Imagining the Numskulls in the context of how bones heal

I don’t know whether you remember the Numskulls? This was a cartoon strip involving little people who lived inside the head of a person and did all of the hard work to make the person’s life function. 

I thought that they might be a helpful analogy for understanding why we really do need to give a broken bone the time to heal properly. So I created a couple of new characters:  

  • Mr(s) Preparation with a broom and all of the cleaning materials
  • Mr(s) Repair with a full tool-belt and DIY kit and team to help build the structure
  • Mr(s) Remodeller with the filler and sandpaper to make it fit in with the rest of the bone

Just like the healing of surgical cuts and tendons/ligaments/cartilage (covered in previous blogs) there are 3 phases, which I have added a little detail to below. Sadly all of this process goes a little slower when we are older (like most things!) – so worth adding a little extra time if you are older and ensuring that you pay even closer attention to the cues from your body.

  1. Reaction – with inflammation and initial tissue formation. The severed blood vessels in area of the break (or fracture – same thing) in the bone release blood into the area and this forms a clot very quickly (normally within a few hours). Then the first few days are characterised by a lot of inflammation as some of the body’s cells start to clear away the bone fragments and other damaged cells. In parallel, the new blood capillaries that have grown into the area bring the cells that start to build fibres to connect the bone and lay down the spongy bone structure.
  2. Repair – initially with a cartilage callus formation and then with bone: this stage starts after about 7-9 days and takes about 2 months to join the two ends together with a bony connection that has most of the bones original strength. During this time it hardens from being a fibrocartilaginous callus to a bony callus matrix, which evolves through two stages of bone hardening. This is often wider or thicker (so much so that you can feel this under the skin).
  3. Bone remodelling: The bony callus is remodelled over the next months (and often takes as long as 3-5 years) with the excess material on the outside and other locations being removed. There are also different layers of bone, so the remodelling gets back to the correct layering of these different types of bone – rather than the fast fix of the callus. Areas of well-healed breaks can remain uneven for years, but with 5-7% of bone mass being remodelled in the body each week, this will get fixed in time.

How is the fracture treated?

If you are lucky with your break, you have not got an infection in the fracture, and there is not the issue of the bone ends not coming together at all, or not coming together in the right way, or coming together too slowly.

These days it seems that many more people are having their fracture stabilised with surgical insertion of plates and screws (which generally stay in forever) and are being given a sling or protective boot, rather than the plaster-cast of old. The reasons for keeping away from the plaster-cast are often to maintain Range of Movement, but are not meant for you to keep doing your sport in the same way!

So what happens if you try to exercise with a broken bone?

Let’s go back to our friends the (new) Numskulls that I introduced at the start of this blog.

In those early days Mr(s) Preparation is out there working her socks off trying to clean everything up ready for Mr(s) Repair to get going. But if the area keeps getting moved, vibrated or jogged more bit of stuff keep falling off and Mr(s) Preparation keeps getting called back and getting in the way of Mr(s) Repair.

Likewise, Mr(s) Repair is trying to build out a new structure into the gap. This job takes weeks (like most building jobs!) and happens once the worst of the swelling and inflammation has passed. But if the area keeps getting moved, vibrated or jogged the bits fall off – meaning the work has to be done over and Mr(s) Preparation has to keep coming back and cleaning up again, rather than sitting down and having a cup of tea!

So activities like running and strong movement of the area lead to delay and having to repeat the healing

But there are a number of things that you can do to really help the healing:

  1. Good nutrition: the body needs a lot of nutrients to heal the bone, so ensuring that you have a good balanced diet with enough protein, and key vitamins (C and D) and minerals (Calcium, Iron, Magnesium and Phosphorus)
  2. Sleep well at night: a lot of healing happens in the deep sleep phases, so ensuring that you are getting your head down for a good uninterrupted 8 hours of sleep (or more if your body feels that it needs it) will be a big help.
  3. Avoid aspirin and ibuprofen, if you can: there can be a lot of pain, especially in the early inflammation stages, but the problem is that aspirin and ibuprofen delay the body’s natural healing process and therefore delay progress. So the sooner that you can stop taking them, the better. (There are some other medications that have impact – so worth checking with your Doctor, if you are taking any medication)
  4. Avoid smoking and limit alcohol intake
  5. Don’t feel tempted to test your broken bone whilst it is healing! Do keep it immobilised and work out how to take away risks in your day-to-day activities that could lead to a knock to the area. If you have been told that you must not be weight-bearing, then respect that and get shower chairs, scooting devices, crutches etc that enable you to do this all of the time (cycling gloves are brilliant for protecting your hands If you are on crutches).

So no sport at all?

You should review this with your medical team and coach. Depending on the fracture and the treatment, there may be some things that you can safely do that keep your strength and give you a cardiovascular workout whilst keeping the fracture immobilised. I have seen some really clever ideas that are safe and keep things going.

But if that is not possible? This is 6-8 weeks of your life. Add up how many weeks you have been alive (52 weeks per year!) – and this 6-8 weeks will be a very small percentage. Be kind to your body: let those Numskulls go their job without having to keep going back and repeating it, because you knocked down their hard work!

Good luck and keep smiling!

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