Sunday, January 30, 2011

The start of the "come back ...

The Comeback
So you’re planning a comeback.. How will you know when your back?  It’s an interesting question eh..? 
Leaving aside small details, such as “Is a comeback possible? “What will it take?  “How long will it take and will you run out of time in the age performance window you’re in?

So here we will look at the science of comeback and how do you measure “being back”. A nice functional measurement of being back would be to measure the power you can produce at the crank  for a given heart rate, in the “I’m back” state vs. the before accident state. Let’s just consider this statement for a moment. By functional I mean for this element we will ignore factors like In a given position on the bike outside the one I used to get a baseline. The other reality might be that for other reasons, the same exact power might not be possible or might happen a lot later (time and other factors allowing) But this approach is tangible.
Below left I have included some pictures including a power sample of 8 min.46 seconds taken 31st Dec 10. This shows that at a heart rate of 141 (my Level 2) my average power was 244 watts. This split was taken in the middle of a 2 hour endurance ride focusing the training at this level.  So that will form the pre-accident measurement.   

For this approach to have any validity I would need to know that the power measurement was consistent and accurate. My faith in this approach will be based on the SRM power metre. I have one for my training bike and one for my race bike.  My training set was calibrated in November and so should not need re-calibration for the measurement of my progress over the coming months.
Calibration of the SRM power unit should be performed yearly, although I have found that there does not seem to be much change year on year.  My 10 speed set, now with oval rings fitted, have just come back from calibration and a new battery. This is the first time I have had these done since new. After 3 years they were out by 14 watts, reading lower than actual, although they are always consistent and this is the most important point.

So now I have a way to measure loss and incremental gains on the way back... There is of course an upside and a downside to this; as much as this approach covers the facts of power at the crank, the psychology of the comeback is probably the more difficult to measure, manage and control.
So now the beginning of the comeback.. “Roll on”

Monday, January 24, 2011


Stationary - No I don't mean in the chair doing nothing I mean in my leg... they used stationary ...  I pasted the pick from today below left.

Today I went to see Sister Sheila; who in her bag keeps staple removers.. nice you're thinking.. YES FOR MY LEG!  "A surgeon throw a leg at me once she said"  not mine i hoped..

So it's 15 days since the op' and there have been positive changes. No more staples..  I am using one crutch, all day, the 2XU compression, has helped a lot with the swelling which is only now at the op' site on the leg.

It's now a tricky balance to ensure the bones knit, while limiting muscle loss and getting some flexibility back. The pain killers are down to a few ibuprofen a day which has consequences

There is some aching in the femur and further down by the knee on the inside of the leg. When you stop the pain killers you realise more about what other damage you have done and also very importantly where muscle weakness and over tightness and imbalance is taking effect. Think this is a good thing in all.

So what can I do?  Well I went out for lunch with my training buddies on Saturday, which was good, I can bend the left me more than 90 deg' ; lift the leg up into bed without holding the leg, stretch to the floor, some sit up's on a fit ball, (70) today which is more than some of the guys who train and don't have anything wrong...

I also looked at some mountain bike riding shorts that had padding protection on the hip. I wish I had thought of this before the accident, it's not like they are big balloon pant's but you can't help thinking, " if i was wearing these, would I be in the predicament?) I now don't have a choice, If I could recommend something for keeping your winter training gains, it might be a bit of protection. it would be good to think that this didn't happen often, but a quick look at this bike radar link  would show otherwise.. something to think about... if nothing else it hurts like F' when you go down like this!

so now I'm hoping to progress with some sensible core work, strength and stretching And It's time for building bikes ready to ride outside in march if all goes to plan :o). now the hard work begins

Thursday, January 20, 2011

The Horror of it all

Some people have asked me " what is a dynamic hip screw?  So in an effort to find something to describe what it's about and being in I.T, - I  "off Shored" the making of Inserting a Dynamic hip screw. The link is Below left. I think I know why my leg hurts more than just my hip... WARNING the video is very detailed.. and the bit with the hammer and chisel..  yeah...  My fav' bit is when you can see the old black and decker chuck in the background. I think that's Tax deductible for tool hire, must ask the accountant..

