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.
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?
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.
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.
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.
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.
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.
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.
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 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!!
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.
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.
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.
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.
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.
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.
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.
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.
The pathology for broken collar bones was changing right as I took up mountain biking, and subsequently shattered my collarbone.
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.
I had a broken collar bone last year in Bucharest and I moved back to my hometown because of it. I had to check in after a week or two to see how it's healing but was lazy about it so I went to the hospital after 3 weeks and was told there's a waiting list 10 days long and go to a private clinic. At the private clinic the doctor didn't even look at me, or the x-rays I just took and just told me to go into surgery back in Bucharest. Luckily when my mother heard she found a surgeon through a friend of a friend that looked at my x-rays on whatsapp and told me it's fine but just to be sure to visit him in Bucharest feel it in person, which the private care doctor never did.
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.
I left out a bit, before I saw the doctor that told me surgery is the only way, I was consulted by another guy that was free and he scolded me because I came without the orthosis saying stuff like I don't want to get better and basically didn't even look at me or check my recovery after 3 weeks of wearing the orthosis. Told me to go to his private clinic and get a new orthosis where I decided to see any other doctor because I was put off by his attitude. I think the private clinic had a contract with the hospital I was sent to for the surgery or something.
I shattered my collarbone - and I do mean shattered, ~8 pieces - in a mountain bike crash September 2023. I went over the bars after the back wheel of my hardtail caught a berm. Landed on my head and shoulder and compressed it laterally inwards by about 2 inches.
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.
Also shattered mine mtn biking (2022), and the surgeon scheduled surgery as soon as he saw the x-ray. I broke it twice as a teenager, and went through the sling route for both of those.
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.
Do yourself a favor and don't wait too long to get rid of the plate: when you crash on that shoulder again, the collar bone won't be able to do it's job of being the predetermined breaking point that saves the shoulder ligaments from ripping. And the AC ligament, unlike bone, will never recover. Not even with the surgery that you'll then likely need to at least restore the other shoulder ligaments. Fractured collar bone is a feature, not a bug.
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)
Shattered mine mountain biking as well (6 pieces). Ortho took one look at it and scheduled surgery for the next day. It wasn't a 'standard' break since it included my AC joint and coracoclavicular ligaments which needed a special type of plate. Ultimately it took 2 surgeries (ORIF, then plate removal). Total recovery was 9 months. My arm/shoulder is as strong as it was before, and it looks anatomically correct.
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.
Mine felt immediately worse after the ORIF. After two weeks getting comfortable in their new positions, all the ligaments really resented getting wrenched back into place.
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!
I should restate - mine definitely did not feel better post-surgery, the ORIF pain was worse than the break, but it felt good to have my bones secure with my shoulder in its anatomically correct place, and not have any more crepitus.
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.
Ah, thanks for the clarification. That post-ORIF pain being worse than the break was my experience too. Even with the plate I became quite paranoid about shifting the screws because it provided so much immediate stability I was worried I was able to do things that may loosen the screws.
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.
Interesting. I shattered mine similarly while snowboarding, but back in maybe 2018. There was definitely no debate on the matter, surgery via ORIF was the recommended option. Then again, my doc was a sports medicine surgeon so perhaps that played into it. Either way, I was never too light with it and it healed very quickly. I was back at 100% about 2 months later.
Get it removed: the next hit will be much worse than a broken collar bone if the bone can't do its job of giving in before less restorable parts of the shoulder give in.
Functional outcomes seem similar, trough we have a increased rate of malunion, delayed or non-union with nonoperative treatment. We usually indicate surgery if it's an active patient.
Thanks! I've always been a surfer, but split my time with other activities. Post-accident everyone thinks I'm scared of getting back on the bike — maybe a bit? — but genuinely my first thought post-crash was how long I'd be out of the water. It was a clarification of what I truly enjoyed, and an excuse to double down on being in the water.
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.
I've still never heard a satisfactory explanation for how in the hell two parts of a bone, broken such that they aren't even touching, can find their way back to each other and heal. My son broke his collar bone, and the hospital sent him home in a sling. When I looked at the x-ray, I couldn't believe that's the correct treatment. But a month or two later and he was good as new. Absolutely blows my mind every time I think of it.
I broke my collarbone about 30 years ago. Then had it partially rebroken when a friend forgot about my healing bone and greeting me with a shoulder grab from behind. (He felt like shit afterwards). I got the most basic healthcare a free college clinic could offer. Today, you can only tell I ever broke it when I'm shirtless and at my skinniest weight.
It starts with bleeding. The blood in the region of the bones forms a squishy mass that is not bone, but through which cells can flow. Specialized cells deposit calcium into this mass, guided by hormonal and chemical signals. If you imagine the two open bone ends as emitting a sphere of chemical signals, where the two spheres interfere constructively is where the 'signal' is strongest and where you want to deposit calcium. Bones are not just calcium of course, but that's the gist.
Apropos of nothing in particular, when I first started mountain biking, a guy I was riding with told me: "You can divide all mountain bikers into two groups: the ones who have broken their collarbone, and the ones who are about to break their collarbone."
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.
For collarbones specifically? Nothing I'm aware of. At least if the explanation that was given to me for the high prevalence of collarbone injuries is correct, that makes sense. Someone explained it to me as "when you start to fall, you instinctive tend to reach our towards the ground to try to break your fall. So your hand is the first thing that hits the ground, and all the energy of the fall goes up your arm and into your shoulder / upper chest area. And the collarbone just happens to be the "weak link" there and so tends to break."
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.
Given the amount of injuries related to mountain biking, is there some specific insurance needed for it? It seems one of those "net-negative for the society activities", like trampolines.
this is such a wild take to me... it's impossible to quantity at what point something becomes a net negative for society. Smoking seems to be an obvious example, because it's addictive quality inhibits a fair decision to the smoker, and it's something with a lifelong pathology.
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)
> but how is that a drain on society, and not primarily the individual?
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.
> 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.
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.
> The first is that a drain on individuals is a drain on society.
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.
Don't forget about the alternatives. Is mountain biking worse than watching movies - biking will of course have more injuries, but it also builds physical fitness and so long term is probably better for you. (or maybe just my anti-movie bias is showing?)
I'm gonna call that sample bias. If you exclude all injuries that are ephemeral, (because they don't get reported, because they're ephemeral, and forgotten), you're left with the injuries that aren't ephemeral. I mean duh, obviously lol. But my point is still, yes injuries are bad, and as a society, we're pretty trash at healing them, but injuries are more impactful for the individual, than for society.
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.
My point is, most injuries aren’t ephemeral in the sense that your body would end up as if you didn’t have the injury in the first place. In particular the sports injuries we are talking about. You may only truly realize that a decade later or so. So I find making that distinction questionable, it trivializes the injuries.
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.
Yes, we should absolutely ban, at the very least, contact football among minors. We have ample evidence of football (and soccer, too, for that matter) student athletes developing full blown CTE by their 20s, and with lifetime risk thousands of times the general population.
A few years back, I thought there would be more of a push to regulate/limit American, at least contact, football. But didn't happen. Soccer? Good luck.
100% anecdotal… one of my town’s youth football (American) clubs shut down before COVID due to lack of interest. When my son played ~15 years ago, the club was fielding 2 teams per age group.
And knowing what they know now, I wouldn’t let a child play today.
I do suspect that soccer has whittled down youth American football over time. It's not quite true that no one played youth soccer when I was growing up but certainly nothing organized at scale to today's degree. I have a friend who has been reffing soccer forever. I should ask him as he probably has some insight.
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.
Controversial take: On a population level, the negatives of smoking are at least partially mitigated by the "smoking suppresses obesity" side effect. Obesity is such a huge (pun not intended) public health issue in modern American society that any intervention reducing it is actually quite valuable.
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.
Smoking is significantly worse for you and your family than obesity. It causes a greater reduction in life expectancy, and can impact the physical health of those who live or work with you via secondhand smoke.
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.
I don't know that "normal" mountain biking is any worse than cycling in general, or sports like tackle football.
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.
The way I always looked at it (based on my own anecdotal experience, plus those of my friends around me)... you're probably more likely to get "hurt" in some sense while mountain biking, but probably more likely to get "killed or maimed" while road cycling (eg, being struck by a car).
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. :-(
Another factor worth considering is that being physically active also prevents other ailments, so (even downhill) bikers may still be more profitable for insurance companies!
I couldn’t agree more. Road biking has entirely fixed my lower back and neck issues, my knees have come right and getting up hills has knocked 15-20kgs off me in the last year. I just wish I could get out there more.
> 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.
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.
> 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.
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.
I think I like what you're getting at (placing blame on the human not the object), but could you tone the attitude down? This read to me as an almost snide correction, I genuinely think you'd convince people if you 'invited' them instead
Nah. Decades of politeness have failed, it's time to get more aggressive about people deciding it's ok to kill other people as long as you do it by driving a car into them and aren't drunk at the time.
Yeah. I did have a fall (for no good reason) cycling on a carriage path in Acadia National Park. But that's almost certainly safer than road biking on a busy road. And I do think a world in which you have insurance companies micromanaging what they will cover for various outdoor activities is not one we want--and it's not clear that it even distinguishes from people who are very sedentary.
In general, "society" deciding what activities are too dangerous to routinely allow is a really nasty slope. Yes, there's some special insurance offered through private organizations for things like higher altitude mountaineering. But it's not that big a step to rule that any contact sport, for example, should require special insurance. I'm sure the insurance companies wouldn't mind.
One thing which comes to mind is - why should we stop at sports, then? we'll immediately be at the point where smokers, alcoholics, obese people etc. should pay more, after all, their way of life statistically causes higher costs.
(i don't think either of those things should result in higher insurance prices, just continuing the thought.)
> we'll immediately be at the point where smokers, alcoholics, obese people etc. should pay more, after all, their way of life statistically causes higher costs.
