Broken legs and ankles heal better if you walk on them within weeks
scientificamerican.com
scientificamerican.com
Broke my femur neck on a mountain bike. Surgery, plates and screws. Surgeon said no weight on the broken bone for 8 weeks and no walking on it for 12. And then we'll see he said.
In 4 weeks I was on a trainer (fork fixed to the trainer). Started easy with 30min sessions and then increased time and force applied to the pedals.
After 2 weeks of "riding", started putting weight on the bone with short walks around the house.
8 weeks after the surgery rocked up to a road race, still on crutches because walking was still a bit uncomfy but being on the bike was fine. Raced to a 3rd place (Masters A) with hard breakaways and all.
12 weeks after the surgery go to see the surgeon to check if I can start walking (already walking by this stage as normal). He X-rays me and says your bone is fully healed. Strange but good he said.
I told him the story. Still don't know if he believed me.
Honest question, how did you know to disregard the doctor 's instructions and start home exercises on the bone at 4 weeks? How did you limit yourself during your riding and other resistance work? How long was the recovery period after every session?
My background (Russian). Don't trust western approach to solve problems with pills etc. End up talking to (usually) Soviet-trained doctors who can't practice here in the west. The advice makes sense so I follow it believing they know what they're talking about. It's always about the cause, not the symptom. This sort of thing.
> How did you limit yourself during your riding and other resistance work
By feel. Biking is a second nature to me. Femur neck wasn't the only bone I broke. More plates too.
> How long was the recovery period after every session?
First few, felt a bit fucked but I think it was both being out of shape and one leg's muscles sleeping for 4 weeks. So the usual, sit for 5-10 min, back on the crutches, off to the shower and the life goes on.
The chisel part happened to my classmate. I rather take western medical titanium screws than second attempt to fix the hand old school.
I think this is commonly accepted now (maybe?), but tendons, ligaments, and cartilage don't heal well without movement to increase fluid exchange. When I was a kid it was a big deal to avoid any pressure on these tissues after an injury, but it seems imperative for recovery.
When my kids hurt themselves in sports, it's straight to easy yoga, light calisthenics, and lecturing them for not cross training and treating their tissues better when they aren't competing. I sound like a dumb old man to them now, but I think in 10 or 15 years they'll be spending a lot more time focused on building that kind of resilience.
It's getting better. RICE protocol after a sprain is still too unknown to/overlooked by many physicians, although I'd rate it to 50-80% these days.
Many would recommend a 4-6 week rest after an ankle sprain, with a prescription of 10 sessions at a physiotherapist 2 weeks in, and crutches til then.
Luckily physiotherapists are better trained and usually tell you to come yesterday, start with massaging to reduce the swelling and promote lymphatic and blood flow, and movements to break down scar tissue as it forms, and walk as much as you can, with crutches not as walking aids but as "seatbelts" so that you have something to immediately lean on instead of the injured foot should you trip over.
Once tissue has healed enough the next step is relearning and recovering strength and movement (general motion, hence why in french physiotherapist is "kinésithérapeute" from greek kinesis a.k.a motion) towards normal levels. Problem is halfway through the allotted 10 sessions are up :/ so you're either down for a trip back to the physician and convince them you need more or you're on your own.
Also surgery has outcomes that are barely better than non surgical interventions, sometimes, and they still recommend surgery.
I went back on the mats a week later. Started with only doing warmups and movement drills, worked up to gentle flow rolling (with my arm tied into my belt) at a month, then drilling techniques with well-chosen partners and conservatively rolling with those same partners at two months.
This was, of course, on top of rigorously following my PT schedule. And being very conservative with the situations I’d put myself in.
By three months I had regained full flexibility in the arm, and by six months I was back to full-contact training five days a week.
I definitely think there’s a fine line to walk here. I explicitly didn’t do judo for six months because that involves direct and unavoidable impact. And I also made sure to choose training partners who would be very cognizant of my arm and limited range of motion and who wouldn’t just grab a submission and crank it. I also would preemptively tap any time that arm got isolated or in a position where it could be attacked. But there was definitely risk that a training partner would make a mistake or I would land on it badly and tear something.
Still, I would do it all over the same way. I definitely think pushing things helped it heal dramatically more quickly and completely than otherwise. But you do have to be careful with the level of risk you’re exposing yourself to.
For me it took about 4 months to feel pretty comfortable with the shoulder(s) and about 6-12 months for skateboarding, weight lifting, etc
What was your surgery if you don't mind me asking?
It depends on the details of the surgery, but this may have helped GP heal a bit faster.
While testosterone is not well-known for helping to heal ligaments/tendons, some HRT compounds (such as nandrolone) that are occasionally prescribed by doctors/urologists, have a lot of anecdotal accounts of reducing perceived joint pain.
Maybe I’m out of touch but I would be astonished to find that it was even remotely close to “nearly everyone” for recreational hobbyists over 35.
The level of injury is just not as high as you’re suggesting for people who aren’t training to be elite competitors. I’ve had perhaps one “small” injury (muscle pull, joint overextension, etc.) every six months or so, reasonably consistently for the last ~7 years of BJJ / judo which I do three to five days a week, 2-3 hours a day.
I had nearly zero ability to lift the arm under its own power at one week and limited (but good for one week) flexibility. To be clear, I did not engage in any actual drilling or movement of that shoulder in training for perhaps a month. It was in the sling, tightly affixed to my body. I started with one-sided warmup movements and drills and progressed as I felt able.
