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trackie
stress fx-- bone stimulator/boot? 3/19/2007 5:09PM Reply | Return to Index | Report Post
I have a tibia stress fracture and just got a boot, crutches and the bone stimulator. Has anyone had success with the bone stimulator and how exactly does the medical boot help the healing process?

any other general advice would be great. thanks a lot
al-CIA-duh
RE: stress fx-- bone stimulator/boot? 3/19/2007 5:13PM - in reply to trackie Reply | Return to Index | Report Post
lemme get this straight, you have a bone stimulator?


whats it do?
trackie
RE: stress fx-- bone stimulator/boot? 3/19/2007 5:17PM - in reply to trackie Reply | Return to Index | Report Post
it is supposed to send a low electic pulse to your bone to help it heal quicker. does anyone know if wearing over the boot is good too?
jaded243
RE: stress fx-- bone stimulator/boot? 3/19/2007 5:45PM - in reply to trackie Reply | Return to Index | Report Post
I got put in a boot about a month ago and not only did it not help the injury - it caused another one. STAY AWAY from boots!!!!!!!!!
may
RE: stress fx-- bone stimulator/boot? 3/19/2007 5:45PM - in reply to trackie Reply | Return to Index | Report Post
>
may
RE: stress fx-- bone stimulator/boot? 3/19/2007 5:59PM - in reply to jaded243 Reply | Return to Index | Report Post

jaded243 wrote:

I got put in a boot about a month ago and not only did it not help the injury - it caused another one. STAY AWAY from boots!!!!!!!!!


how is that even possible?
may
RE: stress fx-- bone stimulator/boot? 3/20/2007 6:13PM - in reply to may Reply | Return to Index | Report Post
bump
jaguar1
RE: stress fx-- bone stimulator/boot? 3/20/2007 8:04PM - in reply to trackie Reply | Return to Index | Report Post

trackie wrote:

I have a tibia stress fracture and just got a boot, crutches and the bone stimulator. Has anyone had success with the bone stimulator and how exactly does the medical boot help the healing process?

any other general advice would be great. thanks a lot


Don't use the crutches-- you need some weight bearing to not only 'maintain' bone/muscle mass but also to aid the healing process (~increased blood flow, muscle and bone strain sitmulates bone formation). Some sort of immobilization (cast/boot/wrap) is more critical for a 'displaced' fracture for ensuring proper/uniform healing of the bone but isn't necessary for a stress fracture. Even if you wore the boot, you would only want to wear it temporarily (not beyond the first 2-3 weeks) and wear it as little as possible (~only during weight bearing). The bone stimulator will absolutely help the healing process, so use it religiously as instructed. I'm guessing it's the Exogen stimulator, which in research studies increases the healing rate by at least 30%. Don't take any steroidal or non-steroidal anti-inflammatories (~ibuprofen)-- they slow tissue healing by inhibiting prostaglandin (~responsible for pain/inflammation). As much as we dread being in pain and having inflammation, it's actually 'good' for the body and shouldn't be inhibited.

On an aside, make sure you're doing the little things too, like sleep (lots of it), diet (protein!, calcium/Vit. D, and LOTS of fruit/vegetables for potassium citrate), and not stressing excessively. Any sort of cross training is helpful too, as tolerated/available (~aqua jogging, elliptical later). How 'well' and how 'quickly' our body heals itself is often dictated by our current state of health, which is all-encompassing of everything we do.
may
RE: stress fx-- bone stimulator/boot? 3/20/2007 8:21PM - in reply to jaguar1 Reply | Return to Index | Report Post
its an EBI stimulator that I wear 10hrs a day. the not using crutches thing is a surprise however
sipho
RE: stress fx-- bone stimulator/boot? 3/20/2007 9:09PM - in reply to may Reply | Return to Index | Report Post
bump
wejo
co-founder
RE: stress fx-- bone stimulator/boot? 3/20/2007 9:59PM - in reply to jaguar1 Reply | Return to Index | Report Post
Jag,
Would you give the same advice for a navicular stress fracture? Are you a doctor? I've had mine for 18 months and they are notorious to begin with for not healing.

I was told boot for at least 2 months and preferrably crutches. I was going to start the crutches up when I got back from Kenya.

And I should probably look into those vitamins you had.
jaguar1
RE: stress fx-- bone stimulator/boot? 3/21/2007 12:14AM - in reply to wejo Reply | Return to Index | Report Post

wejo wrote:

Jag,
Would you give the same advice for a navicular stress fracture? Are you a doctor? I've had mine for 18 months and they are notorious to begin with for not healing.

I was told boot for at least 2 months and preferrably crutches. I was going to start the crutches up when I got back from Kenya.

And I should probably look into those vitamins you had.