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.
Health insurance can't ask about this since ACA (I think).
Life insurance can and often requires an actual physical exam. And can exclude specific activities such as flying on small private aircraft from coverage.
Health insurance premiums used to be different based on whether or not you smoked; maybe they still are. It would still be nice if you could lower your health insurance premiums by losing weight or buying a policy that didn’t cover mountain bike injuries or whatnot.
At a former company, there was some trivial discount for an annual health care screening which I stopped doing because it was trivial and something that wasn't between me and my doctor. I would absolutely not sign onto a screening that invasively wanted to know about specific athletic or other activities of that sort. (Which would probably also give the insurance company untold levers to deny your claim.) "Oh, you said you don't rock climb, well that 'hike' looks like a rock climb to us."
>> we'll immediately be at the point where smokers [...] should pay more, after all, their way of life statistically causes higher costs.
> 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.
The smokers who DON'T get lung cancer still have more heart and lung problems (like emphysema, COPD, etc.), and those get significantly worse late in life.
I don't know about alcoholics, but smokers and obese people actually cost less in medical care because they usually die before age-related diseases takes hold which are the most expensive, they most often die of heart attack and stroke which are the cheapest deaths, and being fat or a smoker disqualifies you from many procedures and operations that they otherwise would do without hesitation.
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.
insurance companies already buy up information from data brokers and use that to jack up people's rates according to whatever they happen to find to justify it. They won't tell you when they do it, you'll just be offered a very different price than you would have been given if you didn't buy as much alcohol, spent more time at the gym, only drove your car in the daytime, or lived in a different zip code.
I play recreational hockey. All of the rinks around here (and most of the US) require membership to USA Hockey which, among other things, provides some kind of insurance to both the rinks and the players.
Trampolines are indicated because YOUR home insurance could be on the hook for someone ELSE being hurt on your trampoline. And it's easy for them to exclude it.
Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
By this logic, most software engineers would also be considered high risk since they work a sedentary job and have higher risks for heart disease and obesity (which likely leads to higher healthcare costs over the long term)
Telling people they're not allowed to have fun in the manner of their choosing because it would be bad for society sounds like a great way to discourage people from caring about society.
Why should you be forced to pay insurance if you don't endanger others? Most situations where you are forced to have insurance are cases where others are endangered (eg. driving).
No? I’ve been mountain biking for over 20 years and never any broken bones or had to go to hospital as a result, despite doing downhill, trials, and dirt jumping. And I have 20 years of fitness to show for it - that’s about as positive as it gets.
He's been flipping the same coin for 20 years and it has never come up tails. That's quite the coin. There is no data set more relevant to a person than their own experience.
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.
> He's been flipping the same coin for 20 years and it has never come up tails. That's quite the coin.
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.
That was his point, or if it wasn't it's my point. It's a physical activity, one that from my POV improves health much more than reduces it. Take the hypothetical where he doesn't ever find a replacement activity, and instead of being fit becomes obese and depressed. that would be worse for society than mountain biking wouldn't it?
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?
There is no specific insurance required that I'm aware of... It's an activity that's well within the normal allowance of jackassery that everyone is entitled to.
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.
I'm all in behind your idea: let's do the net result for society of every activity, and mandate people to do the most positive one, while banning the most negative ones!
The good thing is, then, I'll be mandated to go mountainbiking instead of staying sitted in front of a computer all day long!
There are smoother and rougher tile surfaces. When getting tile put in my house I've made something of a point of avoiding the very slickest/smoothest tile.
I feel only rocky texture will be satisfactory after a year. Or is there any chemical that can safely strip the soaps and other fatty stuff from the mineral?
My roughest and lightest tile--which has to be replaced for other reasons after a couple decades in what we call a mudroom in New England--could probably be cleaned but would be a procedure. In general, darker and just somewhat textured tile seems to work pretty well in less-trafficked areas.
There's so much about showers in hotels that I hate a good proportion of the time: super-slick tiles, high step-in tubs, accompanied by no handholds. I've gotten more sensitive to this over time but even when I was much younger, nearly took spills a couple of times.
That's fair. It's one thing to tell people "don't build things in such a way that other people would be put at risk", and quite another to threaten people with punishment for choosing to take risks themselves.
Also broke my collar bone and no surgery, shoulder is less large by 2cm, I had no issues in the short term, but now after 10+ years it's cracking more, it doesn't age well
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
A personal philosophy in medical decisions:
- unless there is a severe risk I might die from lack of intervention (on any reasonable timeline besides life), I avoid intervention.
In some cases (my messed up jaw and a whole 9 wisdom teeth), I broke this rule. But generally, it has served me well.
I have a similar viewpoint; over a decade ago, I had a nuisance tendon issue and went to a specialist who recommended surgery.
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.
You must have broken yours around the same time my dad broke his. They didn't operate and apparently some of the people who saw the x-rays were quite surprised how well the natural healing process handled pulling the bone pieces back together.
usually it shouldn’t affect position or function of the shoulder once healed, and while the clavicle does tend to heal with a “bump” in it at the site of the break, its long been thought that the risk of surgery at that site outweighs the benefit. But it does depend on the specifics of the fracture:
https://www.orthobullets.com/trauma/1011/clavicle-fractures-...
When I was a kid (not in the U.S), I remember village elders diagnosing all kinds of illnesses simply from checking one's pulse, without asking any questions or even talking. These are people with minimum education, minimum or zero exposure to science or labs or modern medicine.
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 wonder how likely that is? I suspect their understanding of their diagnostic technique is flawed, but beyond that, would a small enough group have a similarly small pool of common afflictions such that you could develop a useful body of medical lore?
I had a bad pilon fracture of my ankle a couple of years ago with both a break on Tibia and Fibia.
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.
I’m going through a very similar process after breaking my ankle in a motorcycle accident. Tibia and double fibula fracture with dislocation and open wound, an ugly one which needed 2 titanium plates and 18 screws.
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
I also broke my ankle about 20 years ago. Once I was out of the cast, I regained all function, and only recently has my ankle been starting to ache. The doctor I saw about it even commented that it was as clean of a fix as he'd ever seen!
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!)
I can relate, 21 year old moron in my case. No surgery needed and clean fix. The problems were gone after a year when I decided to get some help in the form physical therapy. It never hurt again until recently when I broke it again
If it's not an articular injury and they fix all the bones, you can more or less walk on these immediately. I've read about protocols like two weeks, and even immediately (albeit that has issues with wound healing)
I suffered a very similar break playing soccer. ER surgeon asked if I fell off a roof. 3 metal plates and 15 screws later I was non-weight bearing for 14 weeks. I lost almost 5 inches in circumference from my left thigh while waiting to put weight back on that leg.
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.
Sorry to hear about the outcome on your leg, I am sure you've tried lots of things to beef up your muscle. Just looking at my two legs I can still see a slight difference in calf thickness.
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.
For sure! Not to mention all the tendons and nerves. My recovery continues, as I’m sure yours does too — I’m back to my pre-injury PRs for most weight lifting, and my goal for this year is to match my pre-injury mile time.
All things considered I’m still pretty lucky. This could have happened when I’m much older and been debilitating for life.
I wonder how and when they choose to remove plates, vs. leaving them in. They left mine in, and when I originally asked them, they mentioned that there was significantly more risk in removing it than leaving it in.
Unless we have a clear indication, plates are not meant to be removed.
For example, plating children we usually remove the plate as to not interfere with growth, or in some cases a fibula plate can irritate the tendons and should be removed, or in cases of infection.
I asked to have them removed because my physical therapist believed they were impinging on a nerve, preventing me from regaining mobility in my toes. They didn’t want to but I kept insisting.
They are within 1 inch of each other, which is fine with me. I haven’t measured in over a year, I know there’s still a strength imbalance but that’s not what feels limiting to me anymore.
Having recently walked away from that exact situation miraculously unscathed (the teenage drunk drivers also managed to walk away somehow), that’s an interesting insight into the type of injury I avoided. Grim, scary, but very interesting. Glad you recovered.
I crushed my leg a few years ago, my wife and I dropped a bridge on it, and I suddenly had 200kg of steel and wood grind down the back of it, and the front slammed into a concrete footing.
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.
That's much more serious than the break I had in 2023. Slid and fell on an icy ramp coming off a river boat in Regensburg, Germany. Snapped the fibula in the middle, but didn't get it x-rayed until I was back in the US. Walking around Newark Airport wasn't fun. After that, wore a boot for four weeks, no cast was needed.
Frozen shoulder isn't fun. I had it for almost 2 years - from onset to the point where my shoulder mobility was pretty much back to normal. That's probably why your doc recommended to keep the arm in motion.
I battled PF for ages, tried literally everything, and when nothing worked, my feet were in pain I decided to do the dumbest thing in the world and try to only thing I was told I shouldn’t do - run.
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.
I essentially had to relearn to walk to clear mine up. Rolling your ankles makes it much worse, but the entire leg is involved in that “decision” and it starts from the gluteus minimus muscles and builds down.
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.
Shoes with a wider toe box. Take your uncomfortable shoes to a reuse/charity drop off and never look back.
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.
If anyone's heard of RICE (Rest, Ice, Compression, Elevation) for healing joints, the new guidance is called POLICE: Protect, Optimal Load, Ice, Compression, and Elevation. The key differences being Protect and Optimal Load, meaning don't re-injure it and expose it to some level of weight-bearing or usage.
IIRC the underlying assumption was that you should be reducing inflammation (RICE is almost all about reducing inflammation). Since then, we've learned that inflammation is a good thing, and helps things heal faster.
I'm curious now if the anti-inflammatory diets popular with dietitians and health influencers could have a negative effect when you really do want inflammation, like when fighting an infection or recovering from injury.
Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional.
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.
Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done.
Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.
Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.