By a month I was helping newcomers by helping them with some details of techniques. Due to being unable to lift the arm under its own power, I would “crawl” my arm using my fingers where it needed to go to show them. This was with zero actual resistance, but I was at least using the arm: moving it, contracting the muscles, working through scar tissue, and getting blood flowing.
Again, I 100% acknowledge that I exposed myself to greater levels of risk by doing this. I did try to mitigate that risk as best I could, but that never drops it to zero. And while I was pushing things, I was also adapting things day by day to what I realistically felt my capabilities were.
Some years after my fuck up, Chris Froome, multiple Tour winner, crashed badly. Much worse than me, broke a lot of bones.
One of them was the femur neck. This one (and maybe in combination with other broken bones) took him a long time to recover from. By the time he did, he was finished as the Chris Froome, no more wins.
Not saying he did anything wrong, the fuck do I know, but I wondered for a while if he tried, how shall I say it, a more head on approach to the fractured bones recovery and if that made any difference.
Good physios will insist on working as soon as possible, even if it's very light work.
Luckily I have a good therapist. But still I'm disappointed as they should know that part better.
He too was an elite athlete (baseball).
Another friend was a bodybuilder. He said that bodybuilders do so many experiments that they sometimes know better than their own physicians. They are biohackers.
"Power users" of a product sometimes end up schooling the customer support team.
If I were to breathe too deeply during the first few weeks, there was a good chance that I'd re-fracture them; sneezing is known to do this. And for what it's worth, despite what you might see on the TV, broken ribs are no joke.
Recovery time is, apparently anything between 6 and 12 weeks. The first 3 weeks were the absolute worst. I'm finally at the 'it feels like a bruise' stage. As a sporty person I know that if I 'feel fine', I need to add at least 2 weeks on that before I actually start any sports again.
I had to use the maximum dosage of codeine for two months, school was fun...
I don't even want to imagine the pain with 3 fractured ribs.
Week 2 was worst I would say. I was sneezing a lot for some reason.
The weird thing though, it was fully healed (it felt like) week 4, but then suddenly several weeks later the same exact pain came back, without me having done anything similar to the first fall from a MTB. It did go away again though, so its all good now!!
A couple of weeks ago I went over the handlebars on my bicycle and broke my collarbone, needed 5 stitches on my forehead, got a little road rash on my hip, and an avulsion (?) fracture on one finger resulting in mallet finger. I'm 54 and have noticed that I'm healing much more slowly than I remember healing when I was a teenager.
Mostly, things are going smoothly and the only thing I'm really worried about is the mallet finger. I've been told to keep it in a splint for 8 weeks and if I accidentally bend it a little before then any healing will have to start over and I might end up needing surgery for it.
If anybody here has had mallet finger, I'd love to hear how it went for you.
Oddly enough I had a similar injury 10 years prior on a different finger and that healed up in 6 weeks as if nothing ever happened to it.
Probably relevant too – systematic endurance training since 12, elite-level racing since 18 (world champion at that point). So not a stranger to all kinds of injury and what works and what doesn't. For me that is.
It was hotly debated at the hospital, if my specific case should be operated on or not. Each time I had a checkup, one doctor would say "wait and see" while the other was saying "I can't believe we didn't operate on this".
At any rate, the outcome was as good as if they had operated on it, according to the doc anyway. Nice of them to test it out on me!
More related to this though, I have broken both my collarbones, the first time I had little direction and just held my arm still for 2-3 months. It took forever to heal, and my arm atrophied significantly. The second time, similar severity. I was guided through rehab and I was back using my arm within the first month, very little atrophy.
Am I right to understand that had I not gotten the surgery my shoulder would’ve likely returned to the normal position?
(i don't think either of those things should result in higher insurance prices, just continuing the thought.)
Wait, do they not? I genuinely assumed they did. I remember when I got private insurance through my work I had to fill in some questionnaire. It was "free", but it was a taxable benefit so you knew how much you were costing the company and me and my friends had different rates.
I wonder what the actual statistics are when it comes to costs with active people that are more likely to be injured vs obese people that are less likely to be injured but more likely to suffer obesity related illnesses.
Life insurance can and often requires an actual physical exam. And can exclude specific activities such as flying on small private aircraft from coverage.
> Wait, do they not?
Why should they? It's not obvious at all that smoking causes higher costs; a smoker who gets lung cancer is a smoker who never needs the medical care we give to the elderly.
You're behind the times lol -- UK
On top of that for smokers, the amount of sin taxes they pay on cigarettes over their lifetime almost always exceeds their entire life-time medical costs.
Paid out a lot of $$$ to quietly settle numerous sexual abuse claims/lawsuits.
https://en.m.wikipedia.org/wiki/Hockey_Canada_sexual_assault...
A lot of the injury risk when mountain biking is reasonably easily mitigated by controlling your speed and walking the bike through terrain that's above your skill level. There was a report out of British Columbia a few months ago about injury rates, and they were high, but BC is also a major downhill trail region.
Certainly, compared to road cycling, I know more people with major injuries from being hit by cars than from crashing solo on a mountain bike. And for my own cycling injuries - a few concussions, the worst of which was on the road bike (during a race) and a few torn rotator cuffs/mild AC joint separations.
Curiously enough, I have been road cycling for 10+ years now (and mountain biking much longer) and I only just picked up my first crash and injury from road cycling on Jan 1. I crashed and sprained my wrist. :-(
_hit by drivers_, you meant?
Speed must be part of it. Low sun and going into the back of a parked car or other obstacle is a common mistake, and road bikes get up some good speed on most rides. Many riders pass 80kmh on a regular basis, which doesn’t leave a lot of room for error. I’m rather slower than that, but 50-60kmh would be a daily event.
