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Moehass
Boulder climber
Laguna Beach
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Topic Author's Original Post - Oct 3, 2015 - 06:11pm PT
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It's all about Karma.
5'9" 150lb 34yo male. Been crazy active all my life, and NEVER been injured. I take VERY good care of myself and try to always play it smart. So this is life-changing. I have solid, basic insurance, but I'm not rich to get the care I feel I need. Your support needed.
3 days ago. Barefoot free climbing at the beach as usual. A familiar hold gets loose. GripBeGone. Down I went a 25ft high (7+meters) cliff and landed heels first on hard ground. I still think I was lucky considering how high I fell.
Immediate outcome: refreshingly dizzying shock; whiplash, later resulting in sore neck and traps; both heels generously bruised (fat pad contusion, Dr said no calcaneus damage); AAAAND, drum roll, chipped left talus, which is not bad enough to warrant surgery, but to me this indicates a LOT of soft tissue damage on both sides. If the impact was hard enough to chip bone, then it probably did a lot of funny things to all those tiny ligaments, muscles and their attachments. I'm also very concerned about posttraumatic arthritis, or compromised mobility later on. Plan is to slow down after the age of 50 and return to dance and ultrarunning. Until then I need to get in as much sprinting and speedclimbing as possible.
I went to ER that evening, and after few hours I walked out of there with a fiber glass splint on, which the nurse wetted (that's what she really did), squeezed in a towel to dry, then molded manually to my leg. It seemed so makeshift-ish and improvisational that I'm now concerned about it's positioning and allignment. Yesterday, when I got to see the "specialist" I brought it up to him, he brushed it off and just said let's order you a boot, which won't arrive until next week. So for at least another week, and for a total of 9 days I will be OCDing about how my tissue is not healing in the optimal position.
Something im thinking about only now, is A) whethet there is a way to determine EXACTLY what soft tissue was damaged, and the best way help it heal swiftly AND optimally. Even if it can't be pinpointed , I'm sure it can be rehabbed to pre injury functionality--how?!!
And B) if you or someone you know experienced anything similar to the injuries described above, and what they did to recuperate, and any tricks, anecdotes or lessons they'very learned from their experience.
I searched the forum to determine if I needed to start a new thread, the closest I found is thishttp://www.supertopo.com/climbing/thread.php?topic_id=333086 so if you have any links, on or off the forum, or books or videos that would help please share.
Thank you!
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TGT
Social climber
So Cal
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^^^^^^^^^^^^^^
what he said
it's gonna rain tomorrow.
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 3, 2015 - 06:31pm PT
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I thought I outgrew this, but it kind of sucks when you're in a wheel chair for the first time, asking for help, and you get mocked for being vulnerable. Even online. Thank you!
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Modesto Mutant
Trad climber
Santa Cruz, CA
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From what you've described I agree you are extremely lucky that the extent of your injuries is not more severe. My long distance guess is with 6-8 weeks of rest/ice and keep your feet elevated you'll be able to return to start working yourself back. I'd also recommend doing some work in a pool after the swelling has subsided. All in all, you're going to be fine so stop obsessing. The body has an incredible ability to recover from trauma.
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Gnome Ofthe Diabase
climber
Out Of Bed
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Oh dude!
Ouch! And yes you are very lucky. This will take a bit of time to put into understandable
Form.
The 1st is my back ground and a bit on my own ground fallzzzz.
The Zs for sake of highlight ; I have hit the ground too much. Mostly I bounced up right away with injuries of varying degree.
Of relevance to you I exploded my right heel in '94. It was a shattered mess. The prognosis
Was bleak and just walking with out a noticeable limp was doubt full. The ground that I f'n hit was flat studded with ankle breakers and it had been very hot that day. I was on a stupid not 25 foot high problem. The day's heat had past and a sheen of condensation was evident as I climbed higher into the damp, my feet left the edges and I campused down at least three moves, then slipped and augured in. I did not get to bounce just crumbled into a heap,
It was as is yours a life changing fall. It took 4years. I had a good friend who also had a shattered foot heal and ankle. He was ten years younger than me and started with the same doctors,
For you and your feet, it may be ok but get a second opinion, and a full set of films ,X-ray and MRI.
I see where you are and recommend that you google crushing injury orthopedic specialists.
