What Do Soft Tissue Damage and Male Orthopedic Surgeons Have in Common?

In the reading the Huffington Post article entitled Orthopedic Surgery: Women on the Rise in a Male-Dominated Field, I was struck by the fact that only 4.3 percent of board-certified orthopedic surgeons are female.  As the author points out, the reasons for such gender disparity are that a certain "amount of physical force is required to maneuver fractured or dislocated bones and joints back into place".  She goes on to say that is changing due an increased use in robots and other medical devices. 

That is is not, however, what caught my eye.  It is the simple fact that physical force is being used to move something around inside the body.  Or that such strain is require to reset our bones, joints, and ligaments.  The thought of it simply makes me cringe.  But it makes sense, given what aches and pains I have felt following my hip fracture surgery.  I now know they did a heck of a lot more than just reatttach two pieces of bone with three screws.

Coincidentally, my reading of this article quickly was shortly after my reading of a similar story to  mine when another gentleman had a hip fracture caused by a bike accident.  In this story he tells of his long struggle to heal and all the different types of treatment he has required to stop the pain and make himself healthy.  In one poignant part of the story, he states, that amount amount of soft tissue damage, or creation of scar tissue - caused by fixing a hip fracture or going through knee replacement surgery - simply cannot be understated.  In other words, our muscles, tendons, fascia, and nerves all take a beating when they are in there fixing our broken bones.

So what can we do about it?  What does all this mean for our recovery?  Short of not having the surgery, it means that we need to include soft tissue repair as part of our recovery plan. 

Soft tissue repair comes in many forms and I suggest you use them all to one degree or another. The most obvious is the use of Advil or any other anti-inflammatory.  But anti-inflammatories should be used on a limited basis due their side effects. 

Thus several other safer choices should be considered:

• Heat and Ice.  To promote blood flow to the area.
• Massage.  Ideally this would be with a proper massage therapist with experience in treating your specific injury.  But massage therapists are not cheap.  A less expensive, do-it-yourself approach would be to purchase a foam roll.  These can be be used on all parts of the body to apply pressure and relief the damaged area. 
• Proper Vitamin Intake.  Vitamins E, K, and C promote collagen that helps heal damaged tissue.

What ever you choose, or what ever works for you, don't forget that not matter how successful the surgery that the muscles and its surround components need treatment beyond just gaining strength.  They need to heal because in all types of surgeries sustain this collateral damage and failing to treat it will simply also pain and discomfort to linger.

I Overate (and I Can't Get Up)

For the first 3 weeks after my hip fracture surgery, I couldn't eat enough.  I felt like I was 15 again.  I would wake up so famished that I thought I was going to pass out.  I was eating and eating, and losing weight.

Then it stopped.  I remember the day like it was yesterday.  A friend brought me lunch, and she knew I was eating like a horse - so she brought me 2 Jimmy John's subs.  I was so happy to have pre lunch and post lunch.  So I scarfed down the first one.  And I expected to feel how I had been feeling: mostly satisfied but knowing I would have to eat again soon.  But instead I felt stuffed - stuffed beyond belief.  I felt like Thanksgiving dinner times five. 

So there I was, on crutches, unable to move, in pain, and stuffed to the gills.  Not a great feeling.  At the time, to deal with it, I went to the garage and did a ton of dips and pull ups.  Now while it probably helped, here is what he experts say one should do when after overeating.  These techniques can also help after eating junk food.

1. Drink a ton of water. Water helps promote digestion and flushes out your system
2. Drink tea.  It also helps with digestion and the caffeine will help you feel full so you don't eat too soon afterwards
3. Get plenty of sleep.  Loss of sleep acts as a stressor to the body and many compensate by eating.  Also a lack sleep depletes your body from the energy it needs to quickly digest.

Many experts also recommend going for a walk but I was out of luck given my situation.  Some also recommend fasting for a period afterwards.  In theory, not a bad idea but fasting can be a bit tricky when recovering from a major injury or when pregnant, for example.  Others also recommend taking a probiotic pill (or eating yogurt several hours later) to promote digestion. 

In the end, it was that last Jimmy John's sub that really signaled to me that I had to make some changes to my diet if I wasn't going to gain a ton of weight while recovering.  In fact, because I made diet changes, the opposite has occurred.  I have lost 20 pounds and am as lean as I was when I was 15.  But the body still won't let me eat like I am...  I guess age is more important than weight...when it comes to consumption.

Thanks for reading...

Contrast Your Bath...or Shower

In continuing with the minor relief theme, I wanted to bring up a simple technique that can help relax the body, ease pain, and promote healing.  It is called a contrast shower.  In technical terms, it is called contrast hydrotherapy.  The concept is pretty simple: alternating between hot and cold water while you are showering to stimulate your body to heat itself up and cool itself down, in order to bring recovery.  Blood rushes away from the extremities to protect the heart and then rushes back.  It is similar to the concept of contrasting a sprained angle with a heating pad and ice pack.

Here is how I do it:

1. Get the water nice and hot
2. Get in the shower and warm up
3. Apply the soap and turn water to cold
4. Rinse off with the cold water and then turn back to hot
5. Put shampoo in hair and turn the water to cold
6. Rinse off with the cold water and then turn back to hot
7. Put conditioner in hair and turn the water to cold
8. Rinse off with the cold water and then turn back to hot
9. Shave in the hot water and then turn back to cold
10. One final rinse in the cold and then get out

When I get out out I feel relaxed and energetic.  For that reason, I like to use this technique when I am tired because I was up with one of the kids or sleeping in a hotel when on the road for business.  To focus on the energetic and get going with your day, end with the cold.  To focus on being relaxed and end your day or take a nap, end with the hot.

