Many players are involved, including growth factors, inflammatory cytokines, antioxidants, bone breakdown osteoclast and bone-building osteoblast cells, hormones, amino acids, and uncounted nutrients. Fracture healing can be divided into three phases. The inflammation phase is the first stage of healing. Immediately upon fracture, a blood clot forms, allowing the influx of inflammatory, clean-up cells to the wound area.
This is followed by a cytokine cascade that brings the repair cells into the fracture gap. These cells immediately begin to differentiate into specialized cells that build new bone tissue osteoblasts and new cartilage chondroblasts. Over the next few months, these cells begin the repair process, laying down new bone matrix and cartilage. At this initial stage, osteoclast cells dissolve and recycle bone debris. The second, reparative stage begins about two weeks after the fracture occurs.
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In this stage, proteins produced by the osteoblasts and chondroblasts begin to consolidate into what is known as a soft callus. This soft, new bone substance eventually hardens into a hard callus as the bone weaves together over a 6- to week time period. The final step of fracture repair is known as the remodeling phase. At this stage the callus begins to mature and remodel itself.
Woven bone is remodeled into stronger lamellar bone by the orchestrated action of both osteoblast bone formation cells and osteoclast bone resorption cells. Each stage of the fracture healing process brings with it increased nutritional demands. For starters, the whole process requires a great deal of energy—which is generally supplied through the intake of calories in food.
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Next, healing requires the synthesis of new proteins, which is dependent upon an ample supply of amino acids derived from dietary proteins. An adequate blood supply is also mandatory for fracture healing, so anything that diminishes blood flow such as smoking or poor circulation slows the healing process. But there are a number of methods you can employ to reduce your healing time:. Fracture healing requires more energy than you might expect. In traumatic fractures of the long bones, for example, there is an immediate increase in metabolic demands that can translate into a caloric demand three times that of normal.
While a normally active adult may require 2, calories a day, a bedridden, injured patient with multiple fractures may need 6, calories per day! If this demand is not met, the healing process is compromised. Bone can be imagined as being somewhat like a sponge made of living protein upon which mineral crystals are embedded.
By volume, roughly half of bone is comprised of protein. When a fracture occurs, the body is called upon to gather protein building blocks together to synthesize a new structural bone protein matrix. In addition, protein supplementation increases growth factors like insulin-like growth factor-1 IGF-1 , a polypeptide that exerts a positive effect on skeletal integrity, muscle strength, immune response, and bone renewal.
Numerous studies document the acceleration of fracture healing with even a modest to gram increase in protein intake. The benefits of supplemental protein are important to everyone and especially important to those with malnutrition or low baseline protein intake. In fact, among elderly hip fracture patients, poor protein status at the time of fracture predicts fracture outcome.
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Those with low protein status take longer to heal, and have more complications, including death. Specific amino acids of special importance include lysine, arginine, proline, glycine, cystine, and glutamine. Lysine, for example, is known to enhance calcium absorption, increase the amount of calcium absorbed into the bone matrix, and aid in the regeneration of tissue. Antioxidants repair oxidative damage.
When a bone fracture occurs, a remarkable yield of free radicals is generated by the damaged tissues. In particular, this damage occurs as the tightly bound collagen strands running through the mineral phase of bone are forcefully broken. These ruptured collagen strands interact with oxygen-yielding oxygen radical metabolites. These free radicals are associated with inflammation, further breakdown of bone collagen, and excessive bone turnover. In fracture healing, increased free-radical production can overwhelm the natural anti-oxidant defense mechanisms. In such cases, antioxidants — including vitamins E and C, lycopene, and alpha-lipoic acid — have been suggested to be beneficial in suppressing the destructive effect of oxidant free radicals on whole body systems and improving fracture healing in animal models and cultured human cell lines.
Inflammation is an essential component of the healing process in bone. Although painful, it is an important part of the cleaning-up and rebuilding process. Many of our standard non-steroidal anti-inflammatory drugs act by inhibiting the COX-1 and COX-2 enzymes—which relieves the pain, but also delays healing. On the other hand, nourishing the body to reduce inflammation naturally speeds healing. Vitamin C, bioflavonoids and flavonols such as quercitin and proanthrocydins, and omega-3 fatty acids naturally soothe the inflammatory process and speed healing.
While protein and minerals may be the building blocks, vitamins are the catalysts for many biochemical reactions and are equally important. In fracture healing, we can clearly identify the vital roles of several vitamins including vitamin C, vitamin D, and vitamin K as well as the energy-producing B vitamins, which should all be taken in therapeutic doses:.