"As soon as it starts to hurt" is not some hopelessly complex and useless standard that involves delving into philosophies of subjective pain sensation. It is actually obvious and easy to follow.
Perception of pain is highly individual. Like I said, people who have tons of tats will complain about an IV. You aren’t afraid of needles, you just don’t like them when they are used for your health instead of marking up your body.
When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice.
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 broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new.
I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.
I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.
> Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger.
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.
Maybe they aren't, but they also aren't unique in this regard. Obstinate tough guy types are obstinate no matter what their job is. I have neighbors and family members who had similar issues where the doctor says something like "you can walk, but take it easy" but they misjudge what "taking it easy" really means.
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.
We're still icing and elevating? I've always felt dubious about our attempts to rectify our bodies evolving inflammation. It doesn't seem like any great evil to let the body part get more blood, signals to stop us using it, and a lower range of movement.
It's HELM now: Heat, Exercise, Lower, and Massage. They're all designed to maximize blood flow to, and inflammation in, the injured area. (Note that exercise just means to keep it moving.) Ice and elevation restrict the flow of fluids in and out of the injured area; ice especially slows down recovery and is only recommended for pain management.
(This is basically a simplified version of the protocol NFL teams have been using.)
... 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.”
> 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.
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.
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.
Mountain bikers becoming injured isn't a question of IF, but WHEN.
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.
Mountain Biking just seems dangerous in general. I do a lot of trail running, and at this point I feel like my most likely source of injury is from a mountain biker colliding with me.
The human body (like most fit organisms) is antifragile. It needs to be challenged. In this context, people who think "ooh that hurts I'll never do that again" and carefully avoid discomfort find that, by middle age, they can't do anything, and everything hurts. Meanwhile people who think "ooh that hurts, I'd better practise it until it doesn't" are still fully functional into old age because they push their bodies in the right way, and so their bodies stay strong.
Don't get me wrong, the latter group still hurt. Getting old sucks. But their bodies work.
The right level is hard though. I know more than one old person who spent time in a hospital because they thought they could do something they couldn't and broke their bone. "For $20 they would install the new dryer, but no we thought we could do it and that is how my foot got broke in the fall". You should have a cane handy when you need one, but don't use it if you don't need it.
Accidents are almost always bad, for sure. Doing things that you are physically capable of, though, is rarely a problem.
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.
I broke my ankle 15 weeks ago, and decided to weight bear early against the advice of my doctors. In my experience, it caused me no issues and prevented my calf from atrophying further. My foot was also super tight, and I can't imagine that would have gotten better by staying off it.
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 my knee surgery (meniscus cartilage tear/repair) and after my appendectomy, I was pretty keen to get up and moving so that I could go outside and smoke. Both times the nurse commented that while smoking on its own isn't great for healing, the fact that it forces you to get up and moving quickly and frequently is generally helpful. In both cases the doctor was quite surprised at how quickly I'd healed up when I went for the follow-up/stitch removal.
It's certainly an understandable view. At least there is more research showing that at least some of these measures aren't meaningfully reducing harm anyway.
I can certainly attest to the consequences. I unfortunately shattered my ankle and broke my back simultaneously, which meant I didn't walk on my ankle until 6 months after the incident. As such, even 10 years later my ankle is a constant irritant to me. I have next to no dorsiflexion beyond a straight leg now. No ankle mobility means persistent pain in my hip, knee, and back on that side, and I'm only 29. God bless the NHS for saving my life at the time and not charging me a penny, but despite my best efforts I can't get any further treatment now to improve the flexion. I'm counting down the years until I can finally afford further surgery and get some quality of life improvements.
An ankle arthroscopy leading to debridement of the joint. I have some bone or scar tissue that is causing impingement, meaning my tibia doesn't glide along the top of the talus like it should do. There's little I can do to fix the arthritis in it now, but I can at the very least free to some movement such that the rest of my body isn't limited by my lack of mobility.
At the risk of sounding like an American stereotype, have you considered starting something like a GoFundMe to pay for the future surgery?
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 betchya it's the same with psychological injury such as death of a loved one or rejection. Getting back on the horse of living your life stops your social connection tendons from shriveling up and becoming chronically hermetic. Take it from someone who learned the hard way.
I broke my wrist on an 11-day hike this past summer (Tour du Mont Blanc). The awesome doctor I dealt with in Switzerland was like "you can finish your hike, just don't fall on your wrist again or it will be really bad" (or something along those lines). It healed so fast I can't even believe it. I was still using poles for the hike, too. The combination of sustained high-output (12hrs+ hiking per day with major elevation deltas) and some usage of the wrist surely bolstered bloodflow and oxygen throughput, etc. .. eating well surely helped too. Was a really cool experience. My climbing friends back home were surprised how quickly I was back on the wall after such a short period of healing up! At this moment I literally don't remember which wrist I broke... lol
I fractured my elbow mountain biking, the tip of my radius. The urgent care doctor gave me a sling and suggested months of immobility. The orthopaedic said to throw away the sling and start exercising the elbow as soon as I could, and prescribed PT. Turns out that was the right move, there are some permanent changes to mobility but it's about 97% what it was before the crash. Immobilizing joints can apparently cause the muscles, tendons, and nerves to seize up and lose significant range of movement permanently.
Feels kinda reasonable. Human bodies cannot possibly have eveolved to require 6 months of rest to fix. All those humans would have died out thousands of years ago.
We archeological evidence of broken bones that healed. If you are alone in the woods fractures would be deadly, but humans generally exist in society, and society often (not always!) takes care of them own. Maybe you can't walk, but we will carry you around and hunt food and such until you heal. Clearly their rest of life was worse after the fracture, but it is also clear that many had a long life after the fracture.
Something really similar happened to me, I broke my radial head cycling last 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.
It was ~20 years ago, so my memory is a little foggy, but I gave myself a "dancer's fracture" in one foot.
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.
I dropped a few hundred lbs on my foot and got my ballerina's fracture. I like "dancer's" better haha. I went to the gym 4 times a week, every week, even in the boot. Just did mostly sitting exercises. It took 4 or 5 months to start to fuse still. :shrug:
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.
Those little bones are fragile... I broke the second from the outside last summer, too much running, and then started running again a little bit too soon and the next one broke :-/
In the 90's my grandma had her knee replaced. She was bed-bound for 2 weeks before they'd start physical therapy to get her knees back in order. (Ironically enough, her first knee was recalled...so she had a total of three knee surgeries Left, Right, then Left again) over a span of 11 years.
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.
I smashed up my wrist in a bike crash, resting it didn't fix shit. When I lifted weights it would tweak out and hurt, so I avoided that for like a year.
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).
Goes for most injuries, in western medicine there has been an unfortunate tendency to fixate injuries from my experience. That just teaches the body to route around it, as it's seemingly not used anymore. Just lying still in a hospital bed for a few weeks is a terrible experience once you start moving again, been there done that.
Maybe the people who walk early on it doesn't have any pain when they do, which bias the results as it's obviously select for not as bad of an injury.
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.
I’ve had a handful of broken bones and other ailments over the years, and some fairly awful back and spine issues. I’ve noticed the change from “rest avoid weight and keep the fragile bones away from danger” to “don’t overdo it, but try use it” over the years. It makes me wonder how much of our “rest” when sick is really the best course of action. I’m not suggesting weightlifting with a flu, but instead of being bed bound trying to get out walking, etc.
I had a chipped right kneecap in 6th grade, around 1980. At that time the practice was to put the whole leg in a brace and baby it; I don't remember for how long.
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...
A friend of mine who is a doctor, osteopath a once played pro basketball in Austria said: if pro sports injuries would be treated like the general population is treated there would be no pro sports.
Basically conservative therapy takes off so much load that you have no muscle strength left once you start training.
Pro athletes will always apply the max stress they can currently handle.
Very interesting, and seems like a delicate balance. Partial weight bearing reminds your body that you do need this bone to heal (much like lifting weights stimulates muscle growth). Too much instability, though, and the fracture won’t heal properly.
I went through a similar thing with a sprained knee (due to pandemic-related inactivity and resulting obesity). I had squatted down to pick something up, and when I got back up my knee, dodgy for years, finally said FU. I was still able to walk, but just barely, and I had to help myself get up out of chairs.
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.
It's really surprising, isn't it? I think they get caught up in minutia of this vs that. So much of medical research just ends up copping out with a surgeons preference option, even though it's meant to inform the surgeon!
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.
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.
Same goes for meniscus injuries in the knee (excluding probably things like bucket handle tears that risk further damage with use).
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).
This is one of those areas where it’s quite obvious how much confirmation bias there is in medicine. I told the patient to do X, they did X and they are better. Only the patient either didn’t do X and lied or they did X and something else and didn’t argue with the doctor about it.
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 Germany this is already common knowledge. I had a fractured radial head. It gets fixiated for 2 weeks (to let the bones heal) and than the fixture gets removed and you need to move it , you also get therapy sessions for that.
Of course this depends on the fracture degree , but it’s really uncommon to have a fixture for more than a few weeks since it makes it really hard at a certain age to still move it 100%
Last year I went to the hospital with a suspected broken foot. They xrayed it and told me it was just a sprain, but that "interestingly" I had an extra bone in my foot. I walked as much as I could for two weeks, went back for a second appointment and was told it wasn't a sprain (or an extra bone) and was in fact broken in three places.
It's good to know they accidentally gave me good medical advice.
Couple decades ago I split my femur in half. Docs put a metal rod down the middle and had the PTs getting me on my feet the next day. It was not pleasant. After a couple days they sent me to a rehab facility for a week, then home with a walker which they replaced with a cane as soon as I was stable enough.
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.
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.)
Another anecdotal story: My brother was hit by a bus and broke his hip when he was in his 20s. The doctors said that there was a good chance that he could stay lame after the bones heal.
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.
I broke the bone that runs along the top of your left foot when I was around 20 (Metatarsal Bone?), about 25 years ago.
