Vitamin D

Vitamin D

vitD2We are given a lot of information in the public domain about the correct levels of this Vitamin and supplements available. As physios we are concerned about the deficiency effects on healing times after surgery or injury so lets explore the issues and the data!

At Richmond Physiotherapy we often have post-operative patients who have been put on Vitamin D supplements when their blood test results demonstrate deficiencies.

We work with a large number of experienced orthopaedic consultants ,rheumatologists and sports medicine doctors and we’ve noticed different approaches to testing for deficiencies which leads us to question if there is benefit in screening for Vitamin D deficiencies and if when a patient is slow to recover we should be asking to test for this.

Asking several experts in the field there seems to be a consensus that
‘customising post operative care and managing expectations is full of opportunity and is multifaceted’

‘Vitamin D is rarely a sole reason for slow recovery unless the patient is particularly frail’

BUT it is acknowledged that having an insufficient level may not help recovery.

What is it?

Vitamin D is a fat soluble vitamin.
It is present in a few foods but is produced endogenously from sunlight striking the skin and Vit D is synthesised. It must go through 2 processes in the body to become active. The first process occurs in the liver and second in the kidney – so if there are any problems with these organs this could have detrimental effects to Vit D levels in a persons body.

The majority of UK residents have low levels of sunshine exposure through out most of the year, we spend a lot of time indoors and when outside in sunshine we tend to sensibly use sunscreen to protect our skin from Carcinogens.

Why do we need Vitamin D ?

It helps calcium absorption in the gut. This will allow for normal levels of bone growth and remodelling ( a part of the healing process or growing process)

A lack of Vitamin D can lead to brittle bones, it can cause “rickets’ in children and ‘osteomalacia’ in adults and ‘osteoporosis’ in the older adult or post menopausal women.

(https://ods.od.nih.gov/factsheets/vitaminD-HealthProfessional/ )

Cathy Speed (consultant in Rheumatology, Sport & Exercise Medicine), Sports Medicine Doctor at The Fortius Clinic), notes that ‘not all will absorb (Vit D) effectively. This means that we (doctors) need to get into blood monitoring, which can put people off’. She goes on to note that she has also had ‘athletes with mind-blowingly low levels (of Vitamin D) that unfortunately have not shown any improvement in performance on correction’ which can only demonstrate the need for more detailed investigations to see what other factors may be involved.

She is keen to stress, though, that ‘there is (no doubt) a role for pre-op screening of all patients based on certain problems a patient might present with, such as:

a) a current medical condition.
b) potential medical issues related to increasing levels of inflammation which include metabolism, sleep and nutrition problems and stress related disorders; all of these could antagonise the inflammation and also the Vitamin D level.
c) certain psychological characteristics.

This should help us identify those that should cope really well with the rehabilitation plan and those that might be slow. It may also help us prepare patients for better outcomes if some correction can be made. Supplementation may be required but it must be noted that it is very customer specific which can only be made following some pre-op assessments and some blood testing.

This type of pre-operative assessment is not formalised at present in the world of surgery and this is why it is common to see patients arrive at our practice with some supplementation on board and some without.

It is with this information that our physiotherapy team are keen on taking a full history on the patient and should anything crop up we pride ourselves on liaising with the patients GP or Consultant should expected recovery times not be achieved. Obviously there are many other areas of concern that might alter recovery times.

I hope this has helped you to understand a little bit more about to Vitamin D levels. Should you have any questions, it might be worth discussing this with your physiotherapist, GP or Consultant.

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