One and Done is Not Enough
Top skier breaks her leg. Doctor fixes it, gives her narcotics, and sends her home. She’s told to come back in two weeks for a checkup and have the rod taken out in a year. Doctor moves on to the next patient. What is wrong with this picture? 
It is not the narcotics. Yes, those drugs stink—but unfortunately, they are the best we have for pain medication in 2018. What is wrong is the absence of all the other information the athlete deserves to hear.
This situation happened recently at the World Pro Ski Tour. A skier launched over a jump in the qualifying races, landed badly, and broke her tibia. She received excellent surgical care from the orthopaedic surgeon at the local hospital, where a rod was placed into her tibia. She returned to the ski hill the next day to watch the race finals. She and her parents were taking in the shock of her injury and its impact on her ski racing career. They had no information and no guidance.
Here is what she should have been told: Bad luck that you broke your tibia. All athletes get injuries. The best use their injury as an excuse to come back to their sport fitter, faster, and stronger than they were before they were injured. Here are some suggestions to help you heal: Ice and elevation when not working out. Reducing the swelling speeds the healing. Ice is also a good pain reliever. Devices like Game Ready and Squid provide both cooling and compression and help the most. Recent work shows that cycling small amounts of heat with cooling may work even better.
Hard sweat workouts start the day after surgery. With a tibia fracture, you can rest your broken leg on a chair while spinning a stationary bike. Elevating your heart rate improves circulation to the fracture, blows off the drugs from surgery, raises testosterone, pheromones, and adrenaline––and makes all athletes feel better.
Work with a strength coach. Focus on core, trunk, and upper body weight lifting while protecting the injured leg. Single leg balance board, proprioception, and hip strengthening elastic band exercises must start immediately, as those skill sets are lost quickly if not trained. Remember: The goal is to get better than you were before your accident. You have never had as much time to spend on these parts of your skill set as you have now, so take the opportunity to perfect them. Engage a great manual soft tissue physical therapist expert who can help reduce the scarring, loss of joint range of motion, and stiffness that occur after any bone fracture. You simply cannot manipulate your soft tissues as effectively as an excellent soft tissue therapist. And soft tissue manipulation works two ways: It directly mobilizes the collagen fibers that make up your tissues—and it stimulates the mechanoreceptors on the cells in the tissues. This helps them lay down new collagen repair tissue along the natural lines of stress, instead of forming disorganized scar tissue. Talk to your nutritionist. Increasing protein during healing and optimizing your caloric intake—balanced against your training program—are part of healing and preparation for your return. There is clear data that people with low protein levels (albumin) in their blood have higher rates of infection after surgery. Talk to your orthopaedic surgeon about the stability of your fracture and determine how soon you can bear weight. Often, immediate weight bearing can help healing if done in a careful fashion. Other forms of bone stimulation, such as ultrasound and magnetic pulsed therapy, can also stimulate more rapid bone healing.
World-class athletes are different from other people. They have the ability and the desire to train hard and to endure pain to reach a physical goal. Engaging that drive determines both their future healing and athletic success. Ignoring it leads to depression—and worse.
The mind game of injury recovery is different for each person, though the goal is often the same. Finding the path that works for each athlete is part of the fun and satisfaction of being a sports orthopaedic surgeon. Few thrills are greater than seeing your handiwork lead to a gold medal—but that takes an understanding of the patient and an ability to engage at a very personal level.
(Kevin R Stone MD contributes his time as the orthopaedic surgeon for the World Pro Ski Tour.)