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
I wonder if this phenomenon was part of the reason why Küntscher's intramedullary nailing was so effective at speeding up the recovery from broken legs.
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.
I fractured my greater trocahnter (not sure if this is the proper english name) in a bike crash 2 years ago. My doctor, seeing the MRI told me I need an operation asap. None of the hospitals that he sent me to (including a sports clinic) wanted to operate it, and just told me to let it heal, with check-ups every 4 weeks. Another doctor in another country told me to get the operation, stay in bed 3 months and get blood thinners. 1 month after the accident I couldn’t take it to stay at home and stand still so I started walking again quite a lot and started weight lifting (upper body and trying to not stress the hip too much). 4 months later you couldn’t even notice that I had the accident, no limping, could start running again, fracture was fully “welded” on its own.
In my experience you do have to tolerate pain for things like range of motion/stretching. My ankle wouldnt have near the range of motion it has now after breaking it if I wasn't pushing into a decent amount of pain to stretch it.
20 years ago, I broke my ankle in a friendly soccer game on the Cambridge Commons field. I was shocked when the doctor who performed surgery to put it back together ordered me to walk on crutches the next day after surgery and to continue placing more load on the ankle thereafter. 20 years later I can't complain :)
This is interestingly relevant to me right now as I just fractured my shoulder this weekend. Urgent care gave me a sling despite the chip being small, though everything I'm reading online is saying to use it and to not take pain killers to let my body do the healing naturally. Talking to my primary care now to see what the recommendation is.
It turns out a friend has a broken ankle right now, so as an experiment I tried walking on it, but he just yelled a lot. I'm suspicious of these results.
Sounds like one of these stats where they just invert the cause and effect to get a story; i.e. People who are healing better will obviously walk sooner. Inverted to people who walk sooner are healing better.
There is a lot of hokum and bad statistics in the medical field. Doctors truly don't have a great idea what improves post op outcomes.
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.
A few decades ago, full immobilization was the gold standard, now it turns out early movement is actually better. I wonder what other long-held recovery protocols will be overturned in the next 20 years. Interesting, but I haven't broken anything in my entire life so far...
I hurt my back a couple of times over the years between squats and leg press. Each time I went to the doctor, they pushed chiropractor or the physical therapist. PT was useless the 3 injuries that I went for, and Chiropractor maybe helped once.
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.
In 2017 I suffered a nasty fall. I landed on my right arm that was so in pain afterwards I was T-Rexin' that one arm for a few weeks. Too much flexion or extension hurt. Guess what set my arm right again: gym rehab. I was lifting weights then, and as soon as I was able I put the dinkiest weight on the bicep curl machine, 10 lbs or so, and just repped with that arm for a couple of sets. It hurt a bit, but training the arm got my body's repair mechanisms headed right to the site, and after a few sessions of this the arm became quite usable if not 100% pain free. It's pretty much back to normal now.
My brother broke both of his legs in the Army Ranger parachuting school a few years ago. He landed wrong because of weird instructions and heard the crack but after they patted him down and told him he was good he spent 2 weeks trying to walk it off.
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.
> 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
Source? Because I found plenty of studies on the topic, and there seems to be a fairly universal consensus that goes the exact counter of what you claim. I.e., studies state that weight and resistance training helps with improving bone density significantly, while aerobic exercise (walking/cycling/etc.) doesn’t.
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.
I think you need to read that a bit more closely - they describe running and jogging as high-impact as opposed to walking, swimming, and cycling. These articles are almost always saying something fairly specific.
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."
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-...
I have some books translated from Russian that that I acquired back in my powerlifting days and that showed studies the Russians did on Olympic weightlifters. The children (who had been lifting heavy since a very young age) had bone mineral densities far higher than average untrained adults. The adult Olympic weight lifters had bone mineral densities that were completely off the scale, as the book put it "in polar bear territory". Granted, these study participants were people explosively lifting hundreds of pounds from floor to overhead in the blink of an eye, not your average gymbro, but still.
"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."
It's my understanding that weight lifting is superior to running for increasing bone density but that both together are superior to any one singular. Makes me think about a Mark Rippetoe article from several years back he helps an older woman (60? 80s?) eliminate her lower back pain with weight lifting and strength training exercises. Rippetoe isn't pefect, but he has a good-enough track record on this stuff.
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 :-)
"Bones stay strong if you give them work to do. The best way to keep bones strong is to do both weight-bearing impact and muscle-strengthening exercises."
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.
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?
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.
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.
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?
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.
Yes.
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.
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!!
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.
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.
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.
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.
if it were true for everyone consistently (faster better healing), where does the tail risk come from?
You fall and break something.
Sounds like you basically tricked your body into healing faster by gradually loading it
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.
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.
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.
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.
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.
The pathology for broken collar bones was changing right as I took up mountain biking, and subsequently shattered my collarbone.
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.
I had a broken collar bone last year in Bucharest and I moved back to my hometown because of it. I had to check in after a week or two to see how it's healing but was lazy about it so I went to the hospital after 3 weeks and was told there's a waiting list 10 days long and go to a private clinic. At the private clinic the doctor didn't even look at me, or the x-rays I just took and just told me to go into surgery back in Bucharest. Luckily when my mother heard she found a surgeon through a friend of a friend that looked at my x-rays on whatsapp and told me it's fine but just to be sure to visit him in Bucharest feel it in person, which the private care doctor never did.
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.
Placebo and nocebo are strong effects. Even when the people taking placebos knows it, they still work.
https://www.nature.com/articles/s41598-021-83148-6
Man, that's a wild ride just to get a proper diagnosis. It's crazy how much a doctor's attitude can shape recovery
I left out a bit, before I saw the doctor that told me surgery is the only way, I was consulted by another guy that was free and he scolded me because I came without the orthosis saying stuff like I don't want to get better and basically didn't even look at me or check my recovery after 3 weeks of wearing the orthosis. Told me to go to his private clinic and get a new orthosis where I decided to see any other doctor because I was put off by his attitude. I think the private clinic had a contract with the hospital I was sent to for the surgery or something.
Anyway thank God I found a decent doctor.
I shattered my collarbone - and I do mean shattered, ~8 pieces - in a mountain bike crash September 2023. I went over the bars after the back wheel of my hardtail caught a berm. Landed on my head and shoulder and compressed it laterally inwards by about 2 inches.
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.
Also shattered mine mtn biking (2022), and the surgeon scheduled surgery as soon as he saw the x-ray. I broke it twice as a teenager, and went through the sling route for both of those.
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.
Do yourself a favor and don't wait too long to get rid of the plate: when you crash on that shoulder again, the collar bone won't be able to do it's job of being the predetermined breaking point that saves the shoulder ligaments from ripping. And the AC ligament, unlike bone, will never recover. Not even with the surgery that you'll then likely need to at least restore the other shoulder ligaments. Fractured collar bone is a feature, not a bug.
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)
Good point, thanks. Will look into it.
Shattered mine mountain biking as well (6 pieces). Ortho took one look at it and scheduled surgery for the next day. It wasn't a 'standard' break since it included my AC joint and coracoclavicular ligaments which needed a special type of plate. Ultimately it took 2 surgeries (ORIF, then plate removal). Total recovery was 9 months. My arm/shoulder is as strong as it was before, and it looks anatomically correct.
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.
Mine felt immediately worse after the ORIF. After two weeks getting comfortable in their new positions, all the ligaments really resented getting wrenched back into place.
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!
I should restate - mine definitely did not feel better post-surgery, the ORIF pain was worse than the break, but it felt good to have my bones secure with my shoulder in its anatomically correct place, and not have any more crepitus.
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.
Ah, thanks for the clarification. That post-ORIF pain being worse than the break was my experience too. Even with the plate I became quite paranoid about shifting the screws because it provided so much immediate stability I was worried I was able to do things that may loosen the screws.
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.
Almost everyone I know that mountain bikes, had broken their collarbone.
Multiple folks in my family have broken their collarbone (myself included). None that ride mountain bikes 2-3 times a week have broken it biking.
(More anecdata to persuade you to buy a bike. Great fun.)
I plan to purchase one in the spring. This thread is giving me second thoughts lmao.
Interesting. I shattered mine similarly while snowboarding, but back in maybe 2018. There was definitely no debate on the matter, surgery via ORIF was the recommended option. Then again, my doc was a sports medicine surgeon so perhaps that played into it. Either way, I was never too light with it and it healed very quickly. I was back at 100% about 2 months later.
I also broke mine in a crash, had surgery, but have not bothered to get the plate removed and it's fine?
The only time I really notice it is if someone pushes on it or if I'm doing front squats with a bar.
Get it removed: the next hit will be much worse than a broken collar bone if the bone can't do its job of giving in before less restorable parts of the shoulder give in.
Functional outcomes seem similar, trough we have a increased rate of malunion, delayed or non-union with nonoperative treatment. We usually indicate surgery if it's an active patient.
Welcome to the waves! Best sport in the world, especially if you can avoid the crowds.
Thanks! I've always been a surfer, but split my time with other activities. Post-accident everyone thinks I'm scared of getting back on the bike — maybe a bit? — but genuinely my first thought post-crash was how long I'd be out of the water. It was a clarification of what I truly enjoyed, and an excuse to double down on being in the water.
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.
I've still never heard a satisfactory explanation for how in the hell two parts of a bone, broken such that they aren't even touching, can find their way back to each other and heal. My son broke his collar bone, and the hospital sent him home in a sling. When I looked at the x-ray, I couldn't believe that's the correct treatment. But a month or two later and he was good as new. Absolutely blows my mind every time I think of it.
I broke my collarbone about 30 years ago. Then had it partially rebroken when a friend forgot about my healing bone and greeting me with a shoulder grab from behind. (He felt like shit afterwards). I got the most basic healthcare a free college clinic could offer. Today, you can only tell I ever broke it when I'm shirtless and at my skinniest weight.
