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Comment by rodary | Hacker News Reader

Anecdotal but...

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.

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I had shoulder surgery last May. My surgeon told me no combat sports (BJJ, judo) for six months minimum. I was 40 at the time.

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.

That's honestly wild to me. I had arthroscopic labrum tear surgery on both my shoulders (1 in 2024, 1 in 2023), and I can't imagine going back to really any range of movement within a week. Even on my solid PT schedule. Glad it worked out for you but I would hesitate to expose yourself to any sort of risk at that stage.

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?

Also note that very nearly everyone practicing BJJ past 35 is taking exogenous testosterone. Without additional testosterone, it would be very difficult to sustain the sport due to frequent small injuries - the extra/"replacement" hormones help speed up recovery and actually allow frequent (>1x/week) training sessions.

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.

I do not take testosterone. I occasionally try to make a habit of taking creatine but other than that and whey protein while weightlifting (another habit I struggle to reliably form) that’s it.

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.

Mine was similar, labral repair as well as rotator cuff arthroscopy.

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.

Ahhh gotcha. Thanks for the response. That puts it in much better perspective for me.

I definitely believe you. I know from a few injuries that with tendons you want to be moving and applying resistance as soon as you are able to prevent the formation of scar tissue and encourage blood flow. It's not a huge leap of logic that bones, too, benefit from movement and resistance when healing.

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?

> how did you know to disregard the doctor 's instructions

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.

Best Soviet doctors! Poor guys working without any equipment to get perfect results. Sure good way for easy cases, bud hard cases are cripples afterwards. Or badly healed bones are separated with chisel and then comes next try… been there, saw that. Thanks but no, I’ll take a western medicine with all the screws and plates. Despite screws and plates being much easier to work with, every sane doctor will try without them at first even for moderately hard cases.

Is this survivorship bias?

Yes.

I just searched around and it’s accurate and worthy reading by user called Minardi-Man: https://www.reddit.com/r/AskHistorians/comments/73aiiu/what_...

The chisel part happened to my classmate. I rather take western medical titanium screws than second attempt to fix the hand old school.

you are not wrong, shattered leg, waited too long, can't do shit now. never healed properly. should have listened to my body rather than my doctors. fucking sucks.

The story of Valentin Dikul is a great read for anyone interested in the importance of physical rehab, https://en.wikipedia.org/wiki/Valentin_Dikul

> with tendons

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.

> I think this is commonly accepted now (maybe?), but tendons, ligaments, and cartilage don't heal well without movement to increase fluid exchange.

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.

Does anyone know sources that talk about muscles, tendons and cartilage healing too? This article specifically talks about bone healing.

That is awesome! Thanks for sharing. Reminds me of a similar story from a friend. He, too, broke his leg and healed it quickly enough to surprise his orthopedist by riding a stationary bike. He said that initially the broken one was kinda just all by for the ride, but he thinks the circulation helped.

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.

Another thing – the surgeon told me I'll need a hip replacement in 10 years' time. This was 16 years ago and I don't feel I need a new hip although it's not perfect the way it works sometimes but nothing even remotely serious.

The cost of this increased healing rate would be the tail risk of compounding injury though. It's not something a doctor could recommend even if it were true for everyone consistently.

if it were true for everyone consistently (faster better healing), where does the tail risk come from?

You fall and break something.

Even if the outcome distribution is the same for everyone and the expected outcome is better healing, you can increase the risk of much worse outcomes if the distribution has the right shape.

Surgery has very well documented known risks and doctors recommend surgery.

Also surgery has outcomes that are barely better than non surgical interventions, sometimes, and they still recommend surgery.

On the other hand, I'm 6 weeks on from 3 fractured ribs, and still no exercise. I'm sure there are a few medical people on here that will tell you that ribs are a special case.

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 a small rib crack when I was teenager, laughing was a pain, as it was winter, flu was going around.

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.

I probably broke a rib, or damaged some cartilege last summer. I never went to a doctor because it was "fine", also our 1177.se site even says not to go unless its very painful and so on.

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!!

This has been knowledge for the top orthopedic surgeons for decades (at least 20 years). But for your local orthopedic surgeon, it depends on when they graduated whether they know this or not.

I guess worth mentioning another story..

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.

Doctors are good at doing the "fixing" work, but the recovery work is something else

Good physios will insist on working as soon as possible, even if it's very light work.

Anecdata but I agree. Had two spine surgeries at two highly regarded places and those surgeons had no clue whatsoever on the recovery. They've fixed their part and the rehab part is someone else's problem.

Luckily I have a good therapist. But still I'm disappointed as they should know that part better.

Anti-anecdotal: Old family member cracked a femur neck. Tried to stand on it after a few weeks despite warnings, broke it, had to go to surgery, plates and screws. A few more weeks of resting and she would have been fine.

Sounds like you basically tricked your body into healing faster by gradually loading it

idk most doctors would not say don't use your limbs for 8 weeks, that would lead to atrophy. but a lot of doctors give generic advice to avoid lawsuits.

How old were you?

Great point!

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.

Sorry to say I'm in almost an identical seat. I broke my thumb and have a gnarly but closed tuft fracture - after 4 weeks I saw a specialist who said there wasn't much healing or bone growth yet, and so decided to do a more aggressive splinting and lock down the whole thumb for another 4 weeks.

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.

Yep, something I'm realizing is a lot of guidelines/expectations around how long something will take to heal seem to be based on people in the 30-45 range. In your teens and twenties you might get injured and heal faster than expected and think "huh, must be my genes/technique/etc" when really it's probably just youth. Suuuuucks when you start to realize that superpower of yours is fading.

43 at the time.

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.

Nice! I was gonna say 43 is encouraging to hear, as someone who's worried about how age will affect my proneness to injury/ability to recover, but that's an impressive background and probably a major factor. Guess that's another good reason to stay active.

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