Comment by ehnto
4 days ago
The pathology for broken collar bones was changing right as I took up mountain biking, and subsequently shattered my collarbone.
It was hotly debated at the hospital, if my specific case should be operated on or not. Each time I had a checkup, one doctor would say "wait and see" while the other was saying "I can't believe we didn't operate on this".
At any rate, the outcome was as good as if they had operated on it, according to the doc anyway. Nice of them to test it out on me!
More related to this though, I have broken both my collarbones, the first time I had little direction and just held my arm still for 2-3 months. It took forever to heal, and my arm atrophied significantly. The second time, similar severity. I was guided through rehab and I was back using my arm within the first month, very little atrophy.
I had a broken collar bone last year in Bucharest and I moved back to my hometown because of it. I had to check in after a week or two to see how it's healing but was lazy about it so I went to the hospital after 3 weeks and was told there's a waiting list 10 days long and go to a private clinic. At the private clinic the doctor didn't even look at me, or the x-rays I just took and just told me to go into surgery back in Bucharest. Luckily when my mother heard she found a surgeon through a friend of a friend that looked at my x-rays on whatsapp and told me it's fine but just to be sure to visit him in Bucharest feel it in person, which the private care doctor never did.
So after 4 weeks I went to this last guy in a public hospital, told me I'm fine and can take off my brace, wait a week or two and go into physical therapy. Also told me in 20 years he only had to once or twice do a collar bone surgery so it's almost never the answer.
It's amazing that just being told I'm fine I could relax and all my muscle aches literally were gone 1 hour after that meeting so my advice in general is, be very careful what doctor you choose because medical hexing really is a thing. We put doctors on this pedestal and if God forbid you catch them in a bad mood they can fuck you up worse than before you saw them.
Placebo and nocebo are strong effects. Even when the people taking placebos knows it, they still work.
https://www.nature.com/articles/s41598-021-83148-6
Man, that's a wild ride just to get a proper diagnosis. It's crazy how much a doctor's attitude can shape recovery
I left out a bit, before I saw the doctor that told me surgery is the only way, I was consulted by another guy that was free and he scolded me because I came without the orthosis saying stuff like I don't want to get better and basically didn't even look at me or check my recovery after 3 weeks of wearing the orthosis. Told me to go to his private clinic and get a new orthosis where I decided to see any other doctor because I was put off by his attitude. I think the private clinic had a contract with the hospital I was sent to for the surgery or something.
Anyway thank God I found a decent doctor.
I shattered my collarbone - and I do mean shattered, ~8 pieces - in a mountain bike crash September 2023. I went over the bars after the back wheel of my hardtail caught a berm. Landed on my head and shoulder and compressed it laterally inwards by about 2 inches.
Even with this mess, it was hotly debated for around two weeks whether I needed surgery. A good chunk of my collarbone was trying to push through my skin and the other half was fusing to my scapular and was starting to compromise nerve function. Even then, because the non-surgical route is now considered the standard, I was meeting resistance to have an ORIF. It seems that the about turn from surgical intervention has been so strong that getting ANY surgical intervention is a battle.
I eventually came across a surgeon who took one look at me (never mind the imaging) and scheduled me for surgery. ~18 months later I’m now on a waiting list to have the plate removed, and strangely have gone off cycling… Surfing has happily taken its place.
Also shattered mine mtn biking (2022), and the surgeon scheduled surgery as soon as he saw the x-ray. I broke it twice as a teenager, and went through the sling route for both of those.
The craziest part about the plate is how quickly the pain from instability was relieved. I could finally sleep and honestly could've used my arm at ~80% days after surgery. I still have the plate which causes some discomfort, but I likely won’t worry about it.
In light of the article, I wonder if the plate encouraged/allowed me to use my arm in ways I wasn’t aware of. Funnily enough, it’s almost the definition of a crutch but one that allows me to use my arm more than if I was just hugging my body in an attempt to avoid that sharp pain.
Never lost my fear of the mtb, just focus on the uphill and cross country more.
Do yourself a favor and don't wait too long to get rid of the plate: when you crash on that shoulder again, the collar bone won't be able to do it's job of being the predetermined breaking point that saves the shoulder ligaments from ripping. And the AC ligament, unlike bone, will never recover. Not even with the surgery that you'll then likely need to at least restore the other shoulder ligaments. Fractured collar bone is a feature, not a bug.