It starts with bleeding. The blood in the region of the bones forms a squishy mass that is not bone, but through which cells can flow. Specialized cells deposit calcium into this mass, guided by hormonal and chemical signals. If you imagine the two open bone ends as emitting a sphere of chemical signals, where the two spheres interfere constructively is where the 'signal' is strongest and where you want to deposit calcium. Bones are not just calcium of course, but that's the gist.
Mine ended up healing with a 15mm overlap. So it is a weird shape. It gives me 0 issues however.
They sense other bone tissue and grow together I guess. Same for severed nerves, up to a point.
Apropos of nothing in particular, when I first started mountain biking, a guy I was riding with told me: "You can divide all mountain bikers into two groups: the ones who have broken their collarbone, and the ones who are about to break their collarbone."
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.
Is there padding or gear sold that can reduce the likelihood?
Strength training can help reduce injuries from crashes up to a point.
Experience helps too but that’s harder to get safely!
For collarbones specifically? Nothing I'm aware of. At least if the explanation that was given to me for the high prevalence of collarbone injuries is correct, that makes sense. Someone explained it to me as "when you start to fall, you instinctive tend to reach our towards the ground to try to break your fall. So your hand is the first thing that hits the ground, and all the energy of the fall goes up your arm and into your shoulder / upper chest area. And the collarbone just happens to be the "weak link" there and so tends to break."
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.
Hmm. Every time I've been in a similar scenario (breaking a fall, warding off an incoming projectile) it has been my wrists that broke.
Given the amount of injuries related to mountain biking, is there some specific insurance needed for it? It seems one of those "net-negative for the society activities", like trampolines.
this is such a wild take to me... it's impossible to quantity at what point something becomes a net negative for society. Smoking seems to be an obvious example, because it's addictive quality inhibits a fair decision to the smoker, and it's something with a lifelong pathology.
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)
> but how is that a drain on society, and not primarily the individual?
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.
> 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.
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.
We draw the lines in different places.
e.g. amateur MMA is illegal in Norway and I think a couple of other places too.
> The first is that a drain on individuals is a drain on society.
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.
> now I want to add obesity, and all mental health conditions
If you have a way to just not have those, the way you can just not use trampolines, I would love to hear it.
Don't forget about the alternatives. Is mountain biking worse than watching movies - biking will of course have more injuries, but it also builds physical fitness and so long term is probably better for you. (or maybe just my anti-movie bias is showing?)
I agree that a ban doesn’t make sense, but even “ephemeral” injuries routinely generate significant costs.
(In my experience, musculoskeletal injuries are rarely completely ephemeral, they tend to have long-term effects, even if minor.)
I'm gonna call that sample bias. If you exclude all injuries that are ephemeral, (because they don't get reported, because they're ephemeral, and forgotten), you're left with the injuries that aren't ephemeral. I mean duh, obviously lol. But my point is still, yes injuries are bad, and as a society, we're pretty trash at healing them, but injuries are more impactful for the individual, than for society.
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.
My point is, most injuries aren’t ephemeral in the sense that your body would end up as if you didn’t have the injury in the first place. In particular the sports injuries we are talking about. You may only truly realize that a decade later or so. So I find making that distinction questionable, it trivializes the injuries.
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.
Yes, we should absolutely ban, at the very least, contact football among minors. We have ample evidence of football (and soccer, too, for that matter) student athletes developing full blown CTE by their 20s, and with lifetime risk thousands of times the general population.
A few years back, I thought there would be more of a push to regulate/limit American, at least contact, football. But didn't happen. Soccer? Good luck.
100% anecdotal… one of my town’s youth football (American) clubs shut down before COVID due to lack of interest. When my son played ~15 years ago, the club was fielding 2 teams per age group.
And knowing what they know now, I wouldn’t let a child play today.
I do suspect that soccer has whittled down youth American football over time. It's not quite true that no one played youth soccer when I was growing up but certainly nothing organized at scale to today's degree. I have a friend who has been reffing soccer forever. I should ask him as he probably has some insight.
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.
Controversial take: On a population level, the negatives of smoking are at least partially mitigated by the "smoking suppresses obesity" side effect. Obesity is such a huge (pun not intended) public health issue in modern American society that any intervention reducing it is actually quite valuable.
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.
Smoking is significantly worse for you and your family than obesity. It causes a greater reduction in life expectancy, and can impact the physical health of those who live or work with you via secondhand smoke.
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.
Nicotine itself isn't very dangerous, it's the carcinogens in tobacco that are and the combustion products in the smoke.
I don't know that "normal" mountain biking is any worse than cycling in general, or sports like tackle football.
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.
The way I always looked at it (based on my own anecdotal experience, plus those of my friends around me)... you're probably more likely to get "hurt" in some sense while mountain biking, but probably more likely to get "killed or maimed" while road cycling (eg, being struck by a car).
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. :-(
Another factor worth considering is that being physically active also prevents other ailments, so (even downhill) bikers may still be more profitable for insurance companies!
I couldn’t agree more. Road biking has entirely fixed my lower back and neck issues, my knees have come right and getting up hills has knocked 15-20kgs off me in the last year. I just wish I could get out there more.
> 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.
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.
> 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.
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.
> I know more people with major injuries from being hit by cars
_hit by drivers_, you meant?
I think I like what you're getting at (placing blame on the human not the object), but could you tone the attitude down? This read to me as an almost snide correction, I genuinely think you'd convince people if you 'invited' them instead
Nah. Decades of politeness have failed, it's time to get more aggressive about people deciding it's ok to kill other people as long as you do it by driving a car into them and aren't drunk at the time.
Well, it was the car that touched them. But yeah, the driver was at fault in ALL instances.
Yeah. I did have a fall (for no good reason) cycling on a carriage path in Acadia National Park. But that's almost certainly safer than road biking on a busy road. And I do think a world in which you have insurance companies micromanaging what they will cover for various outdoor activities is not one we want--and it's not clear that it even distinguishes from people who are very sedentary.
In general, "society" deciding what activities are too dangerous to routinely allow is a really nasty slope. Yes, there's some special insurance offered through private organizations for things like higher altitude mountaineering. But it's not that big a step to rule that any contact sport, for example, should require special insurance. I'm sure the insurance companies wouldn't mind.
One thing which comes to mind is - why should we stop at sports, then? we'll immediately be at the point where smokers, alcoholics, obese people etc. should pay more, after all, their way of life statistically causes higher costs.
(i don't think either of those things should result in higher insurance prices, just continuing the thought.)
> we'll immediately be at the point where smokers, alcoholics, obese people etc. should pay more, after all, their way of life statistically causes higher costs.
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.
Private life insurance may. I don't think health insurance generally does. Certainly Medicare doesn't ask about any of those things.
Health insurance can't ask about this since ACA (I think).
Life insurance can and often requires an actual physical exam. And can exclude specific activities such as flying on small private aircraft from coverage.
Health insurance premiums used to be different based on whether or not you smoked; maybe they still are. It would still be nice if you could lower your health insurance premiums by losing weight or buying a policy that didn’t cover mountain bike injuries or whatnot.
At a former company, there was some trivial discount for an annual health care screening which I stopped doing because it was trivial and something that wasn't between me and my doctor. I would absolutely not sign onto a screening that invasively wanted to know about specific athletic or other activities of that sort. (Which would probably also give the insurance company untold levers to deny your claim.) "Oh, you said you don't rock climb, well that 'hike' looks like a rock climb to us."
>> we'll immediately be at the point where smokers [...] should pay more, after all, their way of life statistically causes higher costs.
> 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.
The smokers who DON'T get lung cancer still have more heart and lung problems (like emphysema, COPD, etc.), and those get significantly worse late in life.
I don't know about alcoholics, but smokers and obese people actually cost less in medical care because they usually die before age-related diseases takes hold which are the most expensive, they most often die of heart attack and stroke which are the cheapest deaths, and being fat or a smoker disqualifies you from many procedures and operations that they otherwise would do without hesitation.
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.
insurance companies already buy up information from data brokers and use that to jack up people's rates according to whatever they happen to find to justify it. They won't tell you when they do it, you'll just be offered a very different price than you would have been given if you didn't buy as much alcohol, spent more time at the gym, only drove your car in the daytime, or lived in a different zip code.
Some countries tax tobacco, alcohol and sugar at higher rates to offset the costs incurred to society?
You mean like an additional tax on tobacco, alcohol, and sugar?
You're behind the times lol -- UK
Aren't there already insurance rebates in the US or something for tobacco-free attestation?
I play recreational hockey. All of the rinks around here (and most of the US) require membership to USA Hockey which, among other things, provides some kind of insurance to both the rinks and the players.
https://www.usahockey.com/insurancemanagement
Hockey Canada is similar.
Paid out a lot of $$$ to quietly settle numerous sexual abuse claims/lawsuits.
https://en.m.wikipedia.org/wiki/Hockey_Canada_sexual_assault...
https://www.cbc.ca/amp/1.6695731
That must be relatively new. Never heard of such a thing. Wonder if it's a reason my undergrad really cut back on intramural hockey.
Trampolines are indicated because YOUR home insurance could be on the hook for someone ELSE being hurt on your trampoline. And it's easy for them to exclude it.
Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
> 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.
By this logic, most software engineers would also be considered high risk since they work a sedentary job and have higher risks for heart disease and obesity (which likely leads to higher healthcare costs over the long term)
Telling people they're not allowed to have fun in the manner of their choosing because it would be bad for society sounds like a great way to discourage people from caring about society.
Why should you be forced to pay insurance if you don't endanger others? Most situations where you are forced to have insurance are cases where others are endangered (eg. driving).
You mostly aren't. But you're also foolish to not carry health insurance and homeowner's insurance (even aside of liability) in the US.