I have been rebuilt at only one hospital, but arrived at the recommendation from the Lakers team doc, he said if you want to walk again, dance and run you will need to stop climbing.
He sent me to the Hospital for special surgery in Ny city, an old doctor who will consult for a few hundred bucks, He has been making cripples walk for 50 years, He may have some Nazi roots, and his name can cause nightmares: Dr Walthar Bohne! Call The Hospital ask if Dr W Bohne is still available, as of 2/13 he was still getting calls from other docs who wanted to talk to him about my old case. He is that well recognized in the field.
Try not to gain weight and start to reduce you intake.
The short deal is not what you want to hear take three years to get it back ?
It will hurt for . . . . well, now I see that Jim Brennan says that he can tell the weather,. So that sounds like you feel it forever.
My injuries were severe and I did not choose a fusion and was expected to. The result was that I can go all day one day at a time.
20 miles a day tops. The next two days I can be so lame that I use a crutch.
The long deal is you seem to have been lucky but get a good look by a well recommended specialist sell the valuable tempting gear now. It will not make a dent in the bills, it may help you deal.
So that is a basic overview : take it year by year
in 6 months you'll want to Boulder. . . When you do,
Use a rope!
And a very tight rope at the start of everything.
Sorry dude time to grow up.
I never ran again
Never surfed the damn ankle dislocates when/if I swim.
Good luck
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Reilly
Mountain climber
The Other Monrovia- CA
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Send me yer X-rays. Failing that I'd say a novena is in order.
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Todd Eastman
climber
Bellingham, WA
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... seem kind of nervous for a dude pulling choss 25 feet off the deck...
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couchmaster
climber
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Most of us have been there done that. Back when I was younger than you, before crash pads even, was barefoot bouldering (shoes cost a lot) and taking 15-20" falls onto dirt. Same route, was so close to topping out that I didn't want to give up. Last time slammed into the earth so hard, both my (bare) feet and my testicles took a hit. It sounds funny now, but I can assure you, with no one even close by to hear my whining and still hadn't hit the topout, it was not funny then. Limped back to the car. Didn't have any money so just layed around and took it easy. Eventually, many months later, could start up (slowly) again.
The upshot of that was that about 4 years back, saw some kids with a crash pad, and I asked if I could try falling onto it. Was barely able to take a "practice" intentional fall from 4 feet up. (measuring from the feet) What I figured out is that although I routinely climb significantly higher than that unroped, I do not expect to fall, and it doesn't bother me. Falling onto a mat from 4 feet up I learned that it is difficult to let go and take the hit.
You'll eventually do fine. Listen to the experts and give yourself time to rehab is the moral of the story. Good luck!
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El Chueco
Ice climber
Altadena, CA
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I'm about a year out from a slightly displaced intra-articular calcaneal fracture. Surgery was an option, but not recommended due to complications and the possibility of not being able to line up the bones that much better anyway. Significant pain in the ankle for six months, but then it gradually just became a sore stiffness and is now only present on long hauls or long days on my feet. The Dr. was initially pretty doom n gloom about the long term - early onset arthritis, later fusion, no running etc. We'll see. Good luck!
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ß Î Ø T Ç H
Boulder climber
ne'er–do–well
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Down I went . . .
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steveA
Trad climber
Wolfeboro, NH
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I wouldn't stress out too much. As others have already said--you will heal.
I'm 69+, and fractured my heal bouldering when I was 23. The other ankle is loaded with shrapnel from Vietnam. Since that time I've broken both ankles multiple times, and 10 years ago, I shattered several bones over the arch,
on a long leader fall.
I just finished hiking 45 miles with a 70 pound pack in the Wind River Range.
Yes, I'm sore a lot but you will live.
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anita514
Gym climber
Great White North
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I haven't broken anything in a long time but did go through some major surgery last year which knocked me off my feet for about a year, so I know how it feels to not be able to do anything, to not even be able to walk, etc. The mental aspect of inactivity is really tough, especially when you are used to being fairly active (in my case). It's easy to get sucked into self-pity and other very negative feelings.
There are others here who have been through worse who can chime in, too.
It's tough. You have to stay positive and focused. Luckily you will heal and it's not a life threatening injury.
