How Smoking Effects Healing

By Drew Zachary, PT, DPT

It’s no secret that smoking has negative effects on one’s health. Common knowledge is that cigarettes greatly increase your risk for developing lung cancer. But smoking also increases the risk of other health issues including slowing the healing process after injury or surgery.

Image of cigarette smoke with labe how smoking effect healing

How Smoking Effects Healing

Effects of Smoking on Healing Time from an Orthopedic Injury

Smoking can delay the normal healing process. This is due to the fact that nicotine, an addictive chemical in cigarettes, is a vasoconstrictor. This means that is constricts blood vessels and reduces the amount of blood flow to skin and other tissues. Slower healing has been observed in smokers with wounds resulting from trauma, disease, or surgical procedures.

Image of vasoconstriction and vasodialation

Nicotine causes vasoconstriction

4 Phases of Wound Healing

The first is the hemostasis phase. This is where blood vessels are constricted and platelets rush to the injury to prevent excessive bleeding. While normal vasoconstriction is normal, excessive constriction caused by nicotine denies important molecules and healing properties in the blood to the affected tissue.

Image of the phases of wound healing

Wound healing phases

The second phase is the inflammatory phase where the wound begins to close. In smokers, this is a very common phase of healing for a wound to get stuck in. The chemicals in cigarettes do no allow proper healing and wounds can become chronic and remain open.

The 3rd and 4th phases are the proliferative and remodeling phase where new tissue is formed and the wound becomes fully healed.

Does Smoking Cause Osteoporosis?

Smoking increases your risk of developing osteoporosis — a weakness of bone that causes fractures. Elderly smokers are 30% to 40% more likely to break their hips than their non-smoking counterparts

Smoking decreases the absorption of calcium from the diet. Calcium is necessary for bone mineralization, and with less bone mineral, smokers develop fragile bones (osteoporosis).

Does Smoking Slow Bone Healing?

When you break a bone, a specific type of cell called an osteoblast is responsible for building back bone at the site of the fracture. Nicotine has been shown to decrease the number of active osteoblast, so bone is redeposited much slower.

Does Smoking Effect Rotator Cuff Tears?

Rotator cuff (shoulder) tears in smokers are nearly twice as large as those in nonsmokers, which is probably related to the quality of these tendons in smokers.

Does Smoking Lead to Bursitis or Tendinitis?

Smokers are 1.5 times more likely to suffer overuse injuries, such as bursitis or tendinitis, than nonsmokers.

When you smoke, your entire body is deprived of oxygen. Hemoglobin is the main oxygen transporter in your blood. When smoke is inhaled, hemoglobin cannot carry as much oxygen as it typically does. This is relevant because oxygen is vital for wound healing. Without oxygen, wounds cannot heal.

As aforementioned, smoking causes narrowing of blood vessels. Think of this as a busy 4 lane highway with cars and trucks carrying precious cargo. In essence, smoking causes the highway to narrow to just 2 lanes, and covers each lane with a sticky, tar-like substance. This reduces the amount of blood flow and denies precious oxygen to the healing tissues.

Can Smoking Lead to Infection?

Smokers have a harder time fighting off infections than non-smokers do. It has been shown that smokers are 4x more likely to develop an infection following an injury or surgical procedure.

What Happens if you Stop Smoking?

The good news is that these effects are not permanent. Research has shown the effects on the body following smoking cessation. Below is a timeline of what you can expect to happen when you quit smoking.

Time After Quitting Smoking – Health Benefits

  • Minutes Heart rate drops
  • 24 hours Nicotine level in the blood drops to zero
  • Several days Carbon monoxide level in the blood drops to normal levels
  • 1 to 12 months Coughing and shortness of breath decrease
  • 1 to 2 years Risk of heart attack drops sharply
  • 3 to 6 years Risk of coronary artery disease drops by half
  • 5 to 10 years Risk of cancers of the mouth, throat, and voice box due to smoking drops by half
  • 10 years   Risk of lung cancer drops by half after 10-15 years
    Risk of cancers of the bladder, esophagus, and kidney decreases
  • 15 years – Risk of coronary heart disease drops to close to that of someone who does not smoke
  • 20 years – Risk of cancers of the mouth, throat, and voice box drops to close to that of someone who does not smoke. Risk of pancreatic cancer drops to close to that of someone who does not smoke
    Added risk of cervical cancer drops by about half.

Click for CDC Resources to Quit Smoking

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If you have an injury, the Jacksonville Orthopaedic Institute can help. To schedule an appointment with a JOI Orthopedic doctor, call (904)JOI-2000, schedule online, or click the link below. To see a JOI Rehab Therapist in 1 of our convenient locations, call (904)858-7045.

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