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GideonY

Protection for ankle and tibia

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What is the right method to protect the damaged ankle and tibia from repeated fracture ?

Background: I broke an ankle 8 years ago, on bicycle ride. Got several screws in tibia, and a plate on fibula. Ankle healed long time ago. A year ago I was involved in skydiving accident (not on landing) and broke the same leg again, tibia and fibula in several places. The most severe fracture was of tibia about 8 cm above the ankle joint. Ankle itself was not damaged. This time I got a titanium rod through the entire tibia, plus screws on both ends. This kind of injury healing very slowly, 12 months were needed for bone to reach normal strength. Now the leg more or least okay, although it is not good as it was before.

I consulted a doctor, he says that bone strength is the same as it was before the accident, so I can assume that it would not fail under normally allowed strain. However, he said, if I will be involved in another accident which will lead to bone fracture, the damage will be severe and unrecoverable. He said that in any circumstances I should not risk breaking the leg again.

Now, I’m about to start skydiving again. I upsized from Sabre 2 170 to Navigator 240 … :D
But I’m not sure how to protect the leg. Opinions expressed about similar subjects in the forum in past are confusing. Many people say that protection accessories should not be used. They say that stiffness of high boots or aircast will funnel the strain to the other parts of the leg (or the body) and will increase probability of fracture in case of accident. Other people are recommending support braces, hanwag boots (designated for paragliders) and military jump boots.

Please let me know what do you think.

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How strong is it? Can you run on it? Back in the day that was the measure of if you can jump or not. Can you jump off a chair? Top of a car? Do you mind losing your leg?
U only make 2 jumps: the first one for some weird reason and the last one that you lived through. The rest are just filler.
scr 316

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Your doctor is the best resource for brace or no brace questions. Ask what would happen if you fell down the stairs or off the back of a truck with/without a brace. It really depends on how much force would damage you beyond an acceptable (to you) level of repair, physically and financially.

Personally, I don't like braces. They limit movement and use of my muscles to keep my body safe. If I need to be careful with a body part such that I'm in a brace to avoid injury, I also limit my activity to reduce the chance of injury to an acceptable level.

For skydiving the scariest thought for me is landing unconscious under a reserve after an AAD fire. My reserve is big, I am careful who I jump with and who I'm in the plane with to minimize the possibility of getting knocked out. My main is 1.2 wL and I don't add extra speed to my landings. That is acceptable risk to me. What is acceptable for you?

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jackwallace

How strong is it? Can you run on it? Back in the day that was the measure of if you can jump or not. Can you jump off a chair? Top of a car? Do you mind losing your leg?


I can run and jump, and have absolutely no intention to lose the leg.

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Kiwiskydiving

You can look into basejumping protection for the leg which includes a knee guard, shin guard, and ankle brace. A good combination is a knee/shin guard + Hanwag sky boots. https://www.apexbase.com/protective-gear


Thank you, very useful information.

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sammielu

Your doctor is the best resource for brace or no brace questions. Ask what would happen if you fell down the stairs or off the back of a truck with/without a brace. It really depends on how much force would damage you beyond an acceptable (to you) level of repair, physically and financially.

Personally, I don't like braces. They limit movement and use of my muscles to keep my body safe. If I need to be careful with a body part such that I'm in a brace to avoid injury, I also limit my activity to reduce the chance of injury to an acceptable level.

For skydiving the scariest thought for me is landing unconscious under a reserve after an AAD fire. My reserve is big, I am careful who I jump with and who I'm in the plane with to minimize the possibility of getting knocked out. My main is 1.2 wL and I don't add extra speed to my landings. That is acceptable risk to me. What is acceptable for you?


Thank you for advice. I already upsized the canopy to reduce wing load significantly below to what is permitted for my [relatively low] level of experience.

“Consult the doctor” - if it only was that easy. The problem is that I cannot find a doctor who can provide meaningful advice. There are many good doctors in Israel, but their specialization is in fixing broken parts of the body rather than advise for extreme sports. One orthopedist (actually my personal friend) told “are you crazy ? find something better to do with yourself”. Other orthopedist (recommended by local skydiving club) told “if the leg will break again, the consequences would be catastrophic. Try Swede-O”. The only relevant item Swede-O have is ankle brace, which doesn’t provide protection for tibia.

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I broke my ankle this past July on a tandem with a student.

My diagnosis of the incident is that my foot stuck on a hard(er) landing. Definitely had harder landings many times in the past, but this time the foot caught or something else, and instead of sliding it imparted enough force in the ankle joint to start a chain reaction.

The end result was a bimalleolar fracture, titanium plate on my fibula to provide mechanical alignment, and two screw at the base of the tibula to hold the part of the ankle joint that broke off.

I was wearing cross trainer type shoes with some tread and grip, maybe smooth skate shoes would have slid enough to keep the force on the anke low enough?

I am cleared to jump again, but haven't started, I am waiting until I am comfortable running and jumping before I get back on the horse.

