Picture this; you are watching your child play hockey when they fall awkwardly into the end boards. You feel a chill go up your spine and realize your child has just had one of the worst things happen to them and the pain is excruciating. A broken bone anywhere in the body is extremely painful and debilitating. You will usually call an ambulance or stabilize the area with a splint before you do anything else and get to the hospital for an x-ray. If it is positive, the doctors will tell you that they have fractured (broken) the bone and will need to be casted for at approximately 6 weeks. In those 6 weeks the muscles underneath the cast will become smaller (atrophy) and therefore the rehabilitation following the cast removal may be quite long and tedious. There are now new advances for fracture management that can get them back onto the rink and out of pain quicker.

In the summer of 2006, Ryan O’Marra (Saginaw Spirit, Canadian World Juniors, and New York Islanders first round draft pick, traded to Edmonton Oilers for Ryan Smith) unfortunately fractured his left fibula bone (outside of ankle). It was x-rayed right away and the bones were close enough that surgery was probably not required. Being a high level athlete, we knew he was going to heal quickly, but since it was right before the NHL training camp we wanted to try and fix it as soon as we could. Typical of any hockey player being away from the rink for a few days, let alone a few months was going to drive him crazy.

I had been seeing Ryan for something unrelated, but obviously when this happened we switched our treatment protocols immediately. I saw him within 3 hours after he broke the bone. He was put into a specialized fracture boot which he was able to remove for treatment purposes only. Right away the treatment started with the Matrix low-intensity laser over the fracture site and acupuncture for pain/swelling relief. He was instructed on the PIER principle (pressure, ice, elevation and rest) to do a home at least every hour. He saw an orthopaedic surgeon the next day and determined that surgery was not going to be necessary (good news finally!). The surgeon referred Ryan to purchase an Exogen bone healing machine.

The Exogen machine is a low intensity pulsed ultrasound machine developed by Smith & Nephew. It is applied directly to the skin outside of the fracture site to try and promote quick healing. Studies have shown that it has increased healing time by up to 38% when applied to certain types of breaks and bones. The downfall is that the machine is very expensive and a one time use only. The Exogen is only programmed to allow up to a certain number of treatments. Therefore at the prescribed two times per day for six weeks, that would equal 84 treatments necessary for a fractured bone. Once these 84 treatments are expired the machine is garbage. They will not re-program the machine due to cost and consider it more cost effective to distribute new ones instead each time.
Due to Ryan’s necessasity to speed the recovery process, he purchased the system and started using it after day five. For four weeks we treated the injury daily with the Exogen, Matrix laser, acupuncture and some manual therapy to speed up the recovery. After week one, he was able to ride the bike (with his boot on) to make sure his cardiovascular system would not suffer, especially after he had worked so hard on it in the off-season. After week four, Ryan was re-evaluated by the orthopaedic surgeon, who subsequently took another x-ray. The x-ray showed that the fracture had completely healed. The typical recovery time for a fracture is 6 weeks. So when Ryan was told it was healed, he naturally was ecstatic and wanted to put the skates on right away.

Ryan now needed to get ready to get back on the ice. He traveled to New York, then to Nova Scotia where the Islanders were having their training camp. He worked on his conditioning and strengthening with the Islanders medical team, but still wasn’t allowed to lace up the skates yet. Seven weeks after the fracture date, he put on the skates for the first time. He was sent back to his OHL team the Erie Otters, where he was traded to the Saginaw Spirit. He played again for Team Canada at the 2007 World Juniors in Sweden where they will repeated as gold medal champions.

Typical of most treatments for a fracture include putting a permanent cast on the area for a minimum six weeks. The fracture is x-rayed at this time and if it determined to be healed, the cast is removed. The physician will then tell you to start moving the affected joint as soon as you can and good luck! Unfortunately you will look at the area and realize how small the muscle has become and wonder if it will ever come back. Don’t worry it will, but certainly some form of therapy following the cast removal will speed up the process. In the future I am sure there will be other ways of healing the bones quicker and cheaper, but until then, this rehabilitation approach we took with Ryan certainly seemed to help speed things up.