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Broken legs and ankles heal better if you walk on them within weeks

scientificamerican.com

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Re: Broken legs and ankles heal better if you walk on them within weeks

#161

Post by Panzer04 »

cortic wrote: post #96

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#162

Post by Panzer04 »

gregwebs wrote: post #75

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.

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#163

Post by tomaskafka »

ehnto wrote: post #3

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,…

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#164

Post by Panzer04 »

bluGill wrote: post #113
taneq wrote: post #22

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 i…

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 righ…

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#165

Post by Panzer04 »

77pt77 wrote: post #27

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…

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#166

Post by Dylan16807 »

layer8 wrote: post #82
miketery wrote: post #14

Earlier quoted context omitted.

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.

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#167

Post by akudha »

ehnto wrote: post #3

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,…

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#168

Post by Scoundreller »

parineum wrote: post #59
ghaff wrote: post #24

Earlier quoted context omitted.

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.

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

Re: Broken legs and ankles heal better if you walk on them within weeks

#169

Post by Panzer04 »

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.

Re: Broken legs and ankles heal better if you walk on them within weeks

#170

Post by m463 »

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."

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