Christmas-induced tramp injuries

OUCH! Tramp diving fracture monkey. PICTURE / SUPPLIED

If you were lucky like me and injured yourself over the summer holidays, you will have let yourself in on one of nature's marvels.
Not pain and misery of course, but the healing process, which needs not one iota of your will or go-ahead to go ahead. In fact, two Bells were to fall foul of physics, and neither enjoyed being part of microscopic marvels, but we did learn a few things that you might benefit from also.

The invention of, ready availability of and peril of the modern trampoline were simultaneously reasons for the insults to our bodies, and within days of obtaining the superstructure, a consumer magazine article bemoaned the lack of trampolines on the market that were up to reasonable safety standards. Oh well, they must be safe to assemble at least.

To cut a short story long, my injury occurred in the shovelling of stones into wheelbarrow, to thwart grass and weeds that threatened to make lush waist high alfalfa grasses under the tramp. Sparing my spine with textbook core stability, I overlooked my right shoulder in the super laden shovel scoop which twanged my biceps like a bluegrass guitarist playing a Bob Dylan tribute.

Youngling number four, who you may remember two years ago as "Nappy Wearing Couch Jumper Breaks Left Arm", graduated to "Undies Wearing Tramp Egress Diver Breaks Same Arm Landing on Stones Responsible For Paternal Injury and Weed Control".
It happened on day three of the Trampoline Era and so we come to my theme — tissue repair, to immobilise or not to immobilise. Supplementary questions may arise on the subject of the installation of dense jelly around the perimeter of trampolines, but I suspect the speaker of the house will rule them out.
Should you immobilise every tissue injury? It seems that there is more than one type of tissue, which is the reason we can do so many things with our bodies, and some should be immobilised, and the rest shouldn't.

Number four most likely broke his radius or humerus again, not so much because the X-ray showed it, but that clinically in the absence of clean cut breaks, he had all the signs and so they bunged his arm in a back slab to totally arrest the bones from moving. You see, delicate is the healing of bone, and as they set back together, if they set ajar, or outside of their prior alignment, you will get permanent change and what we in the game call, very sensitively, deformity. He took it well and happily wore a green cast for four and a bit weeks. Bursting out of the cocoon two weeks ago was a slightly stiff elbow, but that's a happy temporary problem that will right itself for him within a couple of weeks, but for some it may need a bit of extra help from someone like me.

A fellow physio with a standard wrist fracture a few years back refused a plaster cast and experimented on himself using a wrist brace and allowing a bit more movement. In his N=1 study he gained back nearly all of his function if I recall rightly, estimating high 90s per cent function, but it will take a lot more than a study of one to change practice in this area. By and large it is best to immobilise bone where possible. Obvious exceptions are ribs, skull and eye sockets.

Soft tissues are very different.
In an albeit older study, some white rabbits willingly offered up their knee medial ligaments to be injured, immobilised and then probably looked at under a microscope afterwards. Ethics and vivisection worries aside, and in no way do I support the harvesting of injured rabbit ligaments, they found that immobilised ligament weakens by 50 per cent over nine weeks. This is why a good physio will beg, plead and instruct an ankle/knee sprain patient to as quickly as possible, ditch the crutches and start loading the healing tissue. This is true for tendon strains, and joint capsule lesions too — controlled early movement, but with common sense ready to step in if reaggravation looks likely. In my biceps case, I knew that slinging my arm was tempting, but the tendon needed to be gliding and sliding, taking force and then adapting, as long as I didn't do a bunch of sneaky chin ups, press ups or lawn mower starts. The other problem with immobilising my arm, or any ligament injury, is contracture — the painful tightening and loss of range of movement in a joint. Yes this happens in the Number Four Tramp Diver case, but the soft tissues were mostly unharmed so they rebounded quickly. In the soft tissue injury, immobilisation causes increases in cross links of collagen, our wonderful tissue building block, resulting in a thicker stiffer tissue. Not what we need.

One soft tissue case bucks the trend — ruptured achilles tendon. A Kiwi surgeon, Bruce Twaddle revolutionised the repair and recovery of tendon using gradually changing positions of immobilisation, with wedges removed sequentially in a moon boot over three months or so.
In this way the tendon ends are pulled together then gradually allowed to lengthen, protecting the repair but slowly stressing it as well, so the paradox of immobilisation and movement is created.

So if you think you need to lock a ligament sprain away for many weeks, it's most likely you don't and a physio will help you negotiate the way back to healthy movement and loading. Bones most definitely do need lockdown apart from some rare cases, and in the case of Number Four Tramp Diver, he is now happy bouncing again, and a massive cling wrap plastic, dad-made wall has appeared to prevent launching through the zipper into the great wide open.

Now who was it that wrote about the risks of Christmas recently? I neglected to include number 6 risk: Tramp Induced Trauma.

Greg Bell is a physiotherapist practising at Bell Physiotherapy. www.bellphysio.co.nz