Now Finished: Ask Me Anything with Trauma & Orthopaedic Doctor Henry Turner

Apr 3, 2019
by Pinkbike Staff  



Update from Dr. Henry Turner: Thanks for all the questions guys! I am sorry I wasn't able to answer all of them. As a last thought, if you are still experiencing significant pain or discomfort from an injury, I suggest you have it checked out or get a 2nd opinion. Enjoy the trails and be safe. Cheers!


Henry Turner is a South African living in Ireland who loves the outdoors, rugby, hiking and mountain biking. He is an active member of the Royal College of Surgeons in Ireland as well as the AO trauma group. His specific interests include Orthopaedic trauma and sports injuries. He competes in a few local enduro races in Ireland and also took part in Round 7 of the EWS 2018 in Ainsa, Spain. He'd like to give something back to the mountain bike community and we figured this would be a good place to start.

What he can answer: Reasonably detailed questions about the limb/ area injured, what exactly happened, what did you do after the injury, where and for how long is it still hurting or affecting your riding/daily activities.

What he cannot answer: Cancer and funny breath questions, opinions about other doctors' management of the injury as I don't know the exact circumstances and I have not examined the patient myself, insurance advice, cost of surgery/treatment.

Disclaimer: The discussion and tips given in this thread should be taken as suggestions only, and under no circumstances should be deemed as formal medical treatment or advice. We recommend that, if unsure, you seek further treatment from a registered medical professional of your choice. An online forum will never be as thorough, detailed and accurate as a real visit to a medical professional.

Loic Bruni shows us how he s healing and how he s feeling about not getting to race these past few weeks.
Greg Minnaar returns to WC racing although is still showing the signs from that crash in Fort William.

Dan Wolfe retired after a crash on stage five and a dislocated shoulder.

How ‘Ask Us Anything' Works:

Starting at 10:00 AM PDT/6:00 PM BST on April 3, 2019, you can type your questions for Dr. Henry Turner into the comment box below this article and he'll have a crack at answering them. Sometimes your answer will pop up in a few seconds; others may take a few minutes while Chris works his way through questions that are popping up. Everyone who posts a question, large or small, will be taken seriously.

To make this go as smoothly as possible, try to follow these guidelines:

• Keep your questions relevant
• Stay focused and to keep your questions on one topic if possible. You can always ask about another item later
• Try to keep your questions to about 100 words
• Ask Us Anything is a service to PB readers who are seeking helpful information, not a forum to broadcast opinions or grievances. If you do have an issue that you want to ask about, no worries, just keep your complaints relevant and in the context of a question so that it can be addressed in a productive manner
• Use propping to acknowledge good (or not so good) questions and bump them up or down to where they belong

Dr. Henry Turner

Other time zones:
• 1:00 PM EST (New York)
• 5:00 PM GMT (London)
• 6:00 PM CET (Paris)
• 7:00 PM SAST (Cape Town)
• 3:00 AM AEST (Sydney, Australia)


376 Comments

  • + 74
 What’s your take on neck braces?
  • + 6
 Hey Doc similar question due to having artificial disc put in my C6-C7 about 18 months ago. It was due to nerve pain from a degenerative disc and some stenosis. Do feel a neck brace would help prevent further injury? I’m doing fine now and concerned a neck brace isn’t going to help with a compression injury. Thanks for the feedback.
  • + 2
 Interested in this as well. I haven't ridden proper DH since I had a spinal shock/concussion about 18 months ago after going head first in to a berm. I also have some spinal stenosis. Am I more at risk of permanent injury than someone else who hasn't had a spinal shock?
  • + 72
 Great question. Neck braces cause ALOT of online debate and I've scanned the articles trying to find a simple answer to whether they help to reduce injuries or not. A study done by the Great lakes EMS included more than 9000 patients between 2008 and 2018. They concluded the following:
1) A Critical Cervical Spine injury is 89% more likely without a neck brace
2) Death is 69%+* more likely (due to Cervical Spine Injury) without a neck brace
3) A Non-Critical Cervical Spine injury is 75% more likely without a neck brace.
4) A Clavicle (collarbone) fracture is 45% more likely without a neck brace.
5)Cervical Spine injuries sustained without a neck brace are more severe, require greater care.
6) A Cervical Spine injury of any kind is 82% more likely without a neck brace.

This study looked back at injuries and its level/strength is not as great as a fully randomised, blinded, etc trial (which would be ethically difficult to perform in any case) and many people argue that the data is incomplete for several reasons( you can check on the forums for detail)

My opinion is this: If you have a big crash and you are wearing a brace, it will most likely reduce the severity of the injury and may even prevent a serious injury from happening in the first place. If I were doing DH, I would wear one.
  • + 9
 @hcturner: Thanks doc. I guessing you feel the same way about enduro / aggressive trail riding? I should have mentioned that I am looking to wear one basically all the time because I make bad choices.
  • + 3
 @vertex66: I’m in a similar situation as you. Had an ACDF on my C5/C6 3 yrs ago and wear a neck brace when I ride DH. Haven’t needed to test out it’s effectiveness thankfully but I feel a little better having it on just in case.
  • + 6
 Mine broke my collarbone last year but saved my neck, I walked off the mountain and was able to drive myself home, neck brace for the win.
  • + 8
 @vertex66: If you want to wear it, wear it man. Better safe than sorry. I would never advocate against safety
  • + 4
 @vertex66: I personally use one and it’s flat out saved my life. I would HIGHLY recommend getting one. If I didn’t have it my neck would’ve been snapped by the ATV I crashed and I’d be a deadman.
  • + 2
 @hcturner: Nobody is advocating against safety, it's the theories about neck braces being more dangerous than not wearing one that has people asking questions. Mostly the idea that we'll naturally turn our head to avoid direct compression on the top of the head (the most dangerous kind) in case of a crash, and neck braces limit this instinctive turning and mobility necessary to keep our head and neck out of harms way. I'm not by any means an expert. Just wanted to clarify why people are asking the doc these kind of questions instead of just wearing one.
  • + 1
 @hcturner: Mine saved my life. Max speed headspear to the ground with direct stop. I would not be here had I not been wearing it. Broke other things, but my spine stayed intact. Peep my pics for the result. My helmet was cracked into 4 sections. Picture that impact going through a helmet and into tiny neck vertebra.
Anyway, point is that I'm so glad to see a doctor confirming what I have found that they actually work.
Thanks Doc!
  • + 0
 @hcturner: FYI I would recommend not using the "statistics" provided in the Great lakes EMS study for future reference, although compelling, they are not representative of reality. Referencing the study is fine and worth a read, but the percentages given are very misleading.
  • + 1
 @ZFuss: He literally said he isn't direcly relying on the statistics from Great Lakes EMS.

"This study looked back at injuries and its level/strength is not as great as a fully randomised, blinded, etc trial (which would be ethically difficult to perform in any case) and many people argue that the data is incomplete for several reasons( you can check on the forums for detail)"
  • + 1
 @patchestobin: The % values given are misleading at best and it is hardly a question of level/strength, "randomized, blinded, etc." is beyond the point. If the %'s are incorrect as he mentions has been discussed, then they should not be further reported. Perhaps instead one could say the study indicates less cervical spine injuries were recorded for riders wearing a neck brace. Numbers are powerful, but with great power comes great responsibility.
  • + 1
 @sammccooey: I hear what you are saying. The problem is a crash usually happens in a split second and we don't always have time to adjust to a "safe" position for landing. Braces are not perfect and certainly don't cover every situation / circumstance. The data shows they are beneficial in certain circumstances and real world feedback from riders supports this. However, the study referenced above is not a fully randomised trial and should be taken in its own context.
  • + 2
 @ZFuss: Like I said, the percentages are what they concluded from their study. This is open to scrutiny and that is why the forum on their website is open to discussion to provide more insight to people looking for answers. For now, we have to use this study along with crash dummy impact testing data and our own common sense to try and make the best possible decision. It's not easy but we have no other option for now.
H
  • + 33
 What is the most under-utilized piece of safety equipment? What do we currently used that has minimal impact (no pun intended)?
  • + 53
 I think riders underestimate the importance of elbow guards. Any injury or fracture around a joint is serious and can keep you off the bike for months to years. It can also lead to residual pain and decreased function. They can be uncomfortable though and I would like to see more development going into them to improve this.
  • + 6
 @hcturner: Great advice! I fell a couple years ago on my forearm (picture a 90 degree bent elbow). It caused some minor nerve damage that kept me off the bike for a month and it took over a year of therapy, exercise, and pain to fully recover. Elbow pads FTW!
  • + 3
 @hcturner: Exactly. Smashed my elbow into a root 5 years ago and broke my radius, dislocated my forearm and tore all my ligaments. It took 1.5 years to feel somewhat normal again and 2 operations as well as physiotherapy 3 times a week for that entire timespan. I will never have a full range of motion again, but I got lucky as just a few degrees are missing...
  • + 8
 @hcturner: interesting. I always wanted to wear elbow pads, but I started only last year, simply because i could not find anything that would be comfortable and wouldn't slide. A protection that is not comfortable and moves around is just a thing taking my attention from what I should be doing. It is amazing that it took gear companies so many years to make a "wear it and forget it" protection and many are still not there. Pre 2010, any upper body armor other than Dainese was utter sht.
  • + 2
 @WAKIdesigns: When I was young I was practicing manuals on my bike while waiting for the bus, but I was clipped in (stupid, I know). I smashed my elbow on the concrete when I went over backwards and couldn't clip out. It healed up in a few weeks, but now years later if I even slightly bump that elbow against a desk or door, it swells up and I can't do anything on it (not even pushups) for like a month.
  • + 5
 @WAKIdesigns: I never wore elbow pads for years and years. I started to wear elbow pad after finding that my elbows and forearms were taking most of the hits in crashes. It is interesting most riders don't wear elbow pads nowadays. Mostly a macho and fashion faux pas thing. I wear long sleeve jerseys now to not have a fashion faux pas. lol.
  • + 1
 @tacklingdummy: a thing is, on one sideto have fashion dummies riding big stuff in half lids and barely any pads. Most of them are good riders but still. But on another side of the spectrum you have fully kitted out folks, gigantic pads everywhere and... Bell Super 2R... it is a plague in the bike parks.
  • + 6
 @hcturner: Elbow guards for sure ! In the late 90s I hit the deck HARD, into a stoney/rocky surface.

No elbow guards. Lots of blood. My friend squirted his water bottle into it to clean it out.

We then went home and watched the crash on VHS tape. Then I went to hospital, they cleaned it out best as. 9 stitches total. Awkward job! It was at a funny angle.

Woke up next day, my whole arm, from wrist to armpit was MASSIVE. I didn’t feel to good!

Docter cut the stitches out straight away, sent me to hospital, I had septicaemia. 8 days inside, my parents were told I had a 30% survival chance.

Erm, I survived. (Phew)

I wear Elbw pads most of the time now.
  • + 1
 @WAKIdesigns: Waki what Elbow pads are you using. I've ridden park with lighter pads on and... Wait for it... My BELL Super 2r lol. Tho I was just following my kindergarter in a DH race. He's on a Proframe and I'm looking for decent DH helmet....and some better elbow pads.
  • + 1
 Haha the metal plate I got in my elbow on October after emergency surgery agrees with the premise of this comment
  • + 1
 @cristiantomlinson: I just had a very similar situation.

It SUPER sucked and would've been so easy to avoid with pads.

Now I ride ( have to ) even XC with elbow pads.

The whole no arm protection thing to be cool is so dumb. I learned my lesson.
  • + 4
 @Svinyard: POC Joint VPD.
@Dustfarter: results may vary. Of around 50 riders I know, none rides frequently in elbo pads and no more than half ride park in them. Only one bloke suffered broken elbow, that’s when riding street. There are more riders with tendonitis (tenis, penis elbow) than injury caused by a crash.Majoroty of World Cup DH and EWS racers don’t use pads and they crash a lot. Serious elbow injuries are simply uncommon. So “fashion”? I tell you what, I see folks riding xc in full body armor every now and then, I can tell most of them will hurt themselves soon. They have no mental capacity to deal with doubt and how to muster self confidence. The fear of crashing is like a shitty antivirus software interfering with every computational process in their head, handicapping their motorics.

Somewhere out there there is a guy with a giant scar on his scrotum, saying it is a stupid fashion to not ride with suspensor
  • + 1
 I went sans elbow pads one day...really for no reason other than trying to be like the cool kids. The day ended as Murphy demanded...major road rash type scar...30days of pain and suffering. It would have been absolutely nothing if I just kept the frickin pads on.
  • + 2
 @WAKIdesigns: IMO it largely depends on the terrain where you ride. If your trails are mostly dirt/roots I wouldn't ride with elbows either. If you live somewhere like I do in BC where half the trail is made of rock it might be worth considering. I like to joke now that "I always wondered how hard the rocks are". I promise you that if you land tip of your elbow first onto a rock that you're going in for emergency surgery.
  • + 1
 @friendlyfoe: I have as much roots, boulders and rocks as in Squamish. Steep happens too
  • + 1
 @hcturner First off, thanks for replying. I appreciate you taking the time.

@WAKIdesigns If I was a sponsor of a pro rider, I would do whatever I could to either demand they ride with elbow pads (protect investment), or put an elbow injury clause in the contract. There are numerous very nice fitting pads out there. It takes all of two or three rides to get used to having something on your arm.
  • + 1
 @rrolly: According to above, you should do that even for neck braces. Also if you were UCI director: knee guards for XCers, considering how rough courses got. Good luck!
  • + 2
 @WAKIdesigns: Squamish isn't that bad for rocks. Living in Penticton (wine region) the trails are mostly made of rock. The metal plate I had put in my elbow 5 months ago says this is the truth.
  • + 1
 @WAKIdesigns: LoL if you're bored feel free to watch this video. www.youtube.com/watch?v=s2fFo0XUmTk&t=65s . One of the more fun black trails here and the trail I broke my elbow on. This is not my video but a feed from one of the locals. Where I went OTB was the roll at 50s. Ridden this trail plenty of times but not a good place to choose to have a crash!
  • + 0
 @friendlyfoe: man, if it was that simple. People get seriously hurt in banal situations, like by tipping to the side and not being able to clip out. Then they crash, falling on their head while casing a 20ft long road gap with front wheel and walk away wiith a few bruises. Been there done that. I’ve done stuff, seen stuff. Including an elbow broken through 661 SP1 armor. Protective gear doesn’t hurt, but won’t save you from the btch called bad luck.
  • + 26
 MIPS. Gimmick?
  • + 10
 Also like to get your take on Bontrager’s new WaveCel!
  • + 8
 Just all these slip layers. Especially your view on how much they help compared to a hairy head in a standard helmet. The skin already slides a little over the skull, the hair slides over the skin, the bandana slides over my hair and the helmet slides over the bandana. How big would the relative contribution be of a slip layer inside the helmet?
  • + 8
 @vinay: When I read this, I thought you said "banana" vs "bandana" and then it struck me... why not a banana?
  • + 2
 Useful for the bald. For others, HAIR is sufficient.
  • + 20
 Good question! MIPS and Wavecel work by reducing the rotational forces on the brain during a crash. The theory is that this reduces the chances of concussion and a more severe injury called diffuse axonal injury. I think its great that the companies are looking into ways to improve helmet safety and efficacy but like all things, cost is the issue. The tests are also performed by using dummies and computer simulations so you need to take that into account as well.

