<![CDATA[Women's wellness physiotherapy - Blog Page]]>Thu, 01 Apr 2021 06:55:11 +0000Weebly<![CDATA[Pelvic Floor Under Pressure! - How to get back to running after a baby.]]>Wed, 24 Mar 2021 22:48:56 GMThttp://boydsphysio.com/blog-page/pelvic-floor-under-pressure-how-to-get-back-to-running-after-a-baby2610172Picture
Your baby is here, you feel amazing, and you're itching to get back to running as soon as possible. And that’s great! But before you reach for the trail shoes, it is important to pause and evaluate whether your body is truly ready. Running is high-impact. Even if you feel fine, your pelvic floor, amongst other things, may not have regained the strength to handle it. Furthermore, postnatal healing is affected by things like breastfeeding, how you delivered, hormones, personal health status, and so much more. So, whilst some women will be good to go 12 weeks after delivering, others might have a much longer wait.

​As a pelvic health physiotherapist, I frequently meet women seeking help for injuries caused by running too soon postpartum or escalating their training too quickly. They always tell me that they wish they had known the risks beforehand, as they might have avoided their present discomfort. I do not seek to deter you from your sport; on the contrary, my aim in writing this article is to introduce you to some of the things you need to consider so that you can set yourself up for a safer return to running. Careful monitoring of your recovery and well-planned preparation for impact training is essential. 

What could go wrong if you start too soon?
Even if you are an experienced runner, it's important to remember that your body has been impacted by pregnancy and the birthing process. It deserves fair recovery time, and certain muscles will need rehabilitation. Tempting as it may be to skip that process, the hard truth is that if you jump back into training too soon, your risk of injury increases almost fivefold. This is due in part to the sudden rise of intra-abdominal pressure when you run. Your pelvic floor and abdominal muscles need to be strong enough to cope with that pressure. If they are weak, the stress can cause bladder leaking, pain, and even problems like pelvic organ prolapse or abdominal diastasis. Don't rush to start before your body is ready. The potential consequences are not worth it. 

Inner core, pelvic floor, pressure—what does all this mean? 
​The inner core comprises the diaphragm, the pelvic floor, the Transverse Abdominis (TA) and the Multifidus. Together, these muscles form the intra-abdominal pressure cylinder. The diaphragm is the roof, the Multifidus is at the back, the TA forms the walls, and the pelvic floor is the base. In this cylinder, the pelvic floor and diaphragm behave as a piston. The diaphragm pushes pressure down as you inhale, and the pelvic floor recoils it back with each exhale. The TA walls keep that pressure contained. Working as a team, these muscles generate and maintain pressure within your abdominal cavity. 

Abdominal pressure gets a bad rep, but it is super important! In a well-balanced core, the pressure is good. It splints your spine and shields you by increasing pressure when larger external forces are acting on your body. In practical terms, it stops you from collapsing in the middle of your body when you jump up and down and protects your organs if you're jabbed in the stomach. Yay pressure!

However, if the inner core is impaired, this pressure can cause big problems. It is common for at least one of these muscles to be affected postnatally. When this happens, you will either have difficulty generating pressure or you won't control it effectively. In either case, the result is a lack of central stability. Your body has to compensate for that to ensure you can still carry on moving and functioning. But this ‘compensation’ strategy often recruits muscles that are not designed for the job, and they squeeze the ‘pressure canister’ in all the wrong places. The outcome: pressure ends up pushing too strongly into the abdomen and the pelvic floor.
What can you do to fix all this and get back to running? 
Ultimately, it comes down to time, retraining the core muscles to work together, and ensuring that all those muscles are strong, flexible and able to do their jobs properly. Please note that the following tips and advice do not replace the importance of a check-up with a women's health physio. If you have a prolapse, incontinence, pain, diastasis, hyper-mobility, or any existing health condition, then you must get professional advice before commencing your run training, and even individuals without any complications really should do the same. With that in mind, let's get started!

Be patient! 
The first three months after birthing are a time of healing and remodelling in the body. You should not attempt to start impact sport until you are at least 12 weeks postnatal. Even then, it should only be undertaken if you have absolutely no other issues. It's good to remember that soft tissues continue to improve for up to two years postnatally, so if you are not ready now, don't fret; things will get better. The key is to be patient, eat and hydrate well, keep fit with low-impact exercise, and let nature do its thing.
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​Correct your alignment. 
During pregnancy, the ribcage has to accommodate your growing baby bump, so it widens and literally tilts back to get out of the way. With your ribs pointing skyward, your brain rewires some information so you don’t feel like you are tipping backwards. Postpartum, your midline perception may still be off-centre, so it’s easy to keep walking around with your upper body hanging behind your hips and not even notice. This posture is problematic because now the ribs (where the diaphragm lives) are no longer in line with the pelvis (where the pelvic floor lives) and this means they lose their synergistic piston relationship. This alignment also makes it hard for your TA walls to engage and keep pressure under control, too. Simply put, the inner core cannot function effectively when you are orientated this way. 

