The Effects of Smoking on the Musculoskeletal System

Everyone knows cigarette smoking is bad for your health. It causes lung cancer, emphysema, and heart disease, to name a few things. What most people don’t realize, however, is how harmful smoking is to your musculoskeletal system. Smoking causes many conditions that are associated with significant pain, and makes healing from injury or surgery significantly more difficult. The general medical risks may be somewhat abstract – too far off in the future to worry about. The truth is, for most smokers, smoking is actually affecting your quality of life – today.

Back Pain

Smokers are about twice as likely as nonsmokers to suffer from back pain, according to several studies. In smokers, quitting smoking improves back pain. Studies have also demonstrated increased disc degeneration in smokers. In addition, in patients who have spinal fusion, the risk of the fusion not healing is five times higher in smokers.

Rotator Cuff Tears

Smokers are about twice as likely to develop rotator cuff tears, and when they do, the tears tend to be larger. Rotator cuff tears often require surgery, and unfortunately, patients who smoke have a much more difficult recovery from surgery and a higher risk of failure. Nicotine itself delays and inhibits tendon to bone healing, which is necessary for recovery from rotator cuff surgery.

Osteoporosis and Broken Bones

Smoking causes osteoporosis and weakened bones, even in young patients. Bone density was decreased in smokers in several studies, across all age ranges. The risk of a broken hip is doubled in smokers. The risk of spine fractures associated with osteoporosis is also significantly higher in smokers. In addition, smokers have a higher risk of a condition known as avascular necrosis of the hip, which often results in the need for a hip replacement. Women who smoke tend to undergo menopause an average of 2 years earlier than nonsmokers, which also affects bone density.

Healing of Broken Bones

Smoking has been demonstrated in several studies to slow bone healing and also increase the risk of broken bones not healing. Well studied examples include collarbone, tibia, ankle, and heel bone fractures, all of which have a higher risk of not healing in smokers. In addition, even smokers who heal are more likely to have persistent pain and other complications after the bone heals.

Rheumatoid Arthritis

Smoking is a well known risk factor for the development of rheumatoid arthritis, which is a more debilitating form of arthritis that occurs when the immune system attacks the joints.

Surgical Complications

In patients who have surgery for musculoskeletal conditions, smokers have a much higher complication rate. The risk of infection after surgery is significantly higher (six times higher in one study on ankle fractures). Wound complications are more common. In addition, the risk of more serious complications like blood clots, stroke, and pneumonia are all higher in smokers. Quitting smoking prior to surgery reduces these risks substantially, in a time dependent fashion.

Quit one week before surgery and the risks are a little lower, quit four weeks before and they are markedly reduced.


Stopping smoking is very difficult, but there are many resources and medical treatments available to help. People who quit not only reduce their risk of serious health issues, but have less pain and feel better overall. The true key of course is deciding that you really want to be rid of the habit. Nicotine replacement (gum, patches, inhalers) may be helpful. There are two medications that have been demonstrated to help – Chantix and Xyban (also known as Wellbutrin). Typically your primary care doctor would prescribe these. There are many local resources to help quit, including the Suwannee River Area Health Education Center ( and Tobacco Free Alachua ( The state of Florida maintains a toll-free hotline for help at 1-877-U-CAN-NOW.