My opinion is this: Your brain is everything, do you really want to take a chance? I would just go for a MIPS/Wavecel helmet and eat less meat and takeout for a few months!
  • + 4
 @vinay: I love your logic! Theoretically, you are correct with your slip layer theory. Bontrager says their tech reduces your chances of severe injury to less than 2% which would be amazing. Maybe you should write to them and MIPS to test your theory on a dummy model?
  • + 1
 @hcturner: looks like the originators of wavecel actually did test on dummies with a cover that's supposed to approximate skin (section 2.2 under Methods): trek.scene7.com/is/content/TrekBicycleProducts/WaveCel_Whitepaper-Evaluation_of_a_novel_bicycle_helmet_concept_in_oblique%20_impact_testing.pdf
  • + 1
 @hcturner: What's your beef with meat, doc?
  • + 11
 @RXN059: No beef! Just a money saving trick haha!
  • + 4
 @vinay: while I hate MIPS fear mongering from a few years back, especially on Swedish market, and their tests results are impossible to evaluate by a regular person, you can evaluate slip planes of your head during a crash to some extent. Put your helmet and bandana on your head. Crouch down and put your head on the ground. Now lift on your toes and loosen support by your arms to put weight on your head. Try to move your head in the helmet. You will see how friction builds up in your "eco version" . When I did it, with the the head completely sweaty, there's been quite a lot of friction between my head and my helmet. When I do the same in MIPS or SLIPS (POC) helmet there is like 1cm of movement felt instantly. The problem is though that latest helmets (and I tried TLD half lid as well as Proframe) have plenty of cuts in the mips layer (reducing it's surface and introducing potential grip points for it) The difference between a ski or fullface helmet with Mips, and highly vented MIPS helmet is evident. In my crappy tests I experienced less friction with large surface MIPS vs swiss cheese MIPS. But lab tests are surely better. My problem with it is that MIPS just became another sticker on the helmet like "eco" stickers on foods, which are meaningless and depend greatly on the particular situation/product.
  • + 1
 @hcturner: Thank you for your response! Yeah I've been discussing this with someone from Kali and they admit there is probably some sense to it but it is just too difficult to test as people head shapes and hair length/types are so different. I get that too. That said, with almost all women having quite a bit of hair on their heads and at least half of the male riders too (I'm a man but with relatively long and curly hair) it would make sense to include this in their testing. I'm actually using the bandana to keep my hair in check so that I can get the helmet on. @danny611: A banana wouldn't help there, but it would be a great solution for those who need to bring a snack but prefer to ride without a backpack. Either way, I think the person from Kali was considering to include this in their testing (the hair, not the banana). Of course I could discuss this with the people from Bontrager and MIPS too. I always just felt the people at Kali came across as most open minded so for a discussion over the internet, those were the easiest to chat with. As for the taking chances bit, yeah that's the question isn't it? An airbag in a car is safer for most people, except for kids in a rearwards facing seat (so you'll need to turn the airbag off). So what if the same goes for Wavecell? That it is safer for bald or short haired people but that it would actually grip long haired heads better. Not claiming that that is the case, just a concern that I think should be looked into. Not being one to eat meat but I've got to say cutting down on omega 6 intake and increasing omega 3 intake isn't cheap either (though also important for brain health).

@WAKIdesigns: I tried your experiment in the cheap On-One/Carnac enduro helmet (POC Trabec lookalike) helmet I'm using. It slides well over that cm. Laterally more than fore aft because my head is relatively long (fore-aft) and narrow for the circumference I need. So there is always a slight gap at the sides. I am considering upgrading to the Kali Maya 2.0 but I just don't get why that helmet is so angular whereas Kali themselves consider it would be best if helmets are relatively smooth to lower the rotational impact. The reason why I went with these On-One helmets is that I don't hesitate one second to dispose one when it cracks in a crash. Back in the days I always felt more reluctant to dispose of a more expensive helmet after a single hard crash, especially as I was crashing loads back then. I buy two of them when they offer them at 15GBP so there is no downtime when one cracks, I can just pick a new one for my next ride. That said, yeah I might try the Kali Maya 2.0 someday. It is just that I'm currently looking for a new full face, I'll probably get one with a slip plane, just to be sure.
  • + 0
 @vinay: which hair care products are you using hahah Big Grin
  • + 4
 @WAKIdesigns: Currently experimenting between chain lube and bearing grease. Chain lube is supposed to work at higher velocities though bearing grease at higher loads, so I'm still trying to figure out what's best for crashing safely.
  • + 1
 @vinay: Kali's free crash replacement policy convinced me to finally get a Maya 2.0 instead of getting cheaper helmets that I knew I would actually replace if I crashed.
  • + 20
 Lower back pain sufferer here. PT says it's all related to hips/core from being hunched forward constantly riding or sitting in an office job. So I've been stretching, doing yoga, core-focussed strengthening and have consciously worked on my posture and routines to sit less. But I have seen marginal gains at best. Is this just a matter of time to undo decades of poor maintenance or are there other approaches to consider?
  • + 6
 hey rob, i'm not the doc here, but i have the same issue as you, plus i had a double herniation L4-S1 about 4 years ago now. it definitely does take time, and i've found that doing stretches that focus on my hip flexors have helped a lot (and a lot of stretching that's recommended for sciatica as well). i recently started swimming laps at the recommendation of of a friend that had a similar injury to me, and i've noticed an improvement since i started. also, see if your employer would install a sit / stand workstation for you. i have one at my job and it helps me not spend so much time in a chair throughout the day.
  • + 6
 Personally I found some weight training helped. The basis of this is that once your leg muscles get tired on a big ride they are assisted more and more by your back muscles, meaning they end up hurting. Stronger legs and back through deadlifts (or similar) helped me massively. Do read up properly and take it slow when strength training your back, if not consult a specialist/expert...
You say you've been doing core stuff though so not sure if you've already tried this...
  • + 5
 Had the same issue with the same root cause - desk job lifestyle caused my core to atrophy to the equivalent of someone who was bedridden. The best evidence based and researched solution I found was the program from professor Stuart McGill who runs the spinal research lab at University of Waterloo. You can look up the routines and research that backs it at his website, backfitpro or look up online videos or borrow his books from the local library. It is more about building core endurance over core strength. I'm not a health professional and have no affiliation with him or his program. It does take time to build endurance - as we all know here - but you can measure the progress easily with how many reps for how much longer time you are able to do the exercises as your core endurance improves.
  • + 1
 Rob, I lead a similar life at work. I finally went with a FMS and was started on the SFIT path. I had major improvements in neck mobility in 2 weeks.
  • + 2
 Try other things, but stick with the PT maintenance schedule. Mine made much more of a difference after a couple years.
  • + 2
 @slimboyjim: This has been the key for me, lots of functional training type movements. Squats, dead lifts, loading one side of my body... Finally riding regularly again! Stretching is important to be able to perform the movements, but is not the true cause of the issue.
  • + 5
 Hi Rob. 20 year old with lower back arthritis. Im one of those unlucky guys. A huge thing to help against constant pain is change of diet. You need to have great hydration. Low sugars and a pretty healthy diet in general. If you consume a lot of sugar or alcohol balance it with water to avoid next day pain. Thought Id mention this since no one else has. Its a big deal. Sugar and alcohol inflames muscles and causes a lot of pain to the spine. Water deflames. Also keeps your spine all lubed up and happy. Smile
  • + 2
 Had lower back pain show up a 6 months after getting back into an office type job. Couldn't shake the pain with core strengthening and other rehab. Did some research on inversion table and bought one (Teeter). Used it daily for a month and back pain is gone. Still need to use it every couple days to maintain gains but very impressed with results considering I thought I would have a chronic issue in that area of my back.
  • + 6
 Another not doc back pain sufferer here: it will take time, but for me the two biggest things that corrected my lower back pain were
1) stretching, particularly hamstrings and hip/groin areas
2) slacklining

Hear me out on this one, but I decided to get back into it after a few years of not rock climbing. The core and stabilizer muscle workout it gives you is pretty unparalleled. It works every stabilizing muscle you’ve got basically. After even just a week or two I noticed I was putting out more power on the bike and my back wasn’t hurting (Probably more power BECAUSE any back wasn’t hurting, but still). At any rate it’s a ton of fun and the balance practice can’t hurt on the bike either, so it’s worth a shot regardless. Cheers
  • + 13
 Sorry to hear that man. Back problems can really reduce your quality of life. General advice would be focused physiotherapy, weight loss, stretching, etc. Results can take time and patience is needed for most back problems. Water based exercise and swimming seems to be a good alternative for balanced core strength and I see some of the guys have given their suggestions below as well. If you have any nerve root symptoms, it might be a good idea to get an MRI at some stage but I'm not sure how your situation is with radiology services at home? (Don't wanna go against local protocol)
  • + 4
 My LBP is lessened when I stretch the hammy's. Stupid office job.
  • + 1
 +1 on this same problem.
  • + 3
 And for all you readers without back issues, get your core sorted out and wired tight ASAP. Do the research, do the work. Herniated discs and other lumbar issues are incredibly painful and (as I can attest) disc surgeries are a modern medical miracle, but the best cure is prevention. Too many wasted years behind the wheel driving to be sitting at the desk then home to the couch cost me a world of pain and misery. Not sure how or if a workout regime will avert stenosis and arthritis, but do the best to prevent what you can.
  • + 1
 Hey Rob, also not a doctor but when sitting we tend to make a lot of mistakes by simply assuming we know how to sit properly. Most of us do not. If you haven't heard this before, sit as if you had a tail. It is a drastically different position for many. The high or mid-backed chairs we find ourselves in so often do not promote proper posture. Correcting my posture while sitting and standing has helped to relieve a small amount of my lower back pain. I have an L5-S1 injury so the biking (fetal) position is some comfort also.
  • + 2
 It took me over 2 years of weight training/PT to get back to normal wrt core and glute strength, and this also causes anterior pelvic tilt. It's super common, you see guys all the time with no a$$ and a big belly. Do front squats, bulgarian split squats, dealifts and 1-leg romanian deads, plus all sorts of extra core, including lateral rotations.

FWIW, I was stuck at ~135 lb front squats for what seemed like forever, then I made rapid improvements for what seems like no reason whatsoever and now can do 225 for 5 reps and still building. Good luck and DON'T GIVE UP!
  • + 0
 @hcturner: what is your take on myofascial release? I exeperienced IS joint inflammation a few months back (due to weight-lifting), possibly coped with minor muscle tears, and as I was almost recovered I tried this "trendy therapy" and my back got screwed up for real. My symptoms got way worse after lacrosse ball "treatment" than what they were straight after the injury. Dr. Google is parted on the subject (which is a warning signal no1) and a few online MTB coaches advise this "treatment" as a good thing to prehab your muscles before the season kicks in. Experienced weightlifting coaches on another hand are quite against it, pointing out at the fact that hard object with little surface apply too much sheering force to the muscles. Just wondering since I blame the bloody thing to be responsible for prolonging my injury for at least a month.
  • + 1
 @cypressjoe: Try stretching hamstrings, calves, lower back, hips, etc. All of that is connected to the lower back and when those areas tighten and shorten it creates back pain. Increasing range of motion and flexibility should help. I suffered lower back pain, sciatica, and spasms for years. Once I started stretching daily, I don't really have back pain. If I do, I can stretch to relieve the pain.
  • + 4
 @tacklingdummy: there are 2 problems with "oh I need to stretch!!!" culture. First of all, many 30yr olds can't even touch their toes and by the time they get 40, for some reason, injury or not, they want to stretch. And many of them do Yoga. Supposedly Yoga is the best way to stretch and it is engraved in fitness culture. The trouble is my second point: Yoga is nothing more but static stretching and is surrounded by a huge dosage of Woo. There is nothing European gymnasts are doing since a hundred years or more that yoga teachers can teach them. Static stretching is ineffective and unsustainable. You need to do it all the time and once you stop for some time it's results wither away quickly. You need to do dynamic stretching in the first place. Forms of it are: good old ( and stigmatized by yoga nad functional movement circles) deadlift and squat. All that and then add the factor of women dominating the static stretching "sports", when they have way more genetically preconditioned flexibility due to their female physiology. So ironically, women who are lacking in strength department but have abundance of flex are into flex, while men who have abundance of strength are more into strength. And fitness world is strengthening this imbalance, and when they finally adress it, the way they do it is to preach the ineffective ways of gaining flex to men and ineffective ways to gain strength to women. Finally they throw highly questionable cardio/fat loss monkey wrench into it.
  • + 7
 Go dig on your trails for 3 hours once a week. You'll be amazed what that can do for core and community strength!
  • + 1
 I'm a PT and have dealt with LBP as well. One of the most awesome things I've come across (as corny as it sounds) is Gold Medal Bodies. Their Elements program is insane for hip mobility and core strengthening which is the root cause of many back problems. Usually loss of range of motion precede symptoms! Also if you're forced to sit for a living, consider getting something like a Salli Saddle. Crazy expensive, but do the math over 10 or 20 years.....
Cheers y'all
  • + 2
 I've suffered from lower back pain for at least 5 years for the same reasons but I've essentially 'cured' it in the last 3 months by doing Pavel's Simple & Sinister - kettlebell swings and turkish get ups every day. It's been an amazing change - fixed my posture and feel so much stronger on the bike. Highly recommend looking into it!
  • + 1
 Look at Sportandspinal.com. Get some good IMS.....it hurts but it works.
  • + 1
 Lower back pain checklist:
1.sufficient mobility (touch your toes with ease)
2.strength (Deadlift 1.5x body weight for men, 30 push ups, 10 pullups)
3.technique: you should be able to bunnyhop over a 1ft obstacle with ease.

