The Ultimate Protocol For Injury Recovery

January 15, 2023 Brian Comly

"Injuries are our best teachers."

- Scott Jurek

One of the best reminders of what we take for granted is an injury. Our independence is immediately compromised and so much of our daily life (not to mention our training) is impacted. Injuries are an immediate reminder that we pushed too hard but why do they have to take so long to heal? Fortunately, we are not just passive vessels waiting for our body to do its job. The choices we make in the aftermath of an injury have a significant impact on how quickly and how well we recover from an injury.

This article is a holistic guide to injury recovery. I start by addressing popular myths and misconceptions like whether to use ice or heat, if inflammation is good or bad and if it’s worth elevating and compressing injuries. Then I break down the injury recovery techniques of the mind and the body as well as nutritional and supplemental suggestions. At the very end are two types of injury recovery protocols to sum it all up: the professionals and the minimalists.

The Injury Recovery Window

The first step is to determine whether your injury is a sprain, a strain, or a broken bone. For the full guide to differentiating between the three and knowing the immediate next steps and the phases of recovery, see my complete guide. If you have a mild sprain or strain then you can likely rehab on your own. For fractures or anything more severe than a mild injury, it is best to see a healthcare provider and possibly an occupational therapist or a physical therapist.

The next step is a focus on recovery. There are plenty of things we can’t control right now that directly impact your injury: the type and severity of the injury itself (unless you keep using it and make it worse, of course), age, gender, fitness level, general state of inflammation, and even your mindset. So let’s pivot to the things we can control: your mind and your body.

"Injury in general teaches you to appreciate every moment. I`ve had my share of injuries throughout my career. It's humbling. It gives you perspective. No matter how many times I`ve been hurt, I`ve learned from that injury and come back even more humble."

- Troy Polamalu

Your body is an incredible machine that can heal itself. Think about that for a minute. Imagine if our bodies were like a car that acquired bumps, bruises, and flat tires but we were never able to take them to the mechanic to get fixed. We would look 80 years old when we were only 15. The body is in a constant state of healing but it is usually only under injuries that impact our daily life that we ever really take note.

Once you sustain an injury, you have a narrow window of opportunity between the time of the injury and weeks to months to years down the road where never-look-back recovery takes place. So while your body does most of the work on its own, it’s important for you to give the body the tools needed from a holistic perspective. Recovery is now your full-time job.

Work Alongside A Medical Professional

I recommend using the tools I am about to describe alongside a medical professional such as a doctor, occupational therapist (OT), or physical therapist (PT). While the treatment interventions listed below have been shown to be effective, every person and every injury is unique. The collaboration of a medical professional provides a combination of experience and knowledge to your situation that could play a pivotal role in your recovery.

How To Use This Information

Injuries are common and impact everyone. As a result, there happens to be a lot of money invested into the best ways to recover from injuries (e.g. spending on healthcare, sports rehab, military). Money leads, research follows, and then we are provided with options.

The information below is not a specific protocol to progress through the phases of recovery. That is for your doctor and your therapist to establish. These are a list of evidence-based tools, techniques, foods, supplements, and approaches to recovery from a musculoskeletal injury quickly and efficiently. You will, however, notice both a “professional’s” and a “minimalist’s” daily recovery protocol at the end of this post which incorporates the information below. Feel free to scroll down for the “TLDR” version.

If you’re well beyond the acute phase of an injury and into the chronic realm then this information can also be useful. Your body is extremely complex and just because the traditional approach may not have worked for you, doesn’t mean you can’t get better. Use the approaches below to come at your injury from a different angle to support healing.

Let’s begin.

Don’t Use R.I.C.E.

The old-school approach was the RICE method: Rest, Ice, Compression, and Elevation. We now know that ice, prolonged rest, and even NSAIDs not only don’t help the injury but they can actually make the injury worse by impeding the recovery process. Gabe Mirkin coined that now-famous RICE method back in 1978. In 2015, he took a step back by publicly conceding that the evidence says this approach may be wrong. “Cold and ice are safe pain medicines, but they delay healing,” he said in The Age.

Over the years, many others have jumped at the opportunity to replace the RICE method with more evidence-based (and not-so-clever sounding) approaches

MEAT (Move, Exercise, Analgesic, Treatment)
POP (Protect, Optimally Load, Pain Management)
PEACE & LOVE (Protect, Elevate, Avoid Anti-Inflammatories, Compression, Education & Load, Optimism, Vascularization, Exercise)
MOVE (Movement. Options: offer other options for cross-training. Vary rehabilitation with strength, balance and agility drills. Ease back to activity early for emotional strength.
METH (Movement, Elevation, Traction, Heat)

Although these approaches all differ, the one thing they all have in common is the use of movement as a treatment. Except for MOVE and METH, they also all suggest managing pain without the use of NSAIDs. NSAIDs work to block the pain from the injury. They not only do nothing to help the injury itself but they increase the risk of gastrointestinal bleeding among other side effects.

