Accident Recovery

October 2015:

It was a surprisingly successful year.  My running is slow (and still pretty ugly), but once I moved up to the 50+ age group I had some success.  I won my age group at Hickory Grove, Copper Creek and the Des Moines Tri Sprint, and got second at Bluff Creek.  I finished in the top half of my age group at USAT Nationals (greatly exceeding my expectations), and had an overall win at an adventure race in Ames in September.

I continue to have pain in my knee, to the point where I fall down every couple of weeks. Strangely it is walking that gives me more problem, as my modified running form keeps me off the damaged section.  As an update on my right wrist, it still has limited mobility… but so much better than was anticipated.  It grinds and the nerve pain is always present all the way though my thumb and three finders (median nerve), but I don’t really pay attention to the pain and have modified what I do to accommodate it as a whole.  My left wrist continues to have intermittent pain, as well as my right elbow, both shoulders and both ankles.  But… it’s all manageable, and I am SO happy to able to still exercise and enjoy life.

March 2015:

My knee pain continues, as the cartilage continues to painful (or lack thereof).  I was given a shot to help create some additional lubrication, with limited success.  I was cleared to “do anything I could tolerate” at the end of December of 2014, and was told my running days were probably over.  They expect my knee will need to be replaced.  I started running about 4 miles a week and pondered if I wanted to just stop running completely.  A friend convinced me to try to qualify for USAT Nationals (same one who convinced me to IM AZ after my accident).  I’m beginning to run move consistently this month.  I’ve had to adopt a different form.  It’s ugly and  inefficient, but running partially bent-legged keeps the contact from where the cartilage is missing.

December 2014:

I had my meniscus repaired at the end of May.  They also did microfracture surgery, where they drill holes in the femur to facilitate stem cells from the bone to create some new cartilage.  It’s not as good as the original, but better than none.

Five days later I felt a pain in my abdomen.  I had appendicitis and had to have an appendectomy… with knee brace still in place from the knee surgery.

Two weeks later I continued to have pain / swelling in my right leg.  I ended up with a blood clot in my calf, which required me to be on blood thinners (Warfarin) until the end of 2014.  I was also restricted from doing any running (due to the microfracture surgery) and outdoor cycling (they didn’t want me to fall on Warfarin).

April 2014:

I tore my meniscus in the Fort Dodge Half Marathon (report here), and they discovered I had significant damage to my articular cartilage in my right knee.  This was around the area where I had significant pain / scrapes from my accident.

December 2013:

I successfully completed Ironman Arizona in November of 2013, with a sub 11 hour finish.  The race report is shown here.

14 Months:

A lot of very positive things have happened during the past three months.  In terms of my fitness and performance, things are going much better than expected.  During my last time trial of the season, I set my highest average power output… ever.  Prior to my accident I had gotten to 282 watts over a 12k TT, and my last TT on the same course averaged 295 watts.  I’m now producing more power than I did pre-accident.  I did my first long course race, Boulder 70.3, in August, and it went great.  Even being at altitude, I had my fastest 70.3 swim ever, fastest bike ride, and second fastest run.  My overall time was 13 minutes better than my fastest 1/2 IM, and I ended up at 4:54 on the event (see my race reports for details).

I also settled with the insurance company on my claim.  Mentally, this was a great burdened lifted from my mind (see my page on claim settlement, if you are interested in the history and strategy involved).  I had been corresponding with the insurance company within two week of my accident, and it was right about 1 year to arrive at a settlement.  You can never recapture lost time, erase memories, or make your aches and pains go away, but I felt Farm Bureau treated me fairly.

I am now on track for Ironman training, as I am signed up for Ironman Arizona, on November 17th.  My long weeks are pushing 16 hours now, and I’ve biked 95 miles, swam 3800 yards, and run 16.7 miles on my long days.  I feel like I am on track to have a good race at IM AZ, and feel I should be able to beat my time at IM CDA.

My injuries have all healed as much as they will, and I’m at at a stable point now.  My right wrist and hand has permanent nerve damage, loss of strength, loss of dexterity, and pain, but is manageable.  I have consciously decided to force myself to use my right hand as “normal” as I can (typing, shaking hands, etc.), even though it hurts.  I don’t think it will get better by not using it.  My left wrist, left shoulder, left ankle and right elbow still hurt intermittently, but less often than previously.  The pains in my right ankle and right knee have subsided.  It may be that my mind has simply stopped listening to the pain signals, which is fine, as for the most part I do what I want to do and don’t spend a lot of time thinking about it.  It’s time to move on and stop being a Brokenman, and go back to being an Ironman…

11 Months:

The last three months have given me the chance to race outdoors again, in both time trials and triathlon (see my race reports for specifics).  I have now done some outdoor rides, the longest being 57 miles.  I also rode my new Tri bike on the road I was hit, and managed to get through it without too much mental anguish.  (Seriously, I do still get shudders at times when vehicles close to me when I’m biking, running or even walking in a parking lot.)  I’ve run up to 12.5 miles and have had swim workouts up to 3500 yards.