Yeah, with downhill biking, “controlling your speed” means making sure you go fast enough to land the jump on the intended downslope. Go too slow and you’ll land wrong.
For society only; what's the TCO of a mountain biking injury times the rate of injuries, over the TCO of obesity and depression times the likelihood a sedentary lifestyle results?
without access to that data, his anecdote does appear to be a stronger argument than literally no data, no?
Meanwhile I don't have enough fingers and toes to count up all the people I've known personally who have been killed or crippled in auto collisions.
That also means nothing, because you said nothing about how often the coin is flipped.
The first papers that show up in google say "Mountain biking athletes were found to have an overall injury risk rate of 0.6% per year and 1 injury per 1000 h of biking." and "75% of the injuries were minor, such as skin wounds and simple contusions"
4000 hours per serious injury would mean 2000 hours per coin flip. A hypothetical person that bikes twice a month, 4 hours each time, for 20 years with these accident rates, would have flipped the coin once.
But if the accident rates were 10x higher, you could easily still get the same results. One person is just not enough data here. Let's use the real data that show it's pretty safe.
Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
I wonder if the guys from Jackass had trouble finding health insurance.
But trampolines and mountain biking are both activities that result in ephemeral injuries. There is the rare case where a particular injury might become chronic, but how is that a drain on society, and not primarily the individual?
by your logic, should we also ban (or require insurance?) for football (hand egg), boxing, martial arts, (Tai chi?), cars, religion, guns, knives, prescription medicine, children, leaving your house at all?
edit; I'm happy to steal more ideas from sibling comments! I already stole football, but now I want to add obesity, and all mental health conditions.
I'm really curious about the context the idea of net negative comes from, but I probably should also take a stab at a conclusion; why contrast individual actions and decisions in the context of society at all? The decision to do anything should stop at 1st order, and maybe 2nd order effects. That is to say, when trying to improve society, it's fair to look down into smoking and say, we should spend attention on fixing this. But it's incorrect to look at an individual decision "should I smoke" and weight it's effects on society. (How will this effect my family, or my environment is 2nd order, and should be accounted for)
(In my experience, musculoskeletal injuries are rarely completely ephemeral, they tend to have long-term effects, even if minor.)
And bonus point; if we're talking about sociatial responsabilities, given injuries are unavoidable, shouldn't we be trying to fix our responses to them rather than trying to limit people from enjoying life? Mountain biking in fun, so are trampolines. Strictly speaking, the world where we've solved injuries (think any sci-fi pantopia) is better than the world where we didn't because we just outlawed getting injured.
As I said, I agree that bans don’t make sense. But the costs are real, and therefore one should take care to avoid injuries instead of trivializing them.
It's at least arguable and perhaps even true that we as a society would be better off if everybody used tobacco at 1950's rates and therefore got skinnier, especially if we all just dipped Zyns or similar smokeless "low harm" nicotine formats instead of smoking.
That said, I personally use 0 tobacco/nicotine etc.
It is simply wild how many ways nicotine can find to kill humans. All kinds of stuff stems from the lowly cigarette. Obesity impacts many more people (that is to say, we have more fat people than smokers/tobacco users), but it's far from as significant a health risk. I'm not sure we know enough to quantify vapes and chew vs. obesity.
And knowing what they know now, I wouldn’t let a child play today.
ADDED: I suspect a combination of the negative publicity for football, less equipment for soccer, etc. Even if American football still largely dominates as you get to college and the pros. Some rugby in college but relatively not a lot in the US.
If you have a way to just not have those, the way you can just not use trampolines, I would love to hear it.
There are two factors.
The first is that a drain on individuals is a drain on society. That's why we outlaw risky behavior like lethal recreactional drugs, driving without seatbelts, driving without a driver's license, etc. We try to protect people from themselves in some of the worst aspects that we can.
Second, of course, is health care costs. Activities that constantly result in injury wind up raising the health care costs for everyone, since that's how insurance works.
> by your logic, should we also ban (or require insurance?)...
You already have to have car insurance, yes. And yes lots of kinds of guns are banned in lots of places.
We draw the lines in different places.
It is a pretty interesting thought experiment to wonder whether people shouldn't be allowed to engage in organized sports that are risky, without paying an additional health insurance premium? E.g. if you play professional football, then your league has to pay extra money into the health insurance fund to compensate for all the extra health care treatment their players need and will need.
e.g. amateur MMA is illegal in Norway and I think a couple of other places too.
Isn't this already in use in multiple countries? I.e. if you want to play football (european) in a league, you have to have a license and also insurance that covers playing it in an organized way - for example in a league.
So team sports are already covered by such things, but individual sports like mountain biking or skiing aren't at the moment.
Citation needed. I don't outright disagree, but I do think you state this as if it's a much simpler fact of life then it really is.
> That's why we outlaw risky behavior like lethal recreactional drugs,
Outlawing drugs is a perfect example, that's something we've done in the US that has gone flawlessly. No one has any notes, complete unambiguous success.... oh wait!
You even elude to this, I assume, by restricting it to just lethal drugs. That's misleading at best. There is plenty of space to say this is more likely to harm the community, than it is to support the individual. PCP is a popular example where the misapplication directly causes said individual to become a direct danger to the community.
> driving without seatbelts, driving without a driver's license, etc. We try to protect people from themselves in some of the worst aspects that we can.
It's legal to drive a car without a license. You need a license to prove you're able to do it safely on public property. It's very different to say, you can't do X ever, and you can't do [something unsafe for other people], around other people who are being safe.