Aim to do that before you look for other remedies. These are basic requirements, not even close to pro riders ability. If you cannot do that and you are doing lots of riding, paired with desk job, you are asking yourself for trouble. Raw strength and explosive cardio are the most underrated factors. All thanks to fitness industry and roadie science.
  • + 1
 Check also how you are sitting on your bike.
I had similar problems for years, especially when riding longer tours. Changed last year to a bike with different geometry (Pole) and the pain is gone! The training, stretching, core-strengh etc is certainly a good thing to do anyway, but a good bike-fit is often overlooked.
  • + 2
 I can add to not overlook conditioning the Gluteus Medius. It is vital for hip stabilization and when your main muscles grow stronger they put more stress on it, while most conditioning rutines do not take it into account. When it gets overused, it can get inflamed and screw up all ligaments of all muscles attaching to the illiac spine of hip bone, as a result taking out glutes, back muscles and maybe even hip flexor as quads start to compensate for compromised glutes. All that + IS joint and when you piss off this bugger, you may end up with symptoms end effects similar to hernia. Side leg raises, monster walks and side planks feel really stupid to do (at least for me) but do them. Overlooking hip flexors is not good either, no bunnyhops after that.
  • + 1
 @WAKIdesigns: I disagree. Why do all the world class athletes stretch? Because it helps to increase performance, avoid injuries, and pain. I have been an athlete my entire life from very young age. Starting doing all my sports at around 5 years old. Static stretching is very effective and I have definitely seen the effectiveness in stretching regularly for mountain biking, running, golf, and snowboarding/skiing.

Dynamic stretching is good to warm up muscles before stretching but doesn't increase range of motion much. The more flexible and higher range of motion definitely decreases injuries. Yes, yoga is static stretching but it doesn't matter what you call it, increasing range of motion and flexibility is beneficial and goal. Men generally have more muscle which makes them less flexible.The more muscle you build, you have to counteract it with more stretching and flexibility. So, if anything men probably should stretch more due to their lack of flexibility and range of motion.
  • + 1
 @tacklingdummy: I am a genuinely terrible writer because I don't know what in your post disagrees with mine. I just said. that static stretching alone is worthless. I didn't say that one does not need to stretch. I said that you need to do both stretch and strength conditioning. Yoga is not a form of conditioning, and even if one would consider it as a isometric workout, it is a pathetic one in that respect.

The last sentence of yours is off though. If you can do a deep squat in full range of motion (especially low bar squat), you are stretched up to all functional movement standards. Same for deadlift, especially the straight leg deadlift. Someone who can't put palms of his hand on the floor with straight knees, will not perform a straight leg deadlift or deficit deadlift. If you can do overhead squat, or better olympic snatch, you don't need to spend time on stretchign sessions, beyond maintenance work. And performing basic lifts is a good motivation to stretch. Both dynamically and statically.

Now if your form on squat or DL is messed up due to lack of mobility, then heh yeah, your muscle growth will indeed inhibit your mobility. But if you perform them with correct form in full range of movement it is a non issue.

Please google static stretching pre workout, you will find quite a lot of stuff on why not to do it. MTBers need flex for injury prevention in case of a crash. But there is not point to overdo it and as with everything, devil is in details.
  • + 1
 @WAKIdesigns: I am still in the camp of pro-static stretching because I have experienced and seen the benefits for many years. A lot of world class athletes static stretch and there still a lot of people in the pro-static stretching. Agree to disagree. Cheers.

Here is a good article on static stretching that dispels a lot of research on stretching and dynamic stretching.

www.outsideonline.com/2055626/rethink-everything-you-know-about-stretching
  • + 1
 @tacklingdummy: Misunderstanding again. I was talking about people who ONLY do static stretching and isometric exercise, eventually some pathetic swingign with kettlebells lighter than their laptop . There is no athlete in the world who does not do strength training (which is dynamic stretching on it's own) and do not do dynamic stretching for the sake of stretching. Static stretching as well. They do everything. I know people who ride 3 times a week and do ONLY Yoga as a side thing. Funny enough two of them are not progressing with their stretching. They cannot touch their toes. Since years. Maybe if they squatted with the barbell over their head (that one of them believes is bad for knees and spine) they would be able to reach basic ROM.

BUT, pro athlete has no problem to take 30 minutes off his day to do static stretching. To finish his 2-4h work out with 30 min stretching + foam rolling, and what not. I can't. So dynamic stretching which is fast and effective, does the job quite well.
  • + 1
 @tacklingdummy: and after all I have all the Functional Movement Screening done with top scores on everything but shoulders, doing next to no static stretching, palms on the floor head to straight knees, not to mention putting both legs behind my head, so well, I am biased. Some people can't touch the floor with their fingers, I don't know what put them in that hole, Yoga won't take them out of it as effectively and as sustainably as the barbell or a damn heavy kettlbell.
  • + 22
 Thanks for giving back
  • + 16
 I've got a load of metal in my collar bone (snowboarding) and a my wrist (i'm terrible at jumping my bike...). All the pros seem to have metal removed, but I haven't.

Should I be concerned about any future injuries? Or are they now strong enough to not unduly worry
  • + 1
 I have always wondered this! Also, I have heard that if you do get the plates removed, it can take up to a year for the holes to fill in and for the bone to be as strong as needs to be. Is this true?
  • + 4
 This depends on a few things: Are the plates/screws/wires bothering you or causing pain/discomfort? If this is the case, they should probably come out. If not, then it depends on local protocol usually. We usually leave metal in unless it bothers the patient.
Your bones should be properly healed by now and strong. If you remove the metal, you will need time for recovery again. Its all a balance and this is something you will need to discuss with a surgeon if you are concerned.
  • + 3
 @hcturner: Thanks for the answer. No issues at all, so I guess they're fine staying in until I break them again!
  • + 2
 Had a plate and screws in my leg after it was broken snowboarding. Had pain from it when I ran or did any impact sport. Had it in for three years, got it taken out, six weeks recovery and now no pain. Like the doc says if it’s causing pain get it out, if not, leave it.
  • + 14
 Thanks for all the questions guys! I am sorry I wasn't able to answer all of them. As a last thought, if you are still experiencing significant pain or discomfort from an injury, I suggest you have it checked out or get a 2nd opinion. Enjoy the trails and be safe. Cheers H
  • + 13
 What are your thoughts on these really young kids going bigger and bigger in their riding? We all love to see it but I cringe of broken growth plates and other injuries especially when I see the long injury list of someone like Cam Zink or Barrecloth. My own kid broke his leg when he was six. Are there extra precautions that should be taken for our young groms?
  • + 4
 I am amazed by what people do and the crashes they survive and walk away from! I would just get them decent quality protective gear and let them start slowly and work their way to more technical stuff.
  • + 6
 Hi Doc! multi-part question - what are the most common MTB related injuries you see? what, in your opinion, is the most notable improvement to protective equipment used by mountain bikers (specifically on the enduro / DH side of things) in the last say, 5-10 years? what area still needs the most improvement?
  • + 5
 Hi Captain! The most common injuries usually involve the shoulder, arm, forearm and wrist. This could be fractures and soft tissue injuries like torn ligaments, capsule damage, etc. (Think your classic broken wrist and dislocated shoulder on a dusty trail in the middle of nowhere!) I think the most notable improvement is probably helmets. They are lighter, stronger, better ventilated and new tech is coming in that can really change things if the claims are accurate. I think joint protection (elbows and knees) as well as spine protection still needs some improvement in terms of greater accessibility and cost vs benefit ratios to all riders.
  • + 5
 Hi Dr. Turner,

Thank you for taking the time to answer some mtb related questions!

I'm a medical student about to start clerkships, and am considering going into surgery. One thing holding me up is the fear of getting hurt, and not being able to meet my clinical obligations. I've had a few attending's tell me I would need to quit DH/motocross if I go into surgery for that reason. How has being a surgeon affected your ability to ride and race?

Second, what is your take on the efficacy of neck braces on preventing SCI? I get asked that question a lot and cannot ever provide a good answer, as I still have not seen any convincing data.
  • + 4
 Firstly, you have to be ready to do something else if you have a serious injury affecting your ability to operate. I actually replied to another question about the exact same thing at the top. Good luck with the clerkships man, its tough but worth it!
  • + 9
 What first-aid essentials should I have on every ride?
  • + 5
 Bandage, alcohol wipes, dressings
  • + 1
 @hcturner: what are the relative +/-'s in alcohol vs benzoiodine?
  • + 1
 @hcturner: I thought alcohol caused further trauma to damaged tissue?
  • + 1
 For me...a couple T3's(acetaminophen/codeine), a few bandaids and a light weight sling. When you snap a wrist, which is one of the most common injuries, it's nice to be able to sling your arm for the walk out.
  • + 1
 @xTwoSnakesx: It at least kills germs and therefore prevents possible infections tho which I think is the greater issue as germs are omnipresent and not everyone is vaccinated against tetanus or alike.
  • + 1
 @xTwoSnakesx: It's more applicable with prolonged exposure. I just use it to clean out any wounds before I put a dressing on. Wouldn't bath my wounds in alcohol or iodine though.
  • + 1
 @half-man-half-scab: I prefer alcohol because it's less messy but both work fine. Not much real world difference.
  • + 5
 I race enduro and my biggest fear is crashing and becoming paralyzed. Is there anything I can do to prevent this (aside from not riding)? Would building muscle and strength around the neck/back/core via deadlifts, shrugs, and squats help? What about stretching? I want to reduce the chances of paralysis. Thanks!
  • + 6
 Besides protective gear, I would say stretching and core strength are the best options!
  • + 10
 I would recommend not crashing, but I am not a doctor!
  • + 8
 Can riding cause Peyronie's Disease and if so, are there any steps we can take to prevent it?
  • + 5
 Lolly sticks and duct tape
tup
  • + 7
 Are you talking about mountainbiking ?

Another case of "instructions not clear, dick stuck in the rotor"
  • + 6
 Haha not sure if there have been many studies on this topic! I would suggest lifting yourself out of the seat every few minutes to reduce the strain on your perineum.
  • + 1
 Get an SQ labs saddle my dude!
  • + 4
 Lower back pain sufferer here. MRIs have shown degenerative disc disease in two discs. Aside from yoga/core strengthening and improving posture is there anything else that you can suggest to allow me to keep on riding? Haven't been able to ride for over 3 months now with little sign of that improving at the moment. Surgery to remove the discs is a last resort as far as I'm concerned. Any help would be much appreciated as I'm meant to be racing the Ardrock enduro in the summer! Thanks.
  • + 3
 Never have surgery for degenerative discs. The vast majority of people have degenerated discs. Surgery outcomes from fused vertebrae are not good. An intense strength program with deadlifts, and other core work is essential to reducing pain and atrophy.
  • + 3
 Sorry to hear that man. General advice usually involves what you are doing. I would suggest trying to lose weight, water exercises and a focused physiotherapy program might add value but degenerative disc disease is not an easy thing to treat. Patience is key here, especially if you want to avoid surgery. I really hope you get better and get to ride Ardrock!
  • + 1
 I strongly disagree with @dualsuspensiondave
I went a ways down the road you are on. PT, meds, cortisone epiderals, the works, for years, up until the point my L4/L5/S1 discs were contacting my sciatic nerve to a degree I could pretty much not walk.

The problem is MECHANICAL. You have a cartilage disc in a place it should not be. You cannot will it back into place. Core strength, swimming, etc. are all great for you - but will not solve the problem. Microdiscectomies are not an extreme surgery, and you likely do not need a fuse. Don't be scared off of surgery, if that is the solution then that is the solution, years of suffering is not worth it. Obviously an "intense strength program" is not in the cards for you in the condition you are in. I recovered from my surgery in 2-3 days, have not had a single issues since and that was ~15 years ago.
  • + 0
 @GorgeousBeauGaston: Microdiscectomies are not what's done to "fix" degenerative discs. You are not aware of what a degenerative disc is, rather you are talking about herniated discs which are completely different. There is no surgical solution to degeneration of discs other than fusing.

We don't have just cartilage between vertebrae. They are fluid filled to act like shock absorbers that have annular rings to protect them. There are a combination of techniques that involve intense strength programs, mobilizations, etc. to fix it. The main component essentially creates a vacuum inside the disc to pull it back back into place. It works, but can take about 2 years to fully rehab. A large percentage of injuries like that, are easily re-injured with surgical techniques. Removing the shock absorber and making yourself a hardtail is not logical. Even after surgery, one would need to do years of strength training to keep it there. The reason for injury like that is due to lack of strength, bad posture, flexion of the spine under load. The majority of surgical patients re-injure themselves in the same spot within 5 years. As a trained professional, with a wife that is a DPT, and also a patient that has fixed their herniations with evidence based PT upon multiple studies and surgeon recommendations, we as a Science community disagree with you.
  • + 0
 @dualsuspensiondave: Interesting appeal to authority, "my wife is a PT so there is a scientific consensus that you are wrong."

"The reason for injury like that is due to lack of strength, bad posture, flexion of the spine under load."
www.ncbi.nlm.nih.gov/pmc/articles/PMC3335178
The scientific community disagrees with you.
"Many practitioners believe environmental factors to be a secondary consideration to the genetic component of DDD."

"There is no surgical solution to degeneration of discs other than fusing. "
That published article names many procedures other than fusing.

@thatwascrackers
Read that study, and remember, it's extremely expensive for an insurer/healthcare provider to go in and solve these issues. It's profitable for them however to sell drugs, send you to a glorified masseuse (chiropracter, PT, etc.). You can drag on for years in pain like I did while people get paid to tell you to "build your core," or advocate for yourself and look into a real solution. My wife and I are both mechanical engineers, and science agrees, if you have a mechanical issue in your spine you need to have it mechanically fixed, not with hopes, dreams, drugs, and witch doctoring from outside your body.
  • + 0
 @GorgeousBeauGaston: You wrongly quoted what I said. Physical Therap[ists go to school for 7-8 years and require a doctoral degree. Both my wife and I have gone through the same training and $200k of student loans to do so. Would make your mechanical engineering degree look like a walk in the park (I'm now a civil engineer). You don't understand that Physical Therapists jobs are to fix the body from a MECHANICAL stand point. You have no idea the knowledge, research, and actual talent it takes to be a PT. They are no way, shape, or form a glorified massage therapist. PT's never recommend the use of drugs in just about any form. People need to understand kinesiology, modalities, medical research, etc. to make any type of judgement about a PT's job. There are good and bad in every line of work, however that's like me disagreeing with you about tolerances and machining without having any formal education. Wake up!

The scientific community does agree with me, hence why insurance companies will not currently pay for disc herniation surgery without an emergency situation, and one has to do PT first. Everything billed to an insurance company has to be evidence based with many studies to back it up. Your article gives no other surgical option than fusion and says nothing about microdisectomies because they are not done for DDD as I pointed out. There are genetic components with many health issues, but they don't necessarily show themselves without the things I listed. Environmental factors almost always make the biggest difference in healthcare, that is common sense in the field.

