fracture healing part 2: rehab and ways to speed recovery

I hoped to have this Part 2 out a little sooner, but I've been working away this week and totally able to do so, yay! At the bottom of this post, you can check out my wrist progress report and day-to-day list of tasks that I've slowly been able to do again... wondering if my progress and ability to do the things listed occurred at an accelerated vs. normal rate compared with others who've broken their radius. Interesting stuff.

Anyway, on to rehab for a bone fx outside of nutrition/supplementation. If you're curious about the timeline for healing a fracture and potential problems in the process, this article is a good quick read.

The 23/24 Rule
I don't think this is an actual "rule" by any means, but it sounds cool. Thankfully this day in age for certain breaks/situations there is the option of a "removable cast" like the Exos brace I have. (That said, I know this isn't the case for everyone, and many breaks require a traditional cast and staying locked up in it 24/7.) But if your break is less severe and you can opt for a brace that's removable, then most doctors/PTs should recommend that as an option, athlete or not.

I was told that right away I should be removing my brace daily and accumulate up to 1 hour a day of time without the cast on, and this will set you up for faster recovery as well as ensuring it heals correctly without deformities (pretty important for the wrist joint!). The time w/o cast can be in 5-10 minute increments or whatever; doesn't have to be one-hour nonstop. During this time you can work on light mobility exercises, range of motion, etc. For my wrist, I cannot be doing pronation/supination yet (or at least not on purpose lol), but I can work on flexion and extension and some other very easy light exercises.Taking the brace off also allows for the area to air out and dry out, which is really nice. I shower without my brace. And if I workout, I need to wash the brace and leave it off for a bit to dry.

Whole-Body Cryotherapy (WBC)

Step into the chamber... bwaaa hahahaaa.

Now, to my knowledge there is no research to show that this technique has been proven to speed up fracture recovery (anyone have a study?), but if you look at what this therapy entails, it would make sense that there could be a benefit. Personally I'm not really a fan of the whole ice bath thing (we talked about it on this podcast), but cryotherapy chambers are a different story and intriguing to me not only for my fracture healing, but for athletic recovery in general from hard training, etc. It even can have benefits for people dealing with chronic pain issues like arthritis or fibromyalgia.

What is it? There's a cylinder-shaped chamber that you step into and the fun begins: The temp drops rapidly and gets as low as -300 degrees F, but it's a dry cold and nothing in there or on you can be wet, which prevents frostbite from occurring. That is key. Just to be safe, you wear dry gloves, socks, slippers and underwear -- and that is all. You stand in this chamber for 3 minutes max -- less if 3 min is too much (you don't get frostbite but it's still dang cold lol.

Just in that short time a bunch of things happen to promote faster recovery and healing. For one, you get a decrease in inflammatory cytokines and increased levels of anti-inflammatory cytokines. You also get more blood flow to the core, which replenishes vital organs with fresh blood -- similar tactics are used in yoga with certain poses, like this one from bikram, which is said to replenish and rejuvenate your thyroid.WBC also doesn't actually have the same negative effects that ice baths do -- ice baths can actually freeze and stiffen tissues, WBC doesn't. In fact, in theory you could go workout right after WBC without risk of being too tight/frozen. Plus 3 minutes of exposure is something I can handle in my busy schedule.

I could go on about the science and research, but in a nutshell the point is: WBC, in theory, is all about accelerating recovery. Does it work? I don't know. I've had four treatments in the past week. Hard to tell. But it doesn't hurt.

If you're in OC and interested: I am going to a place in Costa Mesa called Polar Cryotherapy. If you're local check it out and tell Dan you heard about it from me.

Want more info? Dan has great links on his website that I link to above. Also: This is a great article that explains more on WBC.


Pulsed Electromagnetic Field (PEMF)
That stands for Pulsed Electromagnetic Field Laser Therapy. Honestly, I do not know much about this nor have I tried it. But the all-mighty Dr. Minkoff suggested I look into it for faster healing. It was the one thing he said he believes actually works to heal faster. However, I haven't tried it yet (oops). I blame that on location of the nearest place (not that far, but far enough), cost, etc.

But PEMF seems to be a trusted therapy. What it does is apparently signal a response that causes increased ATP production, restores normal cellular function and, thus, enhances the healing of damaged tissues.

And as opposed to Cryo, there is direct evidence of PEMF healing bone fractures more quickly. But then again, research is inconclusive. I gotta look into it more. Maybe I'll suck it up and take a drive to my nearest clinic or spend my Friday night researching scholarly articles. (Or not ;))

Anyone out there have comments on PEMF? Tried it?

