Fracture Healing with PEMF
by Jonathan Bowen, July 7, 2016.
How the bones work.
The human body is a biological machine assembled on a frame constructed out of bone. However, the bones of the body are not simply structural, they are storehouses for minerals and factories which replicate and repair themselves on a regular basis. Bones have four major functions
- Provide the mechanical support for the body
- Provide physical protection for the vital organs
- Operate as the body’s factory for new blood cells
- Serve as the body’s bank for minerals such as Calcium and Phosphate – these will serve as the mineral building blocks of the bones.
Bones are living materials, with blood vessels and nerves running through them. The bone is encased in a thin layer of dense connective tissue known as Periosteum. The periosteum provides a good blood supply to the bone, and is the place where the muscles attach. Below this is a small layer called the Cortex which is made up of many compact layers, which gives the bones their strength (we will come back to this in a moment). On the inside of the bone there is a light porous tissue called Spongy bone, which looks like netting, and works like trusses in a roof to give the bone its maximum strength. It is usually found at the ends of the bone. At the very center of the bone is the Medullary cavity which contains the marrow, which is the body’s blood factory, and produces approximately 500 billion blood cells per day.
Repairing fractures with the bone building mechanism
When a fracture occurs, the site is immobilized due to swelling. The blood brings the platelets which begin clotting (haematoma) around the area. The bone cells at the end of the fracture will die due to a lack of oxygen, especially in the fracture fragments. Fibroblasts migrate to the fracture site transforming the clotted area (haematoma) into granulation tissue, creating a fibrin mesh-network. Once the major area is secured, the process of bone rebuilding can begin.
The area of the bone that is engaged in rebuilding is the two layers of the Periosteum. The outer “Fibrous” layer contains the fibroblasts which are the storehouses for the minerals and proteins in the extracellular matrix. These are the building blocks for new bone materials. When bone building is required, the minerals are combined with collagen in a process called synthesis. The second, inner layer is the ‘Cambium’ layer which houses the progenitor cells which develop into osteoblasts (the cells responsible for bone formation).
What is interesting is the progenitor cells usually lie dormant, or operate very slowly to replace lost cells through normal attrition. However, during injury such as a fracture, progenitor cells are activated and mobilized toward damaged tissue.
When bones need to be repaired, or when fractures take place, the whole process works like a microscopic road repaving system. There are three components that work together – Osteoclasts, Osteoblasts and Osteocytes.
Osteoclast means “bone breaker” and operates like road milling machines that churn up and recycle weakened asphalt so new asphalt can be laid down. These are dispatched to the site of the break and they remove the dead or damaged bone cells.
Following these come the osteoblast, or bone generators. They operate like asphalt laying machines, which put down the new surface of road, except osteoblasts are laying down new bone material. Together with osteocytes (meaning bone cell - in this case a mature star shaped bone cell), they form osteons, or units of compact bone. This process is called ossification or osteogenesis.
Slowly, the bone rebuilding mechanism will replace the clotted area (or hematoma) with a callus. Inside the callus the bone structure is slowly regenerated to include all the original components. This can take a period of time depending on the distance between the two breaks.
Bioelectrical signals in the bones
The bones are incredibly well designed systems complete with bioelectrical messages that help control development of bones. A recent study published in Stem Cell research in 2015 describes the process:
Osteogenesis is a complex series of events by which bone marrow stromal cells differentiate to generate new bone… For quite some time, mechanical forces have been known to affect molecular signaling and molecules in bone cells via mechanotransduction. The conversion of mechanical loads to bioelectric signals (i.e., pressure generated potentials also known as piezoelectricity) in bone has been suggested to control repair and remodeling. These signals are attributed to electrically-generated kinetic behavior where mechanical forces generate electrical signals due to the motion of ion-carrying extracellular fluid in the bone matrix. This effect is known as streaming potential.1
What does this mean? As the weight and stress is placed upon a bone, a piezo-electrical current is generated which acts as a biological trigger that stimulates the bone to thicken, (increase density), over time, or decrease density without stress being placed on the bone. ‘Piezo’ comes from two Greek words epi (meaning on), shortened to pi, and sed (meaning to apply pressure onto). Put them together and you have piezo (pressure on). Piezo-electricity is a common phenomenon experienced every day when a high degree of pressure is applied to a quartz crystal, deforming it and creating an electrical current. This spark is seen in cigarette, barbeque and stove lighters which use piezo-electricity to ignite the fuel.