I'm finishing my Master's thesis on the application of vibration to enhance bone recovery following a period of disuse (~hindlimb unloading in rats). What it all comes down to in terms of recovery (or preventing bone loss) is a balance between stress and rest. We know that mechanical loading is critical to bone maintenance, and 'complete' removal of this stimulus (skeletal unloading such as with limb immobilization, bed rest, space flight) induces bone resorption and/or impaired bone formation (hence bone removal). There's been countless studies showing that exercise/vibration/ultrasound/electrical stimulation can help 'prevent' bone loss during a period of disuse/skeletal unloading AND may also enhance tissue healing/recovery. All of these methods stimulate bone formation, but a lot of it depends on the duration, magnitude, frequency, low vs. high bone mass, site-dependency, etc..

Is your navicular stress fracture a non-union/delayed union? That's an aweful long time for a bone to heal, so intervention is likely needed. I'm not completely familiar with this type of stress fracture, but I do know that bones that are difficult to heal (~hip, 5th metatarsal, pelvic, navicular, jaw) tend to have a poor blood supply and/or are under more stress (~inadequate rest for proper bone formation). From looking at a study by Khan KM et al. (1992), non-weight bearing in a cast was actually more effective for complete healing of navicular stress fractures in athletes (86%) as compared to full weight bearing with limited activity (26%). So in your case, it may make sense to unload it (boot, crutches may be overkill). Getting a bone stimulator would likely help as well by providing a 'low level' stress.
jaguar1
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:00AM - in reply to may Reply | Return to Index | Report Post

may wrote:

its an EBI stimulator that I wear 10hrs a day. the not using crutches thing is a surprise however


I'm not as familiar with this stimulator, bu from a quick Google it looks like it's an electrical muscle stimulator which is supported by research. Do you know what frequency it operates at? 10 hrs./day seems extreme. I'm curious to learn more about it. The Exogen stimulator relies on ultrasound applied at a frequency of around 1.5 MHz for only 20 min./day. Our whole body vibration platform is at a frequency of 90 Hz and an amplitude of 0.3g, which allows for more of a 'functional' recovery. I don't see any added benefit with crutches, considering you have the boot, which in itself should be temporary.
moon boot
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:42AM - in reply to trackie Reply | Return to Index | Report Post
Disclaimer: I am not a medical doctor. I had a compound tibia fracture. It was essentially not healing until I started using a bone stimulator. The stimulator seemed to rapidly increase the healing process. My doctor also had similar advice as Jaguar. Once my leg was semi-healed and in the walking boot, he told me to ween off the crutches as early as possible.
moon boot
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:43AM - in reply to trackie Reply | Return to Index | Report Post
Disclaimer: I am not a medical doctor. I had a compound tibia fracture. It was essentially not healing until I started using a bone stimulator. The stimulator seemed to rapidly increase the healing process. My doctor also had similar advice as Jaguar. Once my leg was semi-healed and in the walking boot, he told me to ween off the crutches as early as possible.
Surviving Spousal Obesity
RE: stress fx-- bone stimulator/boot? 3/21/2007 11:47AM - in reply to jaguar1 Reply | Return to Index | Report Post

We know that mechanical loading is critical to bone maintenance, and 'complete' removal of this stimulus (skeletal unloading such as with limb immobilization, bed rest, space flight) induces bone resorption and/or impaired bone formation (hence bone removal).


Pick your brain for a minute regarding my stress reaction in the lesser trochanter, confirmed by MRI 7 weeks since last run, now about 9 weeks since last run.

Trying to determine what caused it, since there is not an actual crack in the femoral neck or linear zone indicating shock travelling up the leg bones from running impact. The MRI showed the overall lesser trochanter is stressed from axial views showing hot spot throughout the lesser trochanter and saggital views showing a half-mood shaped hot spot with its radial center at the leser trochanter.

This might suggest that the injury was related to tugging at the lesser trochanter in combination with impact shock.

The injury occurred during ball-of-foot running after very gradual year-long buildup to 6 mile runs 3 times a week.

I may not have had enough rest days and may have had too much cumulative activity on the iliopsoas insertion site at the lesser trochanter...I would think the iliopsoas muscle or its tendon would be the weaker link, not the bone to which it is attached.

Some overuse contributors may have been: Doing 6+ mile runs 3 times a week with lots of hamstring pulls with this style of running, doing 15 min. intensive impact drills before each run, forward weighted leg drops (static lunge), hopping (called foot-taps but really lifting the knee up and dropping in rapid succession standing on other leg), 80 minutes of high resistance elliptical 2 times a week, doing rapid air bicycles for 3 minutes before each run to warm up knees, sometimes "throwing the leg forward and pulling back harshly, doing 2 to 4 sets of hanging leg lifts (ab crunches).

The question is that, now I am 9 weeks since last run, what can I do safely and which stimulates bone recovery?

I am doing easy elliptical (40 to 45 min twice a week).

I had planned on starting walking 2 miles, 2 times a week, but the Orthopedic surgeon said not until after next followup.

I don't think this is accurate since I don't have much pain at this time unless I were to jog or hop excessively for quite a while.