I am planning on using a soft brace that is use in basketball to keep the ankle joint from rolling. I am not worried about it breaking again any more than my other ankle, but I am worried about it being sprained or rolled.

I think I will also be using high-top skate shoes with smooth soles, to try to limit sudden stops on my feet while sliding.
"The restraining order says you're only allowed to touch me in freefall"
=P

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Doctors don't understand skydiving, you have to ask them questions about everyday activities that would apply similar force: like falling down stairs, running through a field that has the occasional divot or small hole that your foot could get caught in (describe your landing area), jumping off the back of a truck or off of a playground swing, sliding in like during baseball. If the doctor tells you to avoid running/jumping/falling unless it's essential for transportation or an emergency, then you probably shouldn't do that stuff for fun either. So no hard landings, running out your landing, flaring too high, or sliding it in, if the doctor tells you not too.

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sammielu

Doctors don't understand skydiving, you have to ask them questions about everyday activities that would apply similar force: like falling down stairs, running through a field that has the occasional divot or small hole that your foot could get caught in (describe your landing area), jumping off the back of a truck or off of a playground swing, sliding in like during baseball. If the doctor tells you to avoid running/jumping/falling unless it's essential for transportation or an emergency, then you probably shouldn't do that stuff for fun either. So no hard landings, running out your landing, flaring too high, or sliding it in, if the doctor tells you not too.



My experience is that doctors won't give useful advice even if they understood the mechanics.

I got mine to tell me that the bone is as mechanically sound as before the injury, and that is about it.

I think I understand their angle, body mechanics are chaotic. They can judge the strength of a bone but how can they forsee all of the forces that can be imparted on it.

If I was in their position I wouldn't want to be weighing in on fitness for skydiving or any high impact sport.

I have 10 years of jumps and I understand the mechanics of a landing very well, but never did I think that I could break and ankle on a landing that wasn't a collapse or really that hard. Student was fine, didn't even know that I was injured. I would have never expected to get injured in a situation like that.
"The restraining order says you're only allowed to touch me in freefall"
=P

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GideonY

***How strong is it? Can you run on it? Back in the day that was the measure of if you can jump or not. Can you jump off a chair? Top of a car? Do you mind losing your leg?


I can run and jump, and have absolutely no intention to lose the leg.

I had a friend I skied with that broke his leg. It healed. He broke it again. It healed. He broke it again and they had cut it off below the knee. He still skis, but on a peg leg.
U only make 2 jumps: the first one for some weird reason and the last one that you lived through. The rest are just filler.
scr 316

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DougH


I have 10 years of jumps and I understand the mechanics of a landing very well, but never did I think that I could break and ankle on a landing that wasn't a collapse or really that hard. Student was fine, didn't even know that I was injured. I would have never expected to get injured in a situation like that.


This is exactly what I had in mind while posting the subject. No matter how experienced and careful you are, and how much safety margin you keep, sometimes, somewhere shit happens. And this is the reason why protection measures are required in addition to precautions.

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I broke tib/fib in a climbing accident 18 yrs ago, rod placed in tib. Took up skydiving about 10 yrs ago. Have taken hard falls on that leg in and out of skydiving with no problems. Now I rarely give it a thought. I was also never told by ortho doc to play it safe. Never thought of using a brace, really don't think it's needed, just my opinion.

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Weight training, plain and simple. Google weight training and increased bone density.

A backpack with 40 plus lbs of sand and a couple heavy dumbbells together with a regime of squats,walking or light bouncing will build the bone density.

“Exercise stimulates bone formation, because bone put under moderate stress responds by building density, and, depending on your age and workout regimen, it can either increase or maintain bone-mass density,” says Steven Hawkins, PhD, professor of exercise science at California Lutheran University. That’s why physical activity can reduce your risk of sustaining a hip fracture (which is usually caused by osteoporosis) by as much as a whopping 50%.

If your bones are still healthy, working out with weight-training machines, free weights, or resistance bands, as well as doing exercises that use your body weight as resistance (sit-ups and push-ups, for example), will all build your bone density. The single best way to increase bone density is jumping (think jumping rope, jump squats, plyometrics), according to Dr. Hawkins.
http://www.prevention.com/health/health-concerns/strength-training-exercises-strong-bones

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Yeah!
Whatever Phil11111 said ...

Exercise increases bone density.
Lately my rehab has included long walks up steep hills. Last night Introtted down the 500 stairs.
Next month I will add water bottles to increase the load on my leg bones ... on the way up.

Long walks up steep hills are also a great way to curb my instinct to throttle the @&$)(?! out of lawyers!

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riggerrob

Yeah!
Whatever Phil11111 said ...

Exercise increases bone density.
Lately my rehab has included long walks up steep hills. Last night Introtted down the 500 stairs.
Next month I will add water bottles to increase the load on my leg bones ... on the way up.

Long walks up steep hills are also a great way to curb my instinct to throttle the @&$)(?! out of lawyers!



