Holistic Care

Surgery places increased demands on your body. Good nutrition before and after surgery provides the building blocks you need to maintain muscle, support tissue repair, and take full part in rehabilitation.

My first priority is protein. Protein supplies the amino acids your body uses to maintain and rebuild muscle and other tissues. That matters after orthopedic surgery, when pain, less activity, and time in a brace or sling all contribute to muscle loss. Muscle loss starts quickly: in healthy adults, measurable losses in muscle size and strength appear within the first one to two weeks of immobilization.

For most patients, the goal is enough protein from food, spread across meals throughout the day:

• Fish, poultry, eggs, and lean meats
• Greek yogurt, cottage cheese, milk, and other dairy products
• Beans, lentils, tofu, and other plant proteins
• Protein shakes or supplements when you can’t get enough from food

Supplements are not a substitute for a healthy diet, physical preparation, or your rehabilitation program. That said, a few nutritional strategies can be useful for the right patient.

Essential amino acids (EAAs).

Research in orthopedic surgery suggests that EAA supplementation around the time of surgery may help reduce postoperative muscle loss. Some studies also show better strength or recovery, although results are not consistent across every procedure and outcome. If you have trouble meeting your nutritional needs or are at risk for muscle loss, a more individualized protein or EAA plan may help.

HMB, arginine, glutamine, and “recovery” formulas.

These nutrients play roles in muscle metabolism, wound healing, and immune function, and specialized formulas containing them have shown benefits in some surgical populations. The orthopedic evidence is still developing, and I don’t consider them necessary for every sports medicine procedure. They may be most useful for patients who are older, nutritionally depleted, already losing muscle, or facing a long period of limited activity.

Collagen, creatine, and fish oil.

I’m generally supportive of these for overall health. The evidence that taking them specifically around surgery improves healing or outcomes is still limited, however.

When it comes to nutrition, this is the order I focus on:

1. Adequate overall nutrition
2. Adequate protein intake
3. Correcting any identified nutritional deficiencies
4. Appropriate rehabilitation and progressive loading
5. Individualized supplements when there is a specific reason to use them

Sometimes. Vitamin D is important for bone metabolism, muscle function, and immune function, and deficiency is common among orthopedic patients. Low vitamin D levels have been associated with poorer outcomes after several orthopedic procedures.

There is an important distinction, though: correcting a deficiency is different from taking extra vitamin D when your level is already normal. Research has not shown that routine high-dose vitamin D improves surgical outcomes for everyone. When it’s appropriate, I would rather check your level and correct a documented deficiency than give everyone high-dose supplements.

Usually not, but I need to know about it. GLP-1 medications such as semaglutide and tirzepatide can be very helpful for diabetes and weight management, and losing weight takes load off painful joints. They raise two issues around surgery.

Anesthesia safety.

These medications slow how quickly your stomach empties, which can increase the risk of stomach contents getting into the lungs under anesthesia. Current guidance from the American Society of Anesthesiologists and other major societies is that most patients can keep taking them before elective surgery. However, you may be asked to hold a dose or stay on clear liquids the day before surgery, especially if you recently started the medication, recently increased the dose, or have nausea, vomiting, or bloating. Your surgical and anesthesia teams will give you specific instructions. Please don’t stop or change the medication on your own.

Protecting your muscle.

When weight comes off quickly on these medications, part of what’s lost is muscle, not just fat. In large clinical trials, a substantial share of the weight lost was lean mass. Surgery and time in a brace or sling cause muscle loss too, so if you’re on a GLP-1 medication, protein intake and strength training before and after surgery matter even more. A reduced appetite can make it hard to eat enough protein, and this is where an individualized nutrition plan can help.

Yes. Much of your body’s tissue repair and recovery happens during sleep. Poor sleep is associated with more pain, lower mood, and a harder time getting through rehabilitation. In young athletes, regularly sleeping less than eight hours a night has been associated with a higher risk of sports injury.

Sleep is often disrupted after surgery by pain, a brace or sling, and a change in routine. After shoulder surgery, lying flat can be uncomfortable for several weeks, and many of my patients sleep better in a recliner or propped up on pillows at first. To protect your sleep during recovery:

• Keep a consistent bedtime and wake time
• Take pain medication as directed so pain doesn’t wake you during the night
• Limit caffeine later in the day, and limit alcohol, which lowers sleep quality
• Keep screens out of bed, and keep the room cool and dark
• Tell us if you’re still sleeping poorly. Small changes to your pain plan or positioning often help.

That’s normal, and it deserves as much attention as your strength and range of motion. Athletes and active patients often describe frustration, anxiety, a loss of identity, and fear of reinjury after a significant injury and surgery.

Fear of movement or reinjury is called kinesiophobia. Patients with high kinesiophobia may avoid the very activities their recovery depends on, hold back even after the joint has healed, or never feel ready to return. Across sports medicine, psychological readiness is one of the strongest predictors of whether an athlete gets back to sport. Fear of reinjury is also one of the most common reasons athletes give for not returning, even when the knee or shoulder has healed well.