Degenerative Disc Disease is something that most people have. I have many degenerated discs right now, and they do not compress the spinal cord unless they are herniated. Therefore you did not have just a degenerative disc, it had to be a herniation to compress the spine that way.

Three years ago, I herniated 2 discs from multiple different stresses when training, and making mistakes while being fatigued (very common). I've had DDD for 15 years before that. I went through the normal procedure and had a MRI. Surgery was an option for me because of the severity of a central herniation. I did all of the evidence based therapy everyday. Within 4 months I had almost no pain, and it would only be painful after about 9-10 hours sitting. Fast forward 2 years, not only has all of the pain subsided due to fixing the MECHANICAL part (weak core, poor posture, etc.), but also my deadlift went from 415lbs. before the injuries to 515lbs. One has to work hard to achieve those goals, and most people that normally opt for surgery are not interested in the hard work to fix the issue. Most don't understand that years of rehab and prehab are needed to prevent the injury again.

You've got a big misconception of how healthcare works. PT is way under funded because there are no pharmaceutical companies funding the studies. PT is about fixing the problem, not creating a crutch or putting on a band aid. PT clinics are not big business models like the rest of the medical field.

Here is a study that shows how to properly treat disc herniations without surgery because the surgery options are not shown to have better long term results. Surgical procedures are shown to not be the most beneficial except for short term pain relief, and in cases that the herniation is a medical emergency (usually less than 5%). www.ncbi.nlm.nih.gov/pmc/articles/PMC3812831
www.ncbi.nlm.nih.gov/pmc/articles/PMC2915533

" Surgical intervention may result in faster relief of symptoms and earlier return to function, although long-term results appear to be similar regardless of type of management. The ultimate decision regarding type of treatment should be based on a surgeon-patient discussion, in light of proper surgical indications, duration of symptoms, and patient wishes."
  • + 8
 What do you carry in your first-aid kit when you go out for a ride?
  • + 5
 Alcohol wipes, bandage, dressing and a few bandaids.
  • + 4
 Ive got an AC separation. Its a bad one to say the least. im about 2.5 weeks out from the injury date and have great mobility with it and really not a ton of pain, just some discomfort. I was told by an ortho surgeon I was on the line of surgery or not with how bad it is; his advice was to do some PT and see how it does on its own which is all good and great. My concern is with my shoulder really, if i dont get this operated on is it possible for my shoulder to drop and basically keep dropping. or is this as bad as it is and will be able to manage with what i have.
  • + 2
 Yo. Not a doc, just one that tore the shit out of my AC joint. I tore all of it, so I had significant drop of the shoulder. It’s been 4 years but if I remember right the doc at that time informed me that I had not torn it all had had no should drop, they did not recommend surgery. I had a bolt and synthetic ligament rope thingy put in mine. I’d be curious to see what the good Dr says on this one.
  • + 3
 Had a full ac seperation here. Elected no surgery. Have no real issues with it other than occasionally my collarbone shifts slightly and there is some mild pain. I'd just wait and see how it works for you. If I didn't feel 100% besides occasional very manageable pain I'd consider surgery, but I feel no reason to go under knife unless it's really necessary. My left shoulder is much worse than the one I seperated due to dislocations, it's probably 90% and I have no plans to get surgery on it anytime soon.
  • + 1
 Jumping on the AC train here--separated mine in June 2018 (btwn type III and V, per a reputable surgeon). I have a nice drop and bump. Did PT and followed orders. No surgery here, but wondering if my body will keep healing or if this is as good as it will be. I have full athletic use again, but I have to be very careful (sleeping, backpacks for hours, foolishly yanking too hard on handlebars while climbing). I'll definitely be going back for a check up, just wondering how long the recovery timeline lasts.

Effing shoulders.
  • + 1
 I'm on the AC seporation surgery waiting list. Grade 3, back on a bike but I don't have full mobility back, strength is 50% after 7 months. Some pain after major use but manageable. I can ride again so I'm very happy! Surgery was offered but I'm now on the fence. It's the plate hook procedure with two operations. One to install cadaver parts and the hook plate and then a few month later a procedure to take out the hook plate. I'm a 42 Male. Lot's of riding left in me ! Should I suck it up or have surgery for a better long term outcome?
  • + 3
 I suffered a type-V AC seperation about 15 years ago. No surgery at my Orthopedic surgeon's recommendation. He said if I continued to ride bikes and snowboard I would likely injure the AC again, which I did several years later, so there was really no point in fixing it as it could result in further damage in future injuris. I regained full strength with a rigorous weigh lifting program targeting stability in my shoulders. If I stop lifting weights for lengthy periods of time my muscles begin to atrophy a bit and I start to experience pain and instability. I just keep a light stability program going year round and I have no issues. I do have a significant shoulder drop and bump which annoyed me for years, simply because I was assymetrical. But after several crashes with this shoulder taking the brunt of the falls I'm glad I didn't have the surgery. I just take care to keep it strong and protected.
  • + 2
 Its difficult to say without actually assessing the grade of your separation but usually its only the very severe types that need early surgery . If you don't have a significant shoulder drop at the moment, It should be okay providing the soft tissue heals up adequately and the rehab goes well.
  • + 1
 Have separated the same AC joint several times over the years (at least 5 by my count, varying degrees of seriousness). In the end I have found the one thing that really helps is a good personal training program. Start slow under the guidance of someone who understands the injury (think physiotherapist at first but a good personal trainer can be better once you are sure you're not going to injure yourself again by training) and progress from there. When I started rehab from the last one, I thought I would never be able to do a pull-up and now I am doing sets of 5 with added weight, or up to 12 with no weight added.
  • + 1
 Complete AC separation 10 years ago on one, and torn rotator cuff 8 years ago on the other. No surgery. What has helped me tremendously is building muscle in my shoulders, as I feel that tends to "stabilize them", whatever that means. I also do lots of hanging exercises. In general, exercising my shoulders, be it stretching/weights/bands etc. has alleviated any issues I've had.
  • + 2
 Had to add to this thread. I've had a grade 2-3 AC joint separation in my right (dominant) shoulder. In the 6.5 months I've had it, I've been on the bike 5 times. I have gone through a good physio familiar with this injury through rugby and cycling and slowly worked through resistance bands then to light weights. I find like some of you that I need to be consistent with weight triaining or the shoulder starts to feel loose. I too was fecked off with the lump, but if you train, it becomes less noticeable. Although if I put my arm across my chest the bone sticks up and looks nuts. Sleeping on it is grand now, but its feels mental. I've read as much as I can, from academic papers, to every forum on the internet ever. I'm still going to see a surgeon in three months, but, I'm thinking this is grand and surgery might not be necessary. I'll change my riding style and keep on top of the weight training. The amount of pro bikers who have had separated shoulders is quite large; Steve Peat, Greg Minaar, Josh Bryceland, Sam Hill, Jerome Clementz, Yoann Barelli, Richie Rude, Jared Graves. Some have had surgery and some havent. You're in good company with this injury. Still sucks, but there are worse things I suppose.
  • + 3
 1. What are the most essential pieces of first aid kit that you should „always” carry for a ride, considering very limited storage capabilities?

2. Is there a piece of first aid equipment that is good to have while riding and is not of much importance while doing anything else (like hiking)?

3. Is there a way for mountain bikers to make paramedics'/trauma doctors' job easier during emergency?
  • + 3
 Bandage, dressing and alcohol wipes. They are pretty much useful for everything! Learn basic life support skills! Like BLS, etc
  • + 3
 I had a particularly aggressive day on some really blown out trails last summer (no crashes), and since then my knee has been clicking pretty badly, particularly when I squat. If I go below 90 degrees on a squat, it starts to sound like velcro tearing. I've had comments from nearby gym goers about it. It doesn't hurt, it hasn't gotten worse, but it does feel off. What would you recommend for tackling this beast?
  • + 2
 You're going to need to see a PT about that one, mate. Knees are complicated and it could be a lot of things.
  • + 2
 Yeah knees can be quite complicated! This can be a few things. If it is painful, feels unstable,wonky or locks up, I suggest you see someone to have it evaluated. The clicking sound can be from your kneecap scraping over the joint surface but it could also just be soft tissue friction around the joint. Best to have it checked out I would say.
  • + 1
 Double post.
  • + 3
 As mountain biker with a medical background, what's your take on concussion protocols (or lack thereof) for the sport? What do you think the pros should/should not be doing to encourage regular people to take trauma and/or injuries seriously? We've all seem how pro riders at big events like a DH world cup/Rampage/EWS ride through some injuries.
  • + 5
 The issue that the pro's have is that their income and livelihoods can be affected if they stop riding. This is a very difficult situation and you have to feel for them. On the other hand, rider safety should be the first priority of the organisers, teams and riders in my opinion. There is no point in injuring yourself more to finish a race. Concussion protocols are usually area dependant and are (hopefully) based on sound evidence. I think that they should withdraw a rider if there is any doubt.
  • + 2
 Hey Doc. Thanks so much for doing this! Also thanks pinkbike! Avulsiion fracture of the fifth metatarsal last fall in my left foot and it was so displaced needed to have it screwed back in. Surgery was in late October. 1) Now if I'm doing somethign with impact (mtb, bmx, skiing) there seems to be a fair bit of blood pooling and it turns a nice shade of greyish blue/huckelberry till I elevate it a bit- how long can I expect that to keep happening/ is it a problem? 2) I was told given the nature of the fracture a real risk is rolling voer my foot a gain as the screw is not as strong as bone- I'm at about 6 months now... is that fear kind of past?
  • + 2
 I'd be careful , but it should be healed now if you have no residual pain. Swelling can take years to go away so dont worry too much about it. If you still have pain, go back to the surgeon to have it checked out. Good luck!
  • + 1
 @hcturner: Thank you!
  • + 2
 Last year I went over the bars and (somehow) injured my R hand (RH). Not what happened or how, didn't have any LOC, just happened faster than I could process it. Anywho, immediate RH pain, went home RICE, swelled up real good and had some slight bruising. a week later didn't get much better (slight reduction in swelling), went to a local ER, XR showed no breaks, was told I'm getting older, aches and pains last longer. Almost a year later swelling is gone, but can't make a tight fist (feels tight/swollen and minor pain). Also, if my R fingers get a jarring or violent movement sideways...shooting pain in RH. I realize it's not normal, but what is the next course of action (hand specialist appt is still 5 months out).
  • + 1
 I'm not a doctor, but would recommend getting it checked out. I had something similar. Sat on it for 4 months as had had a similar situation which was just tendency damage a few years earlier. Turned out to be a non-union scaphoid fracture in my wrist/lower hand. They are really hard to see, apparently; you x-ray the hand in a completely different way to get it to reveal itself.

Hoping they find a fix for you mate
  • + 1
 Should add to other reply, there are some quick checks a mate who is a military doctor showed me for a quick prelim diagnosis: scaphoids break a lot from falling on outstretched hands. Spread your hand out and push the thumb from the tip back into the wrist, pinch the "anatomical snuffbox", and then also try poking in from the inside of the hand into about 2cm after where your hand first starts to widen out from your wrist. He said pain in these areas usually signify a possible broken scaphoid
  • + 2
 Hello, I broke a collarbone in July 2017, left side. Due to the fall the scalene neck muscles were injured. These are tight all the time my physio tells me and my osteopath. This results in me constantly cracking my neck left and right. I try stretching and it relieves some of the tightness but not all. Any tips?

Also would poor posture from anterior pelvic tilt and rounded shoulders hinder this recovery? I'm currently tackling all this at the moment with an osteopath. The strength I've gained back in my core is huge but stiffness, pain and joint cracking is still very common daily.

If this isn't relevant sorry. Thanks
  • + 2
 Hi man. I would recommended you actually try and strengthen your neck muscles and combines this with stretching regularly.
Posture is usually corrected by core strengthening and self discipline during your daily routine. There are products to help you sit properly at your desk/chair available.

Continue the exercises and stretches and be patient. It should get better with time.

Good luck
  • + 1
 @hcturner: Ok thnaks! Ill give it a shot!
  • + 2
 Grade 3 A/C Separation.
41 year old avid biker sustained A/C separation while skiing last weekend. Although I am feeling better each day there is no way that I will be on my bike anytime soon. My question would be as an avid biker should I opt for the corrective surgery or should I hope to heal well while rehabbing through physical therapy?
Thank you for your time.
Justin
  • + 1
 Guidelines say grade 3 is borderline and I understand your predicament. You should be okay with conservative treatment but I might take longer. I would go and speak to a surgeon and see what their experiences have been in the past with patients that had similar circumstances as yourself?
  • + 2
 @hcturner: I got grade 3 ac over 6 months ago and although feeling better it is still really deformed. Will this ever go back to normal or should I consult a surgeon too?
  • + 2
 @Gabtab: I posted in the AC question above (grd. 3 10 years ago), but it likely won't "look" less deformed. I was in that same predicament, but chose not to have surgery due to a variety of factors, mostly the risk involved. I've had a lot of luck with strength training and building some muscle around my shoulders and haven't had issues in the last 10 years. It still "shifts" in ways that a normal shoulder does not, but I haven't had any pain/issues with it whatsoever.
  • + 1
 @splitlit: @gabtab grade 3 twenty years ago, end of collarbone about an inch out. It’s still about 3/4 inch out but works fine and doesn’t hurt.. Didn’t have surgery, because NHS. You’ll probably always look lumpy.
  • + 1
 @Gabtab: If it's bothering you and affecting your daily activities, I suggest a 2nd opinion but I'm not sure whether they will offer anything more at this stage. Hope it gets better!
  • + 2
 Hey good Dr. I am curious on a knee injury I had 8 years ago. I took a big tumble and tore my MCL, PCL and miniscus. I did physical therapy at the time but have not had any surgery. I say fit at active and dr here say that as long as I am pain free to not worry about it. I am concerned with it ever giving out and having a larger issue? I have also shattered the tibia plateau on this same knee. Hoping to avoid a knee replacement/reconstruction as long as possible.
  • + 3
 Howsit man! The main thing are you symptomatic/is it bothering you? This would include pain, your knee feeling unstable (like it wants to give way or actually has given way beneath you), locking up ( your knee locks in a certain position and it cannot move unless you wiggle it or do certain maneuvers to free it up again), swelling ,etc. If you have these things, I suggest having it checked out by someone. Otherwise I would not worry about it for now. A tibial plateau fracture MAY contribute to arthritis in the long run but as long as you are active and happy, I would not worry about it.
  • + 2
 @hcturner:
Thank you sir!
  • + 4
 As a trauma doctor AND enduro racer, what protective gear to you wear while competing? Is that different from what you wear on a normal ride?
  • + 6
 I usually wear a trail helmet, knee guards with hard caps and elbow guards on every ride( I've seen major injuries happen on "normal" rides) I take my back protector and full face to races and bike parks. I don't do full DH racing but I would suggest a neck brace for that if you can get one.It is important to note that I'm probably biased because I see what can go wrong on a daily basis, but I would rather be safe than sorry!
  • + 2
 Thoughts on back protection while riding, specifically regarding a spinal fusion, I have a fusion from T2-T4 from an old MX injury.