What About Compression And Elevation?

The use of compression garments is a popular recovery strategy. It is used to reduce swelling but does it work? A review of the RICE method in The Sport Journal stated,

“It is difficult to assert that compression and elevation are always advantageous when utilized in a recovery protocol, as clinical research has not yet provided definitive guidelines on their usage. However, besides the possibility of applying too much pressure to the limbs and reducing circulation, there are no adverse side effects associated with applying compression. Consequently, if the application of compression or elevation creates a placebo effect and makes the athlete, patient, or client feel better during the recovery process then it may be justified to continue their use. However, prioritizing the application of compression or elevation over another therapeutic approach is unsubstantiated.”

According to a 2012 study on recovery for sprained ankles “Evidence supporting the use of compression in the treatment of acute ankle sprains is limited. No evidence exists to support or reject the use of elevation in the treatment of acute ankle sprains.” A 2015 study, however, concluded that “Compression may be an effective tool in the management of ankle injuries and has been shown to reduce swelling and improve quality of life in single studies….The most effective form of compression to treat ankle sprains is yet to be determined.”

The verdict: The evidence is scant and lacks a unanimous stand. The use of compression appears to be a low-risk low reward so use it if you want but don’t expect big improvements in recovery.

Inflammation: Friend Or Foe?

Inflammation is the natural immune response to an injury to the body which helps to heal tissues. There are two types of inflammation: acute and chronic.

Acute inflammation is the response of the body to an injury. When you suffer a sprain, strain, fracture, or even a cut your immune system sends pro-inflammatory cells such as macrophages and adipocytes to the injury to produce cytokines, proteins, and enzymes in order to repair the area. This response is essential in order to prevent infection and start the healing process but it comes with side effects of warmth and redness (both triggered by more blood flow to the area), swelling (caused by the leakage of fluid, plasma proteins, and leukocytes from the blood vessels), and pain and less mobility. Our role in this acute phase of inflammation is to facilitate the body to do its job.

Chronic inflammation is when these compounds hang around too long or when the immune system continues to send these signals even when there is no threat. This impedes the recovery process. Our role in this chronic phase is to stop this inflammatory onslaught and decrease the inflammation in the body.

The inflammatory process is heavily dependent on the circulatory system. When pro-inflammatory mediator cells are triggered they activate the endothelial cells in the blood vessels which helps to clear the debris. The molecules necessary to heal the injury (neutrophils, cytokines, etc.) are the EMTs on the blood vessel highway. If the circulatory system is impaired then the EMT can’t get to the accident and healing is stalled and chronic inflammation ensues.

A healthy circulatory system includes the basics such as not smoking or being overweight, frequent movement throughout the day, and a healthy diet. There is also a link between less common strategies such as limiting noise pollution, managing stress, grounding, staying hydrated, stretching, hot and cold exposure, doing breathwork, and having a healthy amount of omega 3’s.