To assess your alignment, place your index fingers on the bony bits at the front of your pelvis, and your thumbs on the rib cage directly above. If your alignment is good, the ribs will be stacked directly over the pelvis, meaning the thumbs and fingers line up perfectly. If they don't, then you can correct this. Exhale and draw the ribcage subtly down until those fingers and thumbs line up. Remember, your perceived centre of gravity might have changed, so don't be alarmed if it feels like you are falling forward; you won't. Keep checking and correcting through the day, and with practice, you will be posture-perfect before you know it! 
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​Optimise your breathing 

You know how to breathe, but do you really? Postpartum breath patterns can be quite muddled up. During pregnancy, the diaphragm gets trapped in a small range of motion for many months. This is because the baby bump blocks its descent path. Once baby has arrived, you might find your ability to manage intra-abdominal pressure is compromised, and you are subconsciously ‘breath-holding' to keep the pressure ‘in.’ This is bad news, as it is forcing that pressure down onto the pelvic floor when tasks get challenging. Sooner or later, the pelvic floor will get exhausted or injured, and result in bladder leaking and unpleasant symptoms in your lady bits.

To check your own breathing, try inhaling slowly, and feel where the breath goes. Did the ribcage and torso expand back, front and sides, did the pelvic floor descend? If so, great! If not, perhaps just your belly rose up and down, or maybe your shoulders moved and nothing else? Now, try exhaling slowly. Did the pelvic floor contract? Did the abdominals draw in? Did the ribs come down? If not, there may be a problem. There are too many dysfunctional patterns to talk about here, but you usually fix them in the same way, and if it proves tricky, please get help from a physio. 
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To correct dysfunction and optimise your breathing, I recommend diaphragmatic breathing in a 90/90 position. This posture stacks your ribcage correctly over your pelvis, making it a great way to work on your breathing whilst keeping a good alignment. Once you feel good in this position, then you can progress to more upright postures.

​Train your pelvic floor 
The pelvic floor is a sling of muscles that act as a hammock for the bladder, bowel and womb. As we now know, when you run, abdominal pressure rises and your pelvic floor has to work hard to keep the pelvic organs supported against that. It also absorbs ground forces up to 2.5 times your body weight with every step and simultaneously performs its essential roles of pelvic stabilisation, maintaining continence, and core control, too. Phew! 

Doing Kegels now and again will not cut it if impact sport is your goal. Your pelvic floor needs to squeeze, lift, and move through a full range of motion with ease. It also requires endurance and coordination and must work synergistically with the other core muscles. To be frank, your pelvic floor needs to be in top condition to handle the forces involved with running. 
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Get practising at least once a day until you can, in a standing position, easily perform: ten 8-second strong-holds, 60-second sub-max holds and ten fast Kegels with good coordination. At that point, your pelvic floor is probably run-ready, provided no other issues are occurring down there.  

Get to know Transverse Abdominis 
The Transverse Abdominis (TA) is a corset-like muscle that originates from your lower back and wraps around the side of your body. The two sides are connected at the front with a broad connective tissue sheet known as an 'aponeurosis.' The TA is crucial in managing intra-abdominal pressure. It provides tension in the abdominal wall by pulling the aponeurosis tight when it contracts, which keeps the pressure contained. It also attaches to the pelvis and has an important role in stabilising your hips, which is essential for those single-leg landings. All in all, training the TA is an integral component of your preparation to run safely.
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To strengthen this muscle, first practice activating the lower, middle, and upper portions, then all three together. The sequence should look like this: Exhale, engage the pelvic floor, draw in the TA, then inhale and release. Start in side-lying if it’s difficult at first, and progress to sitting and then standing. When the whole muscle engages correctly, the abdominal wall will draw toward your spine with no kinks. Practice with a mirror so you can see if it stays flat as you contract it. Remember, the TA is part of a team with the pelvic floor and diaphragm, so coordinate it with your breathing.
​Make sure your legs are super strong!
Let's not forget your lower limbs! Your legs need power to drive you forward, endurance to keep a good form, and landing control to reduce the stress on your body from ground forces. To be strong enough for running, you should perform the following challenges with ease. If you can’t do these tasks, and don’t know how to fix that, then you guessed it: see a physio or fitness professional!
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​Start your training and progress gradually
The key here is to take it slowly so that your body can progressively increase its tolerance. If you were running marathons before, you will need to be very patient. It takes time to work up to that level safely.