> Second, of course, is health care costs. Activities that constantly result in injury wind up raising the health care costs for everyone, since that's how insurance works.
> You already have to have car insurance, yes. And yes lots of kinds of guns are banned in lots of places.
> We draw the lines in different places.
Right, I'm aware, but prove that's actually a bad thing? That's what I'm asking. Is it sane to go "AHHHHH THAT'S RISK! All risk is bad for society! Quick, ban it!". Again, using "Non-lethal" drug, seem to suggest that the risks of banning something out weight the risks of that thing. We already learned that banning alcohol was a net-negative, and we seem to be figuring that out for marijuana now too.
> It is a pretty interesting thought experiment to wonder whether people shouldn't be allowed to engage in organized sports that are risky, without paying an additional health insurance premium? E.g. if you play professional football, then your league has to pay extra money into the health insurance fund to compensate for all the extra health care treatment their players need and will need.
Is this a good idea? Car insurance protects others from your carelessness. Sports insurance protects you from... you? Is it reasonable for society to subdivide itself like that? Should old people have to pay more money for insurance? Should people with diabetes pay more? Should women of childbearing age pay more? Or should we as a society, look down from a higher level view, acknowledge that healthy individuals are better for society, and decide that we're not going to treat individuals differently, that because everyone is in this game of life together, where nobody gets out alive, that we're all going to make it as easy as we can for everybody to be their best, while refusing to define best for any individual.
I'm imagining some rough sandpaper layer that comes off every time you shower until it's smooth anyway. Glue is expensive, you know?
The good thing is, then, I'll be mandated to go mountainbiking instead of staying sitted in front of a computer all day long!
How can I vote for your program?
I think that a big part of the issue is that banning it sounds a little like banning all sex because someone might get a venereal disease. Yeah, maybe there are some negatives, but there are also a lot of positives, and people are really like the positives.
Knock on wood, 20 years later I still haven't broken a collarbone, but I've had plenty of scrapes, bruises, cuts, etc, a couple of concussions, a torn rotator cuff, and quite probably a broken neck (never went to the doctor to have it diagnosed, but I landed on my head hard enough to crack my helmet and knock me unconscious for a few minutes and my neck hurt for like 6 months afterwards).
Still, wouldn't trade it for anything in the world. Nothing like being out in the woods, on a bike.
Now maybe that's just folk wisdom that isn't really true, but it sounds plausible to me. And if we reason by analogy a little, it's not too far off what my surgeon told me when I tore my rotator cuff. I fell and came down on my elbow, and he explained that the energy from the fall pushed my humerus up into my shoulder, and pinched my rotator cuff between two bone heads, which is what caused the tear.
So yeah, not much padding can do about stuff like that I guess.
Experience helps too but that’s harder to get safely!
So after 4 weeks I went to this last guy in a public hospital, told me I'm fine and can take off my brace, wait a week or two and go into physical therapy. Also told me in 20 years he only had to once or twice do a collar bone surgery so it's almost never the answer.
It's amazing that just being told I'm fine I could relax and all my muscle aches literally were gone 1 hour after that meeting so my advice in general is, be very careful what doctor you choose because medical hexing really is a thing. We put doctors on this pedestal and if God forbid you catch them in a bad mood they can fuck you up worse than before you saw them.
Anyway thank God I found a decent doctor.
Even with this mess, it was hotly debated for around two weeks whether I needed surgery. A good chunk of my collarbone was trying to push through my skin and the other half was fusing to my scapular and was starting to compromise nerve function. Even then, because the non-surgical route is now considered the standard, I was meeting resistance to have an ORIF. It seems that the about turn from surgical intervention has been so strong that getting ANY surgical intervention is a battle.
I eventually came across a surgeon who took one look at me (never mind the imaging) and scheduled me for surgery. ~18 months later I’m now on a waiting list to have the plate removed, and strangely have gone off cycling… Surfing has happily taken its place.
My shoulder immediately felt "better" after ORIF. I would suggest it if it's way out of whack... mine was drooping probably 2". I can't imagine how much it would suck if the bones healed that way.
Good illustration was that my run of the mill, 45 minute surgery ended up taking 4.5 hours.
It’s good to hear that everything felt good after your plate was removed. At 18 months post-surgery, I’m in a really good place where I can do most anything I want. Only occasionally experience discomfort if my son headbutts the plate or a backpack strap rubs on it. I was in two minds about having it removed as it would be a step backwards to post-surgical, but the likelihood of me doing something stupid again in the future means it’s worth it. Rather have the fuse that a clavicle is rather than fracture my sternum!
My plate was extremely uncomfortable, it was a "hook plate" which held my collar bone to my scapula. I couldn't raise my arm above shoulder height with it installed, it had to be removed after 6mo.
Plate removal was a bit tougher than anticipated (short term). I read accounts of it being a 'relief' but I was in quite bit of pain.
A hook plate sounds horrible! Mine is a simple straight plate, bent into a helix shape to follow the natural rotation of the bone. I've got almost full mobility, although that shoulder does seize up quite readily. Not sure whether that's the plate or just remnants of the reduced mobility post-crash and post-surgery.
I've been told to expect two weeks of surgical healing and a further 4 weeks of babying it and avoiding impacts. I'm hoping your removal being tougher was due to the different plates. Would quite like it gone and to get on with my life now.
Jumping is anecdotally where most noobs bin it hard, you don't need to do jumps at all if you don't want. Many people ride around them.
(More anecdata to persuade you to buy a bike. Great fun.)
The only time I really notice it is if someone pushes on it or if I'm doing front squats with a bar.