Yeah, I failed to get my plate removal appointment in time, then I got a plate replacement appointment on the fast track and the next removal appointment then happened to be almost the same day as the one originally scheduled (the plates for separated shoulder stay in much shorter, and they better should, because they aren't painless at all)
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Shattered mine mountain biking as well (6 pieces). Ortho took one look at it and scheduled surgery for the next day. It wasn't a 'standard' break since it included my AC joint and coracoclavicular ligaments which needed a special type of plate. Ultimately it took 2 surgeries (ORIF, then plate removal). Total recovery was 9 months. My arm/shoulder is as strong as it was before, and it looks anatomically correct.
My shoulder immediately felt "better" after ORIF. I would suggest it if it's way out of whack... mine was drooping probably 2". I can't imagine how much it would suck if the bones healed that way.
Mine felt immediately worse after the ORIF. After two weeks getting comfortable in their new positions, all the ligaments really resented getting wrenched back into place.
Good illustration was that my run of the mill, 45 minute surgery ended up taking 4.5 hours.
It’s good to hear that everything felt good after your plate was removed. At 18 months post-surgery, I’m in a really good place where I can do most anything I want. Only occasionally experience discomfort if my son headbutts the plate or a backpack strap rubs on it. I was in two minds about having it removed as it would be a step backwards to post-surgical, but the likelihood of me doing something stupid again in the future means it’s worth it. Rather have the fuse that a clavicle is rather than fracture my sternum!
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Almost everyone I know that mountain bikes, had broken their collarbone.
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I also broke mine in a crash, had surgery, but have not bothered to get the plate removed and it's fine?
The only time I really notice it is if someone pushes on it or if I'm doing front squats with a bar.
Get it removed: the next hit will be much worse than a broken collar bone if the bone can't do its job of giving in before less restorable parts of the shoulder give in.
Interesting. I shattered mine similarly while snowboarding, but back in maybe 2018. There was definitely no debate on the matter, surgery via ORIF was the recommended option. Then again, my doc was a sports medicine surgeon so perhaps that played into it. Either way, I was never too light with it and it healed very quickly. I was back at 100% about 2 months later.
Functional outcomes seem similar, trough we have a increased rate of malunion, delayed or non-union with nonoperative treatment. We usually indicate surgery if it's an active patient.
Welcome to the waves! Best sport in the world, especially if you can avoid the crowds.
Thanks! I've always been a surfer, but split my time with other activities. Post-accident everyone thinks I'm scared of getting back on the bike — maybe a bit? — but genuinely my first thought post-crash was how long I'd be out of the water. It was a clarification of what I truly enjoyed, and an excuse to double down on being in the water.
I'm now doing anything and everything to get in the sea and improve my surfing. Lengths at the pool for strength and endurance, free diving (and spearfishing) to reduce the anxiety of those big hold-downs. It's been liberating choosing just one sport to be good at.
I've still never heard a satisfactory explanation for how in the hell two parts of a bone, broken such that they aren't even touching, can find their way back to each other and heal. My son broke his collar bone, and the hospital sent him home in a sling. When I looked at the x-ray, I couldn't believe that's the correct treatment. But a month or two later and he was good as new. Absolutely blows my mind every time I think of it.
It starts with bleeding. The blood in the region of the bones forms a squishy mass that is not bone, but through which cells can flow. Specialized cells deposit calcium into this mass, guided by hormonal and chemical signals. If you imagine the two open bone ends as emitting a sphere of chemical signals, where the two spheres interfere constructively is where the 'signal' is strongest and where you want to deposit calcium. Bones are not just calcium of course, but that's the gist.
I broke my collarbone about 30 years ago. Then had it partially rebroken when a friend forgot about my healing bone and greeting me with a shoulder grab from behind. (He felt like shit afterwards). I got the most basic healthcare a free college clinic could offer. Today, you can only tell I ever broke it when I'm shirtless and at my skinniest weight.
Mine ended up healing with a 15mm overlap. So it is a weird shape. It gives me 0 issues however.
They sense other bone tissue and grow together I guess. Same for severed nerves, up to a point.
Apropos of nothing in particular, when I first started mountain biking, a guy I was riding with told me: "You can divide all mountain bikers into two groups: the ones who have broken their collarbone, and the ones who are about to break their collarbone."