No? I’ve been mountain biking for over 20 years and never any broken bones or had to go to hospital as a result, despite doing downhill, trials, and dirt jumping. And I have 20 years of fitness to show for it - that’s about as positive as it gets.
Get 8 billion people to flip a coin 30 times in a row, and one is likely to get heads 30 times in a row. It means nothing.
He's been flipping the same coin for 20 years and it has never come up tails. That's quite the coin. There is no data set more relevant to a person than their own experience.
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.
> He's been flipping the same coin for 20 years and it has never come up tails. That's quite the coin.
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.
You haven't addressed the argument (riskiness of the activity) with your anecdote.
That was his point, or if it wasn't it's my point. It's a physical activity, one that from my POV improves health much more than reduces it. Take the hypothetical where he doesn't ever find a replacement activity, and instead of being fit becomes obese and depressed. that would be worse for society than mountain biking wouldn't it?
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?
There is no specific insurance required that I'm aware of... It's an activity that's well within the normal allowance of jackassery that everyone is entitled to.
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.
Kids have so much joy on trampolines! I know they have dangers but net negative? Do you have data or anything?
I'm all in behind your idea: let's do the net result for society of every activity, and mandate people to do the most positive one, while banning the most negative ones!
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?
People slip in the shower so lets stop bathing.
I've been advocating mandatory shower-helmet laws for many years now; it would make as much sense as a lot of the other nanny-state regulation does.
On the other hand, mandatory rough surfaces on the floor of showers seem pretty reasonable.
My friend's parents dropped a shampoo bottle in their new build, and it broke through the bathtub. I hope this rough surface will be more durable.
I'm imagining some rough sandpaper layer that comes off every time you shower until it's smooth anyway. Glue is expensive, you know?
There are smoother and rougher tile surfaces. When getting tile put in my house I've made something of a point of avoiding the very slickest/smoothest tile.
I feel only rocky texture will be satisfactory after a year. Or is there any chemical that can safely strip the soaps and other fatty stuff from the mineral?
My roughest and lightest tile--which has to be replaced for other reasons after a couple decades in what we call a mudroom in New England--could probably be cleaned but would be a procedure. In general, darker and just somewhat textured tile seems to work pretty well in less-trafficked areas.
There's so much about showers in hotels that I hate a good proportion of the time: super-slick tiles, high step-in tubs, accompanied by no handholds. I've gotten more sensitive to this over time but even when I was much younger, nearly took spills a couple of times.
That's fair. It's one thing to tell people "don't build things in such a way that other people would be put at risk", and quite another to threaten people with punishment for choosing to take risks themselves.
We probably should have lanyard-equipped showers.
people will hang themselves on the lanyard and die. Not all such cases will be suicide.
Why do you suppose hotel showers all have grip bars?
All? Ha ha.
My wife is a physiotherapist in Europe, and even ten years ago she would tell you to start exercising it (with guided exercises) as soon as possible.
Also broke my collar bone and no surgery, shoulder is less large by 2cm, I had no issues in the short term, but now after 10+ years it's cracking more, it doesn't age well
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
A personal philosophy in medical decisions: - unless there is a severe risk I might die from lack of intervention (on any reasonable timeline besides life), I avoid intervention.
In some cases (my messed up jaw and a whole 9 wisdom teeth), I broke this rule. But generally, it has served me well.
I have a similar viewpoint; over a decade ago, I had a nuisance tendon issue and went to a specialist who recommended surgery.
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.
You must have broken yours around the same time my dad broke his. They didn't operate and apparently some of the people who saw the x-rays were quite surprised how well the natural healing process handled pulling the bone pieces back together.
I had a clean break on mine. If I had not had surgery I believe my shoulder would have been a centimeter or two lower. So I got a plate and 7 screws.
Am I right to understand that had I not gotten the surgery my shoulder would’ve likely returned to the normal position?
usually it shouldn’t affect position or function of the shoulder once healed, and while the clavicle does tend to heal with a “bump” in it at the site of the break, its long been thought that the risk of surgery at that site outweighs the benefit. But it does depend on the specifics of the fracture: https://www.orthobullets.com/trauma/1011/clavicle-fractures-...
When I was a kid (not in the U.S), I remember village elders diagnosing all kinds of illnesses simply from checking one's pulse, without asking any questions or even talking. These are people with minimum education, minimum or zero exposure to science or labs or modern medicine.
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.
when my grandma was a kid she remembers the village doctor telling her she has ghosts in her blood and she should do cocaine about it
I get the impression from the second part of this that you think the village elders were correctly diagnosing things?
I wonder how likely that is? I suspect their understanding of their diagnostic technique is flawed, but beyond that, would a small enough group have a similarly small pool of common afflictions such that you could develop a useful body of medical lore?
I had a bad pilon fracture of my ankle a couple of years ago with both a break on Tibia and Fibia.
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
I’m going through a very similar process after breaking my ankle in a motorcycle accident. Tibia and double fibula fracture with dislocation and open wound, an ugly one which needed 2 titanium plates and 18 screws.
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 broke my ankle about 20 years ago. Once I was out of the cast, I regained all function, and only recently has my ankle been starting to ache. The doctor I saw about it even commented that it was as clean of a fix as he'd ever seen!
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!)
I can relate, 21 year old moron in my case. No surgery needed and clean fix. The problems were gone after a year when I decided to get some help in the form physical therapy. It never hurt again until recently when I broke it again
If it's not an articular injury and they fix all the bones, you can more or less walk on these immediately. I've read about protocols like two weeks, and even immediately (albeit that has issues with wound healing)
I suffered a very similar break playing soccer. ER surgeon asked if I fell off a roof. 3 metal plates and 15 screws later I was non-weight bearing for 14 weeks. I lost almost 5 inches in circumference from my left thigh while waiting to put weight back on that leg.
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.
Sorry to hear about the outcome on your leg, I am sure you've tried lots of things to beef up your muscle. Just looking at my two legs I can still see a slight difference in calf thickness.
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.
For sure! Not to mention all the tendons and nerves. My recovery continues, as I’m sure yours does too — I’m back to my pre-injury PRs for most weight lifting, and my goal for this year is to match my pre-injury mile time.
All things considered I’m still pretty lucky. This could have happened when I’m much older and been debilitating for life.
I wonder how and when they choose to remove plates, vs. leaving them in. They left mine in, and when I originally asked them, they mentioned that there was significantly more risk in removing it than leaving it in.
20 years on, and it's still hanging in there.
Unless we have a clear indication, plates are not meant to be removed. For example, plating children we usually remove the plate as to not interfere with growth, or in some cases a fibula plate can irritate the tendons and should be removed, or in cases of infection.
I asked to have them removed because my physical therapist believed they were impinging on a nerve, preventing me from regaining mobility in my toes. They didn’t want to but I kept insisting.
What's your leg circumference at, now?
Mine is also smaller, due to patella tendinopathy.
They are within 1 inch of each other, which is fine with me. I haven’t measured in over a year, I know there’s still a strength imbalance but that’s not what feels limiting to me anymore.
Having recently walked away from that exact situation miraculously unscathed (the teenage drunk drivers also managed to walk away somehow), that’s an interesting insight into the type of injury I avoided. Grim, scary, but very interesting. Glad you recovered.
I crushed my leg a few years ago, my wife and I dropped a bridge on it, and I suddenly had 200kg of steel and wood grind down the back of it, and the front slammed into a concrete footing.
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.
That's much more serious than the break I had in 2023. Slid and fell on an icy ramp coming off a river boat in Regensburg, Germany. Snapped the fibula in the middle, but didn't get it x-rayed until I was back in the US. Walking around Newark Airport wasn't fun. After that, wore a boot for four weeks, no cast was needed.
I broke an arm and the emergency room couldn't see it on the x-ray and gave me a sling to wear.
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."
Frozen shoulder isn't fun. I had it for almost 2 years - from onset to the point where my shoulder mobility was pretty much back to normal. That's probably why your doc recommended to keep the arm in motion.
Imagine how many people end up with stiff joints just because they were told to keep still
Remember, "Pain is weakness leaving your body".
Well in my case pain was half a bone trying to leave my body. :)
That phrase always felt more like a gym bro mantra
Pain is an illusion of the senses.
Literally, it's just electrical impulses travelling through your body.
Doesn’t make it any less real though.
I battled PF for ages, tried literally everything, and when nothing worked, my feet were in pain I decided to do the dumbest thing in the world and try to only thing I was told I shouldn’t do - run.
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.
I essentially had to relearn to walk to clear mine up. Rolling your ankles makes it much worse, but the entire leg is involved in that “decision” and it starts from the gluteus minimus muscles and builds down.
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.
Interesting. For me PF gets worse when I walk more. Even with special soles. Still trying to figure out what works.
Constantly stretching the heel in two ways works well for me, both to cute it and prevent it in the future.
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.
Thanks I’ll try that!
Stretching and rolling with a small foam roll helps me as well.
Shoes with a wider toe box. Take your uncomfortable shoes to a reuse/charity drop off and never look back.
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.
I wonder how it would go without shoes. It's an enjoyable change from wrapping your feet up all the time anyway :)
If anyone's heard of RICE (Rest, Ice, Compression, Elevation) for healing joints, the new guidance is called POLICE: Protect, Optimal Load, Ice, Compression, and Elevation. The key differences being Protect and Optimal Load, meaning don't re-injure it and expose it to some level of weight-bearing or usage.
The guy who termed RICE (Gabe Mirkin) later came out and said he made a mistake. Specifically with the "Ice" part (and partially with Rest). See: https://drmirkin.com/fitness/why-ice-delays-recovery.html
IIRC the underlying assumption was that you should be reducing inflammation (RICE is almost all about reducing inflammation). Since then, we've learned that inflammation is a good thing, and helps things heal faster.