This is the reason why astronauts lose bone density in space: there is no gravity, and therefore, force triggering the piezo-electrical current in the bone and its density steadily decreases. This condition is called osteopenia (meaning bone poverty) or bone mineral density loss. Interestingly, it is observed much more in athletes who participate in non-load bearing sports such as swimming or cycling, than it is in sports like running which cause more impact, triggering the piezo-electrical current.
The same result can happen due to a lack of movement or exercise due to injury, sickness or aging, or just a more sedentary lifestyle. Osteopenia eventually becomes Osteoporosis as bone density drops to a chronic level. The problem can be intensified due to lack of nutrition, eating disorders, or from smoking and consuming too much alcohol. Deficiencies in Vitamin D, Vitamin K, Calcium and Magnesium are also contributing factors. If a bone is underutilized it will slowly degenerate, thin out and become brittle. One of the main causes in death of bone cells is oxygen deprivation which occurs as the result of immobilization or under use.
This is why walking, combined with a healthy diet where the right minerals are being absorbed, will stimulate the bones to increase in density by the piezo-electrical currents created during the process.
Simulating bioelectrical signals with PEMF
According to Physiotherapist Brian Simpson in his study on “The Structure and physiology of bone and physiotherapeutic modalities to promote fracture healing,”
Historically, it has not been the usual practice in any branch of medicine, to treat fractures i.e. to influence the rate of healing. Fractures rather than being treated, tend to pass through three main stages of management: Recognition… Stabilization… and Rehabilitation.2
Research into pulsed electro-magnetic field therapy is changing this approach. In the 2015 Stem Cell Research study on the effects of PEMF on bone marrow the researchers concluded:
The use of EMF to stimulate osteogenesis is based on the idea of stimulating the natural endogenous streaming potentials in bone. The same physiological frequencies (8–30 Hz) caused by natural muscle contractions and subsequently induced EF in bony tissue, can be used to regenerate tissue as well as differentiate bone marrow stromal cells into osteoblasts….1
In other words, PEMF can be used to stimulate bone repair, the same way piezo electrical forces do. They help the bone factory release the necessary minerals for osteogenesis (or bone creation).The study continues:
Bone remodeling is a highly integrated process of resorption by osteoclasts and formation of bone tissue by osteoblasts, which results in precisely balanced skeletal mass with renewal of the mineralized matrix…. cell exposure to PEMF significantly increased alkaline phosphatase expression during the early stages of osteogenesis and substantially enhanced mineralization near the midpoint of osteogenesis. Increased cell numbers were observed at late stages of osteogenic culture with this same PEMF exposure. The production of alkaline phosphatase, an early marker of osteogenesis, was significantly enhanced at day 7 when exposed to PEMF treatment in both basal and osteogenic cultures as compared to untreated controls.1
Delayed and non-union fractures
Some of the most difficult fractures to heal are non-union fractures, where bones fail to re-unite, or are deformed. About 5-10% of fractures will result in delayed or non-union. There are several reasons for this, but the major issue is a poor blood supply during the healing process. According to Physiotherapist Brian Simpson infections are also a significant issue:
The high speed nature of these fractures often result in bone piercing skin and even clothing, sometimes embedding in soil and even fragments being lost on a roadside or race track. Such pollution of the bone ends often results in infection and non-union.
It must be understood that, as well as infection being caused by bone piercing skin and protruding into a bacterially polluted area, there is a percentage of cases in which the infection may be introduced surgically and result again in non-union. 3
Success of PEMF in fracture healing
The fact that bone regeneration is stimulated by piezo-electric currents has lead researchers to investigate the use of PEMF in healing fractures. After a fracture it is difficult to stress a bone and incur the piezo-electric current, therefore, pulsed electro-magnetic frequencies have been found to be an effective alternative simulating currents down the length of bone as a response to stress. How effective is PEMF in treating fractures? Consider the results of the studies:
An article published in the September 2003 edition of the American Academy of Orthopaedic Surgeons stated:
“Pulsed electromagnetic fields… induce fields through the soft tissue, resulting in low-magnitude voltage and currents at the fracture site. Pulsed electromagnetic fields may be as effective as surgery in managing extremity nonunions... The PEMF signal was developed to induce electrical fields in bone similar in magnitude and time course to the endogenous electrical fields produced in response to strain. These fields are thought to underlie the ability of bone to respond to a changing mechanical environment… results in a time-varying extracellular and intracellular electrical field. 4
Having reviewed a series of studies, the authors relate that “more than 250 published basic research and clinical investigations have evaluated the efficacy of PEMF stimulation.”
Some of the areas identified by the study include delayed fracture healing in large bone of the lower leg (called the tibia).
