‘Dem Bones, ‘Dem Bones
This month’s “Oh, My Aching Body” submission will address our amazing bones and the problems we cause them on occasion.
This might seem off topic, but I’m going to start with a look at the honeycombs that bees are so good at constructing. Not a single bee ever attended engineering school, and none of them have ever been taught that the hexagon is one of the strongest strength-to-weight shapes that can be constructed. But there they are, constructing those honeycombs like engineering masterminds.
The reason I bring this up is because our bones have a very similar structure. If our bones were solid, they’d be REALLY heavy, and it would be much harder for us to move. But the honeycomb-like construction allows them to be ounce-for-ounce stronger than concrete, yet light enough for us to move and function the way we do.
I know I’ve said it before, but I’ll say it again. …. Miraculous.
In addition to giving our bodies form and structure, our skeletons are home to the bone marrow that produces our blood cells. Some of those blood cells carry oxygen to all of our tissues (the red ones), some of them fight infection and give us immunity to ailments (the white ones), and other blood cells cause the blood to clot so we don’t bleed to death with every little cut or bruise (platelets). So while we may look at a classroom skeleton and see an inanimate structure, or a Halloween decoration, the bones inside our bodies are really quite active and full of life.
Bones adapt wonderfully to activity. Several years ago, scientists measured the bone density of a bunch of third graders’ tibias (shin bones) at the beginning of the school year. Half of the third grade classrooms were led by their teachers to stand up next to their desks and stomp their feet 20 times each, 5 times per day. The other half of classrooms didn’t do anything different than usual. At the end of the experiment, those little third grade bones that stomped 100 times per day showed REMARKABLE differences in bone density. It’s not like their non-stomping control group counterparts weren’t also jumping and running and playing as much as they possibly could during the experiment. They’re all third graders, so they’re non-stop motion, jumping off playground equipment, running wildly for no good reason, hopping onto benches to avoid imaginary lava, jumping over rocks to avoid imaginary alligators…. But the experimental group stomped an additional 100 times per day, and their bones adapted noticeably to the added stress.
Ballet dancers who spend a lot of time en pointe have remarkably thicker first metatarsal (instep foot bone) than non-dancers, because that bone becomes a weight-bearing bone, and must adapt to support the entire body weight of a ballerina (like, 85 pounds, right?). But it’s not all good news for bones under stress. Sometimes we ask more of our bones than they can deliver. Those dancers with the super thick first foot bones are at a fairly high risk of experiencing something that’s actually called “Dancer’s Fracture” when the fifth foot bone just snaps while they’re dancing.
Last month I wrote an article about muscle strains and joint sprains, and I was able to give a pretty standard recommendation for approaching any and all strains/sprains. For virtually every strain/sprain you’ll ice, rest, and elevate for 48 hours, then add heat and return to play slowly. But when we’re talking about bones we can’t make such sweeping statements. For example, one time I had two football players with broken lower legs. One broke his tibia (shin bone), which is the weight bearing bone of the lower leg. The other broke his fibula, which is the non-weight bearing bone on the outside of the lower leg, and its main function is to serve as an attachment point for the tendons and muscles that operate our toes and ankle. One player was in a cast, on crutches, not allowed to put any weight on his foot for several weeks. The other player was walking around in a walking boot three days after breaking his leg. Both of those are fractured lower-leg bones, but the protocols varied significantly. If you break your wrist, you’ll have a different protocol than if you break your skull. If you break your nose, you’ll have a different protocol than if you break every. single. rib. in your rib cage.
I don’t know which readers need to know this, but after menopause we lose estrogen, and that leads to lack of bone density.
After that sentence I have two things to say.
First, it’s wise to stomp your feet and stress your bones after menopause, to counteract the effects of a natural decrease in bone density.
Second, shout out to the guy who discovered the correlation between estrogen levels and bone density! World War II was underway at the time of this discovery, so while one group of scientists was figuring out how to turn atoms into weapons of mass destruction, Fuller Albright was connecting the dots of a mystery that had plagued women for millennia, about three decades before the emergence of “Women’s Health” as a medical discipline. So, hooray for his pioneering work on estrogen replacement therapy! He discovered that women who received estrogen replacement didn’t shrink as much as women who didn’t, and they didn’t experience osteoporosis and bone fractures the way their control group counterparts did. It was really a remarkable finding, it didn’t happen until my mother’s lifetime, and today we take that knowledge for granted.
More recent scientific advances have figured out that in osteoporosis, the cells that build new bones aren’t working as quickly as the cells that cart away decaying bone. Scientists figured out how to slow the function of the cells that cart away old bone. (WHAT?!?! That’s incredible!) People with brittle bone disease and osteoporosis have a new lease on life with medications like Fosamax. But whenever humans get involved in modifying how the body works, we always solve one problem but create others (as you’ll always learn when you listen to the side effects portions of pharmaceutical commercials). Fosamax might increase bone density, but the density isn’t being preserved in a hexagonal/lattice pattern discussed at the outset of this article, so there’s a higher incidence of people’s femurs (thigh bones) just fracturing horribly under normal activity when they take Fosamax. A woman will just be walking down the sidewalk with the dog, and her thigh bone breaks! Her wrists and spine and other bones are fine, but then she experiences what everyone says is the most painful fracture possible. I encountered one woman with a fracture like the one you’re seeing in this x-ray image when I was working at a physical therapy clinic in Phoenix. She went on a ski vacation and managed to break her femur when she wrapped her thigh around a tree trunk while downhill skiing. It’s not an easy bone to break, usually requiring a car accident or motorcycle accident, and setting it right takes a lot of anesthesia, traction splinting, rods, plates, screws, and pins. To fracture a femur while walking a dog illustrates the necessity and brilliance of that honeycomb design that makes our bones function more like steel, and less like a stick of chalk.
One of the newest interventions for osteoporosis is vibration plate therapy. Instead of stomping on the floor next to an elementary school desk, similar benefits can be gained by standing on a vibrating plate for just a few minutes each day. Vibration plates deliver stomp-like stresses to the bones and muscles, forcing them to adapt by getting more dense. Whole Body Vibration (WBV) on a vibration plate also increases the abundance of those cells that build bone, which is an effect also noted with regular exercise (like pickleball).
In summary, if you think you have a broken bone, you’ll need a doctor to evaluate it. For it to heal - I hate to say it - you’ll have to rest it. Bones that are broken are very busy at the cellular level, and must be allowed to knit together for about six to eight weeks, without the added pressure of holding a pickleball paddle with a broken hand, or getting around without crutches on a broken ankle, or protecting your panting lungs with broken ribs. Just sit down and let the bone heal. If this is relevant to you, ask your doctor about hormone replacement therapy, consume calcium, take some Vitamin D to help absorb the calcium, and stomp or vibration plate your way to some better bone density. The best thing for your bones is weight-bearing activity, so do some planks for stronger arm bones, walk or stomp for stronger leg bones, and keep getting your bones out onto the pickleball court!
Any other topics of interest? Let me know!