I'm now doing anything and everything to get in the sea and improve my surfing. Lengths at the pool for strength and endurance, free diving (and spearfishing) to reduce the anxiety of those big hold-downs. It's been liberating choosing just one sport to be good at.
The craziest part about the plate is how quickly the pain from instability was relieved. I could finally sleep and honestly could've used my arm at ~80% days after surgery. I still have the plate which causes some discomfort, but I likely won’t worry about it.
In light of the article, I wonder if the plate encouraged/allowed me to use my arm in ways I wasn’t aware of. Funnily enough, it’s almost the definition of a crutch but one that allows me to use my arm more than if I was just hugging my body in an attempt to avoid that sharp pain.
Never lost my fear of the mtb, just focus on the uphill and cross country more.
Yeah, I failed to get my plate removal appointment in time, then I got a plate replacement appointment on the fast track and the next removal appointment then happened to be almost the same day as the one originally scheduled (the plates for separated shoulder stay in much shorter, and they better should, because they aren't painless at all)
I asked if it was possible to do a surgery now, so they'd have to break and restore a longer collar bone, more straight, but surgeons don't seem positive for this
In some cases (my messed up jaw and a whole 9 wisdom teeth), I broke this rule. But generally, it has served me well.
The surgery had a risk of serious, life-long consequence if it went wrong. He said that if I can live with the tendon issue, we can delay surgery indefinitely... so we delayed.
A month later, I stopped doing a certain workout at the gym, which resolved the issue within days. No need for surgery at all.
I do think that some specialists can be so focused on their speciality (i.e. surgery) that they don't think outside of that paradigm (try a different workout at the gym), and it's up to the patient to effectively shop around to get the best advice.
Now we have all kinds of powerful, fancy machines and drugs and procedures and today's doctors still misdiagnose, mistreat even relatively simple issues.
I don't know if it is because we as humans have lost touch with nature, our own bodies or we have way more illnesses today than I was a kid 4 decades ago or what else is the reason. It is kinda depressing and mind boggling at the same time.
I fell off a ramp whilst pushing a wheelbarrow full of rubble into a skip (should've stuck to building code instead of building a house!).
Normally that type of injury is associated with car crashes when someone instinctively puts all their force on the brake and the shock of the crash travels up the pedal into the ankle.
It was a really scary time for me as the doctors were trying to manage expectations and plan how to fix my ankle. There was a possibility of my foot being fused to my leg permanently at 90 degrees angle.
Fortunately I had an awesome team of orthopaedic surgeons who managed to do ORIF surgery with about £70,000 worth of titanium inside my leg.
6 weeks later I was out of my plaster cast and into a "moon boot" with my physio starting and doctor telling me to put weight on it already as the titanium was holding it together effectively. Always pushing me to break the mental barrier of protecting my broken leg.
Long story short, physio, putting weight on my toes meant my ankle is about 95% back to how it was, just a small limitation in dorsiflexion and plantarflexion.
Can run, cycle, Jiu-jitsu etc.
NHS emergency care - great!
NHS physio care - poor, had to go private.
Here's a photo of the damage - https://photos.app.goo.gl/z8J8RfhnZ2jnVHFYA
My post-break recovery has not been as good as yours sounds. Almost 3 years later and I rate my ankle at 75% of what its sibling is capable of. I had follow-up surgery to remove one of the plates and clean up scar tissue, and _that_ surgeon was appalled at how long I was immobilized.
Anecdata and all that, but my personal experience says waiting for weight ain’t it.
Mine is also smaller, due to patella tendinopathy.
One thing I didn't appreciate is that in a break the bone is the easy part, but getting the muscle back or preserving it is the hard part.
All things considered I’m still pretty lucky. This could have happened when I’m much older and been debilitating for life.
20 years on, and it's still hanging in there.
I was out of my plaster after week 2 so that I could start moving the ankle, and started physical therapy on week 5. I'm currently on week 7 and have already started _walking_ with the "moon boot".
I can stand on the brokenish ankle with 90% of my weight on it. It's kind of scary to be doing all this to the ankle when the bone is still not fully fixed, but it improves the recovery time and final outcome. I will probably be out of the boot on week 10-12. I'm 10 degrees away from full dorsiflexion range, and apparently it will still take some time and effort to get to the full range, if at all.
Treatment for these kind of injuries have definitely come a long way, this is a massively different experience from breaking my ankle 20 years ago playing football in the US and being on a cast forever, plus dealing with ankle pain for a year after the injury as I didn't get any physical therapy
EDIT: some of the parts for the curious
- https://www.arthrex.com/foot-ankle/titanium-ankle-fracture-s...
- https://www.arthrex.com/products/AR-9943H-03?objectID=human....
I also didn't do much physio, but that was mostly due to me being a 23 year old moron (which, believe it or not, also had a lot to do with me breaking my ankle in the first place!)
Internally degloved my calf, broke my fibula, and took a chunk out of my tibia - and being me, decided to ice it, strap it, look out for compartmentalisation and rhabdomyolysis, and hobble around on it until it was better. Took about two months before I could walk normally.
I only know what I did to it because I dislocated my knee last year skiing, and they were thoroughly confused as to what they were looking at - had to explain that I mashed my leg and couldn’t be bothered wasting my time sitting in A&E for a few days.
Either way, it healed just fine with zero intervention. My calf is a slightly funny shape from the fascia still being bunched up around my ankle, but it doesn’t seem to do any harm, and the break to the fibula healed almost perfectly - slightly offset but works just fine.
A couple days later I got to see an actual bone doctor and he got the x-ray and immediately pointed to the fracture.