“a double-blind trial of delayed unions in 45 tibial shaft fractures managed by plaster cast, with active PEMF for a period of 12 weeks. 45% in the active group healed, compared with 12% in the control group.” 5
A 2012 study in the Journal of Orthopaedic Surgery and Research demonstrated a healing rate of 77.3%. The study included xrays showing the progress before and after PEMF was introduced.
Before PEMF (a) (b) After PEMF (c) (d)
The first two xrays in the study show the nonunion 10 months after the fracture - (a) and (b).
The second two xrays show the results of PEMF stimulation of fracture site leading to fracture union 5 months after the first xrays (c) and (d).
Original Xray (a) (b) 6 months post op (c) (d) With PEMF (e) (f)
The first two xrays (a) and (b) show the initial fractures.
The second two xrays (c) and (d) are 6 months after surgery showing healing is delayed.
The third set (e) and (f) are seven months after introducing PEMF and show formation of bridging callus in 3 out of 4 cortexes.
The study stated:
In our study, the healing rate was 77.3% but patient or fracture variables as well as time of treatment onset didn’t affect the healing rate. Longer periods of PEMF application were associated with a trend for increased union probability.... PEMF have been advocated to stimulate the synthesis of extracellular matrix proteins and exert a direct effect on the production of proteins that regulate gene transcription. Electromagnetic fields may also affect several membrane receptors… Moreover, when osteoblasts are stimulated by PEMF, they secrete several growth factors such as bone morphogenic proteins.6
According to MedScape, “Fractures of the tibia and the fibula… are among the most challenging fractures to be treated by an orthopedic surgeon.” The Basset study examined fractures to the mid-section of the Tibia bone, called the diaphyseal.
A series of 127 diaphyseal tibia nonunions treated with PEMFs yielded an overall success rate of 87%. 7
A second Basset report a year later stated:
The results of PEMF treatment with surgery and bone grafting in 83 nonunions with wide fracture gaps, synovial pseudarthrosis, and malalignment. These patients achieved an 87% success rate. 8
A comprenshive review of literature comparing PEMF treatment of non-unions with surgical therapy was published by Gossling, and he found:
81% of reported cases healed with PEMF versus 82% with surgery. Also, the success of surgical treatment for infected non-unions was 69%, whereas 81% of the PEMF treated group healed….. in closed injuries, PEMF managed fractures healed more frequently than did surgically treated fractures (85% and 79%, respectively). This study indicates the efficacy of PEMF treatment to be comparable to that of surgical intervention for fracture nonunion. 9
With PEMF being equally as effective as surgery in some of these studies, it could easily be used as a viable alternative without the possible complications of invasive surgery, or at least as an adjunct to enhance and expedite the post-surgery healing process. The conclusion of the 2003 American Academy of Orthopaedic Surgeons study is fairly clear:
PEMF treatment is recommended as an adjunct to standard fracture management. Indications for use include nonunions, failed fusions, and congenital pseudarthrosis.10
PEMF has also been found to be effective for other fractures. According to Dr. Eeric Truumees, MD, “trauma to the low back (lumbar spine) is common. People find hundreds of ways to injure their low back: car accidents, sports injuries, workplace injuries, falls, and violence.”
The Mooney Study looked into the effects of PEMF on lumbar fusions following surgery stated:
A randomized double-blind prospective study of pulsed electromagnetic fields for lumbar interbody fusions was performed…. In the active group there was a 92% success rate….” 11
A similar study conducted in 2000 looking at discogenic low back pain by Doctor Richard Marks found fusion succeeded in 97.6% of the PEMF patient group, while only 52.6% of the unstimulated group had successful fusion, and concluded,
The use of PEMF stimulation enhances bony bridging in lumbar spinal fusions. 12
A 2013 study on the role of biolelectromagnetic medicine came to the profound conclusion:
The experimental record of the past 40 years makes it impossible to dismiss the underlying electromagnetic (EM) nature of cellular signaling. 13
The study stated that electromagnetic treatment provides innovation for medicine:
It is clear that electromagnetic applications can be used to treat illness following pathways that are outside present clinical biochemical regimens. 13
The article cites PEMF as being a leader in the field of bioelectromagnetic medicine:
There is potentially a wide diversity to the clinical applications… The earliest example dates back to the 1980s when it was applied to the repair of bony nonunions and as an adjunct to healing following spinal surgery. This application used… pulsed magnetic fields… The pulsed magnetic field approach applies pulses with a repetition rate of 15 Hz, which may be the actual source of the biological stimulation… Very significant responses are consistently observed (often providing a noninvasive alternative to amputation), at success rates approaching 80% 13
Curatron the leader in PEMF fracture healing.