Would a CE level 2 back protector provide a useful amount of protection other than impact protection?
Would a neck brace do more harm than good by transferring impacts to my shoulders and almost directly into my fusion from the back plate of the neck brace?
  • + 3
 I would definitely use a back protector yes! CE2 is stronger than CE1 and I would recommend that as well. I've answered the neck brace question above in the first question if you want to have a look.
  • + 2
 I've had two collarbone breaks in the past year on the same side. Both were treated with ORIF. The second time I broke my CB I bent the (single) plate that was in there. I now have two plates (anterior, superior) following the second break.

In your practice, do you typically leave the hardware such as mine in place indefinitely or do you remove it after a certain period of time?

I ride left foot forward and this is on my left side. I think it's pretty safe to assume I will take more blows to this shoulder if I continue riding. I'm worried if I fall again onto this shoulder the force that would normally break the CB will be transferred to another part of my shoulder, leading to a separation or dislocation.

Thanks
  • + 2
 Difficult question man. The more surgeries you have, the higher your chances are of having complications fromthe surgery itself. You can either break it again around the hardware or get an AC injury,etc. I would leave it in for now BUT maybe you should visit and Occupational therapist and get some kind of protective bracing made for your riding days?
  • + 2
 I have a Plate on my left femur and a nail in my right tib,
98% of the time I do not notice them, but..
If I got into a bad accident could they cause extra trama to that body part if that is the area that might have broken?
Joints etc?
  • + 4
 I dont think you can say that they would cause extra trauma BUT if you fracture your femur and tibia around the hardware, it usually is a more complex injury to treat than a "new" fracture. This is all worst case scenario though and that is why we usually leave metal inside unless it causes issues. If you are prone to crashes, it might be a good idea just to mention this to your surgeon, but I dont know if this would change their management plan necessarily.
  • + 1
 @hcturner: thanks! I had a similar question
  • + 1
 I had ACL/MCL reconstruction December 1st. My surgeon told me to stop wearing my brace daily but keep it on for activity. My Physiotherapist is more cautious and has recommended I wait 6-8 months before getting back to mountain biking. I've been riding lightly for the past few weeks (4 months out). Am I making a big mistake?
  • + 1
 I'm not a MD or surgeon, but I've had 2 knee surgeries and I would be very careful with that. Road biking has helped me immensely to recover from both, so if you have the urge to get on two wheels, that's the best option. Stay conservative man, lots of time in the riding season. When you start re-tearing ligaments and cartilage and having multiple surgeries, your quality of life will inadvertently decrease. Good luck.
  • + 1
 Also not the doc, but two ACL repairs under my belt with the most recent on dec 1st 2017. After the most recent, I took the graph from the link below and posted it next to my desk. You are in the phase where the ligament is at its weakest, but you start to feel fine. Best advice is to be patient, use the time to build cardio, and be extremely conservative about your rides. The motion of biking is great for strengthening the muscles that stabilize the knee, but even a little foot dab could easily wreck the graft and put you through all the pain and boredom of the last 4 months again. Be patient and do your PT religiously, and you'll be nearly as good as new by mid summer.

kneesurgerysydney.com.au/acl-recovery
  • + 1
 I would follow the PT advice. Rather take longer and have a better outcome than risk it for an earlier comeback. Good luck
  • + 1
 Hey Doc Turner, I have a broken clavicle (10 days fresh, no surgery needed). What is your opinion on figure of 8 braces instead of using a traditional arm sling? I feel like my shoulder is folding forward in a sling and its uncountable the majority of the time. If I pull my shoulder back (slowly) it seems to feel better. Thanks
  • + 1
 Hi Kieran. there is no difference in the outcomes between the 2 but if you feel more comfortable in figure 8 you can ask them for one.good luck!
  • + 1
 @hcturner: thanks
  • + 1
 I had a proximal humerus greater tuberosity fracture with displacement that required surgery last July. The doctors were all "so you quitting riding bikes when you're healed, right?". I got back to riding in January as soon as the surgeon said I was healed. Still in PT a fe times a month. What's your opinion? Should I be riding in the parking lot on a tricycle or is getting back to riding bikes a good idea?

PS. I'm taking at least a season off of DH and park riding which is where all my injuries come from.
  • + 1
 You'll be at risk of injuring it again but I understand you wanna get out again. I would avoid DH and park and wear a shoulder brace if you can find one that is comfortable. good luck!
  • + 1
 @hcturner: Thanks. Heading to Finale Ligure in a few weeks but will be taking it easy. Plus it's enduro so I should be totally fine Smile
  • + 1
 Dr. Turner

I dislocated my left shoulder 2 weeks ago today. First time with any shoulder injury. Passive range seems to be improving but my active ROM in flexion and abduction are still very limited and feel inhibited. What is a reasonable timeline to just getting back to daily movement? Back to cycling? We ortho later in the week and holding out for some good news. Also any suggestions for sleep (meds, positions) as this is wreaking the most havoc on in the mental game, only getting 3-4 hours of interrupted sleep per night still.
  • + 1
 Hi Doug. It will be at least 6 weeks before I suggest you do anything more than mild movement. I think it will take a few months before you could realistically be back on the bike, especially for gnarlier stuff. Although I am conservative and you may fly though rehab and get back earlier which would be great. The pain issue is difficult. I suggest sleeping on your back with pillows preventing you from rolling onto the shoulder, using NSAIDS sparingly to avoid kidney damage and also I would avoid sleeping tablets unless absolutely necessary. Good luck!
  • + 1
 How much is known about post concussion syndrome and the effects of a concussion? I've had multiple issue that seemed to start and worsen after my moderate-severe classified concussion that still plague me 13 years after my first concussion.
  • + 1
 lots of info around this in the NFL I think. If you are having issues, I suggest you go and see your GP first and he can evaluate you for possible referral to neurology. Hope it gets better man. Good luck
  • + 2
 @hcturner: Thanks for the reply. I've been seeing a neurologist for the past two years and every time the topic of the concussion is brought up it is dismissed as a potential root cause of the migraines and memory problems, however every time there is an additional blow to the head the problems worsen considerably for a short time.
  • + 1
 One more general question...what is your opinion on icing? It seems the literature keeps swinging back and forth on whether it's good or bad. Best I can tell, current wisdom is it's better than medication if using for pain control, but otherwise don't do it because swelling is generally a good thing and reduces healing time. Agree or disagree?
  • + 1
 This is controversial and you are right about the changing recommendations. My opinion is mild movement and protecting the injured area should be sufficient. Also avoid using too much anti-inflammatory meds. H
  • + 1
 @hcturner: Awesome thanks. Yea, I try to never take anti-inflammatory (or any other) meds. Just turmeric, omegas, and vitamin D. It's so funny because my first surgery was 20 years and the advice back then was constant icing and anti-inflammatories to keep swelling to a minimum. Now I understand it's pretty much the complete opposite.
  • + 1
 I avoid icing as much as possible. I have found success implementing contrast baths into my routine for my ankle.

2 buckets. 1 hot water & epsom salts. 1 cold cold tap water. 2 minute dunk in each. Alternate 3 - 4 times. So like 15 minutes total give or take.

Turmeric, glucosimine/condritin, omegas, vit B - C - D... Like a boss.
  • + 1
 Hey Doc,
A while back I had a serious elbow injury that involved it getting twisted in the socket more or less. It took a long time before I could extend it, but now when I ride I notice some pain in it from time to time. Is this a sign that I should stay off the bike a bit longer and keep rehabbing it or do you think cycling poses a low enough risk to elbow joints that I should take it easy but keep riding? Cheers
  • + 1
 Hi man. Did you have it checked out?

You may have a small fracture or soft tissue injury. I would have it evaluated before doing any serious riding. H
  • + 1
 @hcturner: I had a physical therapist check it out and they recommended some strengthening exercises to help mobility and re-develop some of my stability in that elbow. The pain during riding is rare but it's so long after the genesis of the injury I'm curious if I need to take a closer look at it. Thanks for the response, you rock!
  • + 1
 Anything new, or on the horizon, on the ankle replacement front? Got a bunch of hardware & deformed joint - spiral/comminuted fracture of distal tibia/pilon-plafond injury. Very complex fracture requiring almost 5hrs ORIF surgery. Injury was just over 3 years ago.

They want to fuse it. The Dr's I spoke to say at present a replacement would only last 5 - 10 years so they wont do it because I'm still young & active.

Cheers!
  • + 2
 Ankle replacement in a young active person is tricky. The hardware will probably not last as long in an active person (vs sedentary person) and you may need further surgery or revisions in the future (which is a big deal and quite specialized) But I also understand your apprehension about the fusion. If it were me, I would try alternatives like strapping, bracing, physio(basically anything to avoid Surgery) and buy as much time as possible before getting more Surgery. If you are in severe pain then a fusion may help but then you have restricted movement. It's tough man, I don't know if I've helped you in any way but I do hope you get some relief and can continue riding..good luck
  • + 1
 @hcturner: Thanks for taking the time to reply. Pretty much what I've been hearing this side of the pond. The 1 surgeon I had wanted to fuse me 8 months post op. I had only been weight bearing for 3 at that point. I said no way. I've been managing with the standard treatment protocol. I also wear a custom ankle gauntlet and walk with a cane. Presently making due with an annual shot of depomedrol & marcaine/lidocaine. Hopefully there is some improvement with the TAR process in the future.

Riding a bike is easier than walking for me believe it or not.

Cheers!
  • + 1
 I have a bum knee. Three surgeries over the last 20 years, torn or stretched pretty much everything except the lateral meniscus. It generally does great with mountain biking, but spinning on a trainer seems to really bother it. This makes it hard for me to train since I can't realistically ride trails 5x/week.

My theory is that it's the constant tension of the trainer that makes it worse than mountain biking. I have started spinning lower cadences and that definitely helps, but doesn't solve the issue. I've also tried all kinds of things to make sure the fit of the trainer exactly mimics my mountain bike, as well as using flat pedals like I do on my bike. None of this has helped.

Any ideas as to why the trainer would aggravate my knee so more than mountain biking, and/or suggestions that might allow it to tolerate the trainer better? Thanks!
  • + 1
 My theory would be that you are probably causing repetitive strain/trauma in the same direction and area in your knee with the trainer vs when you are on the bike, there is strain in multiple areas and directions because of the varied terrain. It's similar to some people complaining of knee pain while running on roads vs less pain when doing trail running.

Only thing I can think is doing more actual biking and maybe gym work to substitute the trainer days? You can also take some rest and go see a PT to check for muscle imbalance to make sure.

Good luck!
  • + 1
 @hcturner: Makes sense. Thanks so much for the advice!
  • + 1
 Doc, last August 25 th broke femur in 3 places intertrochanter, lesser trochanter, spiral fracture, I have 17 inch rod 3 screw and wire. All is going well, skiing, biking and just started running. My it band right near my scar gets so sore and inflamed, Any ideas of how to keep it loose, I stretch and foam roll
  • + 1
 Make sure your muscles around your knee and hip are balanced and try to improve your overall flexibility. A PT would be able to help you with this. Good luck!
  • + 1
 Hi,

1. Mountain biking is a recent sport.
What kind of health problem do you expect to see on an avid old rider ?
2. While riding a mountain bike, the body is exposed to a lot of vibrations or small hits.
This is even worse with a hardtail or rigid fork (like trial riding). Do you think that these hits or vibration might affect the body on a long term ?

Thanks fr your answer.
  • + 1
 some people have lower back issues and your upper limbs take a beating with crashes. I dont think the vibrations are a main concern really. Good luck with the riding!
  • + 1
 Hello Dr. Turner, Any suggestions for someone riding post Glenohumeral reconstruction? It's been a few years since surgery. Any suggestions on keeping it the shoulder healthy and in place. It's been dislodged 2x after the surgery,
  • + 1
 I also have a unstable shoulder due to a chronic labral tear, so I understand your concern. I suggest strengthening your rotator cuff muscles and using resistance band training works well. You can also try a shoulder brace and see if it improves your stability? Some people get their shoulders strapped before riding but you need to learn how to do this properly from a PT. Hope it gets better.
  • + 1
 Hello, I’m 54 YO and recently found out that I suffer from CPPD in my left knee. So badly that it caused a massive hemotoma into my left calf muscle as my knee along with bits of cartilage bled into my calf. Such wonderful pain. At any rate I had it drained. Dr. Told me I had to stop taking NSAIDS as I had already done 2 rounds of steroids and fistfuls of ibuprofen over the month that I suffered from it. I ended up taking CBD oil for a week or so. Everything I read said to mix it with some THC. So I did. The relief was profound. Dr. Said to go ahead with that as they had nothing for me but acute treatment of drainage and cortisone shots. I’m doing better now but should I keep up with cannibis therapy in order to keep inflammation down long term? I know it doesn’t help with the calcium pyrophosphate crystals but can it help mitigate the damage? Can’t seem to get a real answer to this one. Thanks for your time.
  • + 1
 Hi man.

Honestly, I’m not an expert in this field and I'm hesitant to say what you should do but here is my ten cents :

If the cannabis/thc is providing relief AND not causing you any side effects or harm, it should be okay. I know that some people have had good results for chronic pain conditions with THC products. Do you have a GP that can do frequent general check ups for you?

I don't know whether it would mitigate or reverse the damage though. If you have severe arthritis, some Surgeons would maybe consider arthroscopic debridement to see if it helps but I'm not sure if this would benefit you without having your exact details.