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ron gomez
Trad climber
fallbrook,ca
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Ankles are a weird joint(s), too many articulations, too many bones, ligaments and tendons. When they get injured it takes a LONG time to heal properly....and you NEED to let the structures heal, don't rush time, won't happen. Were you at CdMar? Not a lot of hard ground there, but if you indeed have a talus fx it needs to heal up, it's a critical articulation in the ankle and if not managed right can have long lasting effects like swelling, loss of range, damaged cartilage. If you get in a walking boot good! Go see an orthopod...plenty of good ones at Mission Hospital, near Laguna, get a good dx and after that, take the docs advice. Once you know what's exactly wrong if possible, keep your range of motion within pain tolerances. Do exercises that involve the foot, gastroc and antertior tib. More is not better at this stage. Look into isometric exercises if range of motion is limited or too painful. But do what the doc says. If managed right and you have limited damage to articular surfaces...in time you should be fine enough.
Questions, feel free to pm me via this site.
Best wishes to a healthy and full recovery
Peace
Blew my ankle to bits in the early 90's, took time but all is well since then...no limitations.
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Fat Dad
Trad climber
Los Angeles, CA
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Sorry you got hurt and hope you heal quickly, but a few things jump out at me from your posts. One, having climbing at The Beach alot back in the day, I'm assuming that's where you got hurt. If so, most of the problems aren't quite that tall, none of them have a hard landing and almost no one climbs barefoot and, of those, no one I ever saw did it regularly. So, already you're story sounds kind of bunk.
Second, for someone routinely climbing barefoot on 20+ tall problems, your response to your injury seems to show a failure to appreciate the risks you appeared to accept on a daily basis.
Third, it sounds like you are receiving appropriate medical care. The problem seems to be you as a patient. You screwed up and got hurt. It sucks (and yes we've all been there) but live with it, own it. I understand the feeling of helplessness you feel, but there's little you can do but be patient. When you're ready to start therapy, that will determine how serious you are about getting better.
B I O T C H, nice find.
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 4, 2015 - 04:46pm PT
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Modesto Mutant, "The body has an incredible ability to recover from trauma." Thank you.
Gnome Ofthe Diabase, I looked up this Bohne dude, that's the kind of medical professional I want on my team. I'll tell my Orthopedist about him and see what he says. Thanks for sharing.
Jim Brennan, I took a lot of pride in never having injured myself. So yeah, meaningless for the world, massive for me. Thanks for support.
ruppell, I read the thread you linked. Inspiring. Thank you.
Todd Eastman, High Fructose Corn Spirit, and Fat Dad, you're right. To climb, I've always used force to compensate for poor technique. This fall is the result of big gap between my strength and my poor skill. Lesson: scale down, and scale accordingly.
And Fat Dad, thank you for the tough love. I PMed you my cell#. I can show you accessible spots through Thousand Steps Beach, especially when tide is low, and the sand would be nicely pcaked and hard. Few are climbable, many are not, almost all are 20+ METERS high. Just let me know when you're in south county, I'll even buy you a nice peruvian lunch.
Anita514, if it effects performance it is life threatening. But I won't let that happen.
couchmaster, the lure is hard to fight: No shirt, no shoes, no rope, or any gear, just you, scant shorts and nature. Easy in, easy out. You can do it anywhere, anytime. No big deal, just feeling invincible with this hidden chest of secret powers. Got my a$$ handed to me good for this poetic bs. Thanks for sharing.
El Chueco, what I continue to learn is that big part of rehab, if not all of rehab, basically aims to break malformed adhesions of scar tissue. And then stimulating it to rebuild optimally. Which is a little harder to do with bones than soft tissue, but is equally possible. There are tools for this that sell for thousands of dollars and certifications that cost even more. With persistance, you/I can do this on our with a car key or the round corner of a cell phone or something. It is one of those things that take a lot of faith and decisive action, especially if you've never done it/been through it before, because from where I am (can't walk, can't shower or poop unassisted...etc) it's easy to get sucked into negative feelings, as anita514 said. As for me, I've upped my intake of antioxidants, garlic, turmeric and fish oil. I'm equipping myself with information and tools for as soon the inflammation subsides suffeciantly, Imma go in there and just own this war like i should. That's what's up!
Here are a couple of videos I found illuminating:
https://youtu.be/ZRi3Q9LXcIg[Click to View YouTube Video]
https://youtu.be/yqhmG5nz_Jw[Click to View YouTube Video]
ron gomez, I PMed you. Thank you for your support.