A good place to start is with the NHS's Couch to 5K programme. This interval training method begins with short-run phases, which gets you up to 30 minutes non-stop running over the 12-week period. You should keep a rest day after each run to allow recovery and adaptation. If you like to keep active on your off-days, you can do low-impact sports like swimming, cycling, and walking. It is also advisable to plan your route to have a mix of soft and hard ground and avoid running downhill where possible.

With that first 12-week phase achieved, you can continue to increase your distance up to 10% per week until you reach your goal. Don’t forget that the further and faster you run, the more pressure there is, so if symptoms suddenly arise at any point in your journey back to running, don’t ignore them. Reach out to a professional for help.
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The bottom line
Taking the time to evaluate where you are in your recovery and doing the work to prepare your body for the high-impact sport is essential. If you have diastasis, prolapse, or another health condition, it does not necessarily mean that running is off the cards forever. Still, it may take longer, and you must seek advice from a specialist physio. The tips above will help you know what to work on to reduce your risk of injury, and you can make gradual progressions until you reach your goal. Running is a great sport; if you love it, you absolutely should plan to get back to it after having a baby. Just do it safely!
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<![CDATA[How to deal with postnatal wrist & thumb pain (DeQuervain's Tenosynovitis)]]>Mon, 01 Feb 2021 09:32:12 GMThttp://boydsphysio.com/blog-page/how-to-deal-with-postnatal-wrist-thumb-pain-dequervains-tenosynovitis
What Is DeQuervain's Tenosynovitis?
DeQuervain's Tenosynovitis is an inflammatory condition affecting the 'Extensor Pollicis Longus and Brevis tendons of your thumb. It's that nagging pain at the side of your wrist, and it can feel very sore indeed. DeQuervain's is also known as "Mummy Thumb" because it's common during the postnatal period. 

​New mums are particularly susceptible to DeQuervain's because their hands have to work extra hard while caring for a newborn and rarely have an opportunity to rest. Furthermore, the hormone' Relaxin' is still present during the postpartum months, causing soft tissues to be weaker than usual. These factors combined can result in the thumb tendons getting very overworked and inflamed.  

Fortunately, 'Mummy Thumb' is only a temporary problem. As your baby grows, the demand on your hands eases which allows the tendons to recuperate, and it will eventually go away. But, whilst you are suffering in the most difficult phase of this condition, here are some tips to help you recover faster and deal with the pain more effectively. 
​1. Apply Ice
​DeQuervain's is characterised by inflammation; so you can make yourself feel more comfortable by addressing this component directly. Here is where ice will be your best friend! You can make a cool pack by wrapping a bag of frozen peas in a damp towel. Then, apply it to your wrist and thumb for 10 to 15 minutes, as many times a day as you need to find relief
2. NSAIDs
Non-steroidal anti-inflammatory pain medications (NSAIDs) can be beneficial if the pain is very debilitating. They are not suitable for everyone, so you must consult with your GP before using them or any other medication, especially if you're breastfeeding. Your doctor may advise you to take a course to address the rogue inflammation more effectively instead of using them solely for pain relief. If you are not keen on or cant take oral medication then you could consider a topical NSAID or to be super natural rub Arnica gel on the area instead.  
3. Modify Activities
When you have a newborn, it isn't easy to rest, but you can modify the most common activities. For example, instead of carrying bags, you can use a backpack to avoid putting your thumb to work. When breast or bottle feeding, you can use a nursing pillow to give your hands a break. You can easily modify most daily activities; remember the goal is to rest your thumb!
4. Change Your Grip
We use the 'L' shaped grip all day long for activities such as holding a phone, lifting our baby, picking up toys, etc. Although it's a useful and instinctive way to hold things, this particular grip causes increased strain on the already suffering tendons. 
​This position will cause even more stress if you're handling weight. It would help if you closed that thumb to rest next to your other fingers when holding things and doing things with your hands. This ergonomic adaptation can be a real game-changer when it comes to speeding up your recovery.
5. Limit Your Tablet and Smartphone Use
​Repetitive actions such as texting, swiping, and simply holding a device will worsen your symptoms. I'm not suggesting you stop using smartphone entirely, but you should limit your sessions whilst you have this condition. Only use your mobile devices when you need to! You can also avoid using your hands by resting it on a surface instead and avoid using your thumb as much as possible. 
6. Use a Soft Splint
​If your pain is making things very difficult, a splint can be helpful. It is not a long term solution, but it will force you to rest the affected area because you won't be able to load or repetitively move your thumb inadvertently. If you use a splint, you should remove it every few hours to do rehabilitation exercises, apply ice, and allow your wrist some gentle movement, so it doesn't become stiff.
7. Isometric Exercises
Isometrics are done by activating the muscle without actually moving. This type of exercise gently loads the tendon to help it get more resilient. There are several benefits to isometric exercise for an irritable condition like DeQuervain's: First, it will allow you to exercise your thumb in a non-aggravating way. Second, Isometrics create a lot of muscle action, meaning your tendons will get stronger over time. Third, it stimulates 'mechanoreceptors' in the tendon, triggering an analgesic effect. Simply put, isometric exercises don't only make you stronger, they can reduce your pain right away. 
​8. Use Nutrition to Optimise Your Recovery
​What you put in your body can have a significant effect on your recovery. You should include foods rich in protein and zinc to provide the building blocks of repair, and omega 3 to reduce inflammation. Hydration is also essential; water helps improve circulation, which is essential in delivering nutrients and oxygen to the injured area. 