Good luck
  • + 1
 What do you think of the new breed of prescussion massagers (theragun, hypervolt, etc) for use before and after riding? I am chronically stiff and know if I could be more loose, I’d be a better rider. Also, always looking to recover faster.
  • + 1
 I'm not really familiar with it myself but there are a few studies that state that it reduces delayed onset muscle soreness. I would start out with a Dedicated warm up and cool down routine before spending your money on this. If you still feel no improvement AND If you can get one for a reasonable price ( not the €600 one I see they are advertising on YouTube) I'd give it a go and see?
  • + 1
 Hi Dr Turner , about 23 years ago while riding mx I had around 13 concussions in the space of 3 months and ended up having head and neck X-ray ‘s and a CT scan , luckily I was ok , my question is other than having slight aching in my neck all the time since then do you think that my brain would have any long term effects?
Since that time I have been knocked out by crashing while riding my MTB around 3 times , the last was last summer....
I would wear a neck brace but not any good width a non full face helmet!
  • + 1
 Hi Pedro It sounds like you have had some significant injuries and I really would advise you wear the maximum amount of protection you can every time you go riding. I would even consider changing my riding to a less impact prone discipline if you can. There are studies that suggest that our brains are affected in the long term by concussion injuries. If you have frequent headaches, blurry vision, problems concentrating, etc, I would have it checked out. Be safe man.
  • + 1
 Hey Doc, thanks for doing this!
So three days ago i took a flip over the bars at speed and landed on my lower back/hip area on rock. Sore, got up check for numbness, walked to stretch and back on the bike for a bit then home.
Question is this back area of pelvis and liver area.. quite sore to touch, pressing in from back of pelvis, around to front near groin... is it possible I am walking around with broken pelvis and or bruised liver? Bruising didn't start until today and i have a drs appt. Tomorrow. Appreciate your time sir!!
  • + 1
 Hi J. I would have it checked out because of the area you injured. There is always a risk of fracture and internal injury, especially if you crashed at a high speed. Hope it's not too serious. H
  • + 1
 With shoulder injuries is there a clear indicator that something is torn?

Specifically labrum or rotator cuff. Tweaked my shoulder pretty hard on a g-out, it did not completely dislocate but felt darn close. Rode through the finial 3 stages of the race with plenty of strength, 3 days post incident mobility is at about 40% coming from a great range of motion and stability. I can feel an impingement going on but only hurts under motion not sitting still. I figured give it a week with ice and light massage to keep swelling down before having a doc asses the damage. Rowing motion is a no go but hanging from a bar causes no pain.

Thanks for all your help! Read through all the comments so far and you have some great advice and wisdom! Cheers
  • + 2
 Hi man It sounds like you have hurt one of your rotator cuff tendons and maybe the labrum depending on if you feel any instability or restricted movement with passive ROM.. I would give it a few days but if no improvement, have it checked out. Cheers H
  • + 1
 @hcturner: Really appreciate you taking the time to reply! I had massage today with some cupping to help the blood flow, and another scheduled next week. Ride on!
  • + 1
 Hi,
I crashed at the beginning of September and tore the UCL on the thumb of my dominant hand (shifter thumb). I did not have surgery and went through all the rehab regaining close to full function and about 90% range of motion. I am riding again and have been since about 6 weeks post injury. It still gets quite sore. Is this normal for being 6 months post injury? The pain is manageable but I'm worried about when I really pick up my riding this spring. How long do these type of injuries take to recover? Your reply is appreciated.
  • + 1
 Hi man.

The UCL can take some time(months)to heal up but if you have severe pain, I would go back for review just to be sure. Every person is different and our activity levels affect injury healing as well. I you want to continue riding, I suggest you use a brace or strapping. Otherwise I think you should keep of the bike until you have it checked.
Good luck

H
  • + 1
 I had a bad crash during a race and broke my collarbone and a few ribs two years ago. I've since completely healed but have had a few weeks of difficulty sleeping every 3 months or so since the injury. Any idea what may be driving this? Physical, psychological, or combo?
  • + 2
 Very difficult to say but if it comes and goes, it sounds like you may be doing something that is either aggravating the old injury or a combo as mentioned above. Try to remember what you were doing during the day which might have caused the aggravation and see if there is a pattern. Then try and avoid this or go see a PT to check it out. Good luck
  • + 1
 Can riding to much chunky downhill cause tendinitis on the hands, or can it make worse?
Also what would be the best treatment for a tendinitis on the back of the hand?
I have this pesky tendinitis now for almost half a year. Of course I visited my doctor and got treatment and medicine.
It hasn't fully healed yet, I still can feel it and it's just so annyoing.
Sometimes it's almost gone for a few days, but than it comes back again and again.
  • + 1
 Tendinitis is usually a overuse injury. The best treatment is rest and physio. Try less gnarly trails or take a few weeks off the bike and see what happens? Good luck!
  • + 1
 @hcturner:
Than you.
  • + 2
 @OneTrustMan
I've been going through the same condition as you. In the beginning, I would just take time off the bike but then as soon as I put in multi-day rides, the pain returns. I have found that working with a bike fit professional to fine tune the angle of my wrists and the amount of pressure on them has helped. Experimenting with different grips (shape, directional, amount of damping) and handlebars has also helped. I also use anti-inflammation muscle and joint rubs. Finally, don't neglect warming up your wrists before rides, and stretching/massaging the forearm muscles after rides. Tight muscles can put extra stress on tendons/ligaments and make them more prone to inflammation.
  • + 1
 @sugaranddirt:
Thanks.
I tried already a lot of different grips, gloves and handlebars, but mostly because of finger pain.
Fine tuning my fork an so on.
I will give warming up and stretching/massaging a try.
Can you recommend a anti-inflammation muscle product?
  • + 2
 @OneTrustMan:
Not sure if this is helpful to you, but when I went for my bike fit, the fitter adjusted the angle/position of my saddle so that there will be less pressure on my wrists, and also taught me how to activate my lats (the latissimus dorsi muscles in your back) when climbing so that there's less sustained pressure on my wrists.

As for muscle rubs, I like those that use Arnica, hemp oil and/or CBD. I think different bodies respond to different things and even different formulations, so I suggest you try a range and then stick with what works.

I also take turmeric and ginger supplements to help with overall inflammation reduction.

It's a lot, I know, but anything to keep me happy on my bike!
  • + 1
 @sugaranddirt:
I had already more than one bike fits.
Mostly because auf knee and back issues which got all sorted out. They helped me pretty well.
The thing about my wrist is that I really like to mash fast through gnarly stuff like roots n' rocks.
It's so much fun, but also tiring.
I will give the CBC oil a try. Thanks for the advice.
  • + 1
 @OneTrustMan: Ah I see, I hope the stretching/massaging and CBD creams/gels help! good luck!
  • + 1
 Do you find that and dealing with orthopaedic and trauma related injuries on a regular basis affects you psychologically when you're riding? Do you find yourself playing scenarios though your head thinking about the possible negative outcomes of what you're about to ride when you're on the trail?
  • + 1
 I get days where it bothers me less but there are some days where I question my sanity haha. I also think it's a personality thing and some people who are in a similar situation may have no issues at all. I sometimes envy people who just send it and seemingly don't have any worries, but I guess we are all different and should just enjoy it our way.
  • + 1
 I broke my clavicle and distal radius close to a year ago and had both plated. Rehab went pretty well, but in the last few months the discomfort and overall tightness has been creeping back up. So my questions are 1. What are some good exercises to do to keep mobility on breaks like this? and 2. Should I consider having the plates removed in order to have a better chance at the best possible mobility and pain-free future?
  • + 1
 You can check a few answers above about the plate. I would suggest you see a PT and do resistance band and aqua based exercise with dedicated stretching. Good luck
  • + 1
 Hello Doc,
How long does it take for a back injury to heal ? I fell from about 3 meters on my butt, terrible pain but nothing broke, I could ride again 3 month after the accident.
But it has been 2 years now and it is still painfull in my everyday life, and even crippling when I'm climbing and during long ride. I'm doing a lot of stretching with my physio but the gains are marginal.
When I see Candide Thovex, who broke his back to pieces and still ride like an animal, I wonder if I have to do something more ? Is it possible to heal at 100% ?
  • + 1
 Im not a MD, but athletes that are at the top of the game train like hell, stretch a lot, and see physios very often. I dont think it is ever possible to heal at 100% once you passed childhood, and candide would probably still ski like a king at 50% so im not sure it's ever a good idea to use these guys as a comparison.
That being said, if you look at minnaar, he has had a long list of injuries, and it seemed he managed to recover pretty well, but last time he injured himself, i think he was saying in an interview that he still feels some left over of the former injuries.
Keep working with the physio, stetching, swimming etc, thats the best you can do
  • + 1
 If you still have severe pain, I would go and see someone about it. Hopefully it's just muscle stiffness which will get better with a proper PT and stretch program (and patience) BUT they can also assess whether you need something like a MRI or not. I hope you get better. H
  • + 1
 Hello Doc. I'm 36, had knee reconstruction surgery 1 year ago and have been riding for the last 5 months now. QUESTION: How long will it be till the knee is 100% I feel fine now and going full retard. I heard the full heal takes 2 years is that true?
  • + 2
 I think he keeps your question unanswered because surgery's and recovery durations are very individual and only a bad doctor can give you an exact answer. If i want to shorten a recovery time of an injury, I always put my concentration on the health of my whole body. For those bigger injuries which need more time to heal it is good to have some confidence and patience.
  • + 1
 Hi man. This is difficult to answer as different people take longer or shorter to heal up due to a variety of factors.I would not go full out yet for 6-12 months. You don't want to risk doing any damage again. You are still young and have lots of time to ride. Rather spend more time now on strengthening all the muscles around the knee and getting your balance right. Good luck!
  • + 1
 Hey Doc,

About 10 years ago I took a bad spill and suffered a Perilunate trans-scaphoid dislocation fracture. It was pretty gruesome. The hand surgeon who did the surgeries said it was one of the worst non-compound fracture dislocations he'd seen. tons of pins and a screw to keep what was left of my scaphoid intact. Due to the torn ligaments, I ended up losing ~70% of my extension and ~25% flexion. Anyways, I'm still riding but I am reminded every day about it. I know I won't get the movement back to a normal person but I have a fair bit of pain pretty much all the time. Would you consider any type of stem cell therapy? Would it be worth pursuing?

Thx
eRod
  • + 1
 Hi eRod

There have been some promising results with stem cell therapy with tissue regeneration. It may help you but there usually is no guarantees unfortunately. Cost is also an issue unless you can enroll in a trial of some sort. If you have access and cost isn't an issue, I would try and see?
Good luck
  • + 1
 I did stem cell and PRP therapy on my knee about 10 years ago after my last surgery. Can't say for sure if it resulted in regrowth, but I can tell you my overall outcome form the surgery and treatments, together, was excellent.

The one thing I'd say is beware that the stem cell extraction can be very traumatic if you are a young person. When I did mine, almost all of the practice's patients were geriatric, which means weak bones and the needle apparently just slides right in. For me, though, with 25-y.o. bones and a 220-lb. frame, it was literally hammering the needle into my hip bone with a mallet, in I think 8-12 different places. That part itself wasn't actually that horribly painful, just really uncomfortable, but the next day it felt like someone had taken a sledgehammer to my low back (which they basically had). I could barely get out of bed.

Not saying all that to discourage you from the treatment. And it could very well be that they do things differently now, 10 years on, so that it's not as traumatic. I just wanted to let you know because no one told me what to expect and I ended up having to take a couple days off work afterward.
  • + 1
 I broke my wrist pretty bad last June, so I've been wearing a Troy Lee brace since I got back on the bike to help give me more confidence and stabilization. Now that most of the range of motion and my confidence has come back, I've continued using the brace, but is there a good reason to either continue using the brace or to stop using it?
  • + 2
 Technically your wrist should be healed now so you can slowly discontinue using it IF you have no pain. I would still keep it in my bag for big days out as a precaution. Good luck!
  • + 1
 Hey Doc, I'm an older rider with some old injuries, one happens to be a shoulder dislocation. It hasn't bothered me for years, but then I slept on it wrong. I didn't get it checked out and babied it for a few weeks hoping it would get better, but it just got worse. Went to have it checked out and X-rays look great. I've been doing PT exercises to strengthen certain muscles (care has been great), and it is improving, but I have good and bad days as far as pain. They haven't told me not to ride, and it seems that using it more actually helps -- but that seems counter-intuitive. I've done some test riding on the street, popping wheelies and going off curbs, and it doesn't seem to bother it, no pain and feels relatively strong. My question is, should I avoid riding and stick to the PT exercises until the pain disappears, or if it doesn't bother me riding, go ahead and ride? Spring has sprung, and itching to get out . . .
  • + 1
 Hi man! Try the PT for a while and see. If no improvement, have it checked out and maybe get a MRI. Hopefully its just a tendonitis. Good luck!
  • + 1
 @hcturner: Thanks doc. Nothing on the x-ray or exam indicated an MRI was necessary, and my insurance sucks now (thanks [insert political figure]) so would like to avoid that expense if I can. Getting older, so should expect things to take a bit longer to heal. Great idea for a thread and appreciate your contribution!
  • + 1
 I landed on my elbow a few months ago. I think I injured my Burstis. It's remained swollen since the initial hit and aches when I do back type gym movements (rows, pullups etc.). The swelling looks like a small gumball in my elbow. I have no range of motion problems. What can I do to reduce the gumball in my elbow? What can I do reduce the pain I get when doing gym movements? TIA
  • + 1
 Sounds like an inflamed bursa yes. Some doctors may be able to drain it for you but it may come back and you may introduce infection this way( which would be a bigger problem) The problem is every time you move your elbow, the tissue stretches and is painful. Aside from analgesics and resting the elbow, there is not much I can suggest unfortunately.
It usually resolves after a few months but if you are struggling, I would have it checked out to make sure you didn't injure another soft tissue structure a round you elbow as well.

