Physiotherapy, bone injury, and why your kids need to get outside and play

What do you think of when you hear bone fracture? Chances are you are thinking of a casted leg, resting on the couch, or backing off and letting nature take its course.

More and more these days, physiotherapists and physicians alike are prescribing an active rehabilitation for end stage or mild bone injuries. Injuries to the bone such as stress fractures, stress responses, and even damage following surgical procedures need to undergo a remodelling in order to become strong again.

Bones, when given the right circumstances and nutrients, are fantastic healers. Even when there isn’t a break, bones are constantly “refreshing” by removing old bone cells and replacing them with new bone cells through a process called osteogenesis or ossification.

What many people don’t consider is that bones will improve their strength and quality based on the stress it is put under. Similar to how your muscles will get stronger with resistance training, so will bone when it is placed under a stress. When this occurs in a bone, we call it bone adaption. A bone will only get as strong as it believes it needs to be for the actions it is currently doing. This means that if you stop doing exercise, your bones begin to weaken.

Bones react differently depending on the stimuli, and the reaction is called an osteogenic response. Research has begun to look into different styles of bone loading to see what creates the greatest osteogenic response. This research allows us to recommend exercise programs to strengthen bones as a way to either prevent fracture, or speed up the recovery following a bony injury.

What has been discovered through this research is that bones will initially respond well to a strong mechanical load, but then their response begins to diminish. In a sense the bone becomes “deaf” to the activity and stress it is under. By understanding this, we can now create a bone loading program that can maximise repair and strengthening by separating the exercises into shorter bouts spaced throughout the day.

What this also means is that it is important to create a loading force in your bones throughout the day. It may mean taking the stairs instead of the elevator, or parking further away from the train station. This is especially important in children and youth, as research has shown that the majority of our bone density is created based on the actions we take during this time in our lives. The fact that bones become “deaf” after a period means that dedicating an hour to kicking your kids off of the iPad probably isn’t going to be as effective as having them engaging in play throughout the day.

If you have suffered a bone injury, or are considering an increase in your exercise regimen, consult with a doctor or a physiotherapist to ensure that you get all the advice and treatment necessary to help you reach your goals.