For fracture healing, it is ideal to use nutrients that are both anti-inflammatory and nourishing to new bone growth. Useful anti-inflammatory nutrients include vitamin C, quercitin and other flavonoids, omega-3 fatty acids, and proteolytic enzymes such as bromalain and trypsin. Bone is complex tissue that requires many nutrients. Given this fact, supplementation with a wide range of key bone nutrients is likely to provide more effective fracture healing than individual nutrient supplementation.
At the Center for Better Bones, we always recommend therapeutic doses of all the 20 key bone-building nutrients for optimum fracture healing. While no scientist has yet conducted a clinical trial using all 20 key nutrients for fracture healing, several studies have found multi-nutrient therapy to reduce complication and accelerate fracture healing.
Another innovative placebo controlled, multi-nutrient study from India administered vitamin C, lysine, proline, and vitamin B6 to tibial fracture patients. This life-supporting eating pattern has been shown to create a health-promoting internal biochemical environment which, among other things, conserves bone building minerals and proteins.
Such a base-forming eating program also has been shown to increase growth hormones and growth factors such as IGF insulin-like growth factor. These growth hormones are among the most important biochemical forces encouraging fracture repair and new bone formation. Throughout history, and even today in much of the world, traditional herbal medicine has been the mainstay of medical practice.
This long tradition of herbal wisdom has employed various herbs to speed fracture healing. Among these is cultivated European comfrey Symphytum uplandics x. Herbalist Susun Weed recommends cultivated comfrey be used as an aid in fracture healing. She also reports great success applying a hot, fresh burdock leaf poultice to reduce the swelling induced by a fracture.gohu-takarabune.com/policy/buscar/fete-programa-para-localizar.php
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Arnica Arnica montana is reportedly another helpful herb, as detailed by herbal researcher Alma Hutchens, but it must be used with caution as large amounts are poisonous. She reports that five drops or fewer of Arnica tincture given every 3 to 4 hours after the initial trauma is said to help recovery from the trauma of fracture.
Horsetailgrass is an herb high in silicon, which can be boiled and made into a tea valuable in the early stages of fracture healing. In all cases, however, herbal medicine should be used under the guidance of a qualified herbalist. Traditional Chinese herbal medicine can be an effective way to reduce the swelling, pain, and soreness of fracture. Chinese medicine can also accelerate healing when used under the guidance of an experienced practitioner.
Finally, the traditional Ayurvedic medicine of India is now becoming known in the West and drawing the attention of scientists and pharmaceutical companies alike. The Indian herb Cissus quadrangularis in particular has been studied for its fracture-healing benefits. As we look around the world, we would indeed expect to find traditional herbal approaches to fracture healing and those with access to an expert herbalist can benefit from this traditional wisdom. Exercise is unlikely to pop into your mind as an important way to accelerate fracture healing — yet it is.
In general, bone tissue responds to patterns of loading by increasing matrix synthesis, altering composition, organization, and mechanical properties. Evidence indicates that the same holds true for bone under repair. Further, fracture healing requires good circulation and an adequate flow of nutrient-replenishing blood to the fracture site — both of which are enhanced by exercise. To avoid stress on the broken bone, joint loading, range of motion, and specific tendon-gliding exercises are employed to accelerate healing and assure return of function post fracture.
For example, in the case of a broken forearm, exercises would involve movements of the fingers and hand, as well as the elbow and shoulder joints. In these situations, the use of electromagnetic bone stimulating devices has proven to speed healing.
Homeopathy, reiki, qi gong, polarity therapy, healing touch, acupuncture, and massage are all non-conventional energy healing modalities with applications for fracture healing. Common over-the-counter homeopathic remedies include arnica as an anti-trauma remedy for immediately after the fracture not to be used if the person is unconscious , symphytum comfrey for pain relief and the joining of set bones, and Calcarea phosphorica for fractures that are difficult to heal.
Low-potency homeopathic remedies 6x, 6c to 30x, 30c are often used for self-help, as detailed in Homeopathic Self-Care by Robert Ullman and Judyth Reichenberg-Ullman Prima Publishing, and at www. Homeopathy is a powerful medicine and when possible the best policy is to seek the advice of a professional homeopath.
Cells damaged from the trauma of fracture release large amounts of inflammatory prostaglandins at the site of fracture. The ensuing inflammation causes pain and the natural tendency is to want to block this painful reaction. In this case, non-steroidal anti-inflammatory drugs COX-1 and COX-2 inhibitors might be the medication we reach for to relieve the pain.
As it turns out, prostaglandin-induced inflammation is an essential component of the fracture healing process, and cyclooxygenase enzymes COX-1 and COX-2 play important roles in fracture repair. These inflammatory prostaglandins are a natural and essential part of initial tissue repair and the initial inflammatory immune response is crucial to fracture healing.