Good luck
  • + 1
 HI Henry, what can you do to increase blood flow in hands and increase grip strength? I've a non displaced scaphoid fracture in my non dominant that has healed well over the last couple years, however my palm goes numb and the hand as a whole cannot grip bars well compared to my dominant hand. On my dominant hand, I've sprained my index a while back and it is very stiff when I try to 'sprawl' out my fingers. There was no fracture, just some tendon/ligament damage. I want to increase it's mobility.
  • + 2
 I suggest you try softer grips for a start and do resistance band training under PT guidance and see how it goes? If no improvement, I suggest you go for an evaluation. Good luck!
  • + 1
 Hey Henry.
Im 18 and a few years ago (about 4 now)I tore my Miniscus and patellar tendon in a Basketball incident. I did PT and worked on it as much as I could. I started Mountain biking soon after this as I though it may be easier on my knee. As am 18 year old I am well into the more aggressive side of riding Enduro and Downhill. From time to time my knee starts acting up on long climbs. I believe it was shoe/cleat related, and my knee may be pointed inward toward the frame somewhat. What can I do to fix/correct this?
  • + 1
 FWIW you may want consider flats. Takes cleat-related issues out of the equation and also reduces risk of catastrophic knee injury.
  • + 1
 Hi Pogan I would go back to physiotherapy and see if they can give you exercises to strengthen the muscles around the joint. This will help with your pain and increase your function hopefully. The PT would also be able to check if there is anything more serious happening now.
  • + 1
 @pogan flats definitely help. i'm also 18 and have some knee problems from running xc and track. I still ride clipped in for more than half the time but flats will take the upwards pull motion out of pedaling which can be linked to knee/lower leg strain. Flats will also make u a much better rider for when u decide to put the clips back on.
  • + 1
 I suffered a high energy wrist injury resulting in a distal radius fracture with a completely dislocated radio-ulnar joint, ulnar styloid fracture, and a complete scapholunate ligament tear. I had the radius plated, and the radioulnar TFCC injury feels like it's healing well as I have had progress in supination and pronation ROM and stability. But the scapholunate ligament was not fixed and now has a 3-4mm space between my scaphoid and lunate. I still have carpal instability and pain in weighted wrist extension 9 months later. Should I just continue rehabbing my hand as is and slowly return to riding, or should I scrap the season now and have the scapholunate ligament repaired? My ortho also seems to think I've had this ligament tear from a previous injury which hadn't limited my ability to ride a mountain bike in the past. But the carpal instability I'm experiencing now makes me think it is new.
  • + 1
 Well, you're outside the window for repair of the SL. There are many options for reconstruction, but none of them are truly great. I would definitely recommend talking with your surgeon about doing something to stabilize the joint before you develop arthritis, especially if you still have secondary wrist stabilizers intact and the scaphoid hasn't rotated out of position. Once you go SLAC, there is no going back!
  • + 1
 @jaydoc14: The scaphoid is slightly rotated and limiting flexion.
  • + 1
 Your case isn't straightforward unfortunately. Firstly, If you still have pain and instability I would not go back to riding yet. There are some authors that say you can repair the scapholunate ligament up to 18 months after the injury but this is variable and may not be applicable in every case. If you are unsure, its not a bad idea to get a second opinion from another surgeon? It is your right and it might give you a bit of reassurance or clarity. The big thing is to prevent SLAC and arthritis!
  • + 1
 @hcturner: Thanks doc. A second opinion it is.
  • + 2
 Had shoulder replacement surgery late Nov 2018 and the he accidentally cut my bicep short head and had to suture it back up. What are my best approach to being able to get back on DH biking?
  • + 1
 Focused Physiotherapy and aqua exercises with resistance band training.. Good luck man.
  • + 1
 I've had two dislocated shoulders (right side) and had surgery to repair my labrum last september. Back to riding now and up to full strength, but it seems like my collarbone pops out of place (subluxed?) near the attachment closest to my neck during some rowing and reverse fly exercises. It hurts so I mainly steer clear of those specific movements, could this be caused by a tighter than normal labrum, and should I be concerned?
  • + 1
 It actually sounds like a sternoclavicular joint subluxation which could be from your initial fall. I suggest having it checked just to make sure there is nothing more serious going on. Good luck!
  • + 2
 I’m experiencing a number of symptoms including: irritability, lack of drive, decreased libido, increased alcohol consumption and thoughtless mile wide stares. Do you think I may have “Huck Fever”?
  • + 1
 Haha I suggest you see someone immediately, maybe your local bike dealer?
  • + 1
 I am not very symmetric due to javelin throwing. My left leg was the back leg for the soft step, right leg was the plant leg. During my final year of intense throwing, my right butt got weird; piroformis, sciatic nerve etc. Then I biked across New Zealand and tore my right MCL at the very end. Now my right foot turns outwards a bit. Wearing out shoes on the right side outside more than the left side outside. On the chairlift, my ski points outwards more on the right side. Feels really uncomfortable to have both skis parallel while dangling in the air. I have to really force parallelism. What should I be doing about all this?
  • + 1
 Do you have pain while running, biking or on the skis? An MCL should heal up usually but If it is affecting you, I would have it checked out. The PT can give you exercises to help restore balance if everything is okay otherwise.

Good luck

H
  • + 1
 Dr. Turner, thanks for taking the time to answer these questions!

Last season I had a total tear of my left ulnar collateral ligament and will be having surgery soon. After the recovery and rehab, are there some specific exercises you would recommend to increase the durability of that ligament? I would love to not have a repeat experience on either hand.

Thanks
  • + 1
 Sorry to hear about the injury! Depending on the repair, I would just recommend that you follow your physio's instructions to the letter and regularly follow up with them to ensure that you are progressing well. Resistance band training is quite good and I recommend you invest in a good pair of elbow guards!
  • + 1
 Hello, 48yo male recovering from clavicle operation (illiac crest and plate) also a broken elbow that did not require surgery but has left me with an inability to fully extend my arm ( I would say about 20 degrees off straight) I have realised that perhaps DH, Enduro and trips to the Alps are probably in the past now. Would XC or even road biking be less of a risk, or is the reduced/lack of suspension going to cause me more issues?
  • + 2
 I don't think a doctor needs to answer this. The reality is that you can get just as hurt on an XC bike as you can on a DH bike. An all mountain bike will do better at sucking up some of the terrain, but you can still wash out, get in a collision or lose your line through a rock garden. In my humble opinion, I wouldn't let those injuries stop you from long descents in the alps. Slow down, sure, but you're not going to be any safer on an XC loop!
  • + 1
 Problem is a crash can happen anywhere. I would continue with the PT and add resistance band training as well to try and get that arm straighter. You can do what your body allows you to do BUT a crash can ruin things again. Wear elbow guards!! Good luck man.
  • + 1
 Question about my knee. Back in 2013 I dislocated my knee tearing my ACL, MCL, and Meniscus. Took about 3 years post surgery for it to come back to about 99%. In March 2018, I crashed pretty hard again on said knee. I thought I dislocated it again but I could still walk, ride, and the knee was overall stable. No locking or slipping. However, I couldn't bend my knee past 90° for about 3 weeks and there definitely was nerve damage, bruising, and swelling. Now, about a year later, I still have MILD pain in the knee after strenuous activity (goes away in about a day) but the feeling in the front of the knee has returned to about back to normal. It's not preventing me from doing normal activities like riding, walking, lifting, etc...so I am hesitant to get it checked out...but should I? Based on the symptoms immediately post injury, I THINK...my knee pad dislocated my knee cap and it relocated itself during the crash. What do you think?
  • + 1
 The ideal would have been to check it out after the 2nd crash but now it's a bit less urgent. If its not affecting you, there is no real urgency BUT I would still have it checked out at some point. My reason for this is you have that previous serious injury and your knee is more vulnerable. It's not necessarily an emergency but if you were better and now you are worse, something must have been injured again. Good luck and protect your knee!
  • + 1
 @hcturner: Thanks for taking the time to respond! I especially appreciate it because the ask me anything had ended already so...I appreciate you responding during your personal time. I was probably going to have it checked out again at the end of this year in the event it needs another surgery or something...so I can be off the bike in the off season.
  • + 1
 What are the odds of someone with a tibial plateau fracture getting back on the bike and riding hard? Do you think just any ortho doc can do the surgery, or is it important to find a sub-sub-specialist? Asking for a friend.
  • + 1
 I broke mine so bad they almost amputated my leg. A few years later, I can charge the mountain as hard as ever on both a board and a bike. I had an awesome surgeon tho. Spent 18h under the knife.
  • + 1
 He should be able to get back but it will take time and lots of PT and patience. If its a complex fracture with many pieces, probably best to go to a sub-specialist, but this is always area and protocol dependant. I hope he recovers well. Good luck
  • + 1
 @hcturner: How about disuse osteopenia. Any chance of getting bone density back? Says he's got the femur & Tibia bone of an 80 year old now. Frown
  • + 1
 Hi Dr. Turner. As someone currently in college to become an Athletic Trainer/Physical Therapist, how would one better position themselves to work with the biking/outdoor community? Also, in terms of evaluation for MTB'ers, what extremities/injuries do you find yourself working with most often?
  • + 1
 Hi Graham. Get involved at Bike parks and Ski resorts in winter, get to know some people who have been in the industry for a while. Upper limb injuries are the most common. Good luck!
  • + 1
 June 2017 i crashed my bike and suffered a intertrochanteric hip break, i now have what i think is called Talon Compression Hip Screws, pic on my porfile. I have since had pain just about daily in the IT Band area. I have read about IT Band syndrome and wonder if that is a possibility with the type of metal plate that is on the side of my femur. BTW also shattered my clavicle, two plates on that well...it's doing fine.
  • + 1
 It MAY be that the screws are irritating the soft tissues or ITB. If it is affecting your activities, I would see someone to review it. Good luck
  • + 1
 Do you think sonic bone stimulators (specifically Exogen by Bioventus) actually reduce healing times for non-union scaphoid fractures? Or is it overpriced snake oil? I've seen varying answers online and they can eat up your entire deductible if you have a high deductible plan (see overpriced American healthcare).
  • + 2
 I have that device and had a evulsion fracture on my foot that would not heal for 4 months, once I got that device it was starting to calcify in 4 weeks. I think it can be a useful tool in the right situation. Our bodies run on frequencies so anything you can do to stimulate in theory should help. I have not read many studies on this but I don't think it would do you any harm to use one. It was stupid expensive, $6k I think?
  • + 2
 They generally work but are crazy expensive. And like all things, you unfortunately have no guarantees. Maybe see if someone has a 2nd hand one or something? (im not familiar with the US system ) Goodluck!
  • + 1
 @hcturner: thanks for the advice, I've seen mixed opinions online.

FYI in the states, they shut off after you don't use them for long enough to stop people from selling them second hand. I was lucky enough to get hooked up with one through my Doctor but the original estimate was $1660.
  • + 2
 @adventuresbycole: Good to hear. I've been off my bike since a crash in Aug and after 5 months My Scaphoid was a non-union. My doc put in a request for one and BioVentus told me it was going to cost me $1660 with insurance. I was a hard pill to swallow when the research seems spotty.

I'm due for my next CT scan at the end of the month. Hopefully, it did its job!
  • + 1
 @sassapig: Best wishes! Take a look at Onnit's Stron Bone. It is as really good supplement for bone heath. www.onnit.com/stron-bone
  • + 1
 Hello, Thanks for taking your time to answer questions-that's awesome. My question is do you have any first hand experience with someone who had a sports accident and suffers from hemiplegia? If yes, do you know about alternative medicines or human growth hormones (that can help)

Thanks JG
  • + 1
 Hi Jenny

I unfortunately have no 1st hand experience with any questions of the above but I have read that there are promising results with stem cell therapy in a variety of tissue regeneration studies. I would maybe look into that? Good luck
  • + 1
 January 30, I had my left knee 'scoped and had some damaged cartilage removed. There is also some arthritis which the doc said will just get worse. Some days, my knee clicks like castanets played by a monkey on crack. Does it take time for the knee to tighten up a bit to remove the extra space? The pain is still there but it is 90% better.
  • + 1
 It does take time for the tissues to heal but it won't really affect the space that much.It sounds like your knee has significant OA changes in it. Usually the pain with oa comes in flares and settles down again with analgesia and rest. I'm glad the scope helped but I unfortunately can't say whether your pain will ever go away fully. I would try and get a dedicated PT program and do some aqua exercises to strengthen the muscles around your knee. I hope it gets better. H
  • + 1
 Short of concussions, what is/are the top injury/injuries that mountain bikers most often have but neglect to treat? It seems like there's generally a culture of not seeking treatment for injuries unless something is very clearly broken or bleeding. Just curious what you've seen!
  • + 1
 Usually shoulder injuries and lower back issues Everyone seems to have a bad shoulder and many people have back pain. PT should help with most cases though.
  • + 1
 Riding with prostatitis. I have been diagnosed with prostatitis and am currently in a bad flare up and have been off the bike for 10 days, and have been prescribed a 10 day course of Bactrim DS...... Any suggestions on how to manage this awful condition?
  • + 1
 I had the same issue a while ago. Just take the antibiotics and you should be good to go. NSAIDS also help a lot.
  • + 1
 Sorry to hear man. I think some time off the bike would be a good start along with analgesia and the antibiotics. Maybe a good idea to see a Urologist at some point to make sure everything is okay. Also use a soft seat and extra padding at the shorts. Good luck
  • + 1
 Thanks guys.... much appreciated. I'm on antibiotics now and will see a urologist who actually specializes in the management of prostatitis. I've been dealing with if for almost 7 years now with this one being the 3rd, and worst flare up yet.
  • + 1
 Hi. My son did a slow speed endo onto concrete and extended both arms into the concrete super man style. He went to emergency and they believe he injured muscles in elbow area, no break. He is 16 and otherwise in good health. What sort of timeline for recovery can be expected? He can touch hands to shoulders but it remains difficult. Thank you for doing this. It’s excellent.
  • + 1
 If there is no fracture, the soft tissue stiffness should resolve by around 2-4 weeks. If the pain & swelling is getting worse, I suggest a 2nd opinion. Good luck!
  • + 1
 Dr. Turner

I'm 15 and was born with bilateral club feet. I race XC and ride on clips. Should I use any precautions while using clips and if my ankles hurt after day long ride would you recommend I wear braces for support?

Ben
  • + 1
 Hi Ben. I assume you were treated as a baby? I would advise you see a Sports Physio 1st to make sure the braces don't interfere with your muscle balance, etc. They might refer you on to a surgeon if needed. Good luck!
  • + 1
 Doc, I suffered several brokern ribs, punctured lung and shoulder separation in a crash several years ago. After P.T. I was treated by an Osteopath that talked about restoring lymphatic pulse to the injured area. It all seem a bit like black magic but it seemed to finish the healing process. Is there really something to this or was it just time that finally restored range of motion and the pain issues? Thanks
  • + 4
 Hi guys! Thanks for all the questions. I'm gonna try my best to answer as many as possible.
  • + 1
 I have suffered from years of lower abdominal pain that I believe is the result of a sports hernia. Back in October, after a steep climb/ride I noticed a sharp pain in my lower right abdomen that progressively gets worse with any physical activity. It's been suggested to me that I have torn an abdominal muscle (I.e a sports hernia). What are the treatment methods to resolve this issue? I have been to physio for 4 months with no improvement. Is surgery an effective option? Thank You.
  • + 1
 I would have it checked out by a surgeon as you are still in pain and it is affecting your QOL. Good luck!
  • + 1
 Hey Doc! Thanks for this. I have some degenerated disks in my lower back, one of which is bulging. I'm still waiting to hear from a specialist about it, but is there anything beyond "make your core strong and stretch" that they might tell me?
  • + 1
 Hi Spinko! It all depends on how big and serious the bulge is. You will most likely be told that weight loss, Physiotherapy and core strengthening are the best options. I recommend water exercises as well. Really hope you get better!
  • + 1
 @hcturner: Thank you!
  • + 1
 @hcturner: I keep winding up in this cycle where I try to work out, I get 3 weeks in and my disk lets go. If I don't work out, it's ok, but then I'm weak on the bike and not achieving the race results (enduro) I want to get.
  • + 1
 @spinko: if riding doesnt hurt it just make that your form of training. skip the gym and just learn your bike and get your legs strong. time on the bike is way more important than how many pounds you can lift in a way that doesnt even relate to riding!
  • + 1
 What is your recommended wait time from scaphoid surgery back to mtb riding? I'm at 8.5 weeks after surgery, have been doing PT, and have been told I'm at 80%. I have also just been okayed for track racing, but not MTB quite yet. Let me know your thoughts on this appendix of a bone.
-Thanks
  • + 1
 A scaphoid bone is tricky because it has a relatively poor blood supply and is prone to have issues when healing. Ideally you should be pain free and your range of motion and grip strength should be around 90% of the other side before you even think of going back to sport. I would take it easy and follow your surgeon's advice. Rather take more time and then have better long term results than risking it for a slightly earlier comeback.
  • + 1
 @hcturner: Thank you, I appreciate the response. I guess I have to push my next MTB fix back a bit longer.
-Happy Shredding
  • + 1
 Since starting riding, I've had a consistent problem with pain in my left hand. I've had bike fits, physical therapy, and tried a number of component changes (Rev grips, foam grips, different bars, etc). Nothing really helped, eventually I went to see an ortho and had a nerve conduction study done. The study indicated that the response time was within normal ranges, however the left (the hand that bothers me the most) between my wrist and pinky was slower than my right on the same place. They concluded that I had Ulnar compression in my left hand. Their advice was to take 3 months off riding and wear padded gloves.