So today I had my first big leg spasm.. It hurt like .. well it hurt.. strangely not doing anything , just sitting in a chair. So sitting in a chair is bad for you, get out and ride right now to save yourself from pain; best get a good 50 miles in to be safe ;o)

Yesterday there was a real crisis.. The Gaggia Baby broke.. ( It's an espresso machine heathen! ) It has undergone major surgery, but only a trickle.. the dangers of clotting are well documented and it's important in regular use to think about what goes in, how much it's used and how well it's maintained.. I'll update how further surgery goes Time for the hammer..

Also thanks for all the nice messages and people taking time to check out my injuries and pass back useful comments and information.

Time to go and do my physio exercises..

Wednesday, January 19, 2011

Damage Limitation

It'a a common thing with cyclists post accident or crash, that you want to get back to riding. You miss the riding outside and you start to go a bit... crazy.. there I said it.. So 11 days post accident and the whole being layed up thing is losing it's charm.. I have surfed the web' looking at hip op's and metal work, read some scary blogs and got to the point where i want to do something.

Although it's different this time. after a bad accident in 2000, with 6 months in physio i wanted to ride at any quality. Now i want to get back to being a quality rider. So the strategy is to build the components in a sensible way that will enable that. The time it takes is a secondary matter.

So part of my work will be to maintain what i can of my gains from my training over the last 2 months, This has to be done while allowing the hip joint to repair. that means no stress on that joint, and not doing something that steels recovery from that joint to other areas.

So to the gym for some very careful work. My gym is very posh.. I am not, but it's close to my house and I am lazy. So it's full up with all the posh people of the Royal Berkshire Racket club. So when Strange cycling bloke comes in on crutches... there was some staring.. A lot of staring... As if what i did usually wasn't strange enough. I think it was when I said to someone " good my arms are getting leaner and more aerodynamic" .. coockoo..

For the aerobic side I selected to sit on a recumbent bike and pedal only with my right leg. Just getting my Ipod, HR monitor and stuff sorted on the bike was like a magicians act.  Bottle hear, while holding crutch and balance bag on arm.. you get the idea.

So I did not want to over stress the right knee as it was doing enough work this week, it needed some support from my arms on the upstroke. I targeted a level one effort upto about 124 HR at most. the video link is below left.

So there I am on the sitting down bikes, next to all the pie girls, who watch east enders while they hardly put any effort in to what they are doing. At one point the girl next to me stopped pedalling as she got so engrossed in the TV.. It was as she was getting off the bike she looked at my crutches and looked at me.. you could see the look on her face... "Freak.."  Ha yes that's right I thought. The gym has some usual characters.. There is "Gold Shoes man" who does endless pull up's in his vest, and there is the "Gazelle" a girl who is getting thinner and thinner and wear's smaller legging each week, Gazelle likes the stairmaster, but only if they are free in the centre where everyone can see her getting thinner. They gawp at me for a moment, and then blank.

Some people go to the gym to look good, So when you go in looking like you just finished filming "Jackass 3"  it doesn't fit for some people..

I did some core work sitting on adjustable bench, as trying a fit ball would probably end with a scene

I normally go to the gym to build core strength and build some strength in my arms, as cycling doesn't do much for that.   The core strength and arm work has been a real benefit while i have been on crutches and is helping my recovery. My tip is, Go to the gym do core and stretching in case you crash!

So progress to now - The swelling is a lot less, compression still working well.  strength and flexibility is coming back. I can now lift my left leg into bed without holding it.. Just.. and less weight is going on the crutches when I walk. i can sense soon I will get up and forget the crutches. The clips come out Monday and when the scar is healed i can swim, to keep the engine going.

Swimming will be great for the Heart and Lungs, It's not that I'm much of a swimmer, but one legged pedalling is not the most satisfying way to spend your time..

Some benefits I have discovered-
 If you want your Starbucks brought to your table, go in with Crutches..
If you want the good seats in starbucks, Grimace as you walk towards the comfy seats and look painfully at the hard seats, Works a charm... what.. don't tell me you don't want that seat..?

The downside, I have to watch rubbish TV.. Lin said, Can you stretch you legs like that Girl from Diversity? I did on Sunday the 9th I said, that's how this happend...