Dingus Milktoast, thank you for sharing. Can you elaborate on what makes a boot or cast fit right? In my case, probably just like you were, I'm concerned about the tiniest variations in positioning that could lead to improper scar tissue placement that could cause any sort of suboptimal functionality, so how can I, or anyone know if the off-the-shelf boot I'm anticipating next week will fit perfectly?
SteveA, everyone, thanks for the love, and stay close to earth :)
Cheers!
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ron gomez
Trad climber
fallbrook,ca
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Nothing yet, but will keep an eye out!
Peace
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overwatch
climber
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SteveA and Anita are tough as nails, I mean that. Admiration and respect to you both.
Nice positive post from Byotch...I mean that too. Thanks
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Splater
climber
Grey Matter
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Your injury does not sound as bad as most. Here are some from other friends of mine:
1) Broken decades ago, no long term huge impact, but some pain & never as flexible.
2) Broken fast roping at night, some permanent damage.
3) Military parachuting impact bad break had to be fused. Guy still somehow climbs.
4) Recreational parachuting break, fully healed.
5) Smashed heel trying to lead Werners at Woodson. Limped for a couple years, never climbed again, mountain bikes now.
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michael hayes
Trad climber
san francisco, ca.
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I took a fall in Yosemite about 3 years ago, and slammed my heal into the wall. Had it xrayed, and it showed no fractures. I walked around for a year with some swelling, and could not do moderate hiking without pain. I finally bit the bullet and went to a Kaiser specialist who said I had damaged the cartilage, and that I was bone on bone. He recommended ankle fusion and swore there would be no more pain, and that I would be able to do most of the things that I enjoy. He was right. Other than a loss of range of motion (can only point my toes 30 to 40 degrees as opposed to 90 degrees), I can still surf, mountain bike, road bike, climb, and hike. I am on my feet all day as a contractor, so I recommend getting shoe insoles custom made to compensate for the fusion. My doctor put me on a machine that photographed how I weight my feet and had custom inserts made for me. A couple of things that I have noticed that are a bit annoying: my stride is shorter, and I can't walk as fast as my girlfriend who is 9 inches shorter, and hiking down a steep slope is tricky because my foot doesn't flex far enough. So, I compensate and compromise, and am currently climbing in Kalymnos having a great time. Two things that kept me sane through 4 months of casts and boots was having a scooter that I rented from a pharmacy, and being able to top rope in the gym using one foot. I put a knee pad on the injured side and a climbing shoe on my good foot and climbed jug routes
Good luck!
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 5, 2015 - 04:13pm PT
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Michael Hayes, how can cartilage damage be found out?
Ron gomez, I got your email. Thanks! I was curious about your ankle injury and recovery.
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 5, 2015 - 04:26pm PT
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Also, learning about how others hurt themselves have definitely helped me cope. I am, and I'm sure many are equally interested in finding the best ways to regain full functionality. I mean ways to induce actual full physiological and biomechanical recovery in the safest and shortest time possible.
Let's get our own RITE (Rapid Iterative Testing and Evaluation) going right here on this forum.
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BAd Wife
Sport climber
Tehachapi
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RICE is dead. Even the guy who developed and promoted it, Dr. Gabe Mirkin, reports that ice inhibits healing. Here's his article about it, and you'll find that the top sports injuries sites agree: http://drmirkin.com/fitness/why-ice-delays-recovery.html
Ligaments and tendons are poorly supplied by blood, hence nutrients. Heat is better at bringing whatever blood supply is available to the site.
As a holistic nutritionist, I also advise either getting (and eating) some gelatin from grass-fed cows (check Amazon) or, since you probably have plenty of time to do so, get yourself some bones from grass-fed cows and make some long-simmered bone broth: toss bones in water to cover; add splash of vinegar; simmer for 48 - 72 hours. The vinegar leaches the minerals from the bones, plus you also get dissolved connective tissue. Probably sounds gross but these are healing nutrients, and the broth is pretty delicious. Use as a base for soups or warm and drink as-is. Cheaper and better than supplements and good counter balance to chips and beer.
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Brandon-
climber
The Granite State.
