Four Ways That Trauma Can Contribute to Post-Traumatic Arthritis

Fractures (breaks in bone) through the joint surface increase the risk of post-traumatic arthritis 20 times. In fact, three out of four people that sustain a break through the joint surface itself may develop arthritis in that joint eventually.

i. Sudden mechanical damage to the cartilage at impact and break-point

ii. Biological response to injury
a. Bleeding, inflammation, etc

iii. Chronic cartilage damage and overload due to uneven joint surfaces and
a. Misalignment after a fracture

iv. Instability
a. Constant altered load on the damaged joint surface

Cartilage is the slick and firm surface of either side of a joint. A joint is two or more bones that move together; the elbow, knee, hip, ankle, wrist, etc are all joints. Cartilage is about 60-85% water by weight and is a matrix of collagen along with other biologic substances.

Cartilage is built to last. The function and structure of cartilage, as well as the body’s innate ability to adapt and heal, is such that it can handle a lifetime of repetitive use and demanding movements and even trauma. However, occasionally trauma is so severe that the cartilage has a difficult time recovering. This type of trauma involves such massive energy or force that the physiologic parameters of the bone and cartilage and ligaments are destroyed and the bone breaks along with the cartilage surface. Many other types of trauma the body can handle heal. If the body is incapable or recovery, then degradation ensues. Fractures through a joint are one cause of arthritis.

The massive energy of a fracture also impacts the cartilage before it too breaks. This causes cell death and dysfunction. The good news is that most of the cell damage has been shown to occur close to the actual fracture line itself. Cartilage and tissue away from that break-line does not show nearly as much damage.

One study demonstrated about 1 in four cells were damaged if directly at or adjacent to the fracture line; further away, less than 10% were. The very high energy required to actually break a bone is necessary for post-traumatic arthritis. Impact injuries that simply pound the cartilage but are not associated with a bone breaking are much less damaging. Basically, the amount of force matters and how long that force is applied to the cartilage.


The biological response to the fracture or impact also plays a role. The initial phase of healing is inflammatory.

Inflammation is totally necessary for healing to occur. However, inflammation also involves the release of reactive oxygen species, or free radicals, that damage tissue. The pro-inflammatory substances that flow into an injury zone can often cause further damage by matrix (collagen) breakdown. Again, the larger the force load applied to the joint surface and underlying bone, the more inflammation and free radicals are produced.

Tumor necrosis factor alpha, Interleukin-1, nitrous oxide, matrix metalloproteinase and others are all associated with ongoing damage. These are actually targets for therapies to treat arthritis. If post-traumatic arthritis occurs, it has been shown to occur rather quickly. Some studies demonstrate changes in the bone within 8 weeks. Others show transformation at the zone of injury in about 4 years. Either way, post-traumatic arthritis occurs earlier and more obviously than normal degenerative arthritis. Therefore, there should always be a difference in appearance of the affected joint relative to other joints in the body if this process happens.

When a joint has a fracture or a break in it, the joint surface changes. Joints are designed to be very smooth and congruent in most cases. A fracture will often leave a fissure or a fault line. Obviously, this will change how the joint moves and can change the pressures applied to the joint surface itself. An ankle fracture may cause changes of up to 300% in terms of pressure on the joint from a simple fracture line. This change in pressure on the joint over time will engender a sustained low-level impact to that particular part of the joint over time; therefore, that part of the joint is at risk of arthritis. One of the goals of fracture surgery is to restore the normal, smooth surface of a joint.


Misalignment and instability also occur after fractures. Typically, for the energy of an event to be great enough to actually break bone and cartilage, there are also torn ligaments and tendons.

Unless the proper soft-tissue balance is restored after such a break, chronic instability occurs. One of the most common reasons to develop ankle arthritis is to have untreated sprains that cause long-term instability. Instability changes where all the pressure on a joint goes and the new locations is likely not built to accept the weight of a person. The level of importance of alignment and instability varies depending upon the joint involved. Some joints can accept a large amount of variability (hip/shoulder) while others cannot (ankle/wrist).

Currently work is being done to further understand what happens to cartilage after it breaks along with a bone (articular fracture). The goals of treatment today are to restore the joint anatomically along with alignment, to produce stability of the ligaments, to limit the inflammation initially and to mitigate the damage at the time of the event.

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Why You Should Consider A Multivitamin Before Surgery

Why You Should Consider A Multivitamin Before Surgery

Why You need a daily multivitamin

before getting surgery

When you are about to undergo surgery, you are usually given a pre-operation checklist for certain things to do or avoid as you prepare for your procedure. This can include things like a round of preemptive antibiotics, not eating certain foods or fasting 12-24 hours before your surgery, etc.