This is part of my research. At NYU Langone, I co-authored a study published in Cartilage showing that patients with more kinesiophobia and pain catastrophizing were less likely to return to sport after cartilage restoration surgery of the knee, even though these factors did not affect their return to work. I’ve also studied psychological readiness after ACL reconstruction, including a study in Arthroscopy, Sports Medicine, and Rehabilitation that compared athletes who had ACL reconstruction on both knees with those who had it on one. The lesson across this research is consistent: the body can be ready before the mind is, and a return-to-sport plan has to address both.

• I measure it. Validated questionnaires, such as the ACL-Return to Sport after Injury (ACL-RSI) scale and the Tampa Scale for Kinesiophobia, help me identify patients who are progressing physically but aren’t yet ready mentally.
• We build confidence gradually. Rehabilitation works step by step toward the movements you fear most, such as cutting, landing, or throwing overhead, so confidence comes back through experience.
• I set expectations early. Knowing what a normal recovery looks like, including the plateaus, makes setbacks less alarming.
• We connect you with coaching. When fear, anxiety, or motivation get in the way, my team can connect you with mental-performance coaching and sports psychology resources.

I understand this part of recovery personally. As a collegiate soccer player, I went through multiple injuries and surgeries. I know the first hard cut or the first game back is as much a mental test as a physical one. I returned to play college soccer after those injuries, and I want every one of my patients to return ready both physically and mentally.

Recovery is easier with help. In the first days and weeks after surgery, you may need someone to drive you, help with meals and household tasks, and help you manage a brace, sling, crutches, or ice machine. Arrange this before surgery. Over the longer course of rehabilitation, family, friends, coaches, teammates, and your physical therapist all help keep you motivated and on track. Athletes who stay connected to their team during recovery often cope better than those who feel cut off from their sport.

My team is part of that support system. We work closely with your physical therapist and can connect you with nutrition and coaching resources when they would help.

Yes. Quitting is one of the most effective things you can do to improve your recovery. Nicotine narrows blood vessels, and carbon monoxide in smoke reduces the oxygen your blood can deliver. Healing tendons, ligaments, bone, and incisions need both blood flow and oxygen. Smokers have higher rates of wound complications and infection, slower bone healing, and, in sports medicine, higher rates of problems such as rotator cuff repairs that fail to heal.

The good news is that quitting helps, and the benefit builds over time. In a pooled analysis of studies across many types of surgery, each additional week without smoking before surgery increased the benefit, and quitting at least four weeks beforehand lowered the risk of complications by about 40%. In a randomized trial of patients having hip and knee replacement, a smoking-cessation program started six to eight weeks before surgery cut the overall complication rate by more than half. Quitting even shortly before surgery is still worthwhile, and staying off cigarettes during recovery continues to protect the healing tissue.

You don’t have to do this alone. Nicotine replacement and prescription medications can make quitting easier, and my team can point you to cessation resources. If your procedure is elective and you smoke, I may recommend a period of quitting before we schedule surgery.

Vaping is not a safe substitute before surgery. E-cigarettes avoid some of the byproducts of burning tobacco, but most still deliver nicotine, and nicotine by itself narrows blood vessels and slows bone and tissue healing. Research on vaping and surgery is newer and more limited than research on cigarettes, but early studies, including a systematic review of wound healing, suggest that vaping impairs healing in similar ways. Studies in orthopedic surgery have also linked non-tobacco nicotine use with more complications after fracture fixation and fusion surgery. For that reason, I treat vaping, nicotine pouches, and chewing tobacco the same way as cigarettes: the goal is to be nicotine-free before and after surgery. Nicotine replacement used as part of a structured plan to quit is a different situation, and we can discuss it.

It can, and I want to know about it without judgment. Cannabis use is common, and the most important thing is that you tell your surgical and anesthesia teams honestly how much you use, how often, and in what form.

Anesthesia

Regular cannabis users may need different doses of anesthesia, and using on the day of surgery can create problems during anesthesia. Anesthesia guidelines recommend telling your team about any use and not using cannabis on the day of surgery.

Pain after surgery

The research in sports medicine is mixed. A study of patients with cannabis use disorder undergoing arthroscopic rotator cuff repair found more pain and opioid use in the early weeks after surgery, but no long-term differences. A study from my colleagues at NYU Langone found that cannabis use disorder was not associated with more opioid use or worse patient-reported outcomes after ACL reconstruction. Other studies have linked cannabis use with more complications after knee arthroscopy.

Smoked cannabis

Smoking anything exposes your lungs and blood to combustion products, including carbon monoxide, and can affect breathing under anesthesia and healing.

Cannabis is not a proven treatment for pain after orthopedic surgery. If you use it, we’ll talk through a plan together.

