You are probably doing everything right on paper
✔ completing rehab exercises
✔ training consistently
✔ staying motivated
…but still experience:
- slow recovery
- persistent fatigue
- plateaus in strength or performance
- recurring injuries
One commonly overlooked factor? Under-fuelling
What does “under-fuelling” actually mean?
Underfuelling occurs when the body is not receiving enough:
- Energy (calories)
- Macronutrients (carbohydrates, protein & fat)
- Micronutrients
to meet the demands of:
- daily life
- exercise/training
- injury repair
How under-fuelling shows up in clinic
A. Slower injury recovery
Clients may present with:
- prolonged soft tissue healing
- recurring strains or niggles
- poor response to rehab programs
→ Nutritional reason: inadequate energy and protein slows tissue repair and collagen synthesis.
B. Increased injury risk
Signs include:
- frequent overload injuries
- stress reactions or bone stress injuries
- “breaking down” easily with training load
→ When energy intake is low, the body prioritises survival over repair.
C. Poor training adaptation
Clients may report:
- “I’m training hard but not getting stronger”
- stagnating strength or endurance
- poor progression in rehab exercises
→ Under-fuelling limits muscle protein synthesis and adaptation to load.
D. Fatigue and low energy availability
Common presentations:
- feeling tired despite adequate sleep
- poor motivation or drive
- needing more recovery time than expected
→ Often mistaken for “poor fitness” when it can be fuel-related.
E. Hormonal and systemic effects
In chronic under-fuelling:
- reduced immune function (getting sick often)
- menstrual irregularities (in females)
- mood changes or irritability
- poor concentration
This is part of low energy availability (LEA) and can progress to RED-S (relative energy deficiency in sport) if persistent.
Why this happens
Common patterns in clinic:
- “I don’t want to put on weight so I eat light”
- busy schedules → missed meals
- high training load but unchanged intake
- over-reliance on protein, under-eating carbs
- appetite suppression from stress or stimulants
What good fuelling looks like (simple guide)
Before activity
- carbohydrate-based snack/meal
- supports training quality and load tolerance
After activity
- protein + carbohydrate within a few hours
- supports repair and glycogen restoration
Across the day
- regular meals (not skipping)
- protein distributed evenly
- carbohydrates not restricted in active clients
When to consider referring to a dietitian
Consider dietetic input when clients have:
- persistent injuries or poor recovery
- fatigue not explained by training load
- weight loss or restrictive eating patterns
- goals for body composition change alongside performance
- confusion around “healthy eating” vs fuelling
- high training loads with low intake
If progress in rehab or performance has stalled, it may not be a training problem, it may be an energy availability problem.
Nutrition isn’t an add-on.
It’s part of the recovery process.