You should take care to avoid processed foods, sugar, alcohol and caffeine. These put stress on your body, drive inflammation, and can slow down your healing.
Final Words
​Although DeQuervain's is the last thing you need when you are a busy new mum, you are not alone, and there are lots of things you can do to ease your symptoms now and promote recovery. With rest, ice, ergonomic adaptions, good food, and some targeted exercises, you will get better and beat this troublesome condition!
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<![CDATA[Still open for physiotherapy services]]>Sun, 10 Jan 2021 16:55:30 GMThttp://boydsphysio.com/blog-page/still-open-for-physiotherapy-services
Hello and Happy New Year!

It's not off to the best start with the COVID rate being so high and a nationwide lockdown. According to the new guidelines, non-essential massage services must pause until the lockdown ends. I have thus removed massage from the online booking for the time being.

Physiotherapy services include MSK physio and Mummy MOT. These services are medical and so permitted. I will be continuing to run those two services as normal unless my regulatory body instructs me to stop. If you feel that your physiotherapy is non-urgent and you would like to postpone, please do get in touch, and I can assist you.

​A quick reminder. If you have an in-person physio appointment, then you must reschedule if you feel unwell. Whilst lockdown is in place, there will be no late cancellation fee if you cancel at short notice.
Virtual services will, of course, be available as usual as they involve no travel or contact.

Keep safe and well everyone,
Stephanie
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<![CDATA[Nutrition to Help Diastasis Healing and Postpartum Recovery.]]>Fri, 01 Jan 2021 20:13:21 GMThttp://boydsphysio.com/blog-page/how-to-optimise-diastasis-healing-and-postpartum-recovery-with-nutrition
Congratulations, mama! You made it through pregnancy and delivered your beautiful baby. During pregnancy you had your body stretched in ways you never thought possible. Now that you’re postpartum, you notice a big gap where your six-pack muscles used to be. You might be wondering what in the world happened to your abdomen. The answer is 'Diastasis Rectus Abdominus' (also knows as DRA).

​DRA starts in pregnancy when the growing uterus stretches your abdominal wall. This causes fascia, known as the Linea Alba to get thin and widen. The result is a separation of the two sides of the Rectus Abdominus, creating a squidgy gap in the middle. In mum terms, it’s that a frustrating post-baby pooch that won’t seem to go away! Diastasis can also contribute to back pain, incontinence and constipation. Ugh! ​​
If you’re experiencing DRA, you’re not alone! In fact, most pregnancies end with some degree of abdominal separation. At six weeks postpartum 60% of women have a tummy gap.  Women's intrinsic healing mechanisms do kick in though and by 6 months the number falls to 40%. For some new mums the problem persists, as almost 33% still have it by 12 months postpartum . What these figures show is that the early months are important for healing. Good nutrition is one of the most powerful tools to support your recovery. If your diastasis hasn’t healed quickly—don’t fret. Physiotherapy and targeted nutrition can help you recover too.

