With spring in full force, and the days staying sunny for longer, residents of the Okanagan Valley are getting outside and getting active.
Mountain biking, climbing, hiking, soccer, baseball—around here the possibilities are nearly endless. These activities, unfortunately, may come with some degree of risk of fracture.
While not wanting to dampen your spirits, I wish to provide some education regarding what a fracture is, what to expect with healing, and what can be done to speed you towards recovery and back to your sport and hobbies.
A fracture is a break in the bone, or of the cartilage on the surface of the bone. It occurs when the stress placed upon it is a greater force than the bone can absorb, such as in the case of a trauma, or when there is overuse creating a stress fracture.
Stress fractures, unlike those created by a one-time high force, are often the result of a too-sudden increase of intensity or overall amount of a physical activity or a change in environment (such as switching to running on a harder surface).
There are different classifications of fractures depending on certain characteristics. Some of these are the location within the bone, if it is complete or incomplete, if the fragments are displaced or aligned, if it is open (breaks the skin) or closed, among other descriptors.
It is diagnosed by x-ray and set, or ‘reduced,’ by a doctor.
In more severe cases, the bone needs to be reduced surgically, and hardware such as pins, plates, or rods, may be required.
After the fracture has been reduced, to align the ends, immobilization is needed. The injury is often immobilized in a cast, or sometimes a boot for the foot and ankle, for approximately four to six weeks. Sometimes this duration can be longer, depending on healing.
Healing time varies with different people, and different situations. Age, fracture location, type of injury and any presence of complications are some of the factors that affect how long it takes for the break to heal. It can range from a couple weeks in young, healthy children, to months in older adults.
With most cases, the soft tissue (such as muscles, tendons, ligaments) is also damaged to some extent.
While immobilization is necessary for proper healing of the bone, it does come with some downsides. Scar tissue formation can occur in the injured soft tissue, muscle atrophy results from disuse, and contractures may develop.
Typically after coming out of a cast there is:
• Swelling
• Reduced range of motion of the joints
• Decreased flexibility of muscles
• Muscle weakness, decreased endurance, and decreased bulk
• Pain.
When your doctor has indicated that there has been sufficient healing, as seen on a follow-up x-ray and removal of the cast, it is important to move and use the body part to help further the healing and to help with the symptoms listed above.
Stretch the muscles, move the joint, and use the body part for functional tasks as pain allows.
If unsure whether you are ready to start, ask your health care provider. Seeking therapy or specific therapeutic exercises can help speed up the process of getting stronger and more mobile.
Therapy may include any combination of the following, depending on your injury:
• Joint mobilizations
• Soft tissue mobilizations
• Manual stretching techniques
• Home exercises
• Modalities—machines such as ultrasound, low level laser, paraffin wax bath, or current for example.
As with any injury, prevention is preferable over reaction.
Some of the risk factors to breaking a bone include low bone mineral density (such as with osteopenia, osteoporosis), weakness of surrounding muscles, overtraining, poor balance or mobility contributing to falls risk.
If concerned about these risk factors, speak to your health care provider regarding exercises and activities to improve balance, muscle strength, and maintain or improve bone strength, or about your diet and nutrition.