Fracture Healing: Bone Strength and Recovery
In this article
Jenalynn Fernandez explores fracture healing and questions about bone strength after a break. She also discusses fracture recovery through nutrition, appropriate activity and emotional support. Persistent pain and return to sport need individual context.
What questions arise about bone strength after fracture?
Those who have ever broken a bone have probably heard that their injury will heal weaker than the rest of their bones. Perhaps they’ve also heard that bones will heal to be stronger than before the fracture. Is there any way to determine which is true? The specter of athletic injury will always be hanging over a competitive athlete’s head. Musculoskeletal injuries can be found in all levels of sport and exercise.
These injuries can be caused by a combination of factors such as repetitive training increasing stress on the bone, or by direct trauma.
What happens during fracture healing?
To answer the question of post-fracture bone strength, we must understand the process through which a bone heals. Hackensack Meridian Health’s 2021 educational article explains that the process begins with a blood clot forming over the injured area as a protection mechanism. Over a couple days, a soft callus made of collagen forms to help reconnect the fractured edges of the bone. The bone gradually becomes harder as calcium is deposited to aid rebuilding.
Then, new cells form at the fracture site to reconnect the bone tissue. Eventually, the fractured bone returns to its normal shape once the edges have reattached.
How does the article explain bone adaptation and strength?
There is still the question of healed bones being stronger or weaker after a fracture. The question can be explained using Wolff’s Law, developed by German anatomist and surgeon Julius Wolff. Wolff’s Law states that a healthy bone will adapt relative to the load under which it is placed. If the pressure increases, the bone will be remodeled over time and become thicker and stronger to resist the imposed pressure.
However, if the pressure decreases, the bone will become less dense due to the reduced force necessary for continued remodeling. This law can easily be seen in tennis players. Tennis illustrates how repeated sport-specific loading can produce differences between the dominant and non-dominant arms. The injured area undergoes rapid mineralization and there is a brief period in the healing process where the fracture site is stronger than the surrounding bone.
Later, remodeling changes the repair and surrounding bone; a temporary callus does not make the bone permanently stronger. For example, using plaster casts to recover from bone injuries may cause muscle atrophy because of disuse. A fully healed fracture does not protect the bone from another trauma; that does not establish identical future injury risk for every person.
What can persistent pain after a fracture mean?
Pain and discomfort can persist after a fracture. Its cause should not be assumed from that history alone. The cited Evercore article notes that, “some people experience chronic pain from fractures like a broken ankle even years after the initial injury occurred.” Persistent pain after a fracture can have several causes; problems with bone healing are one possibility. Typically, there is acute inflammation that occurs at the time of injury.
But continued inflammation can be a sign that the healing process has either been interrupted or that there may be additional damage. General nutrition advice is not a substitute for understanding persistent pain after a fracture. This type of diet favors fruits and vegetables, foods containing omega-3 fatty acids, whole grains, lean protein, healthful fats and spices. It should cut out processed foods, refined sugars and excess carbs, according to a 2020 report.
Curcumin is a component of turmeric. General evidence about inflammation does not establish that a turmeric extract treats fracture pain or speeds bone healing.
How do nutrition and healthy habits fit fracture recovery?
Recovery can involve gradual work toward your prior activity level, with exercise and loading guided by your treating team. Healthy habits can help with bone strengthening. According to Hackensack Meridian Health’s 2021 educational article, eating calcium rich foods like cheese and other dairy products, green vegetables and fortified foods and beverages help strengthen and restructure bones. Eating foods rich in Vitamin-D is also advisable as it helps the body to better absorb the calcium.
Other healthy habits include exercising regularly (especially weight bearing exercises), ceasing smoking and limiting alcohol intake. The 2021 article stated that, “When women have more than 1 drink per day or men have more than 2 drinks per day, it increases the risk of osteoporosis.” If your diet isn’t as rich in calcium or Vitamin D, you may ask your doctor if you should take daily supplements to boost intake.
How does the source discuss gradual return and prevention?
To prevent further injury, some precautions should be taken. Start slowly and work up within your limits, as advised during recovery. This will allow your body to adapt to the physical demands of the activity. Taking breaks between exercising also allows your body the time it needs to heal properly between sessions. Some general tips for preventing sport injuries include wearing the recommended safety equipment, having properly fitted gear, and being aware of the heat and your exertion level.
Stretching prior to any exercise will help warm your muscles. Drink plenty of fluids to replenish those lost through sweat. Another important reminder is that you should not be in physical pain. If something hurts, you should stop the activity. There could be more serious issues that will only worsen by adding too much additional stress.
How can emotional support help during recovery?
Sometimes recovery takes a measure of mental toughness alongside physical rehabilitation. Many scientists and athletes believe that there is a strong mind-body connection that can affect healing. It is understandable that any kind of trauma to the body can lead to negative thoughts. The cited Bone & Joint article quotes Stanford University psychologist Alia Crum, PhD, who stated that “what patients think and expect about treatments can influence health outcomes.” If patients constantly think negatively about their healing process, it may be harder for them to restore their level of activity.
If those feelings are left unchecked, they can lead to anxiety and stress which can raise cortisol levels that increase blood pressure and inflammation (Bone & Joint, 2021). Depression is also a major concern during the healing process. It is understandable to become discouraged and irritable when simple daily movements like walking to the kitchen become more difficult because of an injury. Feeling depressed does not make ongoing pain inevitable; it is a reason for support rather than a judgment of effort.
Depression can also suppress the immune system’s productivity and can drain motivation, making it harder to continue with doctor recommended instructions and exercises (Bone & Joint, 2021). It can interfere with sleep as well as decrease your appetite, depleting you of beneficial nutrients, causing slower healing. But according to Bone & Joint Surgery Centers, there is light at the end of the tunnel. There are ways to help prevent these negative thoughts.
Sharing your feelings, especially with your family and friends, may lead to valuable support through your recovery journey. It may also be helpful to share your feelings with your healthcare provider or a counselor as it may feel easier to handle if you find out you’re not alone in your situation. It is best to trust them enough to follow their recommendations. They are here to help you.
For some people, it’s comforting to know what to expect in the rehabilitation process. So, learning everything about your injury and recovery process can also be beneficial so that you’re not blindsided. In general, a warmhearted home support system and an understanding health care team can aid you in making your recovery process a positive one.
What is the author’s balanced recovery message?
The strength and function recovered after a fracture depend on physical healing and individual circumstances. Stability, blood supply, nutrition and rehabilitation matter, while emotional support can help a person cope and follow care. The cited material does not show that mental toughness alone determines bone mineralization. So, work with your health care team, eat well and return to activity according to their recommendations.
References
Editorial Highlights
“The specter of athletic injury will always be hanging over a competitive athlete’s head.”
“Wolff’s Law states that a healthy bone will adapt relative to the load under which it is placed.”
“Persistent pain after a fracture can have several causes; problems with bone healing are one possibility.”