5 days until I can swim.. maybe
 17 days until I can spin on the Turbo and start physio, and we know how I love the turbo... :o(
47 days until I can ride outside.. Well at least it will be warmer..

Time to do work on the bikes

Sunday, January 16, 2011

Back at home

I got back home from hospital on Wednesday the 12th of Jan, It's now Sunday 16th Jan. Each day gets a little better. The swelling in the leg which was right over my Knee is now reducing. I had tried icing the swelling while in hospital, and now I am back at home I am experimenting with compression which seems to be working well.

I have used compression post racing  since 2004. A chat with Sean Yates, convinced me to give it a go. Sean had been using it for years inc' when in Motorola. Good enough for me.

Currently I am using 2XU, it's used by pro's and developed with the Australian institute for sport. They also use it at the Great Ormand Street Hospital.  I need to have compression on the right leg post op' for DVT protection. But they don't provide it for the operated leg, which I thought was strange.

I talked to the surgeon and physio about it in the hospital and they seemed to think calf compression would be useful. If you subscribe to the thinking that you want to reduce swelling then it would make sense.

My Left leg had a lot of swelling even the left calf. so night one calf compression as shown in the pic below left. Amazing over one night the calf was back to normal. I did use the loo a lot night one, but fluid goes somewhere I guess. as an experiment I left the calf compression off, but the calf did not refill.. interesting I thought.. SO the compression had a longer effect than when you wear it.

So I moved on from Calf Sleeves yesterday to full legs upto the top of the thigh. full on the right and just above the knee on the left.

again swelling down in the left. I didn't want to progress too fast, as I speculated that your body can only deal with so much fluid in movement. I needed to think about blood flow too and I also wanted to use compression on the right leg as that was getting a lot of work, each time I stood up and the right knee was getting a few twinges. Secondary strain and compensation injury can happen as a result of overuse of other parts of your body doing more, or even sitting differently. So finding a way to support and deal with that stress was important.

So overall getting better, the left quad is very tight and probably a result of operation, being clamped and moved and new metal work inside the leg.  so now more stretching and finding a way to limit the losses in other areas, including the heart and lungs.

Stairs on crutches.. that's scary the first day.. but getting used to it, Time to get a lift to starbucks ;o) well if you can't fit the ride in, you should still have the coffee!

still going with Cherry juice and plenty of rest.

Saturday, January 15, 2011

The day after

Tuesday the 11h of Jan, the day after the operation. 2nd night of no sleep. When you enter the hospital system under A&E, if your not a celebrity or super star; your going to have to manage the best you can. The reality of being a racing cyclist with a hip injury, is that most other people in your ward will be 70-90 years old. not a problem, but in my case, the guy opposite had some very real mental issues.

His party piece every night  was to climb over the barriers of his bed, dragging his cafeter bag behind him. He had a major leg op the day before. The staff would run in.. No Mr Walk-about-late... ( yes his name did contain 2 of these parts..) .. you must stay in bed you will hurt yourself, full volume conversation.. they would drag him back in bed, apply more dressing and then return to where ever they went.  10 mins later, there he was again, climbing over the rails of the bed  and repeat..  No No Mr Walk... you get the idea.. Yes all night.. he would pull out the cafeter bag too, great UTI patient empties bladder on floor along with a day full of piss...

Yet they would still leave him with the words.. Please stay in bed.. yeah sure he will..

He was opposite me, so I felt obligated to press my buzzer each time this started.  So my night was progressing with me keeping an eye on him.. Buzzzzzz .. No No Mr Walk...

Sleep Deprivation is not known as a proven recovery technique.. after A few days of this type of behaviour your basic survival instincts surface. The combination of pain, drugs, and no sleep drive self preservation.

In the day Mr Walk... wife would come in.." Have you been behaving for the Nurses..? Oh yes dear.. Have you been resting.. Yes.. The temptation to throw my 3 bottles of urine at them were building..

