Injury recovery

I broke my ankle 3 months ago, so I thought this would be a good time to recap how things went, and what I did to get back on skates quickly and safely. I had 3 main concerns that I researched quite a bit:

  • How to heal the bone and ligaments as quickly as possible
  • How to avoid losing too much of my VO2 max
  • How to prevent or at least reduce the loss of muscle mass (atrophy)

A little bit of background first: I broke my right fibula on May 26, doing a very simple movement by myself during a roller derby practice. I stepped back to re-attack a brace with more speed, and my right fibula snapped as I was pushing off my right foot. So I was pushing laterally while on my toe-stop, which means my ankle was in an inverted, supinated, and plantar-flexed position. Apparently, this specific position puts a lot of pressure on the fibula, which is probably why it snapped so easily. I had surgery 2 days after the injury, and they put a plate and 7 screws in my fibula.

I was non-weight bearing for 6 weeks, which meant I had a lot of free time on my hands to figure out how to optimize my recovery.

 

  • How to heal the bone and ligaments as quickly as possible

The first thing I wanted to do was rent a low intensity pulsed ultrasound (LIPUS) device for a month. I’d read some studies saying that low intensity pulsed ultrasounds could speed up bone healing by 30%, which sounds pretty amazing (but other studies weren’t conclusive, so here is a review on it). Using a LIPUS device required being in a boot to have access to the skin near the injury, and my surgeon was insistent to have me in a cast, so I didn’t rent it (turns out I did get switched to a boot after 3 weeks.)

Since I didn’t rent this fancy device, I focused mainly on diet and supplements instead.

Diet to heal faster
  • green leafy vegetables
  • avocados
  • red meat
  • salmon
  • unsweetened cultured dairy
  • anything rich in antioxidants
  • eating A LOT of calories
  • no alcohol, no refined sugars, and as little coffee as possible
Supplements
  • Vitamin D + calcium
  • Natural calm in the evening (magnesium & calcium)
  • Upgraded collagen
  • Omega 3-6-9
  • Better bones builder from the Women’s Health Network, which is the most complete one of this list, but it took a very long time to receive it from the US and I only got it at week 6 (I’m still taking it right now.)

I also tried to increase blood flow to the injured area by staying as active as possible (see below for more detail on this) and by using an electromyostimulation (EMS) device everyday. I used a Compex device and put it primarily on the quads and hamstrings, but also on the calf of the injured leg as soon as I was switched to a boot.

 

  • HOW TO AVOID LOSING TOO MUCH OF MY VO2 MAX

As I’ve already talked about before, VO2 max is very important in derby, particularly for jammers. I remember one of my professors during my undergrad saying that when you get injured, you can lose up to 20% of your VO2 max in just a few weeks, which is a big dip for something so hard to gain. So I tried to go back to a decent activity level as quickly as possible after the surgery.

WEEK 1 OF IMMOBILIZATION:

I was on crutches the first week and didn’t have a knee scooter yet. So I tried to go out on my crutches every day, at first only about 600 meters, then I worked my way up to 2 kilometers, which actually took quite a while on crutches. My goal here was to feel that my heartbeat was getting elevated, even if upper body strength was my main limiting factor during these excursions.

WEEK 2 OF IMMOBILIZATION:

I got a knee scooter, and started riding that thing like there was no tomorrow.  I’d ride it for an average of 1.5 hours everyday, trying to go as fast as possible anytime the sidewalk was nice. Knee scooters can mess with your hips quite a bit, so I started getting frequent deep tissue massages, focusing primarily on the glutes.

WEEK 3 OF IMMOBILIZATION:
3 weeks post-surgery update: - I've been cleared for swimming! So the plan is to swim everyday, and hopefully save what's left of my VO2 max. - I got a new cast again, and this one will stay on until the end of the 6 weeks. It's so light, it just feels like a big sock. - I've figured out which long-term visa I'll be applying for. - 3 weeks left with a cast; already halfway there!

3 weeks post-surgery update:
– I’ve been cleared for swimming! So the plan is to swim everyday, and hopefully save what’s left of my VO2 max.
– I got a new cast again, and this one will stay on until the end of the 6 weeks. It’s so light, it just feels like a big sock.
– I’ve figured out which long-term visa I’ll be applying for.
– 3 weeks left with a cast; already halfway there!

I got a waterproof cast, which meant I could go swimming. I started swimming without the legs first, then I realized it wasn’t hurting if I used my legs, so I switched to normal swimming (only crawl or butterfly legs though, no breaststroke kick). I also started doing some intervals on an assault bike, with my right foot on the static foot holder on the front of the bike.

Since everything started to feel better at that point and I was getting pretty antsy, I also started lifting weights again. Here are some examples of the workouts I would do at the gym (in lower/upper body supersets):

IMG_2386 IMG_2387

WEEK 4 & 5 OF IMMOBILIZATION:

Still keeping up with the weightlifting, swimming, and knee-scootering, I started getting a little more adventurous at the gym. So I started using both my legs on the assault bike and I also started using the rower. I was obviously very careful with how much pressure I put on the right leg, and I let pain guide what I could do (I’d stop anything that became painful or felt unsafe).

WEEK 6:

Freedom! No more cast and no more boot, so I started biking again after a few days, and this is what I’ve been doing since then. Running probably won’t happen for a while, so I’m embracing all the biking (and still doing some swimming, rowing, assault bike, etc.) I started skating again around week 8 post-surgery, but the intensity of my skating was so low at first that I really couldn’t count it as endurance training.

 

  • How to prevent or at least reduce the loss of muscle mass (atrophy)

During an immobilization, muscle atrophy occurs at around 0.5% per day, and functional strength capacity is lost three times more than muscle mass. So regardless of how many supplements I took, I still lost a ton of strength and muscle mass, and my right leg looked incredibly small by the end of the immobilization period.

Even if you have to accept that you’ll lose a lot of muscle, some nutrients can help you keep muscle on your body for as long as possible:

Leucine : 2-3 grams per day

Amino Acids : 10-20 grams per day

Creatine monohydrate : 10 grams per day

Hydroxy Methyl Butyric acid (HMB) : 3 grams per day

Vitamin D3 : 800 to 1000 IU per day

Fish oil : 3 grams per day

I won’t go into all the details to explain the recommended dosages, but feel free to read the studies below if you want to know more.

relevant Scientific studies:

Nutritional strategies to attenuate muscle disuse atrophy

Influence of concurrent exercise or nutrition countermeasures on thigh and calf muscle size and function during 60 days of bed rest in women.

Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest.

Fish oil supplementation suppresses resistance exercise and feeding‐induced increases in anabolic signaling without affecting myofibrillar protein synthesis in young men

Effects of creatine loading and prolonged creatine supplementation on body composition, fuel selection, sprint and endurance performance in humans

Effect of calcium β-hydroxy-β-methylbutyrate (CaHMB) with and without resistance training in men and women 65+ yrs: A randomized, double-blind pilot trial

Live strong and prosper: the importance of skeletal muscle strength for healthy ageing

Although I lost muscle very fast, regaining it has been fairly fast as well. I’ll try to write another blog post about the rehab phase, but at 3 months post-surgery, I think my quads and glutes look to be almost the same size as before I got hurt. My right calf is slower to regain all the muscle mass though, and I’m definitely still very limited by my reduced range of motion and pain from the plate and screws, which tend to rub on my skates.

What about you? Did you have an injury and came up with some strategies to heal faster? Feel free to share your experience or ask questions in the comments below.

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