Recovery Strategies Of The Body

Sleep. Researchers joke that if you were to rank the top 5 recovery tools, sleep would be numbers one through five. Nothing else comes close. Prioritize getting to bed and waking up at the same time. See the articles below for specific tactics to implement for a great night of sleep
Exercise and Movement. There is obviously a part of your body you can’t fully use to exercise but there are likely other parts you can. If you have a shoulder injury then go for more walks and do prison squats throughout the day. If you have a lower-body injury then incorporate upper-body strength training. At the very least, move frequently throughout the day. Movement promotes vascularization, helps move fluid through your lymphatic system, decreases your risk of blood clots, and improves your mood.
Sunlight. Get sunlight on as much of your skin as possible for 20 minutes first thing in the morning and intermittently throughout the day. Getting sun through windows does not count. See this article for a deep dive into the effects of light on your health and how you can use it to hack your environment.
PEMF. PEMF (pulsed electromagnetic field) therapy is a modality that sends small amounts of energy through the body to stimulate the cells. It has been shown to improve the healing of fractures and it may improve recovery, sleep, and decrease pain. PEMF devices are expensive so find a location that has one and trial before committing to buying it.
Electrical Stimulation. Electrical stimulation is a modality used to improve circulation and strength, and decrease pain. The research states that “Basic science studies have shown conclusively that electrical stimulation techniques lead to bone cell proliferation.” Using an electrical muscle stimulation (EMS) device you can easily apply electrodes to the muscles around the injury to enhance recovery.
Peptides. Synthetic peptides are natural signing agents composed of amino acids. They are typically injected into the body and “signal” the body to do what it already knows to do through the use of neurotransmitters, hormones, enzymes, etc. There are limited human studies on peptides. There’s also no regulating authority because the peptides that are available are technically only allowed to be used for research (although that does not stop many people). As a result, there is no overarching regulating authority to provide guidance. and the peptides that are available are not legally on the market are We are in the very early days of synthetic peptide use but I see a future booming with the use of peptides not only for injury recovery but for a variety of fields including anti-aging, neurology, GI, ophthalmology, and rehabilitation. The future is bright but talk to your doctor about the use of synthetic peptides.
Grounding. “Grounding” or “earthing” is simply making physical contact with the natural ground. This used to be normal for humans until the last couple of centuries. Research shows that it reduces pain and stress and it improves sleep, immune system function, wound healing, and injury recovery. Walk, stand, or sit outside with bare feet for at least 20 minutes a day. In addition to natural materials like grass and sand, metals and concrete are conductive but asphalt, wood, and rubber are not (see a list here). For places I can’t go barefoot I use Earth Runners Sandals which connect your skin to the earth via a copper lining. See more evidence here and here and here. For a deeper dive into this topic read my article here.
Infrared Sauna: Infrared saunas use photobiomodulation (a combination of heat and light) to provide a host of benefits including increased blood flow to the injured area, raising white blood cell counts, and strengthening the immune system. It does this through a process called hormesis. Use a low-EMF infrared sauna like the HigherDOSE sauna blanket. Or you can search for health clinics around you that offer the use of infrared saunas. See more evidence here, here and here for fractures.

Recovery Strategies Of The Mind

Your body is in a highly sympathetic (fight or flight) state after an acute injury. When your body is in this stressed state, your resources are diverted to the areas of the body that allow you to fight off a predator and not necessarily to the part of the body that is recovering. This stressed state also uses up valuable resources (calories, hormones, neurotransmitters) which negatively impacts your recovery.

In order to optimize the healing process, you need to down-regulate your nervous system to activate the parasympathetic nervous system (rest and digest). An objective way to measure your autonomic nervous system activation (sympathetic vs. parasympathetic) is through the use of HRV. HRV can also be a great biofeedback tool.

Movement is a great way to manage stress, however, due to your injury, you are likely moving less. Here are some other stress reduction strategies:

Meditation. Start with sitting in a comfortable position and take one long, slow, deep breath. Use an app like Headspace or Insight Timer to guide you. Then work up from there. See the evidence here.
Breathwork. You can use this in conjunction with your meditation practice or separately. Find a relaxing technique that you like and incorporate it every hour. My favorite is the extended exhale. In addition to managing stress, breathwork can be used as a vasoregulator which can dilate or constrict the size of the blood vessels which has a direct impact on the site of the injury. Many people use their mouths to take short and shallow breaths through their chest and shoulders most of the time limiting their circulation. See the evidence here and this article on breathwork techniques and ways to implement them.
Gratitude journaling. Have a book or notepad and just sit down and write 5 specific things you’re grateful for. This may sound “woo-woo” but the science backs it up with evidence of decreased inflammation and anxiety and improved sleep. You’re in a tough situation right now but it could be worse. Change your mindset by putting things in perspective.
Reading. Use reading as a way to relax instead of doom scrolling. Set aside at least 15 minutes to read at least once a day. I recommend The Obstacle is the Way by Ryan Holiday and Resilience: Hard-Won Wisdom for Living a Better Life by Eric Greitens to help with your mindset through this injury.
Consider L-Theanine. Injuries often elicit stress due to frustration, anxiety, and difficulty coping with a new way of life. This stress releases cortisol which impacts sleep, testosterone production, suppresses the immune system and impedes recovery L-Theanine is an amino acid with a variety of healing benefits including decreased stress, improved sleep, and inducing relaxation without drowsiness. Take 100-600mg per day from a source like this.
Socialization. With an immediate stop to many of the things you did before your injury, it might be easy to turn into a hermit while you Netflix and doom scroll. According to this study, social relationships “affect a range of health outcomes, including mental health, physical health, health habits, and mortality risk.” While loneliness and social isolation may be linked to higher levels of inflammation. Make an effort to spend time with family and friends.

Nutritional Recovery Strategies

The importance of nutrition in the recovery of any injury is critical. There is a window of opportunity from the time of injury to fully healed in which time is of the essence.