Everything you take. “Natural” doesn’t necessarily mean safe around surgery. Some vitamins, herbal products, fish-oil supplements, and other supplements can affect bleeding, blood pressure, anesthesia, or prescription medications. Please give my team a complete list of every medication, vitamin, supplement, herbal product, weight-loss medication, and performance or recovery product you take, along with any tobacco, vaping, nicotine, or cannabis use. Don’t start a new supplement right before surgery, and don’t stop an important medication or prescribed supplement, without talking with us first.

No single supplement, medication, or strategy guarantees better healing. The goal is to go into surgery well nourished, with a plan for your medications, and to keep as much muscle as possible, correct important deficiencies, protect your sleep, prepare mentally for the recovery ahead, and have the right support in place. Your plan will depend on your age, diet, medical conditions, lab results, procedure, and expected activity restrictions.

If you have questions about nutrition, medications, or the resources available to support your recovery, please contact my office.

Nutrition and muscle preservation

1. Dreyer HC, et al. Essential Amino Acid Supplementation Mitigates Muscle Atrophy After Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial. JB JS Open Access. 2018. PubMed — EAA supplementation and postoperative muscle loss.
2. Wall BT, et al. Short-term Muscle Disuse Leads to Substantial Muscle Loss. J Clin Endocrinol Metab. 2014. PubMed — Muscle loss within days of immobilization.

GLP-1 medications

3. Kindel TL, et al. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. 2024. PMC — ASA, AGA, and other societies on continuing GLP-1 medications before surgery.
4. American Society of Anesthesiologists. Most Patients Can Continue Diabetes, Weight Loss GLP-1 Drugs Before Surgery. 2024. ASA — Patient-facing summary.
5. Wilding JPH, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity (STEP 1). N Engl J Med. 2021. PubMed — Includes body-composition data on lean mass loss.

Sleep

6. Milewski MD, et al. Chronic Lack of Sleep Is Associated With Increased Sports Injuries in Adolescent Athletes. J Pediatr Orthop. 2014. PubMed — Sleep duration and injury risk.

Kinesiophobia and psychological readiness

7. Triana J, Rao N, Buldo-Licciardi M, Lott A, Rynecki ND, et al. Kinesiophobia and Pain Catastrophizing Leads to Decreased Return to Sport Following Autologous Chondrocyte Implantation but Does Not Affect Return to Work. Cartilage. 2024. PMC — Dr. Rynecki Baker’s co-authored study.
8. Triana J, et al. Increased Kinesiophobia Leads to Lower Return to Sport Rate and Clinical Outcomes Following Osteochondral Allograft Transplantation of the Knee. Knee Surg Sports Traumatol Arthrosc. 2024. PubMed — Companion NYU Langone study in osteochondral allograft patients.
9. Ardern CL, et al. Psychological Responses Matter in Returning to Preinjury Level of Sport After Anterior Cruciate Ligament Reconstruction Surgery. Am J Sports Med. 2013. PubMed — Psychological readiness and return to sport after ACL reconstruction.
10. Webster KE, Feller JA, Lambros C. Development and Preliminary Validation of a Scale to Measure the Psychological Impact of Returning to Sport Following ACL Reconstruction Surgery. Phys Ther Sport. 2008. PubMed — The ACL-RSI scale.

Smoking, vaping, and cannabis

11. Mills E, et al. Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis. Am J Med. 2011. PubMed — Each week of cessation increases benefit; ≥4 weeks reduces complications.
12. Møller AM, et al. Effect of Preoperative Smoking Intervention on Postoperative Complications: A Randomised Clinical Trial. Lancet. 2002. PubMed — Randomized trial in hip and knee replacement.
13. The Implications of Vaping on Surgical Wound Healing: A Systematic Review. Surgery. 2023. PubMed — Vaping and wound healing.
14. Non-Tobacco Nicotine Dependence Is Associated With Increased Complications Following Clavicle Open Reduction Internal Fixation. PMC — Non-tobacco nicotine and orthopedic complications.
15. Shankar DS, et al. Cannabis Use Disorder Not Associated With Opioid Analgesic Use or Patient-Reported Outcomes After ACL Reconstruction: A Retrospective Matched-Cohort Analysis. Sports Health. 2024. DOI — NYU Langone study.
16. Cannabis Use Disorder Is Associated With Increased Early Postoperative Opioid Use and Pain but No Long-Term Differences After Arthroscopic Rotator Cuff Repair. J Shoulder Elbow Surg. 2026. JSES — TriNetX cohort study.
17. Bank NC, et al. Cannabis Use Is Associated With Increased Postoperative Complications and Healthcare Utilization Following Knee Arthroscopy: A Propensity-Matched Cohort Study. 2026. DOI — Knee arthroscopy outcomes.
18. Shah S, et al. Perioperative Cannabis Use: Guidelines From the American Society of Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2023. PubMed — Anesthesia recommendations for cannabis users.