Knock on wood, 20 years later I still haven't broken a collarbone, but I've had plenty of scrapes, bruises, cuts, etc, a couple of concussions, a torn rotator cuff, and quite probably a broken neck (never went to the doctor to have it diagnosed, but I landed on my head hard enough to crack my helmet and knock me unconscious for a few minutes and my neck hurt for like 6 months afterwards).
Still, wouldn't trade it for anything in the world. Nothing like being out in the woods, on a bike.
Is there padding or gear sold that can reduce the likelihood?
Strength training can help reduce injuries from crashes up to a point.
Experience helps too but that’s harder to get safely!
For collarbones specifically? Nothing I'm aware of. At least if the explanation that was given to me for the high prevalence of collarbone injuries is correct, that makes sense. Someone explained it to me as "when you start to fall, you instinctive tend to reach our towards the ground to try to break your fall. So your hand is the first thing that hits the ground, and all the energy of the fall goes up your arm and into your shoulder / upper chest area. And the collarbone just happens to be the "weak link" there and so tends to break."
Now maybe that's just folk wisdom that isn't really true, but it sounds plausible to me. And if we reason by analogy a little, it's not too far off what my surgeon told me when I tore my rotator cuff. I fell and came down on my elbow, and he explained that the energy from the fall pushed my humerus up into my shoulder, and pinched my rotator cuff between two bone heads, which is what caused the tear.
So yeah, not much padding can do about stuff like that I guess.
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Given the amount of injuries related to mountain biking, is there some specific insurance needed for it? It seems one of those "net-negative for the society activities", like trampolines.
this is such a wild take to me... it's impossible to quantity at what point something becomes a net negative for society. Smoking seems to be an obvious example, because it's addictive quality inhibits a fair decision to the smoker, and it's something with a lifelong pathology.
But trampolines and mountain biking are both activities that result in ephemeral injuries. There is the rare case where a particular injury might become chronic, but how is that a drain on society, and not primarily the individual?
by your logic, should we also ban (or require insurance?) for football (hand egg), boxing, martial arts, (Tai chi?), cars, religion, guns, knives, prescription medicine, children, leaving your house at all?
edit; I'm happy to steal more ideas from sibling comments! I already stole football, but now I want to add obesity, and all mental health conditions.
I'm really curious about the context the idea of net negative comes from, but I probably should also take a stab at a conclusion; why contrast individual actions and decisions in the context of society at all? The decision to do anything should stop at 1st order, and maybe 2nd order effects. That is to say, when trying to improve society, it's fair to look down into smoking and say, we should spend attention on fixing this. But it's incorrect to look at an individual decision "should I smoke" and weight it's effects on society. (How will this effect my family, or my environment is 2nd order, and should be accounted for)
> but how is that a drain on society, and not primarily the individual?
There are two factors.
The first is that a drain on individuals is a drain on society. That's why we outlaw risky behavior like lethal recreactional drugs, driving without seatbelts, driving without a driver's license, etc. We try to protect people from themselves in some of the worst aspects that we can.
Second, of course, is health care costs. Activities that constantly result in injury wind up raising the health care costs for everyone, since that's how insurance works.
> by your logic, should we also ban (or require insurance?)...
You already have to have car insurance, yes. And yes lots of kinds of guns are banned in lots of places.
We draw the lines in different places.
It is a pretty interesting thought experiment to wonder whether people shouldn't be allowed to engage in organized sports that are risky, without paying an additional health insurance premium? E.g. if you play professional football, then your league has to pay extra money into the health insurance fund to compensate for all the extra health care treatment their players need and will need.
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Yes, we should absolutely ban, at the very least, contact football among minors. We have ample evidence of football (and soccer, too, for that matter) student athletes developing full blown CTE by their 20s, and with lifetime risk thousands of times the general population.
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> now I want to add obesity, and all mental health conditions
If you have a way to just not have those, the way you can just not use trampolines, I would love to hear it.
Don't forget about the alternatives. Is mountain biking worse than watching movies - biking will of course have more injuries, but it also builds physical fitness and so long term is probably better for you. (or maybe just my anti-movie bias is showing?)
I agree that a ban doesn’t make sense, but even “ephemeral” injuries routinely generate significant costs.
