Understanding broken bones
Broken bones are known interchangeably as fractures. Fractures are defined as a breach in the structural continuity of the bone cortex, which may involve a degree of injury to the surrounding soft tissues (1).
Fractures are a public health issue the world over, and for the individual can lead to disability, impaired quality of life, health loss, and more broadly speaking high healthcare costs (2). A review from 2008 of fracture epidemiology estimated that in England alone the overall annual fracture incidence is 3.6% of the population (3).
Since fractures are so common, helping them heal well is undoubtedly beneficial not only in the short-term but also for avoiding the potential longer-term repercussions of poorly healed fractures. These can include disability, reduced bone strength, mobility and therefore quality of life.
Herbs can play an important role in helping bones to heal successfully and efficiently.
How do broken bones heal?
There are three main stages to bone healing:
- Inflammation
- Repair
- Remodelling
Inflammation
The inflammatory stage of fracture healing begins immediately following a fracture and involves the formation of a hematoma at the fracture site.
Blood vessels supplying the bone and periosteum (the outside covering of bones supplying blood, nerves, and cells for growth and healing) are ruptured during a fracture. This rupture of the blood vessels causes the formation of a hematoma around the fracture site. The hematoma is a clot which creates a temporary frame for subsequent healing to occur. The injury to the bone activates the secretion of pro-inflammatory cells at the fracture site, which triggers a cascade of events including bringing immune cells to the area which clean up damaged tissues, and the secretion of other cells which stimulate growth and healing at the site of injury (1).
Any residual bone fragments in the distal fracture are usually resorbed, which is why a fracture line is not evident initially. This means cells are removed by gradual breakdown into component materials and removed via circulation. Sometimes fractures take about a week after the injury to become evident as the bone fragments are resorbed (4).
Repair
The reparatory stage of fracture healing involves the formation of a callus which bridges the gap between the broken bone ends. The callus is a tissue mass made of collagen fibres and cartilage (5), also known as a collagen-rich fibrocartilaginous network (1). Cells called fibroblasts produce collagen fibres which eventually form the callus, while new blood vessels develop which allows the formation of cartilage spanning the fracture line (4).
Immobilisation is usually needed during the first 2 stages of bone healing to allow the growth of new blood vessels (4).
Remodelling
The remodelling phase of fracture healing involves the breaking down and rebuilding (or remodelling) of bone. The soft callus eventually hardens as the cartilage becomes ossified and replaced by bone. Remodelling of the vascular supply to the area is also an important change which occurs alongside the formation of bone (1, 4).
It is during the remodelling stage patients are generally advised to gradually resume normal movements, including load-bearing (4). Remodelling lasts for many months and eventually results in the regeneration of normal bone structure (1).
Understanding the root of bone healing
The development of new blood vessels is essential for every stage involved in the healing of bones. Disruption of the blood supply of broken bones is one reason that they can take a long time to heal (5), and disorders that impair peripheral circulation (such as diabetes or peripheral vascular disease) slow the healing of broken bones (4).
This highlights the importance of healthy circulation and blood vessels in bone healing. Therefore, herbs which support the integrity of blood vessels and circulation are helpful in the repair of broken bones.
Additionally, bone remodelling requires adequate minerals and vitamins:
Minerals
- Calcium and phosphorus are required in large amounts for strengthening and hardening of new bone.
- Magnesium, fluoride, and manganese are required in smaller amounts. One must be careful not to have too high of a dose of fluoride and manganese as they can negatively impact the nervous system.
Vitamins
- Vitamin A stimulates osteoblasts which are cells involved in the formation of the fibrocartilaginous callus, and in the remodelling phase of bone healing.
- Vitamin D assists in bone building by increasing absorption of calcium from food.
- Vitamins K and B12 are necessary for the synthesis of bone proteins (5).