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Dude, you're going to be fine. As you regain mobility, it's going to hurt. Breaking scar tissue or some such. Ankles hurt, and sprains are worse than breaks. Be strong and learn to love the pain. FWIW, I've broken each ankle twice, sprained my left twice, and my right three times. This was a while ago (10-15 years), and I'm functioning just fine now with minimal professional care. I'm dealing with what seems to be a broken metatarsal right now and it's a pain in the ass. Basically, don't worry so much. :)
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michael hayes
Trad climber
san francisco, ca.
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Moehass,
According to my doc, damaged cartilage does not show up on X-rays. What did show up after a year of walking around in pain was bone on bone. There was no space between the ankle bones which indicates loss of cartilage. Fusion scrapes away any left over tissue and screws the bones together so that they grow together as one solid piece. He did not recommend a rebuilt ankle because they are still working out problems with them, and he said I would not be able to do the things I do because they are more delicate. My only worry is problems with other parts of my body such as hips or knees in years to come,, but there have been no signs yet.
Good luck
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 6, 2015 - 02:18pm PT
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So, michael, that damaged cartilage would have shown up had you gotten an mri at time of injury, no?
Bad Wife, I'm familiar with gelatin soup (that's what we're talking about, right?), superhero stuff. It's somewhat of a delicacy in some cultures where they use calve's feet--feet soup! :) I never thought about it for my case, but it makes perfect sense!!! And no, it doesn't sound gross. I've hade feet soup, aka kaware3 with my egyption friend in Anaheim few months ago, and I miss it.
Re icing, I've followed Kelly Starrett of Mobility WOD since 2009, and he pointed out the same thing in a 2010.
Brandon, I think this will turn out to be a blessing. By next spring, my hands and arms will be a helluva a lot stronger, I will have strengthend and reconditioned my ankles and feet to superhuman level, and I will have the balance and coordination of an olympian. I'm going to take my time and I'm going to win.
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Ksolem
Trad climber
Monrovia, California
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I've broken three ankles, all in bouldering falls. Ankles healed well. It sucks because you are unable to hike, walk around etc. 'till it heals. I'll take an upper extremity injury over a lower any day. Still, it sounds like you got off easy.
As was said, see an ortho. Hopefully he/she can get you into PT when the time comes? Even if you can only go a couple times be inquisitive and learn the exercises. In these early stages keep it elevated as much as possible.
FWIW Yer gonna die!
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Ksolem
Trad climber
Monrovia, California
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BADwife I'm really curious about RICE but your link takes me to an investment firm...
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ron gomez
Trad climber
fallbrook,ca
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Moe,
Kris is very knowledgeable in this area as well, hope our conversation this morning clarified some things for you, but like Solem says, ankles heal up....just do it right.
Peace
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JEleazarian
Trad climber
Fresno CA
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Something im thinking about only now, is A) whethet there is a way to determine EXACTLY what soft tissue was damaged, and the best way help it heal swiftly AND optimally. Even if it can't be pinpointed , I'm sure it can be rehabbed to pre injury functionality--how?!![Empahsis added]
Unfortunatley, optimally is not always swiftly. Despite taking some impressive bouldering falls, I was never injured climbing enough to require medical attention until after I'd been climbing for 44 years, and I severed an achilles tendon in a bouldering fall. Although the physical therapist said I healed far quicker than anyone else she'd seen - including patients a third of my age - with that injury, my doc did not want me to climb for a full nine months. I followed his advice and healed (I'm tempted to pun here) completely.
I was sixty when that happened, and in the four years since, I've done at least as much climbing and bouldering as I did in the ten years before that, so I wouldn't be so certain that you're going to want to stop at 50. In any case, do what the professionals tell you, and your chances of an optimal recovery improve. I hope you're completely recovered with plenty of time to enjoy the rest of your life.
John
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healyje
Trad climber
Portland, Oregon
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I had congenitally weak ankles and have sprained my ankles like a dozen times, broken one and a broke a talus one time when a guy I didn't know tries to give me an unasked for spot out of nowhere. Next day I'm on crutches for the heel even though the front of my foot is fine.
We were in Eldo on a trip and going to do T2 that day so I hobble up to the base with my two friends to watch them do it. The one leads p1 fine, the other can't do the bottom moves. I figure, what the hell, I'll be on the front of my foot the whole time so I second it. Wrong!!! Had to do the entire descent backwards, face-to-the-rock, by starlight. It took so long we were the last ones there and old man Fowler was giving us hell raving up to us in the dark.