I'm curious now if the anti-inflammatory diets popular with dietitians and health influencers could have a negative effect when you really do want inflammation, like when fighting an infection or recovering from injury.
https://www.health.harvard.edu/staying-healthy/quick-start-g...
https://nutritionsource.hsph.harvard.edu/healthy-weight/diet...
As I understand it such diets allow the immune system to work more effectively, not suppressing it like, say, corticosteroids do.
Also, elevation is useless and compression is potentially harmful as restricting blood circulation and compressing tissue limits healing.
Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional.
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.
Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done.
Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.
I’m in PT and dealing with orthos right now, and according to them, that IS how pain works for the vast majority of ortho injuries
Sorry, which comment are you affirming?
Go until just before it hurts, which is a moving target that you will have to calibrate carefully
Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.
> “Optimal load” is really just a tautology.
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.
"As soon as it starts to hurt" is not some hopelessly complex and useless standard that involves delving into philosophies of subjective pain sensation. It is actually obvious and easy to follow.
Use it, but when it hurts, stop.
Yeah, but given the huge variations in pain tolerance, some will reinjure it while others will never use it again.
tolerating it doesn't mean you can't detect it.
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.
Clearly, you have never worked in healthcare.
Sleeve tattoos but needs an IV? “Oh, I’m not good with needles, you need to sedate me first.”
How is that relevant?
Perception of pain is highly individual. Like I said, people who have tons of tats will complain about an IV. You aren’t afraid of needles, you just don’t like them when they are used for your health instead of marking up your body.
When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice.
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 broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new.
I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
>What defines optimal load?
Uncomfortable but not painful, just like pretty much everything else physiology-related in life.
RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.
> I think these are things that have to be considered for medical protocols
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.
I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.
> Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger.
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.
Maybe they aren't, but they also aren't unique in this regard. Obstinate tough guy types are obstinate no matter what their job is. I have neighbors and family members who had similar issues where the doctor says something like "you can walk, but take it easy" but they misjudge what "taking it easy" really means.
I mean so we don't make a generally good recommendation because one pro wrestler got their foot amputated?
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.
I mean so we don't make a generally good recommendation because one pro wrestler got their foot amputated?
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.
> Please try to converse in good faith.
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.
We're still icing and elevating? I've always felt dubious about our attempts to rectify our bodies evolving inflammation. It doesn't seem like any great evil to let the body part get more blood, signals to stop us using it, and a lower range of movement.
No, reducing inflammation can help manage pain, but beyond that is not beneficial (actually is detrimental) to healing. https://drmirkin.com/fitness/why-ice-delays-recovery.html
It's HELM now: Heat, Exercise, Lower, and Massage. They're all designed to maximize blood flow to, and inflammation in, the injured area. (Note that exercise just means to keep it moving.) Ice and elevation restrict the flow of fluids in and out of the injured area; ice especially slows down recovery and is only recommended for pain management.
(This is basically a simplified version of the protocol NFL teams have been using.)
I love how this is basically the complete opposite of the old protocol lmfao.
Makes sense to me, though :D
from https://www.outsideonline.com/health/training-performance/fo...
> 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.
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.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8325614/
The meta-analysis study you cite suggests 2% loss @ 5 days and 5% loss at 10 days at the knee extensor muscles.
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...
Some good videos on Starting Strength of what they have done for older people: https://www.youtube.com/watch?v=ekJOT0kn5vs (Such as the 86 year old lady in the video).
My main take away from this thread is to never take up mountain biking.
I noticed this years ago. First thing two cyclists do upon meeting each other is compare injuries. It's like dogs sniffing each other's butts.
Mountain bikers becoming injured isn't a question of IF, but WHEN.
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.
Mountain Biking just seems dangerous in general. I do a lot of trail running, and at this point I feel like my most likely source of injury is from a mountain biker colliding with me.
Damn I hit 30 this year and planned to buy one.
It's not that bad. And if you start early in your life, any injuries that might happen to you will heal much faster.
The human body (like most fit organisms) is antifragile. It needs to be challenged. In this context, people who think "ooh that hurts I'll never do that again" and carefully avoid discomfort find that, by middle age, they can't do anything, and everything hurts. Meanwhile people who think "ooh that hurts, I'd better practise it until it doesn't" are still fully functional into old age because they push their bodies in the right way, and so their bodies stay strong.
Don't get me wrong, the latter group still hurt. Getting old sucks. But their bodies work.
The right level is hard though. I know more than one old person who spent time in a hospital because they thought they could do something they couldn't and broke their bone. "For $20 they would install the new dryer, but no we thought we could do it and that is how my foot got broke in the fall". You should have a cane handy when you need one, but don't use it if you don't need it.
I have no idea how to find the right balance.
Accidents are almost always bad, for sure. Doing things that you are physically capable of, though, is rarely a problem.
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.
Yes and no.
Professional athletes are usually miserable later in life due to doing exactly that.
I broke my shoulder and they immediately offered me a handicapped placard.
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.
I broke my ankle 15 weeks ago, and decided to weight bear early against the advice of my doctors. In my experience, it caused me no issues and prevented my calf from atrophying further. My foot was also super tight, and I can't imagine that would have gotten better by staying off it.
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 my knee surgery (meniscus cartilage tear/repair) and after my appendectomy, I was pretty keen to get up and moving so that I could go outside and smoke. Both times the nurse commented that while smoking on its own isn't great for healing, the fact that it forces you to get up and moving quickly and frequently is generally helpful. In both cases the doctor was quite surprised at how quickly I'd healed up when I went for the follow-up/stitch removal.
Primum non nocere
It's certainly an understandable view. At least there is more research showing that at least some of these measures aren't meaningfully reducing harm anyway.
I can certainly attest to the consequences. I unfortunately shattered my ankle and broke my back simultaneously, which meant I didn't walk on my ankle until 6 months after the incident. As such, even 10 years later my ankle is a constant irritant to me. I have next to no dorsiflexion beyond a straight leg now. No ankle mobility means persistent pain in my hip, knee, and back on that side, and I'm only 29. God bless the NHS for saving my life at the time and not charging me a penny, but despite my best efforts I can't get any further treatment now to improve the flexion. I'm counting down the years until I can finally afford further surgery and get some quality of life improvements.
What surgical treatment do you expect to improve your outcome?
An ankle arthroscopy leading to debridement of the joint. I have some bone or scar tissue that is causing impingement, meaning my tibia doesn't glide along the top of the talus like it should do. There's little I can do to fix the arthritis in it now, but I can at the very least free to some movement such that the rest of my body isn't limited by my lack of mobility.
Brutal. Hope you can make the best of it and the arthritis doesn't advance further.
At the risk of sounding like an American stereotype, have you considered starting something like a GoFundMe to pay for the future surgery?
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 betchya it's the same with psychological injury such as death of a loved one or rejection. Getting back on the horse of living your life stops your social connection tendons from shriveling up and becoming chronically hermetic. Take it from someone who learned the hard way.
I broke my wrist on an 11-day hike this past summer (Tour du Mont Blanc). The awesome doctor I dealt with in Switzerland was like "you can finish your hike, just don't fall on your wrist again or it will be really bad" (or something along those lines). It healed so fast I can't even believe it. I was still using poles for the hike, too. The combination of sustained high-output (12hrs+ hiking per day with major elevation deltas) and some usage of the wrist surely bolstered bloodflow and oxygen throughput, etc. .. eating well surely helped too. Was a really cool experience. My climbing friends back home were surprised how quickly I was back on the wall after such a short period of healing up! At this moment I literally don't remember which wrist I broke... lol
I fractured my elbow mountain biking, the tip of my radius. The urgent care doctor gave me a sling and suggested months of immobility. The orthopaedic said to throw away the sling and start exercising the elbow as soon as I could, and prescribed PT. Turns out that was the right move, there are some permanent changes to mobility but it's about 97% what it was before the crash. Immobilizing joints can apparently cause the muscles, tendons, and nerves to seize up and lose significant range of movement permanently.
Feels kinda reasonable. Human bodies cannot possibly have eveolved to require 6 months of rest to fix. All those humans would have died out thousands of years ago.
Most of these fractures would be deadly affairs thousands of years ago anyway.
Immobilization has its uses.
Surgery is many times essential.
We archeological evidence of broken bones that healed. If you are alone in the woods fractures would be deadly, but humans generally exist in society, and society often (not always!) takes care of them own. Maybe you can't walk, but we will carry you around and hunt food and such until you heal. Clearly their rest of life was worse after the fracture, but it is also clear that many had a long life after the fracture.
Something really similar happened to me, I broke my radial head cycling last 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.
It was ~20 years ago, so my memory is a little foggy, but I gave myself a "dancer's fracture" in one foot.
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.
I dropped a few hundred lbs on my foot and got my ballerina's fracture. I like "dancer's" better haha. I went to the gym 4 times a week, every week, even in the boot. Just did mostly sitting exercises. It took 4 or 5 months to start to fuse still. :shrug:
> It took 4 or 5 months to start to fuse
That's an insanely long time-frame for healing.
Bones usually start fusing in weeks, not months.
> It took 4 or 5 months to start to fuse still
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.
Those little bones are fragile... I broke the second from the outside last summer, too much running, and then started running again a little bit too soon and the next one broke :-/
But plenty of people here are saying to just force it...
What did the doctors say after it healed?
Did they take credit for it?
In the 90's my grandma had her knee replaced. She was bed-bound for 2 weeks before they'd start physical therapy to get her knees back in order. (Ironically enough, her first knee was recalled...so she had a total of three knee surgeries Left, Right, then Left again) over a span of 11 years.
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.
I smashed up my wrist in a bike crash, resting it didn't fix shit. When I lifted weights it would tweak out and hurt, so I avoided that for like a year.
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).
Goes for most injuries, in western medicine there has been an unfortunate tendency to fixate injuries from my experience. That just teaches the body to route around it, as it's seemingly not used anymore. Just lying still in a hospital bed for a few weeks is a terrible experience once you start moving again, been there done that.
