Broken Legs and Ankles Heal Better If You Walk on Them Within Weeks

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.

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 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 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."

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.

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.

from https://www.outsideonline.com/health/training-performance/fo...

    ... 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.”

My main take away from this thread is to never take up mountain biking.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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!

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.

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.

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...