What surprised me was that he said not to use the sling, because it would lose my range of motion.
"Keep moving your arm, use the entire range of motion, and let pain be your guide."
Literally, it's just electrical impulses travelling through your body.
I picked a day when my plantar fascia was not too painful and did the first training from c25k plan (roughly 8 minutes of jogging if I remember correctly).
It actually helped me. Don’t try it at home, I think I got lucky because my PF was really not a PF anymore. But I would never found out if I did not run that day. I’ve been running daily ever since, no issues whatsoever.
The first is hanging your heels off a step and letting them stretch down, both with straight legs and bent knees (one foot at a time).
The second is putting your heel as close to a wall as possible, with toes on the wall.
Both work better with sneakers on.
Stretching and rolling with a small foam roll helps me as well.
Every time I wore shoes that were too narrow my problems multiplied. Reworking the laces helped a bit but it was not enough and I had to switch brands.
But it’s more than wide boxes. For example I had some nice big New Balance and they were horrible. I think mainly because of the cushions. ASICS work best for me.
Went from pain after more than 2km total per day to walking a half marathon just over three hours. And then my knees decided they didn’t like that at all and have not yet forgiven me.
What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.
Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
Use it, but when it hurts, stop.
no amount of pain tolerance will help you if something is broken.
you WILL feel it. simply stop when you do.
it's not a hard thing to grasp.
Sleeve tattoos but needs an IV? “Oh, I’m not good with needles, you need to sedate me first.”
It's not just a tautology, because it correctly implies that the right amount of load is not zero.
And it's hard to expect an acronym by itself to be very specific.
What makes you think those things haven't been considered?
The comment you replied to said, "the new guidance is..." I took that to mean those things have been considered.
Honestly, I don't think wrestlers -- certainly those from the von Erich era -- are beacons of authority when it comes to sensible recuperation/rehabilitation from injury. Kevin von Erich said it was due to his brother trying to get some food but there are other accounts:
> Moody says Kerry turned up on crutches and was feeling too much pain, so the doctors injected a liquid-type numbing painkiller on his injured foot so he could go on. The match went under 6 minutes with Kerry beating Adias, but according to Moody, even with his foot under a painkiller influence, Kerry still felt a lot of pain, which led to the amputation of his foot.
The fact that general medical guidance isn't tailored to you shouldn't come as a surprise. Whether you take it or not is up to you.
Please try to converse in good faith.
The fact that general medical guidance isn't tailored to you shouldn't come as a surprise.
In general, doctors treat people, not ailments.
Can you just trot that out when you don't like that the other person thought your point was ridiculous?
If you are able to say that the majority of people are bad candidates for POLICE over RICE then I'd engage with that. But it feels unlikely that you can do this because the prevailing medical wisdom seems to be that the majority of people are good candidates for POLICE over RICE.
I will acknowledge that if a patient is a drug-addled professional wrestler who is desperate for a burger then yes perhaps they should just stay off the foot.
Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.
I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
Uncomfortable but not painful, just like pretty much everything else physiology-related in life.
(This is basically a simplified version of the protocol NFL teams have been using.)
Makes sense to me, though :D
I thought, why should we try to intervene with millions of years of evolution? Inflammation has to be there for a reason. Nitpick that statement all you want but in this specific case I'm glad I didn't mitigate the inflammation.
I was unaware of the acronym HELM and told everyone I was doing the exact opposite of RICE on purpose.
https://www.health.harvard.edu/staying-healthy/quick-start-g...
https://nutritionsource.hsph.harvard.edu/healthy-weight/diet...
... After a heroic research effort that took 2.5 years and 500,000 euros, he and his colleagues had managed to shepherd a large group of frail, elderly subjects through a six-month strength-training program. Those who had taken a daily protein supplement managed to pack on an impressive 2.9 pounds of new muscle. Success! Old people could be strong!
... On his phone was a photo one of his students had just sent him of a large plate stacked high with bulging cubes of raw beef. In total, there were 3.1 pounds of beef—a graphic visualization of the muscle lost in just one week by subjects of a bed-rest study the student had just completed.
“I usually put this in more obscene language,” van Loon says, “but you can mess up a lot more in one week than you can improve in six months of training.”This is significantly out of line with other research I've seen. Marusic et al. (2021) meta-analysis[1] found an average muscle loss of ~2% after 5 days. It did not report average absolute muscle loss, but the average person has about 1/3 of bodyweight as muscle, so at an average weight of ~180 pounds, that would represent 1.2 pounds of muscle loss in a ~week, not 3.1 pounds.
Notice that percentage loss is more than double for a doubling of bedrest time. It's not linear.
You're suggesting that muscle loss at the knee extensor is the same percentage for the rest of the body.
from the full text of the bedrest study mentioned in the outsideonline.com article - muscle loss was measured via DXA scan. see https://diabetesjournals.org/diabetes/article/65/10/2862/350...
After 1 week of bed rest, participants lost 1.4 ± 0.2 kg (range: 0.6 to 2.8 kg) lean tissue mass (Fig. 1A) (P < 0.01), representing a 2.5 ± 0.4% loss of lean tissue mass.Don't get me wrong, the latter group still hurt. Getting old sucks. But their bodies work.
I have no idea how to find the right balance.
The perception of things like weightlifting being dangerous or bad for your back though are almost entirely a myth. It is possible to screw it up, but from what I've read it's very rare for people just lifting things to hurt themselves.
Professional athletes are usually miserable later in life due to doing exactly that.
I am the type of person to become offended at the suggestion.
I parked at the back of the lot and took the longest walk I could instead.
That has paid off.