WRONG!!! Without sidetracking this thread too much. Once you have a real experience in the courts you realize that lawyers are actors. That the courts are a Kabuki theater where stories or pantomimes are presented in the hopes that their story is accepted by the judge or jury.

Years from now you will still be thinking about how to deal with lawyers and your skepticism with any court decisions.

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DanG

Actually, there was a recent study that showed that exercise did not have any effect on bone density. Exercise does, however, strengthen the muscles, ligaments, and tendons that support the bones.



.............:...................................................

Challenge DanG to share that study with the rest of us.

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DanG

Actually, there was a recent study that showed that exercise did not have any effect on bone density. Exercise does, however, strengthen the muscles, ligaments, and tendons that support the bones.



I think that study is fatally flawed.

http://www.space.com/6354-space-station-astronauts-lose-bone-strength-fast.html

https://www.sciencedaily.com/releases/2015/07/150714150936.htm July 2015

From 10 years ago, http://www.nytimes.com/2016/04/02/health/exercise-is-not-the-path-to-strong-bones.html
Debunked Below: From the Journal BONE 2015

http://www.sciencedirect.com/science/article/pii/S8756328215002446

and recently from Journal of Bone and Mineral Research, Aug. 2015:
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2499/abstract;jsessionid=D93E1FF712699A74D7241C9881A25BDE.f01t01?systemMessage=Subscribe+and+renew+is+currently+unavailable+online.+Please+contact+customer+care+to+place+an+order%3A++http%3A%2F%2Folabout.wiley.com%2FWileyCDA%2FSection%2Fid-397203.html++.Apologies+for+the+inconvenience.&userIsAuthenticated=false&deniedAccessCustomisedMessage=

Which showed a 6-12% increase in bone strength as a result of exercise and quantified by CT scan.

"Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p < 0.001), with larger changes (> 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p < 0.001), with localized changes of > 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were localized rather than being evenly distributed across the proximal femur."

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The study reported on in Science Daily had no control. It also only applied to men who already had low bone density. It is the same study you link to from ScienceDirect.

The NYT article admits that astronauts lose bone density. It is not clear why, which is why NASA is doing a lot of research on that issue.

The Bone and Mineral study is the one discussed in my article. Gains were very small.

I must commend you, however, for claiming that "my" study was fatally flawed, and then linking to the very same study to prove it. Excellent post-fu.

- Dan G

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DanG

Misconception: All you have to do is walk or do modest strength training exercises to build strong bones.

Those studies failed to find anything more than a minuscule exercise effect — on the order of 1 percent or less



Bet you that those people also didn't have any muscle mass or strength gains over 1% either.

To get mechanical body adaptations you have to stress the part of the body you want to adapt, otherwise the body will happily just plow along and maintain the current levels.

Anyway, to get back to the OP, the best way to protect the ankle/leg is to know your canoy inside out so that you can land it where you want and how you want every single. Breaking my leg was the best thing that could happen to me with regards canopy control, as ever since the landings got a hell of a lot more serious and the rewards for not shutting it down fully at the end of the plane out is a load of pain if i need to run it out :o

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DanG

The study reported on in Science Daily had no control. It also only applied to men who already had low bone density. It is the same study you link to from ScienceDirect.

The NYT article admits that astronauts lose bone density. It is not clear why, which is why NASA is doing a lot of research on that issue.

The Bone and Mineral study is the one discussed in my article. Gains were very small.

I must commend you, however, for claiming that "my" study was fatally flawed, and then linking to the very same study to prove it. Excellent post-fu.



"BMD significantly increased after 6 months of RT or JUMP and this increase was maintained at 12 mo; "...
http://www.sciencedirect.com/science/article/pii/S8756328215002446

"There are two types of exercises that are important for building and maintaining bone density: weight-bearing and muscle-strengthening exercises.
Weight-bearing Exercises

These exercises include activities that make you move against gravity while staying upright. Weight-bearing exercises can be high-impact or low-impact.

High-impact weight-bearing exercises help build bones and keep them strong. If you have broken a bone due to osteoporosis or are at risk of breaking a bone, you may need to avoid high-impact exercises. If you’re not sure, you should check with your healthcare provider.
http://nof.org/exercise

"Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. For most people, bone mass peaks during the third decade of life. After that time, we can begin to lose bone. Women and men older than age 20 can help prevent bone loss with regular exercise. Exercising allows us to maintain muscle strength, coordination, and balance, which in turn helps to prevent falls and related fractures. This is especially important for older adults and people who have been diagnosed with osteoporosis.
The Best Bone Building Exercise

The best exercise for your bones is the weight-bearing kind, which forces you to work against gravity. Some examples of weight-bearing exercises include weight training, walking, hiking, jogging, climbing stairs, tennis, and dancing."
http://www.niams.nih.gov/health_info/bone/Bone_Health/Exercise/default.asp

I'll rely upon national institutes health and scientific study. Who formulate guidelines on general proven scientific concepts rather than one doctor that offers one opinion. Dr. OZ offers ideas on TV and some people accept them as fact. Most all of his ideas are unsupported by the scientific community.

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