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?
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.
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.
That is awesome! Thanks for sharing. Reminds me of a similar story from a friend. He, too, broke his leg and healed it quickly enough to surprise his orthopedist by riding a stationary bike. He said that initially the broken one was kinda just all by for the ride, but he thinks the circulation helped.
He too was an elite athlete (baseball).
Another friend was a bodybuilder. He said that bodybuilders do so many experiments that they sometimes know better than their own physicians. They are biohackers.
"Power users" of a product sometimes end up schooling the customer support team.
Another thing – the surgeon told me I'll need a hip replacement in 10 years' time. This was 16 years ago and I don't feel I need a new hip although it's not perfect the way it works sometimes but nothing even remotely serious.
The cost of this increased healing rate would be the tail risk of compounding injury though. It's not something a doctor could recommend even if it were true for everyone consistently.
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!!
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.
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.
Anecdata but I agree. Had two spine surgeries at two highly regarded places and those surgeons had no clue whatsoever on the recovery. They've fixed their part and the rehab part is someone else's problem.
Luckily I have a good therapist. But still I'm disappointed as they should know that part better.
Anti-anecdotal: Old family member cracked a femur neck. Tried to stand on it after a few weeks despite warnings, broke it, had to go to surgery, plates and screws. A few more weeks of resting and she would have been fine.
idk most doctors would not say don't use your limbs for 8 weeks, that would lead to atrophy. but a lot of doctors give generic advice to avoid lawsuits.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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)
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.
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.
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.
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!
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.
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-...
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.
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 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!)
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.
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.
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.
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.
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.
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 did this after breaking my ankle. I was carefully walking the next day, hiking within a week, and skateboarding within 2-3 weeks. Fully healed after a month or two. Everyone thought I was insane but I'm very glad I did it.
I thought, why should we try to intervene with millions of years of evolution? Inflammation has to be there for a reason. Nitpick that statement all you want but in this specific case I'm glad I didn't mitigate the inflammation.
I was unaware of the acronym HELM and told everyone I was doing the exact opposite of RICE on purpose.
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.
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.
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.
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.
... 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.
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.
This sort of thing starts at a WAY younger age than people imagine too. I'm 30 and used to not be able to stand up from sitting on the ground without grunting and effort.
Got a dog. Sit on the floor to play with him all the time. Can now stand up from sitting on the ground without effort or grunting or using my arms to push myself up.
Absolutely. One grandmother worked as a farmer. The other worked as an book keeper. The book keeper who believed "exercise is for other people" is frail and extremely week. The farmer is also weak but is far more independent and is seldom sick.
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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 went back on the mats a week later. Started with only doing warmups and movement drills, worked up to gentle flow rolling (with my arm tied into my belt) at a month, then drilling techniques with well-chosen partners and conservatively rolling with those same partners at two months.
This was, of course, on top of rigorously following my PT schedule. And being very conservative with the situations I’d put myself in.
By three months I had regained full flexibility in the arm, and by six months I was back to full-contact training five days a week.
I definitely think there’s a fine line to walk here. I explicitly didn’t do judo for six months because that involves direct and unavoidable impact. And I also made sure to choose training partners who would be very cognizant of my arm and limited range of motion and who wouldn’t just grab a submission and crank it. I also would preemptively tap any time that arm got isolated or in a position where it could be attacked. But there was definitely risk that a training partner would make a mistake or I would land on it badly and tear something.
Still, I would do it all over the same way. I definitely think pushing things helped it heal dramatically more quickly and completely than otherwise. But you do have to be careful with the level of risk you’re exposing yourself to.
For me it took about 4 months to feel pretty comfortable with the shoulder(s) and about 6-12 months for skateboarding, weight lifting, etc
What was your surgery if you don't mind me asking?
Honest question, how did you know to disregard the doctor 's instructions and start home exercises on the bone at 4 weeks? How did you limit yourself during your riding and other resistance work? How long was the recovery period after every session?
My background (Russian). Don't trust western approach to solve problems with pills etc. End up talking to (usually) Soviet-trained doctors who can't practice here in the west. The advice makes sense so I follow it believing they know what they're talking about. It's always about the cause, not the symptom. This sort of thing.
> How did you limit yourself during your riding and other resistance work
By feel. Biking is a second nature to me. Femur neck wasn't the only bone I broke. More plates too.