Food and supplements can also help in preventing muscle atrophy, specifically if the injury needs to be immobilized. When this is the case muscle loss occurs as quickly as 36 hours and a “significant loss of muscle tissue within 5 days of inactivity,” according to research.

Prioritize a variety of nutrient-dense whole foods, avoid inflammatory foods, and strategically implement supplements. If you want to see if you are deficient in any macro- or micronutrients consider an app like Cronometer.

Here are evidence-based approaches to further maximize your recovery.

Drink mineral water in glass containers to avoid the consumption of microplastics.

Getting enough of the right vitamins. Prioritize getting the bulk of your micronutrients from whole foods. Foods that contain the most amount of each vitamin and mineral are in parentheses. Use a reputable multivitamin to fill in the gaps. See more evidence here and here.

Vitamin A (beef liver)
Vitamin B12 (clams)
Vitamin C (guavas)
Vitamin D3 (salmon)
Vitamin E (sunflower seeds)
Vitamin K2 (kale)
Copper (oysters)
Manganese (mussels)
Magnesium (spinach)
Phosphorous (yellowfin tuna)
Zinc (oysters)

Things to Limit or Avoid

Avoid inflammatory food and drinks. This includes alcohol, sugar, seed oils, and processed foods.
Limit acidic foods. A diet high in acidic foods can decrease your bone density and contribute to pain. There is a lot of misinformation about alkaline diets so see how you react to different types of foods. See a list of the most acidic foods here.
Don’t overeat. Eating too much requires your body to shuttle resources to digestion when your body wants to prioritize recovery.
Try to avoid NSAIDs. These can obstruct the healing process and cause GI distress. (Also, the FDA warns against the use of non-aspirin NSAIDs because they increase your risk of stroke, heart attack, and high blood pressure.) Alternatives to NSAIDs include curcumin (see below), PEMF, and electrical stimulation (evidence here and here).
Environmental toxins. Environmental toxins can play a huge role in your health and most of us are unaware of it. I wrote about the impact of toxins on your health, the 8 most common ones, and how to avoid them in the article How Environmental Toxins Impact Your Health and Your Kitchen is Killing You. Tips to Eliminate Toxins.

Supplements

Electrolytes. In addition to excessive sweating and a poor diet, electrolyte imbalances are associated with surgery, wounds, burns, trauma, and old age. (Interesting side note: electrolyte imbalance is associated with fractures.) Prioritize getting most of your electrolytes from foods (good list here) and avoid electrolyte drinks that tend to contain sugar and dyes. If you still find yourself deficient in electrolytes use something like a sugar-free LMNT powder packet. For a deep dive into electrolytes and for more suggestions, read my article here.
Creatine monohydrate. Creatine works to create more ATP in your cells which is the “energy currency” of your body. It is shown to prevent muscle atrophy and dehydration and improve strength, cognitive performance, and recovery. This study showed that it helped with tendon overuse injuries in swimmers. Take 5g a day of a source like this.
Curcumin. Curcumin is the principal compound in turmeric which works as a powerful anti-inflammatory, antioxidant, and pain reliever. Include curcumin as a spice on your food (in combination with black pepper, or bioprene, to help absorption) but to get the full benefits you likely need to supplement. This is my go-to for pain relief as I haven’t touched an NSAID in many years. Take 1g three times per day of a source like this. See more evidence here.
Fish oil. Fish oil consists of the omega-3 fatty acids DHA and EPA. Fish oil has been shown to improve protein muscle synthesis, improve muscle performance, and still reduce soreness. Fish oil has also been shown to reduce pain in patients with arthritis as well as effectively as NSAIDs do. Try to get some of your fish oil by eating the S.M.A.S.H. fish (Salmon, Mackerel, Anchovies, Sardines, Herrings) which are low in mercury. Take 4-6g a day of a reputable brand like this.
Beet root powder. Beets contain nitrates, antioxidants, and polyphenols to help with circulation and recovery. Take 1500mg daily of a source like this. See more evidence here and here.
Digestive enzyme. Digestive enzymes promote healing by activating immune-system proteins and slowing the clotting mechanism. Research has also shown that they decrease strength loss and improve short-term recovery after an injury. They have been shown to improve healing after surgery and to decrease inflammation. Take digestive enzymes on an empty stomach so that they work to heal your body instead of digesting your food (although that is not a bad thing either). Start with 100 to 300 mg as a standard dose from a source like this. For significant injuries take up to 1,000 mg.
Essential Amino Acids (EAA). The body needs over 20 amino acids to perform basic functions. Most of these our body can make on its own but there are “essential” ones that it relies on food and supplement intake to use. EAA are a more well-rounded approach than using Branch Chain Amino Acids (BCAA) because EAA includes all 9 of the essential amino acids our body needs to do things such as build muscle, repair damaged tissue, and digest food whereas BCAA only requires 3 amino acids (although they are important ones for muscle building). Research on post-operative patients concluded that taking EAA had less muscle atrophy and better functional mobility after surgery. Another study showed that amino acids help heal fractures. Prioritize whole foods such as eggs (best bioavailable source), red meat, fish, and poultry. Aim for 20g twice a day. Use a reputable source without fillers.
Magnesium (has been shown to protect damaged muscles). (evidence here) There are multiple ways to get more magnesium:
- The best way to use magnesium after an injury is to apply it transdermally (through the skin) to improve absorption using a topical one such as this.
- Epsom salt is another form of magnesium that is great to use when you are soaking in a tub through a bath at home (use 2-3 cups). It is also used in float tanks. You can likely easily find a float tank location near you through a quick online search.
- Oral magnesium. Magnesium glycinate is the best bioavailable form.
Ashwagandha. Ashwagandha works to both improve muscle strength and decrease cortisol levels in the body to further promote recovery. Take 600mg twice a day from a source like this. See more evidence here and here.
Organ meats. The words “liver,” “heart.” and “kidney” don’t typically get a great reception but their impact is undeniable. In addition to being loaded with vitamins and minerals, organ meats promote muscle maintenance. Work these into your diet on at least a weekly basis. If you’re not ready for that then go with the capsule form.

