How smoking or vaping can delay tendon healing

Yes, vaping is relatively clean compared to regular cigarette smoke, which can contain more than 4000 toxic compounds, but if your vaping solution contains nicotine it is still bad for injury healing. In this article, Maryke looks at how both smoking and vaping can impact healing and why tobacco smoke specifically should be avoided if you would like to make a speedy recovery from Achilles tendinopathy or tears.

In this article:

1. How nicotine interferes with injury healing

2. Carbon monoxide and hydrogen cyanide

3. How tobacco smoke affects collagen turnover

4. Would it help my Achilles if I reduced my smoking or stopped for a short period?

5. How we can help

I also discuss the effect of smoking and vaping on healing in detail in this video:

How nicotine interferes with injury healing

Getting a good supply of fresh blood to the injury site is extremely important as your cells require a constant supply of oxygen and nutrients to multiply and be healthy. Nicotine reduces the blood flow to your tissue in 2 ways:

1. It causes your blood vessels to contract and narrow (vasoconstriction) so that less blood can flow through it and

2. it also makes your platelets in your blood stick together more, causing your blood to thicken and this makes it more difficult for the blood to move through the smaller blood vessels in your body.

Tendons already naturally have a poor blood supply so this can potentially affect them more severely than other structures in the body. This means that if you smoke or vape regularly in the day, your tendon may be struggling to get enough oxygen and nutrients for large parts of the day which will interfere with its ability to heal.

Carbon monoxide and hydrogen cyanide

Tobacco smoke also contain carbon monoxide and hydrogen cyanide (and 4000+ other toxins). These two components have been shown to further reduce the oxygen that is available to cells. Carbon Monoxide binds much more easily to red blood cells than oxygen does which means that, instead of carrying oxygen to your Achilles tendon, the blood will carry carbon monoxide.

Carbon monoxide and hydrogen cyanide also reduces the number of white blood cells in your blood and these play an extremely important role during the first 3 to 5 days after you’ve sustained an injury like a tendon tear. If you don’t have enough white blood cells, your body will struggle to get rid of the damaged tissue and, in the case of open wounds (if you require surgery to repair an Achilles tear for instance), it will also struggle to defend you against infections.

How tobacco smoke affects collagen turnover

The main building block (80%) of a healthy tendon is collagen, and your Achilles tendon is made up of several bundles of strong collagen fibres. To recover from an injury like Achilles tendinopathy or a tear, your tendon has to create new strong collagen fibres. But to be honest, even without injury, your tendon has to produce new fibres every day to replenish ones that may be a bit old or that have been damaged through normal use (this happens in all the structures of the body, not just tendons).

Researchers are not entirely sure which of the toxins in cigarette smoke are to blame, but smoking has a very detrimental effect on collagen production in that it lowers the production of new collagen fibres. This means, that if you choose to smoke while injured, you’re effectively dialling down your body’s ability to produce the key building block that it needs to heal.

If you smoke on a regular basis when not injured, you may also be putting yourself at risk of injury. To my knowledge, smoking as not been extensively researched in relation to injury risk in Achilles tendons but there is strong evidence that it can cause degeneration of the intervertebral discs of your spine.

Would it help my Achilles if I reduced my smoking or stopped for a short period?

Very likely. It can take up to three days for the carbon monoxide to leave your body, but the research is not clear on how long the other toxins may continue to hang around. Even a small reduction in the levels may already help to increase the blood flow to your tendon and allow your body to function better.

I know that nicotine addiction is extremely hard to kick, but making the switch from cigarette smoke to nicotine-only options (like vaping or gum) may already provide you with some benefit. There are so many different services and products out there these days that could be of help, and speaking to your GP about it is usually a good first step.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate, Facebook, Twitter or Instagram.

References:

1. Elmasry, S., Asfour, S., de Rivero Vaccari, J. P., & Travascio, F. (2015). "Effects of tobacco smoking on the degeneration of the intervertebral disc: a finite element study." PLoS One, 10(8), e0136137.

2. McDaniel, Jodi C.; Browning, Kristine K. "Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice." Journal of Wound, Ostomy and Continence Nursing: September/October 2014 - Volume 41 - Issue 5 - p 415-423.