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It’s important to take your surgeon’s advice while you’re preparing for your surgery. Not only are surgeons skilled enough to understand the science behind these procedures, they are also experts in the science behind healing. Nutrition is a key factor in repairing tissues affected by surgery, and starting a supplement regimen is a great way to make sure your body is optimized and ready to begin the healing process.

healing after surgery

and getting back to normal

The healing process after your surgery centers on the building of collagen – which is the main component in many tissues, such as your skin, tendons, muscles, ligaments, cartilage, blood vessels, bone, and more. Basically, any tissue that can be affected by surgery – “surgically traumatized tissue” – needs collagen to rebuild. The production of collagen, and the overall healing process, happens in three stages after surgery:

  • Inflammatory phase (up to 5 days): Right after surgery, the body forms a blood clot to stop bleeding. Infection-fighting cells and debris-cleaning cells are sent to the surgical site. Redness, swelling, and inflammation ensues.
  • Proliferative phase (2 days – 3 weeks): Fibroblasts, specialized collagen-forming cells, start building tissue at the surgical site.
  • Remodeling phase (3 weeks – beyond): Over time, the body slowly replaces the collagen that was initially formed at the surgical site with stronger collagen – to strengthen the tissue at the surgical site and promote better function over time.

Without proper nutrition, this healing process can take longer and may even encounter complications. A balanced diet, including essential vitamins and minerals, is extremely important for your healing experience to go smoothly. This is why many surgeons will recommend a multivitamin or specialized supplement regimen before and after surgery.

The right amount and combination of supplements can greatly impact your surgical recovery in a positive way. But you shouldn’t start a supplement regimen without guidance.

Inform (And ask!) Your doctor

about supplements

While most supplements should be safe and beneficial to take as you’re preparing for surgery, there are some supplements that could actually harm your recovery process. For example, certain herbal supplements and over-the-counter drugs can reduce your body’s ability to clot blood – an essential component of a smooth recovery. Other supplements can interact negatively with other medications your surgeon may recommend for your healing process.

Your doctor would be more than happy to recommend certain vitamins and minerals to promote healing, and can tell you which supplements to avoid or discontinue while leading up to surgery. You should bring up supplements during your pre-op consultation to make sure there are no delays, as it can take a week or more for any medications to fully leave your system.

Surgeon-Designed Multivitamin

for your peace of mind

If your doctor prescribes many different vitamins and minerals, your pre- and post-op supplement routine can get expensive, and complicated, very quickly. It’s far easier to carefully choose an inclusive multivitamin and have your doctor confirm that none of the ingredients would interfere with your procedure.

In her years of practice, orthopedic surgeon Dr. Meredith Warner found herself prescribing many different supplements and multivitamins to help her patients prepare for surgery. She specializes in surgical procedures impacting the foot – which contains nearly one-fourth of all bones in the human body. The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments… all working together to enable movement and balance.

For procedures as high-stakes as these, she believes that proper preparation is essential for ideal outcomes for her patients. This is why she created a multi to support the connective tissue in your body. It contains highly fortified ingredients ideal for pre- and post-surgery recovery, including Calcium Citrate, Magnesium Oxide, Full Spectrum Hemp Powder, Vitamin C (ascorbic acid),Vitamin D3 (cholecalciferol), Zinc Gluconate, and more.

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CBD Vitamin + Multivitamin by Well Theory

One convenient daily serving has everything she recommends her patients take daily to promote surgical recovery and overall musculoskeletal health. Gain peace of mind before your procedure by using our breakthrough formulation that was completely designed for orthopedic conditions.

More Details About Dr. Warner's Custom

designed connective tissue vitamin

These ingredients work best together – while each is a necessary supplement on its own, together they pack a powerful punch.

Full Spectrum Hemp Powder

Hemp interacts naturally with your endocannabinoid system to add a long-lasting anti-inflammatory, tons of antioxidants, and a pain-relieving component.

Vitamin C

Vitamin C promotes proper collagen formation and helps with wound healing, supports the joints, and contributes to healthy bones & teeth.

Calcium Citrate

Calcium Citrate helps promote healthy bone growth, and is integral to nerve signaling & muscle contractions.

Vitamin D3

Vitamin D3 aids in your body’s ability to absorb calcium and supports nerve health. Important to almost every human system.

Magnesium Oxide

Magnesium Oxide also regulates magnesium levels to reduce muscle cramps, fortifies the bones, and is essential for nerve and muscle function.

Zinc Gluconate

Zinc Gluconate is an awesome assistant for wound healing and connective tissue - and also promotes tissue growth and development.