(In my experience, musculoskeletal injuries are rarely completely ephemeral, they tend to have long-term effects, even if minor.)
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Controversial take: On a population level, the negatives of smoking are at least partially mitigated by the "smoking suppresses obesity" side effect. Obesity is such a huge (pun not intended) public health issue in modern American society that any intervention reducing it is actually quite valuable.
It's at least arguable and perhaps even true that we as a society would be better off if everybody used tobacco at 1950's rates and therefore got skinnier, especially if we all just dipped Zyns or similar smokeless "low harm" nicotine formats instead of smoking.
That said, I personally use 0 tobacco/nicotine etc.
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I don't know that "normal" mountain biking is any worse than cycling in general, or sports like tackle football.
A lot of the injury risk when mountain biking is reasonably easily mitigated by controlling your speed and walking the bike through terrain that's above your skill level. There was a report out of British Columbia a few months ago about injury rates, and they were high, but BC is also a major downhill trail region.
Certainly, compared to road cycling, I know more people with major injuries from being hit by cars than from crashing solo on a mountain bike. And for my own cycling injuries - a few concussions, the worst of which was on the road bike (during a race) and a few torn rotator cuffs/mild AC joint separations.
The way I always looked at it (based on my own anecdotal experience, plus those of my friends around me)... you're probably more likely to get "hurt" in some sense while mountain biking, but probably more likely to get "killed or maimed" while road cycling (eg, being struck by a car).
Curiously enough, I have been road cycling for 10+ years now (and mountain biking much longer) and I only just picked up my first crash and injury from road cycling on Jan 1. I crashed and sprained my wrist. :-(
Another factor worth considering is that being physically active also prevents other ailments, so (even downhill) bikers may still be more profitable for insurance companies!
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> Certainly, compared to road cycling, I know more people with major injuries from being hit by cars than from crashing solo on a mountain bike.
Speed must be part of it. Low sun and going into the back of a parked car or other obstacle is a common mistake, and road bikes get up some good speed on most rides. Many riders pass 80kmh on a regular basis, which doesn’t leave a lot of room for error. I’m rather slower than that, but 50-60kmh would be a daily event.
> A lot of the injury risk when mountain biking is reasonably easily mitigated by controlling your speed and walking the bike through terrain that's above your skill level. There was a report out of British Columbia a few months ago about injury rates, and they were high, but BC is also a major downhill trail region.
Yeah, with downhill biking, “controlling your speed” means making sure you go fast enough to land the jump on the intended downslope. Go too slow and you’ll land wrong.
> I know more people with major injuries from being hit by cars
_hit by drivers_, you meant?
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Yeah. I did have a fall (for no good reason) cycling on a carriage path in Acadia National Park. But that's almost certainly safer than road biking on a busy road. And I do think a world in which you have insurance companies micromanaging what they will cover for various outdoor activities is not one we want--and it's not clear that it even distinguishes from people who are very sedentary.
In general, "society" deciding what activities are too dangerous to routinely allow is a really nasty slope. Yes, there's some special insurance offered through private organizations for things like higher altitude mountaineering. But it's not that big a step to rule that any contact sport, for example, should require special insurance. I'm sure the insurance companies wouldn't mind.
One thing which comes to mind is - why should we stop at sports, then? we'll immediately be at the point where smokers, alcoholics, obese people etc. should pay more, after all, their way of life statistically causes higher costs.
(i don't think either of those things should result in higher insurance prices, just continuing the thought.)
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I play recreational hockey. All of the rinks around here (and most of the US) require membership to USA Hockey which, among other things, provides some kind of insurance to both the rinks and the players.
https://www.usahockey.com/insurancemanagement
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Trampolines are indicated because YOUR home insurance could be on the hook for someone ELSE being hurt on your trampoline. And it's easy for them to exclude it.
Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
> Medical insurance generally covers your own accidents/mistakes, because it's not like you're going out searching for them for fun.
I wonder if the guys from Jackass had trouble finding health insurance.
By this logic, most software engineers would also be considered high risk since they work a sedentary job and have higher risks for heart disease and obesity (which likely leads to higher healthcare costs over the long term)
Telling people they're not allowed to have fun in the manner of their choosing because it would be bad for society sounds like a great way to discourage people from caring about society.
Why should you be forced to pay insurance if you don't endanger others? Most situations where you are forced to have insurance are cases where others are endangered (eg. driving).