Signs and symptoms
The most common signs of a broken bone are:
- Pain
- Swelling
- Deformity
Sometimes it is difficult to tell clearly if a bone is broken, and other symptoms may include:
- Hearing or feeling a snap or grinding sound at the time of injury
- Swelling, bruising or tenderness may be present around the injury
- Pain on weight-bearing, touching, pressing or moving the injury
- You may feel faint, dizzy, or sick because of the shock of breaking a bone
If you suspect breaking a bone, it is always best to get this checked as soon as possible.
Herbal solutions
There are key herbs which are helpful in bone healing due to their effects on tissue repair.
Herbal solutions for broken bones look at specific areas to support, such as:
- New tissue growth.
- Collagen synthesis.
- Reduction of inflammation (after the initial phase of inflammation which is important to recruit cells which promote healing to the area of injury).
- Improved circulation.
- Supporting the integrity, growth (angiogenesis) and repair of blood vessels.
- Antioxidants to remove waste products and keep tissues healthy.
- Mineral-rich herbs to support the requirements of bone remodelling.
Gotu kola (Centella asiatica)
Gotu kola is a key herb in healing from injuries, having been used as a powerful wound-healing herb traditionally in Ayurveda. Research has shown that gotu kola may promote and modulate collagen synthesis, which is involved in wound healing and tissue repair. It also seems to reduce fibrosis, scarring and local inflammation (6). It is thought that gotu kola improves the integrity of blood vessel walls, thereby improving circulation, and making it an excellent support for the healing of broken bones.
A recent systematic review of gotu kola concluded that it may be helpful in wound healing due to it increasing angiogenesis (formation of new blood vessels), as well as its anti-inflammatory effects (7). It is thought that gotu kola may enhance wound healing due to its stimulating effect on collagen synthesis and fibroblast growth factor which are important cells in wound healing and angiogenesis. Both of these are applicable in healing bones and so gotu kola is one of the first herbs to reach for to aid the process of recovery from broken bones.
It can be taken internally as an infusion of the dried plant material, as a tincture (alcohol extract), and also applied topically in a cream or ointment once the fracture site is accessible. Applying topically will aid healing not only of the bone but also any surrounding soft tissues which may have been damaged during the injury.
Additionally, gotu kola is classified as an adaptogenic herb and a nervine tonic. Adaptogens help to increase the body’s resilience to stress, while nervine tonics help to restore healthy function of the nervous system. Therefore, when taken internally, gotu kola will be helpful not only with the physical aspect of healing broken bones, but also provides support for the mental and emotional stress of experiencing an injury.
Comfrey (Symphytum officinale)
Also known by the common name ‘boneset’, comfrey is a powerful promoter of new tissue growth and has a long history of traditional use in the healing of bones, as suggested by this common name.
Comfrey is considered a vulnerary herb, meaning that it specifically aids the healing of wounds when applied topically. This will help with any soft tissue damage surrounding a broken bone, whilst the constituent known as allantoin found in comfrey acts to specifically promote wound healing and bone growth.
Comfrey can be applied topically in a cream or ointment (of 10 – 30% comfrey) to the injury site (6).
Note: Comfrey is for external use only.
Nettle (Urtica dioica)
Nettle leaf is considered traditionally as a natural nutritive tonic herb for building strength. It is high in various vitamins and minerals content, and specifically vitamin K which is required for synthesis of bone proteins and therefore beneficial in bone healing. Nettle leaf is also a rich source of silicon (8), which is helpful for strengthening bones. Additionally nettle leaf also has a depurative action, meaning that it cleans the blood by helping to improve detoxification and removes metabolic waste products in the body (6), which is also helpful in the case of bone healing.
Nettle can be drunk as an infusion, and combines well with gotu kola and horsetail.
Horsetail (Equisetum arvense)
Traditionally horsetail is used in Ayurveda as a healing herb for broken bones and is considered to supply nutrients to bone tissue (9).
Horsetail is also considered to have a styptic action, meaning that it helps to reduce bleeding, which is helpful in wound healing in general. Its high silicon content is helpful in the case of bone healing (although the bioavailability of it is questionable) (6).
