Smoking, Vaping & Your Recovery: What You Need to Know
When recovering from an injury or surgery, we often think about rehabilitation, exercise, sleep and nutrition. But another factor that can influence recovery is smoking and nicotine exposure.
From a physiotherapy perspective, this matters because rehabilitation relies on the body’s ability to repair and adapt tissue.
Here are a few things you might not know about smoking and vaping:
Smoking can slow bone healing
Research involving almost 40,000 people found that smokers had around 2.5x higher odds of a fracture failing to heal properly compared with non-smokers.
That matters if you’re recovering from a fracture, bone surgery or an injury where your bone needs to repair itself.
Smoking can affect wound healing
Smoking reduces blood flow and oxygen delivery to your tissues. Your body needs both to repair damaged tissue.
This matters because tissues such as bone, tendon and ligament require an adequate blood supply and collagen production to repair and remodel effectively.
Research has linked smoking with problems such as slower wound healing and a higher risk of wound complications after surgery.
What about vaping?
This is where things get interesting.
We know much less about vaping because it hasn’t been around for as long as smoking. However, early research suggests that vaping may affect some of the processes involved in wound healing.
A 2023 systematic review found that the evidence is still limited, but recommended treating vaping similarly to smoking around the time of surgery until we have better evidence.
And nicotine?
Nicotine isn’t only found in cigarettes, it’s also present in many vapes and nicotine replacement products.
A 2026 review found that nicotine can affect bone healing in laboratory and animal studies, particularly at higher doses. However, we still don’t have enough human research to know exactly how nicotine alone affects healing in people.
In summary...
You don’t have to be a 'perfect patient' to recover from an injury!
As physiotherapists, we can help optimise the things we know support recovery:
Appropriate progressive loading
Strength and mobility
Sleep and recovery
Following post-operative restrictions, protocol and advice
Managing relevant health conditions
Discussing smoking and nicotine use where appropriate
We can give you the right exercises and guidance to help put your body in the best possible position, but your body still needs a good environment to actually repair and heal.
So, if you're having surgery or recovering from a significant injury, reducing or stopping smoking, and discussing vaping or nicotine use with your healthcare professional, may give your body the best chance to recover.
Sources:
Patel, R.A. et al. (2013). The effect of smoking on bone healing: A systematic review. Bone & Joint Research, 2(6), pp. 102–111. https://pubmed.ncbi.nlm.nih.gov/23836474/
Xu, B. et al. (2021). The influence of smoking and alcohol on bone healing: Systematic review and meta-analysis of non-pathological fractures. eClinicalMedicine, 42, 101179. https://doi.org/10.1016/j.eclinm.2021.101179
Ashour, O., Al-Huneidy, L. and Noordeen, H. (2023). The implications of vaping on surgical wound healing: A systematic review. Surgery, 173(6), pp. 1452–1462. https://doi.org/10.1016/j.surg.2023.02.017
Travis, L.M. et al. (2026). The effect of non-tobacco nicotine on bone healing: A systematic review and application to total joint arthroplasty. Journal of Orthopaedic Surgery and Research, 21, 253. https://doi.org/10.1186/s13018-026-06733-3
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