You mostly aren't. But you're also foolish to not carry health insurance and homeowner's insurance (even aside of liability) in the US.
No? I’ve been mountain biking for over 20 years and never any broken bones or had to go to hospital as a result, despite doing downhill, trials, and dirt jumping. And I have 20 years of fitness to show for it - that’s about as positive as it gets.
Get 8 billion people to flip a coin 30 times in a row, and one is likely to get heads 30 times in a row. It means nothing.
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You haven't addressed the argument (riskiness of the activity) with your anecdote.
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There is no specific insurance required that I'm aware of... It's an activity that's well within the normal allowance of jackassery that everyone is entitled to.
I think that a big part of the issue is that banning it sounds a little like banning all sex because someone might get a venereal disease. Yeah, maybe there are some negatives, but there are also a lot of positives, and people are really like the positives.
Kids have so much joy on trampolines! I know they have dangers but net negative? Do you have data or anything?
I'm all in behind your idea: let's do the net result for society of every activity, and mandate people to do the most positive one, while banning the most negative ones!
The good thing is, then, I'll be mandated to go mountainbiking instead of staying sitted in front of a computer all day long!
How can I vote for your program?
People slip in the shower so lets stop bathing.
I've been advocating mandatory shower-helmet laws for many years now; it would make as much sense as a lot of the other nanny-state regulation does.
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We probably should have lanyard-equipped showers.
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My wife is a physiotherapist in Europe, and even ten years ago she would tell you to start exercising it (with guided exercises) as soon as possible.
Also broke my collar bone and no surgery, shoulder is less large by 2cm, I had no issues in the short term, but now after 10+ years it's cracking more, it doesn't age well
I asked if it was possible to do a surgery now, so they'd have to break and restore a longer collar bone, more straight, but surgeons don't seem positive for this
A personal philosophy in medical decisions: - unless there is a severe risk I might die from lack of intervention (on any reasonable timeline besides life), I avoid intervention.
In some cases (my messed up jaw and a whole 9 wisdom teeth), I broke this rule. But generally, it has served me well.
I have a similar viewpoint; over a decade ago, I had a nuisance tendon issue and went to a specialist who recommended surgery.
The surgery had a risk of serious, life-long consequence if it went wrong. He said that if I can live with the tendon issue, we can delay surgery indefinitely... so we delayed.
A month later, I stopped doing a certain workout at the gym, which resolved the issue within days. No need for surgery at all.
I do think that some specialists can be so focused on their speciality (i.e. surgery) that they don't think outside of that paradigm (try a different workout at the gym), and it's up to the patient to effectively shop around to get the best advice.
You must have broken yours around the same time my dad broke his. They didn't operate and apparently some of the people who saw the x-rays were quite surprised how well the natural healing process handled pulling the bone pieces back together.
I had a clean break on mine. If I had not had surgery I believe my shoulder would have been a centimeter or two lower. So I got a plate and 7 screws.
Am I right to understand that had I not gotten the surgery my shoulder would’ve likely returned to the normal position?
usually it shouldn’t affect position or function of the shoulder once healed, and while the clavicle does tend to heal with a “bump” in it at the site of the break, its long been thought that the risk of surgery at that site outweighs the benefit. But it does depend on the specifics of the fracture: https://www.orthobullets.com/trauma/1011/clavicle-fractures-...
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When I was a kid (not in the U.S), I remember village elders diagnosing all kinds of illnesses simply from checking one's pulse, without asking any questions or even talking. These are people with minimum education, minimum or zero exposure to science or labs or modern medicine.
Now we have all kinds of powerful, fancy machines and drugs and procedures and today's doctors still misdiagnose, mistreat even relatively simple issues.
I don't know if it is because we as humans have lost touch with nature, our own bodies or we have way more illnesses today than I was a kid 4 decades ago or what else is the reason. It is kinda depressing and mind boggling at the same time.
when my grandma was a kid she remembers the village doctor telling her she has ghosts in her blood and she should do cocaine about it
I get the impression from the second part of this that you think the village elders were correctly diagnosing things?
I wonder how likely that is? I suspect their understanding of their diagnostic technique is flawed, but beyond that, would a small enough group have a similarly small pool of common afflictions such that you could develop a useful body of medical lore?