to call on. There are mixed views on whether a collagen supplement help, or whether a diet with things like oily fish and chicken broth are sufficient.

Through the next phases of healing, gentle movement through the range of movement (with no weight or resistance) will be key in order to get the sticky fibres to only stick in the right place! If you start to get into a lot of pain, you should be:

  • Talking with your physiotherapist and surgeon about the risk of unwanted adhesions and sharing what pain you have at different parts of the range of movement.
  • Showing them your scar – especially if you feel that it is too raised up from the surface of the skin, or too indented.

Best of luck – do not be despondent if you are someone who lays down scar tissue differently. The body is an amazing thing, and it will do the remodelling. It may just take a little more time, and that may mean a longer recovery phase for you and sadly more pain for a while, plus needing to keep focusing on range of movement for a little longer before you progress back to your activities and sports.