A review of the pharmacological actions of horsetail reported in-vitro studies of human cells (in test tubes), whereby a horsetail extract was shown to reduce the activity of osteoclasts (cells which break down bone), whilst seeming to promote the activity of osteoblasts (cells which play a key role in the formation of new bone) and prevented the risk of infection (10). However it is important to note that studies are not carried out on humans, and they are using an extract of horsetail applied directly to cells, meaning the results are not directly transferable to internal consumption of the herb. However, these studies may begin to explain the pharmacology behind the long history of traditional use for this herb in bone healing. Along with its other potential benefits, horsetail is worth including in the bone healing herbal toolkit.
Horsetail can be taken as an infusion and combines well with gotu kola and nettle. It is not advised for continued long-term use, so would be recommended to take for the bone-healing period only.
Bilberry (Vaccinium myrtillus)
Bilberry promotes healing, which is probably due to its content of polyphenols. Polyphenols are protective against free radical damage, reduce inflammation, and improve the repair of connective tissues. Polyphenols also improve circulation, both by promoting peripheral circulation, and improving the integrity of blood vessels in microcirculation such as within the capillaries. This protective effect on the circulation and action on the repair of connective tissues makes bilberry a wonderful additional support during recovery from broken bones.
Ginkgo (Ginkgo biloba)
Ginkgo is a relatively new herb in the medicine chest, so there is not a long history of traditional uses in the West. There is a long-standing history of use in Traditional Chinese Medicine, but not for bone healing. It has however been found that high doses of the extract can improve blood flow, as well as provide oxygen and nutrition to tissues. Although most of these studies have looked at one specific extract of ginkgo, it is hopeful that due to its effects in improving circulation ginkgo could be a beneficial adjunct in the herbal treatment of broken bones.
Arjuna is also an excellent healer and rejuvenative to skin and bone tissue, supporting the body’s natural healing process with a particular focus upon broken skin and bones and damage caused by chronic viral and bacterial infection.
Arnica
Arnica can be used in the first few days after a break or fracture to reduce swelling and pain, and calm the inflammatory response. It can only be used topically.
Ashwagandha has been shown to improve bone calcification, and proliferates the number of cells that produce bone tissue. This in combination with its anti-inflammatory effects makes it a useful plant in the bone healing process (11).
Boswellia is used externally to quicken the healing of wounds and broken bones, particularly if there is local inflammation. It is also helpful for many different types of pain especially after trauma or inflammation.
Cannabis (CBD)
CBD and topical use of cannabis can be helpful for reducing pain and inflammation. You can read more about this in our article Herbal quality and safety: What to know before you buy. However, studies show that internal use increases risk for delayed bone-healing, and cannabis users demonstrate lower bone mineral density and are at increased risk for fracture (12).
Dan shen (Salvia miltorrhiza)
Dan shen can treat bone diseases, and promote bone healing. A study showed that there were 33 active components and 70 targets related to traumatic bone defects. These included various enzymes and messengers involved in the inflammatory and healing process such as MAPK1, MAPK10, MAPK14, TGFB1, and TNF. The study showed that dan shen might treat to bone trauma through an osteogenic (relating to formation of bones) differentiation pathway (13). Salvianolic acid B is one of the compounds that assists this.
The resinous characteristics of myrrh, traditionally indicated it in the healing of bone based fractures and the healing of deep-seated wounds. A study showed that myrrh inhibited osteoclastogenesis, which means it blocks osteoclasts being made. Osteoclasts are cells which degrade and resorb bone structures, and so myrrh may be helpful for osteoporosis which is a common cause of bone breaking (14).
Traditionally, turmeric and milk is used to heal bone fractures, and curcumin is said to prevent osteoclasts being made. This is vital for forming new bones.
Holistic solutions
Taking reset and immobilising the broken bone during the initial stages of bone healing is usually recommended, and then gradual re-introduction of weight-bearing / movement during the later stages of bone healing once the remodelling phase is in place (usually after about 6 weeks).