> How long was the recovery period after every session?
First few, felt a bit fucked but I think it was both being out of shape and one leg's muscles sleeping for 4 weeks. So the usual, sit for 5-10 min, back on the crutches, off to the shower and the life goes on.
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.
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.
Also surgery has outcomes that are barely better than non surgical interventions, sometimes, and they still recommend surgery.
If I were to breathe too deeply during the first few weeks, there was a good chance that I'd re-fracture them; sneezing is known to do this. And for what it's worth, despite what you might see on the TV, broken ribs are no joke.
Recovery time is, apparently anything between 6 and 12 weeks. The first 3 weeks were the absolute worst. I'm finally at the 'it feels like a bruise' stage. As a sporty person I know that if I 'feel fine', I need to add at least 2 weeks on that before I actually start any sports again.
I had to use the maximum dosage of codeine for two months, school was fun...
I don't even want to imagine the pain with 3 fractured ribs.
Week 2 was worst I would say. I was sneezing a lot for some reason.
The weird thing though, it was fully healed (it felt like) week 4, but then suddenly several weeks later the same exact pain came back, without me having done anything similar to the first fall from a MTB. It did go away again though, so its all good now!!
Some years after my fuck up, Chris Froome, multiple Tour winner, crashed badly. Much worse than me, broke a lot of bones.
One of them was the femur neck. This one (and maybe in combination with other broken bones) took him a long time to recover from. By the time he did, he was finished as the Chris Froome, no more wins.
Not saying he did anything wrong, the fuck do I know, but I wondered for a while if he tried, how shall I say it, a more head on approach to the fractured bones recovery and if that made any difference.
Good physios will insist on working as soon as possible, even if it's very light work.
Luckily I have a good therapist. But still I'm disappointed as they should know that part better.
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.
Probably relevant too – systematic endurance training since 12, elite-level racing since 18 (world champion at that point). So not a stranger to all kinds of injury and what works and what doesn't. For me that is.
It was hotly debated at the hospital, if my specific case should be operated on or not. Each time I had a checkup, one doctor would say "wait and see" while the other was saying "I can't believe we didn't operate on this".
At any rate, the outcome was as good as if they had operated on it, according to the doc anyway. Nice of them to test it out on me!
More related to this though, I have broken both my collarbones, the first time I had little direction and just held my arm still for 2-3 months. It took forever to heal, and my arm atrophied significantly. The second time, similar severity. I was guided through rehab and I was back using my arm within the first month, very little atrophy.
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.
https://www.nature.com/articles/s41598-021-83148-6
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.
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.
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.
The only time I really notice it is if someone pushes on it or if I'm doing front squats with a bar.
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.
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)
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.
Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
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.
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?
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I asked if it was possible to do a surgery now, so they'd have to break and restore a longer collar bone, more straight, but surgeons don't seem positive for this
In some cases (my messed up jaw and a whole 9 wisdom teeth), I broke this rule. But generally, it has served me well.
The surgery had a risk of serious, life-long consequence if it went wrong. He said that if I can live with the tendon issue, we can delay surgery indefinitely... so we delayed.
A month later, I stopped doing a certain workout at the gym, which resolved the issue within days. No need for surgery at all.
I do think that some specialists can be so focused on their speciality (i.e. surgery) that they don't think outside of that paradigm (try a different workout at the gym), and it's up to the patient to effectively shop around to get the best advice.
Am I right to understand that had I not gotten the surgery my shoulder would’ve likely returned to the normal position?
Dead Comment
Now we have all kinds of powerful, fancy machines and drugs and procedures and today's doctors still misdiagnose, mistreat even relatively simple issues.
I don't know if it is because we as humans have lost touch with nature, our own bodies or we have way more illnesses today than I was a kid 4 decades ago or what else is the reason. It is kinda depressing and mind boggling at the same time.
I fell off a ramp whilst pushing a wheelbarrow full of rubble into a skip (should've stuck to building code instead of building a house!).
Normally that type of injury is associated with car crashes when someone instinctively puts all their force on the brake and the shock of the crash travels up the pedal into the ankle.
It was a really scary time for me as the doctors were trying to manage expectations and plan how to fix my ankle. There was a possibility of my foot being fused to my leg permanently at 90 degrees angle.