Don't be as stupid as me - give it a rest. That was close to forty years ago and I'm still climbing at a decent level, I just have to pay attention to every footfall on trails and descents.
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Delhi Dog
climber
Good Question...
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I'm sitting here at the gate in Bangkok getting ready to fly home to Delhi after ACL reconstructive surgery and a whittled down meniscus. I feel your pain. Spent the last 4 days in the hospital drugged up on morphine.
Being wheel chair bound sucks, but what the hell else can you do.
I'm looking at 6-8 months recovery time. But people better than me have been through a lot worse. Hang in there bro.
Mine wasn't even from climbing...Ultimate Frisbee. "Pop" goes the weasel...
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monolith
climber
state of being
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Wierd, BAD wifes's link takes you to the wrong destination. Copy and paste it into your browsers url field instead.
drmirkin.com/fitness/why-ice-delays-recovery.html
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 7, 2015 - 07:15pm PT
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"It turns out that I didn't need the ACL in the first place due to my skeletal anatomy."
What does that mean?
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Delhi Dog
climber
Good Question...
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I didn't mean to add a thread drift to this, but I appreciate the info.
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BAd Wife
Social climber
Tehachapi
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Moehass, yes, gelatin soup, though you can make it with a combination of knuckle and marrow bones. Feet aren't required, but they're a nice addition. It's the 48-72 hours of simmering that's super important.
The link I posted works when I use it, so I agree, try copying and posting into your browser, or simply check out drmirkin.com.
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Frozenwaterfalls
Ice climber
California
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I can't stress enough how important an excellent PT is for soft tissue damage when you get to that stage of healing. I dislocated my heel (yes, you can dislocate your heel) when my foot went down between two bouldering pads. I reduced it immediately right on the spot and then got hauled off to the ER because I couldn't weight it at all. The docs there didn't believe anything was wrong because a) they didn't believe I had reduced it myself and b) they couldn't see anything in the x-ray which was because my foot was the size of a baseball and they didn't get good resolution. They sent me to a podiatrist?!?! who put me in a boot and told me to stay on the crutches and said I would be fine in 6-8 weeks. I thought this was total BS so searched around for the best foot orthopedic surgeon Kaiser has and forced them to give me a visit with him. He was horrified at the diagnosis and after MRIs said I did have a small break and that I needed to be in real PT, not what Kaiser offered. He wrote a note for me so I could go out of plan and I went to the place where every other climber I know gets treated. Very long story short - 3 months of Kaiser PT still had only 50% range of motion. 1 week of excellent PT had 80% range of motion and by 2 weeks had 95% back. I am still careful now but did waterski on it 2 months out of injury (not smart) and was windsurfing to try and improve my proprioception (with the blessing of my good PT) and doing 50 km hikes (also with her blessing) within 5 months. Crack climbing was 7 months later. I really credit where I am at with the correct diagnosis by the right doc and the excellent PT (Sports Orthopedic Specialists in Oakland). And in the meantime, while still in the boot but off crutches, I did a lot of "hiking" in the pool. Doesn't hurt when you faceplant ;). Also used a hand erg and hang board. There are still ways to stay fit! Good luck and heal up well!
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 8, 2015 - 02:19pm PT
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Jim, thank you for sharing. This goes to show there's always a better way, we just have to find it.
Bad wife, the simmering serves to get all the collagen/connective tissue out and in a bioavailable form, right? So something like collagen hydrolysate from Vital Proteins would be just as good, right? Feel free to pm me your thoughts if there is a thing on this forum about endorsing commercial brands...etc
Frozenwaterfalls, what do u mean by 'reduce' here? Relocate?
Also and forced them to give me a visit with him , He wrote a note for me so I could go out of plan those are formidable feats, I didn't think that was even possible, how did you do it? I mean how did you build your argument? What did you say?....etc.
Obviously I suck when it comes to dealing with insurance
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 8, 2015 - 05:07pm PT
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Also, Frozenwaterfalls, it would be great if you can go into the details of what techniques and methods were used by both pts.
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Frozenwaterfalls
Ice climber
California
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Reduce is to put the bones in the joint back where they belong. Not sure why it is called reducing a dislocation but that is what I was always taught (in WRF and such...) My foot was at about 90 degrees of where it should be. Was pretty obvious something was dislocated and adrenaline and pain made me want it back in place pretty quickly!