Curatron has become established as the leader in Pulsed Electro-Magnetic Field Therapy. Curatron uses pulsed sinusoidal waves with alternating frequencies to ensure cells are constantly stimulated. Sinusoidal waves are pure waves and serve as the “building blocks” for all other periodic wave forms.
Any fracture is prone to infection in the injury area, causing non-unions. Curatron combats these infections by boosting the immune system through stimulating the lymphyatic system, increasing oxygenation, and detoxifying.
The Curatron has the power necessary to penetrate bone, measured in microTesla, and operates at frequencies designed to stimulate the osteoblasts and the bone matrix. In his study on PEMF and fracture healing, Simpson relates that in clinical application the strength of the pulse needs to approach the 1000 gauss range (100,000 microTesla) in order to be effective. He states:
“All the studies quoted in this section of the article are regarding pulsed magnetic fields and NOT static magnetic fields”14
Curatron devices recommended for bone healing operate at between 70,000 microTesla and 160,000 microTesla.
Curatron has a proven track record, effectively stimulating bone and cartilage reproduction. There are no involuntary muscle contractions, and the device can penetrate plaster and plastic casts.
By charging the cells, therefor increasing the production of ATP, and oxygenation, the Rouleaux Effect is eliminated in the blood, and the necessary minerals and nutrients can be delivered to the healing mechanisms, while toxins and waste by-products of repair are removed, speeding the healing process.
1 Christina L. Ross, Mevan Siriwardanea, Graça Almeida-Poradaa, Christopher D. Poradaa, Peter Brinkc, George J. Christa, Benjamin S. Harrisona. The effect of low-frequency electromagnetic field on human bone marrow stem/progenitor cell differentiation. Stem Cell Research, 2015. Page 100
2 Brian Simpson, M.C.S.P. The Structure and physiology of bone and physiotherapeutic modalities to promote fracture healing. Page 5.
3 Brian Simpson, M.C.S.P. The Structure and physiology of bone and physiotherapeutic modalities to promote fracture healing. Page 6.
4 Fred R. T. Nelson, MD, Carl T. Brighton, MD, PhD, James Ryaby, PhD, Bruce J. Simon, PhD, Jason H. Nielson, MD, Dean G. Lorich, MD, Mark Bolander, MD, PhD, and John Seelig, MD. The Use of Physical Forces in Bone healing. The Journal of the American Academy of Orthopaedic Surgeons, September 2003. Page 344.
5 Sharrard WJ: A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures. J Bone. Joint Surg Br 1990; 72: Pages 347-355.
6 Aggelos Assiotis, Nick P Sachinis, Byron E Chalidis. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature. Journal of Orthopaedic Surgery and Research: June 8th, 2012
7 Bassett CA, Mitchell SN, Gaston SR: Treatment of ununited tibial diaphyseal fractures with pulsing electromagnetic fields. J Bone Joint Surg Am 1981; 63: Pages 511-523.
8 Bassett CA, Mitchell SN, Schink MM: Treatment of therapeutically resistant non-unions with bone grafts and pulsing electromagnetic fields. J Bone Joint Surg Am 1982; 64:Pages 1214-1220.
9 Gossling HR, Bernstein RA, Abbott J: Treatment of ununited tibial fractures: a comparison of surgery and pulsed electro-magnetic fields. Orthopaedics 1992; 15: Pages 711-719.
10 Fred R. T. Nelson, MD, Carl T. Brighton, MD, PhD, James Ryaby, PhD, Bruce J. Simon, PhD, Jason H. Nielson, MD, Dean G. Lorich, MD, Mark Bolander, MD, PhD, and John Seelig, MD. The Use of Physical Forces in Bone healing. The Journal of the American Academy of Orthopaedic Surgeons, September 2003; Page 347.
11 Mooney V: A Randomized Double-Blind Prospective Study of the Efficacy of Pulsed Electromagnetic Fields for Interbody Lumbar Fusions, Article in Spine 15. July 1990; 7: Pages 708-12
12 Marks RA. Spine fusion for discogenic low back pain: outcomes in patients treated with or without pulsed electromagnetic field stimulation. Advanced Therapy Mar-Apr 2000; 17: Pages 57-67
13 Alberto Foletti, Settimio Grimaldi, Antonella Lisi, Mario Ledda & Abraham R. Liboff, Bioelectromagnetic medicine: The role of resonance signaling. Electromagnetic Biology and Medicine, July 2012: Page 1, 3, 7
14 Brian Simpson, M.C.S.P. The Structure and physiology of bone and physiotherapeutic modalities to promote fracture healing. Page 9.