Got a dog. Sit on the floor to play with him all the time. Can now stand up from sitting on the ground without effort or grunting or using my arms to push myself up.
If you have a coworker in their 30s or 40s who is just starting to get into mountain biking (a common midlife crisis hobby), expect them to have a MTB related injury within the next year.
2 days later I got a call from the doctor telling me to start moving it as much as I could, I asked when I should stop with the sling and he told me yesterday.
Immobilization has its uses.
Surgery is many times essential.
Also worth looking into clinical trials. Obviously not ideal to be a guinea pig, but sometimes you can find experimental treatment on these things and they won't charge you.
I think a lot of medical advice is based on what doesn't go wrong, rather than what might give the best outcome. I'm sure there are doctors who have tried one thing or another, had it go wrong and then become more conservative as a result. This prevents the worst outcomes, but also gives a lot more people and average or subpar rather than great outcome.
In any case there's a lot of research showing that rest is almost always the wrong answer nowadays. Tbh, I don't understand how people can stand it; I was thoroughly sick of the hospital bed within a day and sick of being a couch potato within a week. I would have walked even earlier I think knowing what I know now.
After many months, it was looking like a non-union. The podiatrist was worried any pin would split the broken bone even more. It wasn't looking good.
I had read something along these lines even back then, so with my crazy immobilizer boot on, I head to the gym and started doing light squats several times per week.
Next x-ray: healed.
Did they take credit for it?
That's an insanely long time-frame for healing.
Bones usually start fusing in weeks, not months.
Yeah it was almost half a year for me. My doctor even started prescribing "non-standard" treatments like electrical stimulation, etc, which didn't work.
I broke my ankle a few months ago. I read similar papers online about early walking on it. Well, if you feel any pain, don't. It's easy to undo weeks of healing by doing a bad move.
In 2018, my mom had her left knee and right knee done at the same time...and they had her up walking the halls of the floor the next day and was back at home less than 72 hours after her surgery, and she's walking just fine these days without any assistance.
Eventually I decided fuck this, and starting lifting weights even though it hurt, then I'd massage it which somehow reduced the pain. Repeat that, and very quickly the wrist fixed itself, zero issues now.
When I broke my collarbone years ago, the docs said just let it heal on its own, which it did just fine(I was hiking/running about 2 hours every day, maybe that helped).
Being a kid and wanting it to heal, I took that advice to heart. But of course I still wanted to do stuff... even riding my bike pedaling with only one leg.
This was highly detrimental. There was no mention of physical therapy or rehabilitation of the knee. The favoring was so quickly ingrained that it continued unconsciously even after the brace came off; now my formerly-injured leg is longer than my other one, leading to mild scoliosis and a lifetime of asymmetrical foot and/or leg problems. I can see (although the casual observer probably wouldn't notice) that my whole body developed to put more weight over my left leg.
It's infuriating. This blunder during a child's growth years can be a disaster. Even as an adult I experienced doctors dismissing this entire sequence of events as the source of measurable deformity. WTF?
I experienced a minor brush with a similar mistake much more recently. A falling basketball fractured my finger by jamming it dead-on from the tip. My general doctor put it in a splint, where it was to remain for a while. I noticed that the swelling and color were not improving over an extended period, and went to a hand specialist. He immediately removed the splint and had me flexing the finger as hard as I could every day. He said if I'd left it in the splint I would have permanently lost some range of motion.
I believe in medicine, but even with access to "good" care it's a minefield. Even a relatively informed and interested patient can't dodge all the harm from incompetent, ignorant, and outright corrupt healthcare and drug purveyors.
Don't even get me started on the serious harm visited upon people by corticosteroids and fluoroquinolones...
I started walking as much as I could stand, and after a long while, the knee improved dramatically. Then I noticed I was also losing weight even though my diet hadn't really changed. After a long enough time of this, I was able to once again put bike rides into the mix, weather permitting.
Daily walks (or equivalent/better exercise like bike rides or snow shoveling) have become part of my routine. I'm down 60 pounds from 2022, and at my best weight in over 20 years.
I had a close friend that broke his scaphoid a couple of years ago.
There was no consensus on whether the thumb should be immobilized in the hitchhikers position.
No consensus on whether to stabilize via surgery apart from extreme cases.
No consensus even on weather the elbow should be immobilized.
A complete joke.
And nothing has really improved in a decade or so for such a common thing with dire consequences.
Just hard to do the basic science in a field like this though, can't go breaking bones to figure out the best way to make them heal.
Because pro athletes get procedures that actually work, vs general population procedures that can be detrimental.
He started getting up and trying to walk as soon as he could, way earlier than recommended, to speed up (according to him, possibly instinctively) healing. Fast forward a couple years and there was no visible issue in his walking. Never heard of him complaining about his hip either after that.
It took a while but I fully recovered. I'm not sure how relevant this is since the metal bore a lot of the load; I'm a little worried that may cause me problems eventually.
It's good to know they accidentally gave me good medical advice.
Tore my right meniscus in a skateboarding accident, was recommended keyhole surgery to shave it down but due to being fresh out of university and starting my career I couldn't be bothered to deal with the downtime of surgery etc. Figured I'd deal with it later if it got worse / didn't improve.
And you know what, after 24 months or so of limping about I was pretty much completely recovered and ten years later the knee is still in good shape. Meniscus injuries do heal, they just take a very long time and most surgeons/patients just don't have the patience for rehab. All-in-all no regrets.
I think clinical guidelines are actually swinging back to conservative treatment now. Kind of a reminder about how poorly evidence based surgery can sometimes be (but of course like any tool also a lifesaver).