As for getting a different opinion, Kaiser is a big pain to be sure. Not only do they want you to only see Kaiser doctors but only ones for the location that your GP is at. And some are more open to you getting a second opinion than others. I looked through their directory of orthopedic surgeons and found one with excellent credentials at the Walnut Creek location (I normally go to the Oakland location). Caveat is I did research in the bone implant field so I know a lot of the academic societies and organizations folks belong to so I could judge that this doctor should be pretty good. I then had to talk with my GP and explain the situation and she was willing to file a whole bunch of paperwork for me in order for me to get an appointment with him. Was a pain for me and a pain for her, but the risk of not getting a good diagnosis was worth the effort. Plus I have an excellent GP who was willing to do this for me.
As for the outside of Kaiser referral, the PTs would not see me without a doctor's note, irrespective of who was going to do the paying. But the orthopedic doc was the first to say that I would get better care outside of Kaiser for sports medicine issues so after we went over my MRI and x-ray results, he was more than happy to write the letter. Mind you, I had to pay for all my PT out of pocket at $80 a visit (whereas it was only a $10 co-pay at Kaiser) but $10 for nothing versus about 5-6 weeks of intensive PT (2-3 times a week for 1.5 hrs) getting me back to almost normal was worth it to me. It was a big expense I hadn't planned on, but therapy for going insane because it was really painful to even walk would probably be more expensive :).
Unfortunately, if you have an HMO, a lot of the time you have to be a very strong advocate for yourself. I am not sure how hard it is to go to a doctor/PT who is not on the list for a PPO or other insurance. Just keep asking questions and if you don't understand a policy or want a second opinion, don't be afraid to ask for clarification. It's your health! Fight for it as much as your fight for that final sloper on the top out :).
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Frozenwaterfalls
Ice climber
California
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Ahhh...been a while, but for the Kaiser PT they just did a few rotational movements while I was there with the PT (once a week) and then gave me a rubber band sort of thing and had me do rotational movements with it for resistance when I got home. Rotational range of motion and strength really did not seem to be my issue, but I am not a PT so I followed the instructions religiously with little benefit.
At my good PT, she first had me do a series of duck walks and other movements so she could see how I was compensating for the lack of rotation of my ankle and heel. Since I couldn't really bend my foot well (required me to hike on my toes when going even relatively gentle uphills), I was compensating by turning my hips out and other weird things. When I went in to PT I had to do a lot of flexion forward and back as well as balancing on one foot and rotating my body forward and back and side to side to try to get my proprioception back. I also did these sliding exercises where I stood with my feet planted and then slid one foot forward as far as I could. I could really see the difference as I got more and more flexibility back in my foot in how far I could slide my foot along the floor. Also toe raises to strengthen my foot in general. These were the later stage exercises and I had some in the earlier stages that I am forgetting. heck, I am forgetting a lot of them I am sure, but basically my PT asked me point blank when I told her about the rotational exercises against the resistance of the elastic band I had been doing what movement exactly in my natural motion does that mimic and strengthen? I had no answer...
I am sure that these descriptions make no sense whatsoever. I had pictures drawn for me and demos at PT so I could figure them out :). But really the big difference was my good PT had me do also sorts of walking around and other movements so she could see what the issue with movement was and could come up with a plan to fix it. Rather than "ankle/heel issues - see page 32 of generic PT protocol" which I had at Kaiser. They are not known for sports medicine PT there...
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 9, 2015 - 04:18pm PT
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Frozenwaterfalls, I think I'm in good hands, but one never can be too sure. Thank you very much for sharing
Everybody, I broke my initial recovery strategy down to three convergent aspects:
A. Proper* reduction of disruptive scar tissue.
B. Proper* restructuring and mobilization of newly modeled tissue or reformed tissue.
C. Proper* restoration and re-activation of proprioceptive function.
What do y'all think?
*Proper: employs Rapid Feedback Loop; aggressive and ambitous, but not hasty or wreckless.
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Moehass
Boulder climber
Laguna Beach
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Topic Author's Reply - Oct 15, 2015 - 01:01pm PT
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Got out of the splint few days ago. The boot fits a little differently with slightly more dorsiflexion, so it caused a little discomfort at first.
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