Promoting balance + health at a cellular level is key to maintaining function for many years to come, and recovering from any procedures you may need in the future. Choose the Well Theory Bone & Joint Health Multi to help achieve baseline wellness and promote cellular health.

Accelerate Recovery, Start Rehabilitation Today

Despite popular belief, rest isn’t the quickest route to recovery.

New research out of Copenhagen shows immediately beginning rehabilitation after an injury may allow patients to recover faster and return to their daily activities much sooner than we once thought.

A study Dr. Meredith Warner recently stumbled upon in the New England Journal of Medicine took fifty athletes and separated them into two, randomly assigned control groups. Each athlete suffered an acute injury of the thigh or calf muscle and was then randomly assigned to begin an early (two-day post injury) or delayed (9 days post-injury) rehabilitation program. These patients didn’t receive any analgesic medications or nonsteroidal anti-inflammatory drugs throughout the study.

The researchers followed these athletes for 12 months during their recovery.

They all went through the same rehabilitation program, monitored closely by a physical therapist. During the first week of training they performed daily static stretching, and during the next phase, they practiced daily isometric exercise. In the final weeks, the athletes performed functional exercise combined with heavy strength training three times a week.

Following the rehabilitation period, results showed athletes who began rehabilitation two days after injury returned to activity about 20 days sooner than those who delayed therapy for nine days.


For even the average person, a delay in rehabilitation can prolong pain and delay recovery. During recovery, especially for acute muscle injuries, it is advisable that patients begin rehabilitation as soon as possible. Muscles do not respond well to inactivity following an injury. Starting therapy sooner can help guarantee success and recovery throughout the treatment journey.

Give recovery your best shot with Well Theory’s tips, resources, and wellness solutions. Try out our Bone & Joint Health Multi to improve your overall health and joint + muscle function.

5 Knee Exercises You Can Do At Home

The best way to maintain healthy and strong knees is to exercise. Strengthening the muscles act to support the knees can help reduce stress on the knee joint. Strong quadriceps and hamstrings help your knees absorb shock. Stretching these muscles are important as well.

Strengthening these muscles can support the knee but can tighten the muscle, which makes them at risk for injury. Implementing a smart exercise regimen and effective stretching can ensure you have healthy knees!

Cartilage responds well to low-impact aerobic activity. A doctor can help you begin building a routine and find which exercises are right for you. Start slowly and listen to your body. Early on you may feel discomfort as your muscles become more accustomed to being challenged. However, if you begin to experience any pain that is not due to basic muscle soreness from exercise discontinue that exercise.

It’s normal to feel stiff and sore after exercise, but if it is difficult to move you may have overdone your exercise. Often a professional physical therapist or exercise physiologist can create a custom exercise program appropriate to you as an individual.

Knee Exercises

These are suggestions and require normal balance and ability. If you have any questions as to your ability to perform these motions pleas consult your physician.

Step Ups

Use a 6-inch high platform and step onto it. Lift your other foot off of the ground and allow it to hang loosely off the platform. Hold for three to five seconds and then slowly lower your hanging foot to the floor. Afterwards, bring your stepping foot down. Repeat on the other side. Make sure your entire foot is on the platform and don’t lock the knee that is stepping onto the platform.

Knee Stabilization

Hold onto the back of a chair and lift one leg. Stabilize your weight on the supporting leg, then tighten the thigh muscle in your lifted left. Move the lifted leg forward, backwards, left and right. Slowly return to the first position and repeat.

Hamstring Curls

Hold onto the back of a chair and balance your weight onto your supporting leg. Lift the other foot and bring the heel towards the buttocks. Hold this position for three to five seconds, and then slowly lower the leg. Repeat this motion with the other leg.

Hamstring Stretch

Sit up with your back straight and both legs extended straight in front of you. Lay your palms on the floor and slide you hands towards your ankles. Hold this position for 30 seconds. Don’t point or flex your feet during this stretch, and keep your back straight. Only go as far as is comfortable of a gentle stretch to the back of the leg.

Quad Stretch

As you hold onto a wall or chair for balance lift one foot up towards your buttocks. Grab your ankle and pull your heel closer to the body. Hold this stretch for 30 seconds. Keep your back straight and knees close together. If you have any knee pain doing this, stop.

If you have any questions about these stretches contact your physician for assistance.

For more information about Knee Exercises visit the American Academy of Orthopaedic Surgeons.

Improve your overall musculoskeletal health with our Bone & Joint Multi! The ingredients in our Well Theory Multivitamin were curated by an orthopedic surgeon to fill gaps in your diet, reduce muscle + joint inflammation, and help you start building a life centered on full-body wellness.