My pacing and power are starting to improve on the bike and run as well.  I’m now getting to within about 2% of my pre-accident run and bike tests.  My efficiency (as reported by TP) is still not at pre-accident levels, in longer bike / runs from a pace/power to HR standpoint.  Besides the analytics, I am finally starting to “feel” a bit more back to normal (from an endurance standpoint) with my biking and running.  My peak training weeks are now getting over 12 hours per week.

Physically, my injuries seem to have hit a plateau, and remain unchanged.  I expect to live with constant pain from here on out.  In the grand scheme of things, I still feel very fortunate.  My injuries could have been so much worse… and I happy to be alive.

8 Months:

A lot has changed in the last three months.  With the confidence of being able to swim, bike and run again, I decided to sign up again with my coach, Elizabeth Waterstraat of Multisport Mastery.  Elizabeth has been helping me to add volume and intensity in a methodical way, to help ensure I avoid injuries or aggravate my existing injuries.

My Tri swimming class is going really well.  We are doing a lot of short speed work, which is helping me to pick up strength and speed.  I am still lacking endurance at the longer swims.  I am being careful not to stress my wrists, shoulder and elbow too much with my swims, and trying to make sure I maintain good form (or at least good form for me).  My shorter distance swimming pace is getting back to normal now.

I also did two indoor triathlons, one in January and one with my daughter in February.  Of course they were very short events, but it felt really good to push myself once again.  Although my body still has a lot of pain from my accident, I was relieved that there was no additional pain associated with racing (i.e. my wrists or ankle didn’t hurt worse than normal).

As noted, my short distance swimming is getting back to where it was prior to my accident.  My shorter distance biking and running are getting to within 5 to 10% of where I was, from a HR to pace or power perspective.  I’m up to 2500 yard swim workouts, around 32 mile bike rides and 9 mile runs.  My running and biking efficiency (pace/power vs HR) as reported in training peaks, continues to be lower than pre-accident, confirming how I feel.

Near the end of December I had a nerve test done on my right hand.  Basically they insert needles in your hand and arm and shock you to measure the response.  They confirmed my median nerve is damaged, which controls muscles and receives sensations in my hand, thumb, and all but my little finger.  They expect I will have some permanent nerve damage.  I have a constant burning and pins/needles in my hand, and it is extremely sensitive to touch.

In mid January, I “graduated” from physical therapy.  They felt I had made as much progress as I could in therapy.  I continue to spend about and hour a day (or more) on my right hand and wrist.  My strength and mobility are about 65% in my right hand, compared to my left.  Based on the extent of my injuries, my progress is much better than expected… my doctor was literally shocked taking the measurements. They attribute it to my persistance in the therapy… I attribute it to the swimming.  The constant and light pressure back and forth have really helped my wrist strength and mobility.  I squeeze rubber balls to improve my hand strength.

Unfortunately my doctor believes my right wrist will get arthritis and will need to be fused in the future.  This will eliminate and early catch in my swim, and will make handling a bike and shifting more difficult.  I’m not spending time worrying about this… instead I’ll keep doing triathlons as long as I enjoy doing them.

Physically, the improvement in pain has lessened, meaning I don’t feel like my body is improving much anymore (most of the healing is done).  I still live with pain every day.  My right wrist/hand hurts constantly.  My left ankle, left wrist, and left shoulder hurt daily.  I still have intermittent pain in my right elbow, and right ankle.  My right shoulder pain and right knee pain has improved to where they only bother me occasionally

5 Months:

The highlight in December was that I was finally able to stop wearing  my brace for exercise.  After 5 months, it feels really strange not to have something on my arm.  My wrist is very weak and as expected, it is painful to move.

I have been exercising consistently since October.  I did a couple rides on my mountain bike (on the roads), but have done the rest of my riding on my CompuTrainer.  I am up to one hour on the bike, 4 miles for running, and 2000 yards of swimming.  I joined my Tri class again (Tri Racers of Iowa) and started swimming and spinning as part of the group.  This has helped me push a bit more on the swim, and I am seeing improvements in my pacing.  I am also starting to see improvements in biking and running, but I’m still well over 10% off what I was prior to my accident.  The loss of fitness is an exponential decay (bigger losses at first, smaller losses over time) and the same seems to be true for regaining fitness.  I am making good progress on fitness overall, but I would guess it will get much harder to get incremental gains as I go on.

I have finished my formal therapy on my ankle and shoulder, although I consistently do the exercises each week.  I am still going to therapy for my hand and wrist, and work daily on these exercises as well.