Maybe the people who walk early on it doesn't have any pain when they do, which bias the results as it's obviously select for not as bad of an injury.
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.
I’ve had a handful of broken bones and other ailments over the years, and some fairly awful back and spine issues. I’ve noticed the change from “rest avoid weight and keep the fragile bones away from danger” to “don’t overdo it, but try use it” over the years. It makes me wonder how much of our “rest” when sick is really the best course of action. I’m not suggesting weightlifting with a flu, but instead of being bed bound trying to get out walking, etc.
I had a chipped right kneecap in 6th grade, around 1980. At that time the practice was to put the whole leg in a brace and baby it; I don't remember for how long.
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...
A friend of mine who is a doctor, osteopath a once played pro basketball in Austria said: if pro sports injuries would be treated like the general population is treated there would be no pro sports.
Care to elaborate on what they meant by that?
Basically conservative therapy takes off so much load that you have no muscle strength left once you start training. Pro athletes will always apply the max stress they can currently handle.
Many athletes are playing with injuries?
It means pro-athletes would never recover so there would be noone left to play pro sports.
Because pro athletes get procedures that actually work, vs general population procedures that can be detrimental.
I was not expecting to learn that "walk it off" is actual valid medical advice. I have a few people to apologise to now.
Very interesting, and seems like a delicate balance. Partial weight bearing reminds your body that you do need this bone to heal (much like lifting weights stimulates muscle growth). Too much instability, though, and the fracture won’t heal properly.
I went through a similar thing with a sprained knee (due to pandemic-related inactivity and resulting obesity). I had squatted down to pick something up, and when I got back up my knee, dodgy for years, finally said FU. I was still able to walk, but just barely, and I had to help myself get up out of chairs.
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.
Medicine is still to a very large degree hocus pocus.
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.
It's really surprising, isn't it? I think they get caught up in minutia of this vs that. So much of medical research just ends up copping out with a surgeons preference option, even though it's meant to inform the surgeon!
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.
There seems to be some truth to 'walk it off'.
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.
Same goes for meniscus injuries in the knee (excluding probably things like bucket handle tears that risk further damage with use).
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).
Yes, of course. Same with herniated discs - you need to keep walking, no matter the pain.
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.
This is one of those areas where it’s quite obvious how much confirmation bias there is in medicine. I told the patient to do X, they did X and they are better. Only the patient either didn’t do X and lied or they did X and something else and didn’t argue with the doctor about it.
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 Germany this is already common knowledge. I had a fractured radial head. It gets fixiated for 2 weeks (to let the bones heal) and than the fixture gets removed and you need to move it , you also get therapy sessions for that. Of course this depends on the fracture degree , but it’s really uncommon to have a fixture for more than a few weeks since it makes it really hard at a certain age to still move it 100%
Last year I went to the hospital with a suspected broken foot. They xrayed it and told me it was just a sprain, but that "interestingly" I had an extra bone in my foot. I walked as much as I could for two weeks, went back for a second appointment and was told it wasn't a sprain (or an extra bone) and was in fact broken in three places.
It's good to know they accidentally gave me good medical advice.
Couple decades ago I split my femur in half. Docs put a metal rod down the middle and had the PTs getting me on my feet the next day. It was not pleasant. After a couple days they sent me to a rehab facility for a week, then home with a walker which they replaced with a cane as soon as I was stable enough.
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.
I was in a cast for 6 weeks. Once they cut me out of it, it was straight into walking.
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.
What doesn't heal better when you use it?
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.)
Another anecdotal story: My brother was hit by a bus and broke his hip when he was in his 20s. The doctors said that there was a good chance that he could stay lame after the bones heal.
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.
I broke the bone that runs along the top of your left foot when I was around 20 (Metatarsal Bone?), about 25 years ago.
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
I had a Brostrum procedure to fix my ankle. I researched lots before. Was expecting months in plaster.
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!
Same! Big shoutout to Dr Thuillier at UCSF. Really changed my life.
I wonder if this phenomenon was part of the reason why Küntscher's intramedullary nailing was so effective at speeding up the recovery from broken legs.
There are case reports of people achieving remarkable rehabilitation by stressing their bones and muscles with weight lifting, for example: https://startingstrength.com/article/barbell_training_as_reh...
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.
I fractured my greater trocahnter (not sure if this is the proper english name) in a bike crash 2 years ago. My doctor, seeing the MRI told me I need an operation asap. None of the hospitals that he sent me to (including a sports clinic) wanted to operate it, and just told me to let it heal, with check-ups every 4 weeks. Another doctor in another country told me to get the operation, stay in bed 3 months and get blood thinners. 1 month after the accident I couldn’t take it to stay at home and stand still so I started walking again quite a lot and started weight lifting (upper body and trying to not stress the hip too much). 4 months later you couldn’t even notice that I had the accident, no limping, could start running again, fracture was fully “welded” on its own.
In my experience you do have to tolerate pain for things like range of motion/stretching. My ankle wouldnt have near the range of motion it has now after breaking it if I wasn't pushing into a decent amount of pain to stretch it.
20 years ago, I broke my ankle in a friendly soccer game on the Cambridge Commons field. I was shocked when the doctor who performed surgery to put it back together ordered me to walk on crutches the next day after surgery and to continue placing more load on the ankle thereafter. 20 years later I can't complain :)
This is interestingly relevant to me right now as I just fractured my shoulder this weekend. Urgent care gave me a sling despite the chip being small, though everything I'm reading online is saying to use it and to not take pain killers to let my body do the healing naturally. Talking to my primary care now to see what the recommendation is.
My counter anecdote I fractured a bone in my leg. Kept walking on it for a year. Only healed when I finally got in a boot.
Related, bone tissue regeneration using coral and marine sponges:
https://web.archive.org/web/20240705042256/https://web.stanf...
Also another hack - doxycycline speeds up repair, and nothing to do with fighting infection. It assists the matrix proteins build faster and better.
Don't believe it? Try it out. It's well tolerated. There's research on how it works, too. Search for it.
It turns out a friend has a broken ankle right now, so as an experiment I tried walking on it, but he just yelled a lot. I'm suspicious of these results.
Sounds like one of these stats where they just invert the cause and effect to get a story; i.e. People who are healing better will obviously walk sooner. Inverted to people who walk sooner are healing better.
There is a lot of hokum and bad statistics in the medical field. Doctors truly don't have a great idea what improves post op outcomes.
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.
Because the more they break the stronger they are.
a vet estimated that ~50% of animals that he treats would have recovered fine without his involvement
if you dont use it... you might lose it...
A few decades ago, full immobilization was the gold standard, now it turns out early movement is actually better. I wonder what other long-held recovery protocols will be overturned in the next 20 years. Interesting, but I haven't broken anything in my entire life so far...
I hurt my back a couple of times over the years between squats and leg press. Each time I went to the doctor, they pushed chiropractor or the physical therapist. PT was useless the 3 injuries that I went for, and Chiropractor maybe helped once.
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.
In 2017 I suffered a nasty fall. I landed on my right arm that was so in pain afterwards I was T-Rexin' that one arm for a few weeks. Too much flexion or extension hurt. Guess what set my arm right again: gym rehab. I was lifting weights then, and as soon as I was able I put the dinkiest weight on the bicep curl machine, 10 lbs or so, and just repped with that arm for a couple of sets. It hurt a bit, but training the arm got my body's repair mechanisms headed right to the site, and after a few sessions of this the arm became quite usable if not 100% pain free. It's pretty much back to normal now.
My brother broke both of his legs in the Army Ranger parachuting school a few years ago. He landed wrong because of weird instructions and heard the crack but after they patted him down and told him he was good he spent 2 weeks trying to walk it off.
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.
Yeah I hurt my arm, had surgery, and couldn't wait to use it.. Now its fuct again lol
"Use it or loose it"
Oh this is so bad:
> 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...
Source? Because I found plenty of studies on the topic, and there seems to be a fairly universal consensus that goes the exact counter of what you claim. I.e., studies state that weight and resistance training helps with improving bone density significantly, while aerobic exercise (walking/cycling/etc.) doesn’t.
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.
0. https://pmc.ncbi.nlm.nih.gov/articles/PMC6279907/
I think you need to read that a bit more closely - they describe running and jogging as high-impact as opposed to walking, swimming, and cycling. These articles are almost always saying something fairly specific.
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."
Your last quote throws bones and muscles into one. Just so you know.
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-...
Squats/Deadlifts, not bicep curls with 3lb dumbbells. And yes, it absolutely will improve bone density.
I have some books translated from Russian that that I acquired back in my powerlifting days and that showed studies the Russians did on Olympic weightlifters. The children (who had been lifting heavy since a very young age) had bone mineral densities far higher than average untrained adults. The adult Olympic weight lifters had bone mineral densities that were completely off the scale, as the book put it "in polar bear territory". Granted, these study participants were people explosively lifting hundreds of pounds from floor to overhead in the blink of an eye, not your average gymbro, but still.
Further down that page it actually says:
"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."
It's my understanding that weight lifting is superior to running for increasing bone density but that both together are superior to any one singular. Makes me think about a Mark Rippetoe article from several years back he helps an older woman (60? 80s?) eliminate her lower back pain with weight lifting and strength training exercises. Rippetoe isn't pefect, but he has a good-enough track record on this stuff.
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.
A mix is always the best.
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 :-)
You can see one of his coaches helping an 86 year old woman deadlift in this video: https://www.youtube.com/watch?v=ekJOT0kn5vs
source?
https://theros.org.uk/information-and-support/bone-health/ex...
That page directly contradicts you since it lists weight lifting exercises like barbell squats
It does not contradict, it lists weight lifting under muscle training, not under bone density.
"Bones stay strong if you give them work to do. The best way to keep bones strong is to do both weight-bearing impact and muscle-strengthening exercises."