Fortunately I had an awesome team of orthopaedic surgeons who managed to do ORIF surgery with about £70,000 worth of titanium inside my leg.
6 weeks later I was out of my plaster cast and into a "moon boot" with my physio starting and doctor telling me to put weight on it already as the titanium was holding it together effectively. Always pushing me to break the mental barrier of protecting my broken leg.
Long story short, physio, putting weight on my toes meant my ankle is about 95% back to how it was, just a small limitation in dorsiflexion and plantarflexion.
Can run, cycle, Jiu-jitsu etc.
NHS emergency care - great!
NHS physio care - poor, had to go private.
Here's a photo of the damage - https://photos.app.goo.gl/z8J8RfhnZ2jnVHFYA
I was out of my plaster after week 2 so that I could start moving the ankle, and started physical therapy on week 5. I'm currently on week 7 and have already started _walking_ with the "moon boot".
I can stand on the brokenish ankle with 90% of my weight on it. It's kind of scary to be doing all this to the ankle when the bone is still not fully fixed, but it improves the recovery time and final outcome. I will probably be out of the boot on week 10-12. I'm 10 degrees away from full dorsiflexion range, and apparently it will still take some time and effort to get to the full range, if at all.
Treatment for these kind of injuries have definitely come a long way, this is a massively different experience from breaking my ankle 20 years ago playing football in the US and being on a cast forever, plus dealing with ankle pain for a year after the injury as I didn't get any physical therapy
EDIT: some of the parts for the curious
- https://www.arthrex.com/foot-ankle/titanium-ankle-fracture-s...
- https://www.arthrex.com/products/AR-9943H-03?objectID=human....
I also didn't do much physio, but that was mostly due to me being a 23 year old moron (which, believe it or not, also had a lot to do with me breaking my ankle in the first place!)
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.
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.
20 years on, and it's still hanging in there.
Mine is also smaller, due to patella tendinopathy.
Internally degloved my calf, broke my fibula, and took a chunk out of my tibia - and being me, decided to ice it, strap it, look out for compartmentalisation and rhabdomyolysis, and hobble around on it until it was better. Took about two months before I could walk normally.
I only know what I did to it because I dislocated my knee last year skiing, and they were thoroughly confused as to what they were looking at - had to explain that I mashed my leg and couldn’t be bothered wasting my time sitting in A&E for a few days.
Either way, it healed just fine with zero intervention. My calf is a slightly funny shape from the fascia still being bunched up around my ankle, but it doesn’t seem to do any harm, and the break to the fibula healed almost perfectly - slightly offset but works just fine.
A couple days later I got to see an actual bone doctor and he got the x-ray and immediately pointed to the fracture.
What surprised me was that he said not to use the sling, because it would lose my range of motion.
"Keep moving your arm, use the entire range of motion, and let pain be your guide."
Literally, it's just electrical impulses travelling through your body.
I picked a day when my plantar fascia was not too painful and did the first training from c25k plan (roughly 8 minutes of jogging if I remember correctly).
It actually helped me. Don’t try it at home, I think I got lucky because my PF was really not a PF anymore. But I would never found out if I did not run that day. I’ve been running daily ever since, no issues whatsoever.
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.
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.
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.
(This is basically a simplified version of the protocol NFL teams have been using.)
I thought, why should we try to intervene with millions of years of evolution? Inflammation has to be there for a reason. Nitpick that statement all you want but in this specific case I'm glad I didn't mitigate the inflammation.
I was unaware of the acronym HELM and told everyone I was doing the exact opposite of RICE on purpose.
Makes sense to me, though :D
What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.
Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.
I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
Uncomfortable but not painful, just like pretty much everything else physiology-related in life.
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.
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/
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...
Don't get me wrong, the latter group still hurt. Getting old sucks. But their bodies work.
I have no idea how to find the right balance.
The perception of things like weightlifting being dangerous or bad for your back though are almost entirely a myth. It is possible to screw it up, but from what I've read it's very rare for people just lifting things to hurt themselves.
Got a dog. Sit on the floor to play with him all the time. Can now stand up from sitting on the ground without effort or grunting or using my arms to push myself up.
Professional athletes are usually miserable later in life due to doing exactly that.
I am the type of person to become offended at the suggestion.
I parked at the back of the lot and took the longest walk I could instead.
That has paid off.