I would think the walking would be OK after a complete rest of 6 weeks with a total of 9 weeks layoff and given that MRI was obtained at 7 weeks looking like a stress reaction as opposed to a stress fracture.

If I don't have pain the next day, would think easy walking would be stimulating rather than breaking down the healing.
This would seem to be especially true if the lesser trochanter was involved, since this is not an impact force as with a femoral neck compression stress fracture.
may
RE: stress fx-- bone stimulator/boot? 3/21/2007 12:47PM - in reply to jaguar1 Reply | Return to Index | Report Post
I belive it uses 50hz but i'm not 100% on that. also, is it best to be at least 15ft from all electronic devices while using the stimulator, so it can work in full effect? does icing do anything for tibial stress fractures to promote healing? what about calcium, protien and vitamin D intake?
Surviving Spousal Obesity
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:05PM - in reply to may Reply | Return to Index | Report Post
I was told by the OS and from a orthopedic PT that I should take 1200 to 1500 mg calcium per day, with vitamin D in the supplement.

I was also told that excessive caffeine (>300mg/day) such as 2 or more cups coffee and excessive cola (greater than one or 2 cups per day) can reduce the calcium uptake. Also found this information from medical studies online.
jaguar1
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:06PM - in reply to Surviving Spousal Obesity Reply | Return to Index | Report Post

Surviving Spousal Obesity wrote:

This might suggest that the injury was related to tugging at the lesser trochanter in combination with impact shock.



I think you've hit the nail on the head here. Stress fractures aren't necessary the result of impact force; they can also be caused by repetitive muscular strain where muscles insert. The forces on a bone are the greatest where the muscles insert, so these are the areas most prone to stress fracture. If the muscles are fatigued, they are poor shock absorbers, and more stress is transfered to the bone. Thus, a stress fracture isn't necessarily an indication of 'weak bones', but can be the result of muscular stress and fatigue. The iliopsoas does insert on the lesser trochanter and is responsible for hip flexion/lateral rotation ('hip flexors'). From what you describe in terms on the activities you were doing, it sounds like repetitive muscular stress to this area was the culprit.


The injury occurred during ball-of-foot running after very gradual year-long buildup to 6 mile runs 3 times a week.


Was this your natural biomechanics, or were you trying to change your biomechanics? Whereas landing on the ball of the foot occurs 'naturally' while barefoot, doing so with shoes may 'go against' the mechanics of the shoe. Our body strives to be the most economical in a given condition. As well intended as you may be trying to mimic what is 'natural' (~barefoot), if it goes against what the body is striving towards in a given condition it may cause unusual stresses in unusual places.


I may not have had enough rest days and may have had too much cumulative activity on the iliopsoas insertion site at the lesser trochanter...I would think the iliopsoas muscle or its tendon would be the weaker link, not the bone to which it is attached.


Yes.


Some overuse contributors may have been: Doing 6+ mile runs 3 times a week with lots of hamstring pulls with this style of running, doing 15 min. intensive impact drills before each run, forward weighted leg drops (static lunge), hopping (called foot-taps but really lifting the knee up and dropping in rapid succession standing on other leg), 80 minutes of high resistance elliptical 2 times a week, doing rapid air bicycles for 3 minutes before each run to warm up knees, sometimes "throwing the leg forward and pulling back harshly, doing 2 to 4 sets of hanging leg lifts (ab crunches).


Wow, all these high-intensity drills! I highlighted the elliptical (80 min.!) because one problem with the elliptical, is it's at a set stride length that may not be ideal for you. Just from my own experience, I find that the stride is 'short' (less range of motion)-- for someone with long legs or a long stride, it can become uncomfortable after a while. This is why the pool may be a better option, initially (non-impact), because it allows for greater range of motion. Some higher impact (beyond normal weight bearing) can be applied later, but in your case the elliptical may not be ideal. We are looking at whole body vibration as a therapeutic method, and you would actually be someone who might benefit from this. They are becoming more common with physical therapists and in gyms (although I would question the types in gyms).


The question is that, now I am 9 weeks since last run, what can I do safely and which stimulates bone recovery?

I am doing easy elliptical (40 to 45 min twice a week).

I had planned on starting walking 2 miles, 2 times a week, but the Orthopedic surgeon said not until after next followup.



Walking is fine as tolerated. The elliptical may be ok, but definitely not 80 min.. Usually the bone is healed after 6-8 wks and any pain thereafter is usually just residual from the surrounding soft tissue. Even with a return to running, pain may be felt but should go away. Can you hop pain free? Considering this type of stress fracture is non-palpable, the hop test would be the best indicator of whether you're ready to return to running.
may
RE: stress fx-- bone stimulator/boot? 3/21/2007 1:41PM - in reply to jaguar1 Reply | Return to Index | Report Post
Can you hop pain free? Considering this type of stress fracture is non-palpable, the hop test would be the best indicator of whether you're ready to return to running.


Hop pain free? is that really accurate because how long should you be able to hop before you feel pain?
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