​Using nutrition to heal diastasis 

The nutritional strategies for DRA focus on optimising fascia and soft tissue recovery. This is because weakness of the abdominal wall causes the condition to persist. By choosing to include collagen and connective tissue-building foods in your diet, you can reclaim your abs. Whilst the following advice is particularly beneficial for diastasis, it’s also helpful for postpartum recovery in general. So all new mums reading this can benefit from applying these tips. Let’s get started! 
Eat foods high in Vitamin C, E & A

Foods high in vitamins C, E, and A are essential when it comes to recovering from diastasis recti. These vitamins aid in collagen production and promote the healing of connective tissue. They can be found in colorful, delicious fruits and veggies including oranges, kiwis, strawberries, pineapple, dark leafy greens, red peppers, tomatoes, avocados, asparagus, sweet potatoes, carrots, and broccoli. These colorful foods are also high in bioflavonoids which can aid in the repair of connective tissue damage. 
Include protein-rich foods

Protein is vital for repairing damaged tissue so aim to include some protein with every meal. Healthy sources include wild-caught fish, nuts, eggs, quinoa, beans, or brown rice.
Consume zinc-rich foods

Zinc is a diastasis healing all-star and should be included as often as possible. This mineral is essential to connective tissue production and can be found in lentils, pumpkin and sesame seeds, sardines, tofu, red meat, poultry, oysters, and mushrooms. 
Consider bone broth
While our bodies naturally produce collagen from many foods, you might want to consider pulling out the “big guns” and supplementing your healthy diet with a direct source of collagen such as bone broth. As the main protein of connective tissue, the more collagen the merrier.
Make sure you get enough fiber

The fiber in plant foods keeps your digestion flowing smoothly, which is very important since constipation can increase abdominal strain.  Good sources of fiber include whole grains, nuts, flaxseeds, figs, beans, lentils, berries, broccoli, green beans, and courgette.
Stay hydrated 

Make a goal of drinking at least two liters of water a day. Water helps improve circulation, which is essential in delivering nutrients and oxygen to the connective tissue. It also keeps your digestion moving, boosts energy levels, and aids in detoxifying your body. So bottoms up!
Avoid inflammatory foods

Avoid inflammatory foods, such as sugar, alcohol, caffeine, processed foods, and trans fats at all costs, as they put stress on your body and can slow down your healing. Stick to unprocessed, whole foods as Mother Nature intended.
The bottom line

These seven tips are important both in early recovery and in persistent cases. By applying these strategies soon after delivery, you can optimise your diastasis recovery. If the condition is already persistent, then nutrition should be combined with physiotherapy. With a well-rounded approach, you’ll be well on your way to healing this bothersome condition. 
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<![CDATA[Eat to heal your injury]]>Fri, 01 Jan 2021 16:29:34 GMThttp://boydsphysio.com/blog-page/eat-to-heal-your-injuryPicture
There is no getting away from it, injuries are an inevitable part of life. Globally, millions of people, every year succumb to a sports-related trauma. A sedentary lifestyle, poor posture, and even plain bad habits might also be the cause of a new injury. 

Nutrition may not be your priority whilst you convalesce, but it should be! If you are resting or in a cast, then eating will help you to maintain muscle mass whilst you are off your game. Furthermore, macronutrients have a significant influence on the healing process. The injured body needs raw material to repair the damage, and those materials come from the foods you eat. Let's look at the key dietary strategies you can put in place to augment your holistic recovery. 

Eat more protein:
Proteins are long chains of amino acids. Your body can only produce 10 out of the 20 types of amino acids. The remaining number, known as 'essential amino acids' comes from your food. They are vital to building muscle mass and repairing damaged tissues. In short, if you don’t meet your body's protein requirements then it can slow down your recovery. 

In practical terms, when injured, we should aim to eat more protein than usual. Its recommend to 'up' our daily intake during these times to 1.6- 2g per kilo of your body weight. But don't eat it all in one sitting; it's best to spread this across the day as our body can only absorb 25-35g in a meal. It is a good idea to include proteins that are rich in Leucine. Leucine triggers the production of human growth hormone, making it a wound healing hero. If your daily intake falls short then you could use a protein shake to supplement. 
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Leucine containing proteins include: Nuts & seeds (peanuts, almonds, soybeans), Animal proteins (fish, chicken, beef), Dairy products (milk, yogurt, cheese). Eggs and Whey protein