Mobilize/Exercise/PT
Obviously the prescription for rehab/physical therapy stuff is going to be very individual to each person and depends on what is fractured, severity, etc. But the underlying theme is to be proactive with hands-on rehab and prevent loss of ROM/atrophy as much as possible. Don't let that area waif away, don't allow your injury to turn you into a sedentary person... do what you can, as soon as you can, but be smart and don't do too much. how about that for specificity? lol. I'm getting in my share of activity with my wrist without being dumb... although when I'm at the gym with a client, it's already getting frustrating not to be able to move around the weights, pick certain things up, set up a workout station, etc... but patience and a good attitude....

Get More X-Rays
Swelling is a natural and normal response when you have a trauma like breaking a bone. For up to two weeks the swelling that occurs can actually hinder the ability to get clear X-Rays and you may not be able to see all the damage. It's important to then X-Ray again after ~2 weeks to re-assess the damage as well as look at healing progress.

I'm getting new X-Rays next week. I'm looking forward to the results. We're going to make sure there weren't any other minor fractures, and I was also advised to look and see if a hard callous is forming yet. If there is a hard callous that could indicate a green light for racing more physical exercise that I'll be able to do.

More Resources To Come...
Next week I'm going to be speaking with a bone specialist on the Endurance Planet podcast to do a show on bone fractures, healing protocols, etc.... a bunch of cool stuff from an expert who deals with these issues every day!

Anything to add?
If you have a bone-healing recovery technique, please tell us/me about it in the comments section!

Wrist Progress Report

Lots to catch up on here. If anyone else has had a similar break as mine, I'd love to hear about your progress vs. mine! Similar or not?

(For reference: Injury on Tuesday afternoon, May 13.)

Happiest trainer session ever? It's possible.

3 days later (Fri):
-could type on computer with L hand, but it was still slow but more efficient
-could extend wrist and fingers even more than day prior
-slept almost normally without being woken up by pain

4 days later (Sat): 
-was able to put hair in a loose/sloppy pony tail.
-*first workout* - rode on trainer 55min mostly easy with 10min tempo. no bad pain during/after. see photo to right. (john set up trainer for me)
-could put on socks
-could finally cut and open an avocado again!
-could cut meat (used knife with R hand however, and used L hand to stabilize fork)
-could open a jar (used R hand to twist, and L hand to hold base in place)

5 days later (Sun):
-felt like i was able to use fingers normally to type; wrist stabilized in brace of course so no pronation/supination
-rode trainer 1:10 with 5 X 3:00 intervals at Z4 watts
-first RUN. did a 4-mile t-run off bike and wrist felt fine.
-could almost floss normally
-carefully showered without the brace (had doc approval to do this)

6 days later
-could apply enough pressure with the broken wrist to put on lotion
-ran 4-5ish miles, easy.

7 days/1 week later
-turn a door knob to open a door (wrist still lock in place with brace on, but able to still use that side for the task)
-hold a regular-sized glass of water that's full
-did an outdoor strength training session with clients that included planks and side planks, which I was able to do!
-treadmill run intervals at 6:30 and faster pace (less than 15min total though)
-could use the puff in the shower with left hand and able to apply enough pressure for washing
-operating virtually like normal in the kitchen for cooking, no pain

8 days later
-could finally do some "real" cleaning around the house with brace on i.e. wash dishes, clean up/hang up clothes that had been piling up, wipe down counter tops, etc, and spend enough time actively doing all that with no bad pain at all.
-definite increase in extension/flexion of wrist and overall wrist mobility when brace off
-tried typing with no brace... possible but need to be careful. any wrong movement and it hurts bad
-comfortable taking off brace at home and moving around the house with it off, doing light movements/tasks with no brace (vs. before I'd take it off and sit quietly in one spot to avoid aggravating it or hurting it in any way because it still hurt)
-bike workout AND I set up my bike on the trainer all by myself for the first time!

9 days later
-today!
-i made breakfast without the brace on, but that was a bit risky and i really had to watch my movement to not do something dumb.
-i feel like I'm ready to try a swim with the brace (duh), but our pool is closed for a couple weeks and I don't feel like driving forever to get to another one. ocean is option, but it's quite choppy and that seems a little risky at this point. we'll see....
-wrist still visibly swollen in area above the radius, but improving.