Thursday, 17 December 2015

You Can Speed Up Fracture Healing!

For people of all ages, there aren't many things more inconvenient than breaking an arm, leg or something else entirely. On top of waiting for the fracture itself to heal, weeks or months of restrictive inconvenience often follows as the muscles need to be retrained. But is there another way? Are there therapies to speed up the healing of fractures? Yes of course!

Low-intensity pulsed ultrasound (LIPUS) and pulsed electromagnetic field therapy (PEMF) are two options used by a number of athletes for promoting repair, with a review of 8 studies showing that both of these treatments can be effective in speeding tibial fracture healing. One of the papers reviewed found a reduction in healing time of 12 days among non-smokers treated with LIPUS (84 days versus 96 days) for clinical healing, and a reduction of 33 days for healing with PEMF (96 days instead of 129). Even in smokers using these therapies the healing time was reduced, 103 days versus 175 in the control group using LIPUS and 96 days versus 175 in the control group using PEMF. In another of the studies, this time evaluating fractures of the radius in the arm, the effects of LIPUS treatment on patients receiving 15 minutes of therapy per day were tested. For patients in the treatment group, clinical fracture healing time was 32 days on average, as opposed to 40 days in the placebo group. These figures do not count the time required to rebuild muscle tissue, so they do not fully describe the benefit of these therapies. Mechanical stimulation with whole body vibration may be another effective way to enhance bone healing and muscle strength, though results vary with the level of frequency and amplitude used. As these can be very expensive, I think they should be publicly funded due to their economic value from helping people return to work sooner. 
Fractures can also be treated nutritionally. For example, it is recommended to increase protein intake in fracture patients by 20 grams daily, as one study found that patients receiving a protein supplement remained in rehabilitation wards for 33 days as opposed to 54 days for the group receiving a placebo of similar caloric value. These patients also had greater increases of growth factor IGF-1, which is necessary for healing in bone fracture patients, and they experienced less than half of the loss in bone mineral density and half as many vertebral deformities compared to controls. Dairy products and some grains can also increase levels of IGF-1, so this is one time when you should not be on a Paleo diet. 
There are micronutrients that can also play a role in fracture healing. For example, an antioxidant vitamin E deficiency can disrupt maintenance of calcium stores, resulting in overactive parathyroid glands and bone loss. In animal studies, antioxidant administration completely prevented bone loss in mice with their ovaries removed, while inhibiting glutathione synthesis (the “master antioxidant”) resulted in a significant level of bone loss in mice with intact ovaries. Because of this, antioxidants are particularly important for post-menopausal women. Vitamin C, an antioxidant that often works with glutathione, may inhibit the bone destroying osteoclasts and sustain the growth of the bone building osteoblasts, by mechanisms such as upregulating collagen type I synthesis. Collagen synthesis is also essential for bone fracture healing in and of itself, because it is part of bone tissue. Certain pro-oxidant and inflammatory chemicals such as TNF-alpha, hydrogen peroxide, nuclear factor kappa-B, IL-8, IL-1 and IL-6 are known to work against bone building in support of the osteoclasts. Therefore, anti-inflammatory nutrients and herbs like turmeric, widely known for its effects against IL-6, may assist in healing. One of my mentors has a liking for potato poultices, and if they can be used, they have an effect against hydrogen peroxide due to the catalase present in raw potato. 
However, certain types of inflammation can benefit bone healing, therefore non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided as much as possible in favor of alternatives including vitamin C (500mg), quercetin, and bromelain. Of course, calcium, magnesium and vitamin D are always indispensable in bone growth and repair, but silicon supplementation as an adjunct may increase the rate of healing, though absorption rates vary.

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