We all know smoking is bad for your lungs and heart, but did you know it also has detrimental effects on your muscles, bones, and joints? If you're a smoker or you work with patients who smoke, it's crucial to understand how this habit doesn’t just affect respiratory health but also takes a toll on the musculoskeletal (MSK) system.
Let’s dive into why smoking matters, particularly when it comes to MSK health, and how quitting can help your body heal, strengthen, and thrive.
Why Does Smoking Matter?
In 2022, 12.9% of the UK population aged 18 years and older were smokers—that's about 6.4 million people. While this is the lowest smoking rate ever recorded in the UK, the risks associated with smoking remain. Smoking is still the leading cause of premature death and preventable illness (PHE, 2019). And here's the kicker: people who smoke generally live in poorer health compared to non-smokers, spending more time dealing with chronic health issues.
How Smoking Affects MSK Health
Many people don’t realise that smoking has a huge impact on musculoskeletal conditions, making recovery from injuries slower and increasing the risk of conditions like arthritis, osteoporosis, and even fractures. Here’s a breakdown of how smoking harms your MSK system:
1. Delayed Wound Healing
One of the key ways smoking impacts MSK health is by delaying wound healing. Whether it's a surgical wound or an injury, the healing process is compromised. Wound healing occurs in three overlapping stages: inflammation, proliferation, and tissue remodelling. However, smoking affects this process at every stage, particularly by lowering oxygen levels in the tissues—a condition known as tissue hypoxia.
Why is oxygen so important? Tissue oxygenation is essential for cell migration, bacterial defence, and collagen synthesis, all crucial for wound healing. Even smoking just one cigarette can impair oxygen levels in tissues. For those who smoke a pack a day, tissue hypoxia can last for a significant part of the day, further complicating the healing process (Jensen et al., 1991).
The harmful chemicals: The primary toxins in cigarettes—nicotine, carbon monoxide, and hydrogen cyanide—disrupt the oxygen supply to tissues. These toxins slow the production of essential cells like white blood cells and fibroblasts, which are crucial for fighting infection and building new tissue (McDaniel & Browning, 2014).
2. Increased Risk of Osteoporosis and Fractures
Osteoporosis, or weakened bones, is another consequence of smoking. Smokers are at a much higher risk of developing this condition, which leads to fractures, even from minor falls or injuries. Smoking weakens bones in several ways:
It reduces blood supply to bones.
Nicotine slows down the production of osteoblasts (the cells responsible for forming new bone).
It decreases calcium absorption, essential for strong bones.
Smoking also accelerates the breakdown of oestrogen, which helps maintain bone density, especially in women.
A meta-analysis by Xu et al. (2022) found that smoking increases the risk of fractures in men by 10-20%. It also delays the healing of fractures—one study found that smokers take almost twice as long to heal from tibial fractures compared to non-smokers (Schmitz et al., 1999). Another study by Xu et al. (2021) showed that smokers are more likely to experience complications like non-union of fractures and surgical site infections.
3. Increased Risk of Injuries
Smokers are more prone to injuries than non-smokers, with studies indicating that they are 1.5 times more likely to suffer overuse injuries like bursitis and tendinitis. Research by Baumgarten et al. (2010) and Carbone et al. (2012) has also shown that smoking is more common in patients with rotator cuff tears, with the risk increasing as smoking frequency goes up.
4. Higher Risk of Arthritis
Long-term smoking has been linked to an increased risk of arthritis and degenerative spinal diseases. A study by Davies-Tuck et al. (2009) showed that smokers experienced more knee cartilage loss over two years compared to non-smokers. The damage doesn’t stop there—smoking also contributes to degenerative disc diseases and spinal stenosis, which can lead to chronic back pain and reduced mobility (Rajesh et al., 2022).
5. Reduced Muscle and Tendon Strength
Smoking doesn’t just affect bones—it weakens muscles and tendons, too. By increasing the levels of carbon monoxide in the body, smoking interferes with the ability of respiratory and muscle proteins (like haemoglobin and myoglobin) to deliver oxygen to muscles. This leads to reduced energy production in muscle cells, weakening their strength and performance (Degens et al., 2015).
A longitudinal study from the Amsterdam Growth and Health Longitudinal Study found that smoking just 100g of tobacco per week was associated with a significant reduction in muscle strength. Specifically, men experienced a 2.9% reduction in quadriceps strength, and women saw a 5.0% reduction (Kok et al., 2012).
How Quitting Can Help
The benefits of quitting smoking go far beyond better lung health. For those with musculoskeletal conditions, quitting can improve healing times, reduce the risk of fractures and injuries, and restore muscle and tendon strength. Even if you’ve been a long-term smoker, quitting today can significantly improve your body’s ability to repair and strengthen itself.
NHS Stop Smoking Services offer a wealth of resources to help you quit for good. From nicotine replacement therapy to support groups, there are plenty of ways to kick the habit and start living healthier.
Final Thoughts
The evidence is clear—smoking is not just bad for your lungs, but for your entire body, especially your musculoskeletal system. Whether you’re trying to recover from an injury or simply stay active and healthy as you age, quitting smoking could be the best decision you ever make. Every day without cigarettes is a step towards stronger muscles, healthier bones, and a better quality of life.
Further Reading:
Smoking and Musculoskeletal Health - OrthoInfo - AAOS
Smoking Cessation - NICE Guidelines
Blog contribution by David Smale, First Contact Practitioner in Primary Care.
References:
PHE (2019) Health matters: stopping smoking – what works? Public Health England. Link
McDaniel JC, Browning KK. Smoking, chronic wound healing, and implications for evidence-based practice. J Wound Ostomy Continence Nurs. 2014 Sep-Oct;41(5):415-23; quiz E1-2. doi: 10.1097/WON.0000000000000057.
Jensen JA, Goodson WH, Hopf HW, Hunt TK. Cigarette smoking decreases tissue oxygen. Arch Surg. 1991;126(9):1131–1134.
Xu, Y., Bao, Y., Wang, M. et al. Smoking and fracture risk in men: a meta-analysis of cohort studies, using both frequentist and Bayesian approaches. Sci Rep 12, 9270 (2022).
Schmitz MA, Finnegan M, Natarajan R, Champine J. Effect of smoking on tibial shaft fracture healing. Clin Orthop Relat Res. 1999;(365):184–200.
Xu B, Anderson DB, Park ES, Chen L, Lee JH. The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures. EClinicalMedicine. 2021 Oct 31;42:101179.
Baumgarten KM, Gerlach D, Galatz LM, Teefey SA, Middleton WD, Ditsios K, Yamaguchi K. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res. 2010 Jun;468(6):1534-41.
Davies-Tuck ML, Wluka AE, et al. Smoking is associated with increased cartilage loss and persistence of bone marrow lesions over 2 years in community-based individuals. Rheumatology (Oxford) 2009;48(10):1227–1231.
Rajesh N, Moudgil-Joshi J, Kaliaperumal C. Smoking and degenerative spinal disease: A systematic review. Brain Spine. 2022 Aug 7;2:100916.
Degens H, Gayan-Ramirez G, van Hees HW. Smoking-induced skeletal muscle dysfunction: from evidence to mechanisms. Am J Respir Crit Care Med. 2015;191:620–625.
Kok MO, Hoekstra T, Twisk JW. The longitudinal relation between smoking and muscle strength in healthy adults. Eur Addict Res. 2012;18(2):70–75.
Carbone S, Gumina S, Arceri V, Campagna V, Fagnani C, Postacchini F. The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. J Shoulder Elbow Surg. 2012;21(1):56–60.
Commentaires