Musculoskeletal Effects of Cigarette Smoking

It is well known that cigarette smoking is implicated in lung cancer, respiratory conditions, cardiovascular disease and impaired immunity.  Heavier smokers (over a pack a day) also create a hypoxic state (lack of oxygen) in the body, which can be attributed to other health issues.  Researchers reviewed the current literature to specifically look at the effects of cigarette smoking on the musculoskeletal system and here are some of their findings: 

Bone Metabolism and Fracture Risk: Smoking appears to affect both osteoblasts and osteoclasts, both of which are important for balanced bone health, and can lead to a decrease in bone mineral density (osteoporosis).  This leads to an increased risk of fracture of the hip, spine, and radius. 

Fracture Healing:  Smoking leads to reduced blood supply and local tissue hypoxia, which increases fracture healing time, and increases the risk of poor healing, infection, and non union of fractures. 

Soft Tissue Healing:  Smokers tend to have delayed wound and soft tissue healing of tendons and ligaments, a higher risk of tendon injuries, increased wound infections and complications compared to non smokers.  Smokers have been shown to have a higher incidence of rotator cuff tears.

Back Pain:  The increased levels of pro inflammatory mediators by smokers can amplify pain as well smoking appears to be associated with an increase risk of degenerative disc disease and low back pain.  However, it is difficult to say how smoking is associated with low back pain, as smokers often have worse health, both mentally and physically, than non smokers. 

Arthritis:  There is an unclear relationship with smoking and osteoarthritis as some studies have shown increased knee cartilage loss in smokers, but it is an accepted risk factor for rheumatoid arthritis.  Smokers have also been shown to have a greater chance of developing lupus, an inflammatory autoimmune disorder.

Perioperative Management:  The negative effects of smoking on wound healing appear to improve after 4 weeks of smoking cessation.  Former smokers tend to do better than current smokers in terms of improved recovery from surgical wounds and have less post operative complications.  It would therefore be highly recommended that smokers cease smoking at least 4 weeks prior to any surgery. 

There are many health reasons to quit smoking, now we can add musculoskeletal conditions to the list!

Citation: Lee et al, The Musculoskeletal Effects of Cigarette Smoking; Journal of Bone and Joint Surgery (Am) 2013; 95: 850-859.

Exercise for Metabolic Syndrome

Metabolic syndrome is made up of five conditions: hypertension, diabetes, hypercholesterolemia, hyperlipidemia and obesity.  There are commonalities among these conditions, so treatment can have an effect on more than one condition in the syndrome.  One such treatment is EXERCISE aimed at weight loss.  Most health care providers understand the benefits of exercise, and often suggest to patients to exercise and lose weight, but they provide minimal instruction on how to do this. 

Aerobic training is the easiest type of exercise to begin with, and once started other components can be added such as flexibility and strength training.  Due to the often poor health status of the person with metabolic syndrome, it would be recommended that a physical exam be conducted before an aerobic conditioning program is started.  Blood pressure, pulse rate, body weight and circumferential measurements of the waist, hip and thighs should be recorded to establish a baseline. 

Aerobic exercise is anything that can elevate your heart rate.   Walking indoors or outdoors, walk/run intervals, running, stair climbing, water aerobics, swimming, rowing, jumping rope, cycling on a stationary bike or outdoors, and dancing are activities that are aerobic.

Exercise can be recommended as a number of sessions a week for a certain length of time, and should be referred to as a prescription, as patients are more inclined to see it therapeutically to treat their metabolic syndrome.  Monitoring is important, for motivation and compliance as well to determine if there are any concerns to address.  Depending on the patient’s pre-existing conditions, assessments should be done monthly if they are just beginning or returning from an injury, but patients who are in better shape or have been exercising longer may have a longer period between assessments.   

The rule for determining minimal intensity is that the patient must be sweating within the first 10 minutes of exercise, and maximum intensity is that the patient must be able to carry on a conversation while exercising.  Another method to determine intensity is to monitor heart rate.  To determine a patient’s target heart rate, subtract the patient’s age from 220 than subtract the resting heart rate from this number.  To burn fat, the number is multiplied by 60-70 percent, for endurance the number is multiplied by 80. 

The final step in aerobic exercise is to keep track of activity by recording duration and dates of exercise sessions.  This helps with compliance and to determine progress.  Of course, exercise is always more fun when you do it with someone else, so get family and friends to join you!