Like the Yamuna Foot Wakers, a contrast shower is something simple we can do everyday to promote healing and help our bodies recover.  Here are a few more resources to learn more:

http://www.vsnaturopathy.com/Shower.html

http://articles.elitefts.com/training-articles/rehabilitation/power-shower/

For an even more extreme method, try an ice bath.  It's a little too much work and too extreme for me but some might like it.  I know the guys in the NFL do...

Thanks for reading...

Wake Up Those Feet

Here is a simple little item you can buy that helps with recovery.  They are called Yamuna Foot Wakers.  These two little half rubber balls are a nice, simple way to massage your feet and relieve foot pain.  They also claim to help with gait and posture.  I can't say much for the gait and posture but they certainly haven't hurt my efforts to improve in that area.

Mostly I posted this product because they are relaxing.  When we are in recovery, our bodies are in constant state of stress.  We have scar tissue and we aren't moving correctly and then we worry about how we have scar tissue and aren't moving correctly.  It is a vicious cycle.  And finding ways to stop that cycle while in recovery is key.

Products like the Foot Wakers provide some respite while standing or hanging around.  You simply stand on them and move your feet backwards and side to side.  It is isn't a 90 minute massage but its something daily we can do to treat ourselves better.

Give them a try!

Thanks for reading...

The Cost of Recovery

I have been thinking a lot lately of writing post around all the aspects of recovery and how we individually have to manage our own recovery.  It was going to be about acting as our own project manager and not relying on the doctor, surgeon, or physical therapist to drive our our recovery.  And I think I will write it in the next few few days.  But I wanted to precede it with the cost of the recovery.

We all have the some of the same costs: insurance, co pays, out of pocket expenses.  And these expenses hurt - I know they hurt.  For most people that is where it ends.  I have seen it many times before. And because of the cost of health care, I totally understand why.

But we must be willing to continue spend to take our recovery to 100% and  keep ourselves healthy and age gracefully.  Surgery and traditional physical therapy (and insurance) will only get you so far.  You must be willing to dig deeper (into your pocket book) to save yourself from a life of pain

Personally I have spent several thousands of dollars on Pilates, Feldenkrais, massage, and chiropractors, and books of all kinds, among others.  To me these are worthwhile expenses - and they are worthwhile expenses now.  The reason I believe so is that the way we recover and rebuild our bodies 2 years after the injury will pay dividends on how how bodies feel 10 years from now.  It is just sound logic.  Father time is ticking and older age has a way of resurfacing injuries that weren't completely dealt with when we were younger.

Now I am fortunate that I can afford some money out of pocket to pay for my recovery.  And I have often paid for private lessons.  But you can do it on the cheap.  Take books out of the library.  Take a Pilate's class at the local community center or YMCA.  Go to a massage school and act as one of the test clients.  Spend what you have but invest in your body today so you can reap the rewards tomorrow.

All in all, it is that you have to spend some money beyond the co pays and out of pocket expenses to get yourself healed.  And you will need to do more self care to stay at 100%, whatever that is for you.  For me I am not there yet but I am only 8 months into my recovery.  That means I am going to invest heavily in myself over the next 12-16 months.  I'll keep you posted on the payoff.

Thanks for reading...

The Turkish Get Up (And Down)

If I had to pick one single exercise that I think has made the biggest impact (aside from Pilates) on my recovery, I would have to say it is the Kettlebell Turkish Get-Up (TGU).  There are hundreds of articles out there on the value of the get up so I wont regurgitate that here.  But it is the only exercise I know of that can build strength, coordination, and function all while serving as a way to identify your weakness, or leaks, as some trainers like to call them. 

It sum, the exercise is basically performed by you lying on the ground with a bell in one hand and the getting up while continuing to hold the bell overhead.  And then going all the way back down.  While it sounds simple, for most people it is difficult until either a) they really get the technique or b) they fix the leaks in their body.

See the below video by Steve Cotter, RKC:

The TGU has been hailed as a way to cure everything from shoulder problems to golfers elbow.  It is so useful that Geoff Neupert and Gray Cook each have programs where pieces and parts of the exercise are performed everyday.  Neupert's program can be found as part of his Kettlebell Express program.  It was the first strength based program I used after I was cleared to walk.  I used it conjunction with physcal therapy, massage, and pilates.  While I am not fully recovered, I believe it was this program that really gave my recovery a "kick start".  I continue to do it combined with a number of other kettlebell and bodyweight exercises.  Check out Gray Cook's Kettlbells From the Ground Up DVD for a similar program.  I don't have any direct experience with it but Gray Cook is a very well respected Physical Therapist and author, having written Movement and Athletic Body in Balance.

In the end, the TGU is one of the best exercises you can do because it both makes you stronger and shows you where you are weak. 

And all us bruised and battered are certainly weak in one way or another.

Thanks for reading...

Knees Up

I found an interesting exercise while searching some new ways to enhance my therapy using kettlebells.  It is  called kettlebell high knees.  It is not the high knees calisthenics exercise we often see in gym classes or boot camps.  In this case, it is performed by hooking your foot through the handle of a kettlebell and then lifting your knee upward.  See picture below:

One the reasons this exercise appealed to me - aside from its use of kettlebells - was the fact that it targets the gluteus medius muscle.  This muscle is often weakened in hip injuries and replacements.  Its weakness is also responsible for poor walking mechanics and a "hip hike" on the non weakened side - something I have suffered from since my accident.  It also has value to those recovering from knee injuries by assisting with the Tensor Fascia Latae muscle.

For more information, see the Physical Therapy Web Space site here.

Thanks for reading...