Reflections from Bed Rest 2

New knowledge:

Bed rest has serious side effects; after a fracture, simply lying still is not the best approach.

First, bed rest is practically a second injury after a fracture. 1. Bed rest causes severe muscle wasting, and it happens fast! A week in bed and your leg muscles can shrink by 10%; a month in bed is enough to leave you unable to stand and walk normally. The standard muscle mass for women is 25–27%; I used to be close to 30%, dropped to 23.3% after 10 days in bed, with a low of 21.5%.

2. Bed rest causes bone loss, and to a surprising degree. The body's "use it or lose it" really is no joke. No wonder so many astronauts have to be carried when they return to Earth: the lack of gravity in space makes bones lose calcium, lowering bone density and wasting muscle. It gets so bad that, back on Earth, a spacesuit weighing a few dozen jin can fracture a bone. What's the mechanism? Bone is an active tissue, constantly remodelling and maintaining itself. The process involves bone resorption (bone cells absorbing old bone) and bone formation (bone cells producing new bone). Gravity is very important to bones: it provides the mechanical stimulus and load they need. When we stand, walk, bear weight or do other physical activity, our bones are loaded, which triggers bone-cell activity. These loads and mechanical stimuli help keep bones healthy and prompt bone formation. When bones no longer bear weight, they lose that mechanical stimulus, and bone cells receive fewer signals to make new bone, while resorption of old bone carries on; resorption outpaces formation, and that is bone loss. Looked at another way, standing and walking at the right time and in the right amount actually helps bones repair and grow. 3. Prolonged bed rest can increase the risk of deep vein thrombosis (DVT). DVT is when blood clots in a deep vein; the clot may break loose and cause serious complications such as pulmonary embolism. 4. Prolonged bed rest may reduce lung capacity and function.

Of course, by the look of it I won't be in bed for very long, but the damage from just a week or two is already this great — truly beyond what I'd imagined. Our blind spots are everywhere, and knowledge matters so much.

Fortunately, exercise rehab can make a big difference. A quick word of thanks: once again, I'm proud to thank my treasure of classmates at Gaoshan Academy. They showed they cared right away, patiently answered all my questions, and in the end even put me in touch with a UC Berkeley-certified rehab therapist who works with the national team. I really am incredibly lucky.

Talking with the therapist shifted my thinking from static rest and waiting to a dynamic understanding of the relationship between muscles, soft tissue and bone — seeking a balance between "keeping the bone stable" and "the right amount of stimulus." Starting rehab training promptly can help me get back to normal life sooner, recover better, and better guard against the risk that this injury leads to bone spurs, lumbar muscle strain and the lower back pain that comes with them.

Muscles, especially the deep muscles, are crucial. There are many muscles around the lumbar spine — the superficial muscles handle most movement, like steak or tenderloin; the deep muscles grip the spine, like the meat on lamb spine bones. The deep muscles hold the lumbar vertebrae in place and make the body more stable. This fracture will have a negative effect on my body's mechanical structure, and I have to accept that objectively. But the body has redundancy: by adjusting spinal mechanics and muscle stability, you can absolutely tap into that margin and get your body into better shape. Over the long term, a bad thing might well become a good one. Much of the body's ageing and pain is caused by "long-term improper use." Lots of small faults and errors in movement patterns, underuse or overuse, pile up over the length of a life and turn into serious wear and strain. No habit is a small matter. Effort is non-negotiable. Taking my bones seriously this time, along with rehab training and learning, may change my old bad habits for a long time to come. As the saying goes: never waste a crisis. Only by starting rehab training promptly can I best help my bones grow and get my life back. I've started changing my daily schedule to make enough time for rehab. My rehab plan

1. Overall approach: progress from bodyweight to small equipment, then to machine training. Move from a low level of everyday activity gradually back to my original abilities. 2. Belly breathing: use belly breathing to stimulate the deep muscles and stabilise the lumbar spine. When breathing out, draw the abdomen in tight against the spine, as in a plank. 3. Exercises lying down: lying flat puts no load on the lumbar spine. When there's no risk, you can feel the muscle stimulus of each movement without worrying. 4. Using a physiotherapy device: on the doctor's recommendation, I've started using a Compex 8.0, a Swiss brand founded in 1988. It works on the thighs, glutes and lower back — rotate between areas! But passive stimulation gets you only half the result for double the effort; you still have to feel and direct the movement through your brain and nerves. 5. Exercise plan

   Ankle pumps: 6 seconds each, whenever you have a spare moment

   Clamshells: 15 reps × 3 sets

   Dynamic dead bugs: 8–12 reps × 3 sets Single-leg glute bridge (knee extended): 8–12 reps × 3 sets Rest 1 minute between sets for all of the above; once or twice a day.

Finally, beyond exercise, I have to stress diet:

1. Your diet must include enough protein, calcium, and micronutrients such as vitamin D.

Be careful not to take calcium alone! Calcium needs vitamin D and other micronutrients to be absorbed; excess calcium that isn't absorbed ends up in the blood as blood calcium and raises blood pressure.

2. Bear in mind that your basal metabolism has already dropped, so don't overdo the supplements.

Especially all the traditional bone broths, which can easily lead to weight gain, higher blood pressure, metabolic problems and so on. My records show that after I fell and was confined to bed on January 7, my metabolism dropped noticeably. You do need to build yourself up, but pay attention to what with.

And last of all, a few more points:

1. Know your limits, progress step by step, and speed up recovery only while staying safe. 2. Wear a back brace to prevent slipping, which could damage the nerves.

I hope I recover soon, and that a bad thing becomes a good one,

and I hope that from here on, we all use these machines of ours more "correctly."