Don't cut the carbs!
Carbohydrates are the "powerhouse" of your body. When injured, your energy expenditure increases whilst your body is repairing the damage. Carbs provide you with the fuel you need for this to happen. An adequate ratio of high-quality carbs also helps with preventing muscle loss. People often fear weight gain and eat less whilst they rest from sport. Whilst understandable, this is actually counterproductive and may slow your recovery. The NHS recommends a daily intake of around 30 grams of complex carbohydrates. Be sure to avoid sugary and processed carb sources though, which are enemies of recovery. 
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Healthy carbohydrates can be found in dairy products, whole grains, vegetables and fruit. ​

Eat Omega-3 fatty acids to reduce inflammation 
Inflammation is a normal part of the healing process and peaks in the first 72 hours of injury. But, if it lingers and becomes persistent then it prevents healing. This is when Omega-3s can help. Omega-3 is one of nature's anti-inflammatory ‘big guns’. These fatty acids also help with preventing muscle atrophy. Nutritionists suggest a daily intake of 3000-4000mg when dealing with problematic inflammation. But, make sure you do not confuse omega-3 with omega-6 fatty acids, which can actually make it worse.
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Foods rich in omega-3 fatty acids include plant oils, seeds and nuts (walnuts, chia seeds) and oily fish (salmon, tuna, herring)​.


​Make sure you get enough Vitamin C

Vitamin C is an organic molecule that helps your body with all sorts of jobs, one is to fight infection. It also has an essential role in collagen synthesis. This improves the body's ability to rebuild and maintain muscles, tendons, and bones. Vitamin C has antioxidant and anti-inflammatory properties too, which will speed up healing.
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Vitamin C rich foods include: fruits (kiwi, strawberries, mango, papaya). dark leafy green vegetables (brussel sprouts, broccoli). red and yellow bell peppers and citrus fruits (e.g., orange, lemon)​.


​Get some Zinc in your diet:

Zinc is a chemical component in over 100 enzymes, proteins, and vitamins. This includes some of those needed for tissue repair and wound healing. It's best to get the zinc from your diet because it can be dangerous in high quantities. Furthermore, zinc supplements may contain other elements that are counter-productive to healing. 
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Foods rich in zinc include shellfish, meat, seeds, nuts and legumes ​

​Foods to avoid!
Primary enemies to wound healing are alcohol, caffeine, processed foods, and white sugars. This is because these can all drive inflammation in the affected area. Refined sugar also damages collagen, making it counterproductive to tissue repair. 
Conclusion
You can manipulate your diet to optimise a holistic rehabilitation from injury. Prevention is the best medicine of course. Balanced nutrition will help keep the musculoskeletal system robust and resilient. So even in good health we should eat enough and eat well to reduce the risk of developing a new injury. 

References

  • Harlan, L. C., Harlan, W. R. and Parsons, P. E. (1990) ‘The economic impact of injuries: a major source of medical costs.’, American Journal of Public Health, 80(4), pp. 453–459. doi: 10.2105/AJPH.80.4.453.
  • Hart, D. W. et al. (2001) ‘Efficacy of a high-carbohydrate diet in catabolic illness’, Critical Care Medicine, 29(7). Available at: https://journals.lww.com/ccmjournal/Fulltext/2001/07000/Efficacy_of_a_high_carbohydrate_diet_in_catabolic.4.aspx.
  • Juhasz, I. et al. (2018) ‘Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases’, Journal of sports science & medicine, 17(2), pp. 279–288. Available at: https://pubmed.ncbi.nlm.nih.gov/29769829.
  • Nicastro, H. et al. (2011) ‘An overview of the therapeutic effects of leucine supplementation on skeletal muscle under atrophic conditions’, Amino Acids, 40(2), pp. 287–300. doi: 10.1007/s00726-010-0636-x.
  • Shaw, G. et al. (2017) ‘Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis’, The American Journal of Clinical Nutrition, 105(1), pp. 136–143. doi: 10.3945/ajcn.116.138594.
  • Smith, G. I. et al. (2011) ‘Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia–hyperaminoacidaemia in healthy young and middle-aged men and women’, Clinical Science, 121(6), pp. 267–278. doi: 10.1042/CS20100597.
  • Tipton, K. D. (2013) ‘Dietary strategies to attenuate muscle loss during recovery from injury’, Nestle Nutrition Institute Workshop Series, 75, pp. 51–61. doi: 10.1159/000345818.
  • Tipton, K. D. (2015) ‘Nutritional Support for Exercise-Induced Injuries’, Sports Medicine, 45(1), pp. 93–104. doi: 10.1007/s40279-015-0398-4.
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