Physically, not a lot has changed.  I still have consistent pain in my left ankle, left shoulder, left wrist, and right wrist.  I have intermittent pain in my right elbow, right knee, right ankle and right shoulder.    The mobility of my right hand is better, although still very limited.  I haven’t seen much improvement in my nerve damage in my hand and fingers in the past few weeks.

12 Weeks:

During the past 4 weeks (for a total of 12 since my accident) I went been through another surgery to remove the two pins from my wrist, and the 4 screws that held the external fixator to my arm.  Unfortunately I will still be wearing splints for the foreseeable future, as my right wrist is not completely healed.

At the 12 week mark I was cleared to exercise again.  I started my day with a 2 mile run, did a 500 yard swim at lunch (with a special thermo-plastic brace made for exercise) and did a 10 mile ride on my mountain bike on the roads.  Of course it felt like a big accomplishment to exercise again, but I also rode my bike down the road where I was hit.  Ironically a Chevy S-10 turned by me on the same road, sending some shudders down my spine.  It really felt like success psychologically just to be able to ride by that area again.

After that point, I slowly began exercising again, gradually working on pacing and volume.  I am being extremely careful in my ramp up, as my body feels very weak.  Being geeky, I have been looking at my HR versus efforts to try to determine what I had lost during 12 weeks off of exercise.  I had read studies indicating that the “normal” would be around 25% of my endurance.  When I did the math, I was down 17% in running (pace vs HR), 31% in biking (power vs HR) and 30% in swimming (pace vs PE).  I believe the Alter-G really helped to minimize my running losses.  When you average these together weighted average based on the time I spend training (historically)… the result is a loss of right at 25% of my total fitness.

Physically, I still have consistent pain in my left ankle, left shoulder, left wrist, and right wrist.  I have intermittent pain in my right elbow, right knee, right ankle and right shoulder.  Ironically my body tends to feel better when I exercise (and afterwards).  The mobility of my right hand is very limited, and I have quite a bit of nerve damage (and pain) in my hand and fingers.

8 Weeks:

8 weeks after my bike accident, I have made some significant improvement, but still have a long way to go:

  • I have been averaging around 25 hours a week on rehab / physical therapy.  In comparison, my peak week of Ironman training was under 20 hours.  I spend roughly 1 hour per day on my right hand, 1 hour on my left leg, and 1 hour on electro muscle stimulation, light spinning, easy running on the AlterG, as well as PT at the PT center.
  • My balance, stability, and flexibility have all improved on my left leg.  It is still not equal to my right leg, and continues to have a lot of pain on the outside of my ankle.  The bone is healing, but the tendons and nerves still have a way to go.  It will be at least another month before I will be able to consider running anywhere other than the AlterG.
  • My right hand is nowhere close to functional.  I am optimistic that when the cast comes off next week, things will have a better chance of improving.  Along with the cast, 4 screws and 2 pins will also be removed.  The PT has had improvement in my finger dexterity, although I still cannot make a fist.  My fingers lack strength, and the nerve damage makes my fingers extremely sensitive (painful) to touch.  The doctor feels this will improve with time.  My hand should be mostly functional within 6 months, with complete healing taking around a year.  I’ve made good progress on dexterity with my left hand… with the exception of writing.
  • My left wrist, right elbow and left shoulder are still painful, depending on what I’m doing.  They discovered that my left shoulder has an AC joint separation, meaning my collarbone has popped up with stretched tendons and ligaments.  It will likely just pop a bit more in the future, and will not return to a normal position in the future.

A couple of items have really helped with my recovery, which I wanted to highlight:

  • My right arm atrophied quickly without regular use, dropping an inch in diameter.  I’ve been able to lift a bit with my left to get it back to normal.  With my cast, lifting weight hasn’t been an option, and my elbow pops making even trying to do isometric exercises difficult.   I’ve used the Compex Electro Muscle stimulator, and have managed to gain back 1/4″ of an inch.  It may not seem like much, but it has been great to stop the loss and actually gaining is a bonus.  I also use it on my left leg.  In recovery mode, it helps my leg feel better after PT.
  • Walking has been difficult with my ankle, so normal running is out of the question.  Instead they have me on the AlterG treadmill.  Basically it is a treadmill that is able to take off part of your body weight to allow you to walk or run safely without pain.  I use this at Iowa Health Outpatient Therapy West.  The link above provides additional information.
  • I get no benefit from recommending these products… they have simply helped me to get better and feel better.

Overall I am anticipating my body will continue to improve, and hope to start regular exercise in October, 12 weeks after my accident.  My hope is to be able to compete in  Tri’s again in 2013.

2 thoughts on “Accident Recovery

  1. Sarah Cooper introduced me to your blog. I’m currently off the bike for an unknown period of time due to spine issues. Can you tell me more about how you used the Compex to regain muscle mass? I’m interested in using EMS to help slow the impending muscle atrophy in my legs. Thanks!

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