Diet
A diet rich in vitamins and minerals required for bone remodelling will be beneficial to aid the process. This includes:
- Calcium: Dark green leafy vegetables, almonds, sardines, some dairy.
- Phosphorus: Dairy, red meat, seafood, legumes, nuts, sunflower and pumpkin seeds.
- Vitamin A: Leafy green vegetables, orange and yellow vegetables (carrots, sweet potato, pumpkin, squash), fish oil, eggs.
- Vitamin D: Cod liver oil, salmon, tuna, sardines.
- Vitamin K: Green leafy vegetables.
- Vitamin B12: Meat, fish, eggs, some dairy.
Plant-based foods rich in polyphenols will help to support healthy circulation and protect against free-radical damage. These foods include:
- Berries (especially blueberries)
- Cacao powder (also a source of magnesium)
- Flaxseeds
In addition to this, short-term supplementation may be considered with a supplement which contains the above vitamins and minerals, particularly focussing on those needed in high amounts for bone remodelling such as calcium and phosphorus. One must be careful with supplements that they are of good quality, are bioavailable and not full of unnecessary additives and fillers.
References
- Sheen JR, Garla VV. Fracture Healing Overview. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551678/. Accessed February 7, 2023.
- Wu AM, Bisignano C, James SL, Abady GG, Abedi A, Abu-Gharbieh E, et al. Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Healthy Longevity. 2021;2:e580–92. https://doi.org/10.1016/S2666-7568(21)00172-0.
- Donaldson LJ, Reckless IP, Scholes S, Mindell JS, Shelton NJ. The epidemiology of fractures in England. J Epidemiology Community Health. 2008;62(2):174-180. doi:10.1136/jech.2006.056622.
- MSD Manual Professional Version. Overview of Fractures. https://www.msdmanuals.com/professional/injuries-poisoning/fractures/overview-of-fractures?query=fractures. Accessed February 8, 2023.
- Tortora G & Derrickson B. Principles of Anatomy and Physiology. 13th Ed. Asia: John Wiley and Sons; 2011.
- Bone, K, The Ultimate Herbal Compendium. Warwick, Queensland: Phytotherapy Press; 2007.
- Arribas-López E, Zand N, Ojo O, Snowden MJ, Kochhar T. A Systematic Review of the Effect of Centella asiatica on Wound Healing. International Journal of Environmental Research and Public Health. 2022; 19(6):3266. https://doi.org/10.3390/ijerph19063266.
- Bone K, Mills S. Principles And Practice Of Phytotherapy. China: Churchill Livingstone Elsevier; 2000.
- Frawley D, Lad V. The Yoga of Herbs. 2nd ed. Twin Lakes: Lotus Light Publications; 2008.
- Al-Snafi AE. The pharmacology of Equisetum arvense- A review. IOSR Journal Of Pharmacy. 2017:7(2.1):31-42. D0702013142.pdf (iosrphr.org)
- M; NPRL. Withania somnifera improves bone calcification in calcium-deficient ovariectomized rats. The Journal of pharmacy and pharmacology. https://pubmed.ncbi.nlm.nih.gov/16597369/. Accessed February 22, 2023.
- Heath D, Hogue G, Bartush K, Koslosky E. Marijuana in orthopaedics: Effects on bone health, wound-healing, surgical complications, and pain management. JBJS reviews.
- Tan Q, Liu Y, Lei T, et al. Study on the mechanism of Salvia Miltiorrhiza in the treatment of traumatic bone defects. Journal of Chemistry. https://www.hindawi.com/journals/jchem/2021/8646394/. Published October 1, 2021. Accessed February 22, 2023.
- Hwang Y-H, Lee A, Kim T, Jang S-A, Ha H. Anti-osteoporotic effects of Commiphora Myrrha and its poly-saccharide via osteoclastogenesis inhibition. Plants (Basel, Switzerland). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151384/. Published May 10, 2021. Accessed February 22, 2023.