The problem I have is that I have done both of those things and it returns, the padded gloves made it worse. I've been working with a PT (Hi Liz!) and on core/upper body strength with a trainer, both are helping me ride better and my hands recover faster, but progress is slow and they are still painful. I talked to a lot of other people with similar issues from riding bikes and moto, with a running theme: It took seeing 4-5 doctors before one finally identified the problem and released the nerve surgically, but they were all to the point of losing hand function due to the damage before anyone did anything.

So my questions are:

1. Will a nerve conduction study show damage or entrapment even though symptoms are relatively minor (pain, no numbness or loss of control)? Does the damage to have to reach a certain point before the study can reveal other solutions are needed (e.g. surgery to release the nerve)?
2. Are nerve conduction studies a fairly objective test or are they open to interpretation? Mainly, I'm trying to figure out if I should go hunt down another doctor to give me more practical, useful advice or if it's something that can't really be misread.
3. Any advice on components or bike setup that could help relieve the pain? Anything you've personally used or prescribed that can help?
3. Any suggestions in general?
  • + 1
 This is a bit complicated! I recommend you have a 2nd opinion from a hand and wrist surgeon if you can get access to one? We use NCS daily but like all special investigations, we have to corroborate the report with our clinical findings.They are fairly accurate usually. To be honest, my suggestion would have been softer grips are optimal ride position which you have already done. I think a 2nd opinion is a good idea. Good luck
  • + 1
 Hey man,
I'm struggling with the exact same issue here, and suspect after my first consultation that I'm also going to be sent down the same route with all the tests until a call for surgery has been made. 2 months off the bike didn't yield any improvement.
In my case, it was padded gloves, and a combination of DMR deathgrips that caused it. I'm used to riding skinnier grips, and the added chunkiness affected the "relaxed" grip I was able to have on technical descends.
I also have some discomfort in my elbow, as the ulnar nerve runs passed it. A fall in October last year on my elbow is to blame for that, but somehow I wonder if there's any correlation.
I've also done some reading on possible bike setup changes, and some suggested ergon grips, and bars with less up/back sweep. I haven't tried that myself, as I'm a bit skeptical of throwing good money after bad.
  • + 1
 Hi Dr. Turner,

Will try to be concise: I had a distal pole scaphoid fracture (non-union) on my non-writing hand and it was 4 months before I got it diagnosed and treated.

I was in a cast for 3 weeks and then the new hospital and doctor (I was moving between countries at the time and they had no access to my medical records) reckoned it had begun to union again. It was then discharged.

It has been almost a year since the crash where I broke it. It aches a bit, especially when riding (more on my road bike than trail or DH bike). I just wanted to ask whether this is normal and should I be concerned? Movement is completely fine, but pressure (e.g. press ups) are not entirely pleasant.

Many thanks for any info!
  • + 1
 I'm no doctor, but I've broken my scaphoid and I'll say this... it always hurts. I still ride and race at a high level (pro-level in the US) and I've just learned to ignore it.
  • + 1
 If you are unsure,in a lot of pain and have access to a surgeon, I would follow up for a second opinion.
  • + 1
 Hi! Is there a website or a resource you could direct me to that describes various core exercises and stretching that are proven effective for mtb? I've been working on core strength and flexibility this winter but want the most bang for my buck because I'd rather be out riding!
  • + 1
 There are few guys who have mtb specific programs online but they are all paid products. I usually just search online and try and find a reputable site that's not just focused on bodybuilding but actual sport. Good luck
  • + 1
 Hey Doc! Suffered a type 2 tibial plateau fracture 5 weeks and 2 days ago. I've got 2 plates and bunch of screws. I'm just looking for some hopeful words really. Feeling discouraged.
  • + 1
 My wife did same injury/plate and screws surgery after ski accident top of Whistler, about 10 yrs ago at age 50. Did lots of physio and she started running and backpacking again after about 4 months but found over 5km run bothered her. Screws started backing out so surgeon removed hardware and she gained more ROM and started biking! By next yr pretty much 100% and now living in BC mtn town she is skiing and biking way better than 10 yrs ago! Every individual case different of course, but early and dedicated rehab program with good physio is key. Lyndsay Vonn not only training hard within a yr of her to surgery but winning WC speed races next season! Your body's healing power is amazing! 4 wks into rehabing grade 3 mcl tear now myself - and I'm an old mtb'er haha! Keep positive brother you are not alone.
  • + 1
 My tibial plateau fractured into 27 pieces (snowboarding, fallen tree under 3' of powder). I did a lot of exercise and weight lifting during recovery to avoid any unwanted atrophy. Still took me about 2 years to fully recover, but now I can do most of the stuff I used to besides running (used to run a mile a day). My injury is why I ride bikes now.

Best advice I can give is to get that hardware taken out as soon as possible. I got mine removed at 10 months, and it was one of the best decisions I've ever made.
  • + 1
 It will get better man. Be patient, follow the PT advice and do the rehab with full commitment. You will ride again, just let it heal properly. Good luck
  • + 1
 Hey Dr. Turner....Can you elaborate on the "nerve root symptoms" you mentioned regarding lower back pain as a possible reason for wanting an MRI? What type of things would these symptoms include?
  • + 1
 This includes numbness in areas on your body, electrical type shocks down your leg or arm, weakness of the affected limb and there are more serious signs like loss of anal sphincter control and unable to void your bladder. Sciatica is also a classic condition which is related to this.
  • + 1
 Had a crash yesterday straight to the face and got some whiplash, pulled all the muscles in my neck and hurts to move my head around. Anything to speed up the recovery apart from rest? Anything to help prevent in the future?
  • + 1
 Rest, physio exercises and consider a neck brace? Hope it gets better soon.
  • + 1
 Do you reckon MIPS or similar rotational injury prevention devices are useful or would thicker and more advanced padding, like multi layer foam, actually make for a more universal protection layer?
  • + 1
 I actually answered the MIPS question above. It sounds like it can make a difference. Multi layer foam may work the design allows the rotational force to be transferred to the helmet?
  • + 1
 Hey! I’m a 30 year old currently in undergrad postbacc prerequisites and appling for medical school. Anything you wish you would have known before you jumped into the profession?
  • + 1
 I wish they told me that my free time would be almost non-existent for the first while after qualifying and doing internship. It gets better later on at least. Good luck!
  • + 0
 What is your advice for finding a great physical therapist in my local community?? There are so many differing opinions...one recommended by someone, is too "general" for someone else...there are a lot of options, and I have trouble trusting google reviews...I want someone that will help me as an athlete and treat injuries, but also provide guidance for prevention down the road.
  • + 1
 I would find out which PT your local sports club uses and contact them?
  • + 1
 Dr. Turner

I suffered a severe subtalar joint injury. 18 months later I’m barely able to get back on the bike due to the imacts from a normal trail ride. Any tips, on how to come back from such a big injury to that joint?
  • + 1
 That's a difficult injury to recover from. The subtalar joint takes a lot of strain. I would suggest you don't lose hope and continue on a dedicated PT program that strengthens your lower limb muscles and supports your ankle. If you haven't seen a surgeon for a while, I would go back for a review and an opinion. They may be able to offer some additional treatment options. Good luck with the rehab.
  • + 1
 Hi doc! I recently had a partial menisectomy done on my left lateral posterial horn, what can i do to prevent more damage in the future? You think more muscle in the leg would prevent arthirits?
  • + 1
 Hi Jonas. Yes I would start out by strengthening the muscles around your knee and improving your flexibility. A dedicated PT program would also be good.I would also invest in a good pair of knee guards and maybe even a brace. Good luck with the recovery!
  • + 1
 10 days ago I brokemy collar bone and it’s a displaced fracture. As it’s not been plated and both ends are moving freely, have you got any experience of making sure the bones heal in the right sort of place?
  • + 2
 go to a doctor, internet advice isn't what you need, even if the advice is from someone brilliant.
  • - 1
 Is the NHS that f*cked already?
  • + 1
 Clavicle fractures usually heal well without surgery as long as they are within certain paramaters of displacement, etc. If you are unsure, you are entitled to a 2nd opinion. Good luck!
  • + 2
 Had a conservative treatment (no surgery) of my clavicula fracture as well and i am not happy with it. The sternoclavicular joint is pretty much dislocated because the two pieces are twisted to each other (not sure if twisted is the right word but you probably get what i mean). Doing some training and physiotherapy since a while by now.
My advise for you would be If you think it is not going well go to a orthopedist for shoulders and ask for a 2nd opinion.
  • + 1
 Hand hyperextension, soft tissue. We all crash with our hands out- it's left me in particular with permanent trigger finger and years of inflammation. Thoughts on injury prevention and soft tissue hand injuries?
  • + 1
 Sorry to hear that. Trigger finger can be very debilitating. Only thing I can suggest is investing in a good pair of gloves with some extra padding. There are theories about teaching yourself how to fall and prevent injuries but I'm not sure how practical this would be when your flying to the ground at 50km/h.
  • + 2
 As a physician and athlete, what vitamins or suppliments do you recomend for general health? Do you take anything yourself?
  • + 1
 I don't really believe in or take multi-vitamins for general use as the evidence shows they don't make huge difference as long as you follow a well balanced diet. I usually just use electrolyte replacement drinks for my rides along with bars/jellies.
  • + 1
 Hi, little late here, hope I am not repeating a question… What do you think about people racing enduro with open face helmet and no kneepads?
  • + 1
 I guess the open face helmet is up for debate but you should always wear knee pads AND elbow guards in my humble opinion.( I would suggest a full face as well)
  • + 1
 Who’s your favorite person to blame in the OR: anesthesia? Scheduling? Turnover? Or the rep(s)? Smile

Also, what’s your favorite surgical instrument?
  • + 2
 Haha no comment! The hammer of course!
  • + 1
 Any suggestions to rehab broken clavicles that have some Ti additions now? Resistance bands, free weights, simple stretching? What would you consider a good rehab regimen?
  • + 1
 I think resistance bands are good as well as water exercises. Free weights help but don't give the same constant tension as the bands. I would see a PT for a dedicated program.
  • + 1
 @hcturner: Much appreciated, did not think about the constant resistance factor, and water exercises had never occurred to me either!
  • + 1
 What is your advice when I'm pedaling for an hour to get start of a trail and my lower back is tingled? Let's suppose I had waist injury in the past.
  • + 1
 It sounds like you are compressing or irritating a nerve somewhere around your trunk. This could be from the previous injury or new. I suggest going to a PT as an initial screening measure and have it checked out.
  • + 3
 Hello dr. Turner. I was wondering how you feel about dentist bikes.
  • + 2
 Dr. Turner,

Thanks for taking the time to answer people here on Pinkbike! Whats your take on mouth guards? Overkill?
  • + 3
 People use them for other contact sports so I guess there is some merit in trying them? Just dont bite a piece off and swallow it during a crash!
  • + 1
 Dr. Turner, I was diagnosed with L4/5 degeneration. Any thoughts on exercises, bike setup, etc to minimize lower back pain?

Thank you for you time.
  • + 1
 tnyetybiker- I also had L4/L5 degeneration, stenosis. Just had a fusion done 3 weeks ago. My symptoms were sciatica in both legs, and sore stiff lower back..Had MRI and Dr first thought microdisectomy would suffice, but due to my degeneration, recommended the fusion. 3 hr surgery, and while the anesthesia was brutal, I have ZERO pain, and besides a few OTC Tylenol, the first week, no pain pills, at all...Still have the no bending, lifting, twisting for 6 weeks, I can walk unlimited amount and ride a stationary upright bike. Sure its a bit stiff at incision, but I am totally amazed on how I feel. I start PT at 6 weeks. My advise is to get a MRI and get 2-3 good surgeons opinion.. I may not be on a MTB for quite sometime, but fusion at this point was good for me..
  • + 1
 I've answered a few similar questions in the thread above. Core strengthening and stretching is the most important thing. Bike setup should be optimised at your LBS. There are some surgical options as well but that is usually a last option.
  • + 1
 If I spiral fractured my femur and have a rod in my leg, is there a type of movement I should look out for?
  • + 4
 Leg movement
  • + 1
 Not anything specific. Just keep your hip and knee muscles strong.
  • + 2
 Just noticed a similar question from @delawhere ...,
  • + 3
 All good, better chance of a response to at least one of us now!
  • + 1
 No question, just wanted to say how bummed I am that PB couldn't book Docta Tomahawk for this event. Smile
  • + 1
 How long can I keep the titanium rod in my tibia? Is it bad to keep the metal in for life? Thanks Dr.!
  • + 1
 It can stay in for life unless it becomes painful or gives you issues. It that happens, it can be removed if needed.
  • + 1
 What is the biggest mistake you see athletes make post-injury? Lack of rehab, lack of rest, etc...
  • + 1
 Going back too early and not doing the full/proper rehab program. Patience is key!
  • + 1
 @hcturner
Thank you sir for taking the time! Already went and had a work up.
  • + 1
 Hey Doc, what's the craic? Is that the big bad wolf in the photo?
  • + 2
 Craic is mighty! I believe it is. Hope he has better luck this year with his elbow.
Below threshold threads are hidden

Post a Comment



Copyright © 2000 - 2019. Pinkbike.com. All rights reserved.
dv65 0.216154
Mobile Version of Website