Probiotics. Probiotics can help muscle recovery, improve digestion, and improve the immune system, research has shown. Try to get probiotics from whole foods like yogurt, kefir, sauerkraut, kimchi, miso, natto, and kombucha.
Bone broth or collagen. Our bones, tendons, ligaments, and skin are all composed of a very high amount of collagen. Your body will likely require a high amount of collagen in your diet to help with the recovery process. Science supports the use of bone broth for a variety of functions including healing injuries, improving sleep, and aiding digestion. Another study showed that the use of 15g of collagen can help with joint function and decrease joint pain. Aim to get collagen in your diet through whole foods such as beef, pork, poultry, eggs and fish. Homemade bone broth is another option. Alternatively, you can buy bone broth and collagen peptides and add them to your meals. Both are great options and choosing between one or the other comes down to personal preference. Just make sure that if you buy bone broth make sure that it actually says “bones” in the ingredient list, otherwise you're just buying broth.
Protein. Your body requires high amounts of protein to rebuild properly. After an injury, you are at risk for significant muscle atrophy. Research shows that an adequate amount of protein and amino acids can help stave off this atrophy. Opt for whole food sources such as grass-fed meat and pasture-raised eggs to get the bulk of your protein then use protein powder to fill in the gaps. Aim for .8g of protein per pound of body weight. Use a clean protein powder that is sourced from organic, grass-fed cows raised without hormones, antibiotics, and steroids. Also make sure it does not contain fillers, GMO, or a proprietary formula. I use this one.

See a breakdown of how to choose a quality supplement and a list of the supplements in my regimen

The Pro’s Recovery Protocol

The professional route is to combine all of the research-driven strategies into one hell of a protocol. Modify the recommendations based on your personality, injury, and food preferences.

The Pro’s Optimal Day Of Injury Recovery

The Pro’s Ultimate Recovery Smoothie

Blend all of the below ingredients together and drink it for your first meal of the day

Water and ice
Organic kale (1 cup)
Organic blueberries (a handful)
Organic kefir (.5 cup)
Nuts (a handful of raw almonds, Brazil Nuts, and walnuts total)
Organic Cacao Nibs (3 tbsp)
Trace mineral drops (1 ml)
Organic Super Greens powder (1 scoop)
Creatine monohydrate (5g)
Whey protein powder (30-40g)
Bone broth (.5 cup) OR Collagen peptides (1 scoop)
A dash of organic Ceylon cinnamon
A pinch of sea salt

The Minimalist’s Recovery Protocol

That is a lot of stuff to take in (figurative and literally) just for recovery. Whether you rolled your ankle or you are recovering from a serious car accident with multiple injuries, having to incorporate all of the above into your recovery might be more stress than it’s worth.

The minimalist route is here to find the 20% of recovery strategies that give you 80% of the results. I also stripped out the more expensive interventions so you don’t have to take out a loan to fix yourself.

The Minimalist’s Optimal Day Of Injury Recovery

The Minimalist’s Ultimate Recovery Smoothie