When I went and read a lot about muscle and back injuries, it sounded like the ubiquitous advice of heat, cold etc can still be used. BUT what really helps is to rest for a day or two to offset some of the bigger damage and then get back into the gym at very low weight and start over.
If you haven’t ripped something to the point of surgery, there is something about keeping active, keeping blood and nutrients flowing to the site that maximizes healing I guess. I was back to where I was squatting within 2 months and my form was better than ever with a lot of attention paid to my back.
My theory is exercise, within certain limits of the injury, increases blood flow to the injury, allowing it to heal faster. If there is inflammation, that means restricted blood flow, so getting your heart to push more blood into those areas from physical activity makes sense to help recovery. No blood flow, no healing.
We can also only remove waste 3 ways. Urinating, defecating and sweating. Sweating is less 'efficient' from a waste removal perspective, but it does help regulate lactic acid and electrolytes. If you're riding the couch, you won't be activating this system. Increased blood flow from exercise throughout would also improve the other waste removal systems in your body, aiding recovery.
If you stop moving, you die.
A ton of biomechanics at play, but walking is the baseline of all human activity. Not running, not swimming.
It's why the 10k steps thing is both a myth and absolutely true.
Being a stupid youngun, I didn't go to the doctor, thinking that it was just a really bad sprain, and I could "walk it off".
It really really hurt but I tried to walk (even run) normally on it, and gradually over months the pain subsided until maybe 6 months later it was "normal".
Except, maybe 10 years later I noticed that I couldn't balance on my left foot as well as on the right, and see that the top of my foot is noticeably less convex (not quite concave though). Probably less structure for muscles and tendons to use for stability. But feels fine and I can walk and run okay :D
Finally the pain got to be too much and they took him in for x-rays. Needed screws all throughout his legs and 2 months to heal.
Now he's fine, goes out for daily runs, still in the military (but failed the Ranger class because he couldn't finish the jump training) and is mostly upset about not being a ranger.
The surgeon bandaged it and gave me an inflatable shoe. After 2 weeks I was allowed to walk on it.
I’m pleased he was progressive!
How many people over the centuries have been told to stay off their cast but got up to get their kid or themselves some cookies from the top shelf? Or to do chores because nobody else was picking up the slack?
In general the theory I usually see now is that rehabilitation is best achieved by putting pain-free stress on the thing being healed, with some arguing for low levels of pain in some circumstances.
Didn't we learn this when that Australian nurse invented physical therapy for treating children with polio in the 1920s? (It took decades for consensus to form that PT was better than immobilization for polio.)
I wonder now if 6 was a bit long. It has healed fine but its still a bit sore over a year later.
But I also have a metal plate which probably doesn't help the soreness.
https://web.archive.org/web/20240705042256/https://web.stanf...
Don't believe it? Try it out. It's well tolerated. There's research on how it works, too. Search for it.
There are some bigger studies coming out that show that early weight bearing is non-inferior to traditional protocols that ask for many weeks of NWB though, and given the obvious qol benefits of walking earlier it seems to me the standard should be mobilise ASAP.
There really isn't good evidence for immobilisation. It seems to be a hold over particularly for surgical fixation, where there's no real fear of displacing things if it's been fixated properly.
> In the 19th century German surgeon and anatomist Julius Wolff recognized that healthy bones adapt and change in response to the load placed on them. That is why everyone—but especially women, who are more susceptible than men to osteoporosis—should lift weights as they age
No, weight lifting won't improve bone density, it's running that will
edit: https://theros.org.uk/information-and-support/bone-health/ex...
I had a lateral fracture of my right humerus (arm snapped in half) and the only thing that made the pain go away was strength training. High-rep endurance exercises didn't help, hundreds of pushups a day didn't help, but after I switched to high-weight lift-to-fail the pain slowly disappeared.
At 40+ I do feel the benefits of adding a weekly hour of stretching and winding at the gym. Exercises everyone can put into the daily life to improve mobility. It even helps with my broken hip that was bolted back together a few years ago :-)
Here are excerpts from one of the papers[0], but you can find many more agreeing with that take:
“Prolonged aerobic training (e.g., swimming, cycling, and walking) is widely beneficial to all body systems, but there are clinical evidences suggesting that none of these activities provide an adequate stimulus to bones”
“Based on the available information, RE [resistance training, e.g., weightlifting/machines/etc], either alone or in combination with other interventions, may be the most optimal strategy to improve the muscle and bone mass in postmenopausal women, middle-aged men, or even the older population.
The Royal Osteoporosis Society recommends "Short bursts of activity are ideal for bones. For example, running then jogging, or jogging then walking." https://theros.org.uk/information-and-support/bone-health/ex...
Btw, don't confuse weight-bearing activities with the weight-lifting that I did quote previously. Resistance training alone, as for example cyclists do, has shown to not improve bone density as pre this meta study https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-...
They specifically mention a combo of the two from one study: "A combination of RE and weight-bearing aerobic exercise (e.g., running, skipping, jumping, or high-impact aerobics) is recommended as RE training provides muscular loading while weight-bearing aerobic exercise provides additional mechanical loading to the bone above gravity."
And they still describe a need for end-to-end evidence for improved outcomes: "For determining the effect of RE on the reduction of fall and fracture risk, further large-scale studies are needed to be investigated."
"Progressive muscle resistance training is the best type of muscle-strengthening exercise for your bones. It involves using weights or resistance bands to build up the work for your muscles to do over time. You do this by gradually increasing the weight you lift, in a slow and controlled way. As you train, you’ll find the movements get easier as your muscles get stronger."