By the following night still with no sleep.. The dark side...  That day a nurse who was trying to fix my bed that was stuck in a zigzag for an hour, had kicked over a urine bottle on my private water bottles and I could not get anyone to sort that.. I had swelling in my leg big time and my tempreture was up, I had been asking for an hour to speak to someone about my temp and swelling. The doctors answer was to prescribe me Codine with my already large dose of Tramadol and Ibruprofen.. Remember the bit about me being allergic to morphine? Well Codine metabolises in the body as Morphine.. Great.. So then I needed an antihistamine,

I spent the night scratching from the histine being so high.. And Mr Walk... was on full song.. so now you start thinking what If I don't buzz..  They had bought out a chair to watch him, some even bought a newspaper for their shift on watch.. oh good nice noisy newspaper. I had an Iphone and listed to my tunes, but this just put a soundtrack to the chaos..

At one point he was backwards in bed, holding his cafeter bag pulling the tubes out.. Not Buzzing..., the next time i looked up from surfing the net on my iphone he was standing next to my bed..  SHHHHHHH.....  Buzzer BUZZEERRRRRRR>>>>  BUZZZZZZZZZZZZ...

Wednesday Morning..  It's like this Miss Physio.. I'm going home today.. stairs, no stairs no matter I'm out of here, I packed and was ready to go by 10.00..

The 90 year old ex para' next to me 'Ray' had been there 12 days, and was staying longer.. nice guy, it's coming to us all i guess.., So enjoy every sunny day on the road.

Things to consider about surviving hospital

99% of the staff are fantastic. That's a great ratio. I am very grateful for the care I got, It's a hard job. I got to go home, they are probably dealing with it again tonight..

Looking after yourself.  The same principles that apply to training recovery apply in hospital. the quality of what you eat and drink will determine your recovery along with sleep, care and hygiene.

Your stomach will suffer, you will have been laying down, the drugs, the first meal will probably be a vacuum packed garage quality sandwich.. all this will have an impact.

Linseed is something I have every morning in a fruit berry blend great to keep your stomach working
Cherry juice is a natural anti inflammatory - the Brit. Olympic cycling team use it. you can only take so many tablets.
Hygiene, get your own bottle of alcohol gel, not the shared one on your bed that 20 people use an hour.
Blood ox' monitors, - if they drag round equipment from bed to bed, putting the pulse ox' on your finger after 6 other sick patients use the gel after before you touch anything.
I had Bupa - but couldn't switch mid treatment

things to add -
I wish i had noise cancelling earphones..
I wish i had DHL'd in a care package day one and had a personnel attendant, lucky for me my wife who was sick bought me essential quality food and drink in. if not call someone and get them to bring you your survival pack. Create your own outcome.

So I  went into A&E Sunday around 11.00 and I left hospital post operation with dynamic hip screw in place Wednesday lunchtime on crutches, partial weight bearing.

I am home, work .. yes i have a job.. have been great, now recovery at home starts. I am experimenting with some things that speed recovery. I will write about these and let you know how that goes.

High level milestones from here

2 weeks stitches out - swim / weights
4 weeks weight bearing and physio start, spinning on a static bike, inflammation providing - follow up with consultant surgeon. discuss plan - swim
8 weeks riding bike outside
12 weeks training ramp build
9-12 months possible removal of hip screw
4 weeks off bike,
8 weeks spin trainer
18 months return to full racing

Friday, January 14, 2011


Operation day, Monday 10th Jan after a night of not much sleep in the ward, I was told i was first on the list for the Op. I had broken left Neck of femur, the joint with the hip. luckily it was undisplaced.  medical term for not displaced, English for where it should be, but broken,, no wonder you are so long in hospital..

Risk with broken hip is blood flow -
the second piece of luck was that the fracture was closer to the femur, than the ball in the hip socket, the reason this is important is the arteries from the femoral artery spur off and loop round the neck joint closer to the head, the ball joint in the hip. If you damage these arteries and blood flow, the head, ball bit can die. effectively it could be starved of blood flow. this is called AVN

For the operation there was a choice, General an or spinal block with sedative,  I went for block, with sedative, I asked for a small shot of GA, either way this bit was ok, I had a prep chat, i was talking then the next thing i'm awake on my right side for the spinal block, then roll forward recovery room. and op done.

later i was told went well small incision,through the layers pulled muscle out of the way and dynamic hip screw 110mm in place with a 2 screw plate. that's the xray picture, this fitting works and should allow full range of movement.

surgeon seemed confident and happy about the outcome. Most of her patients were older, with less interest in the science. Not used to sports science cross examination... ;o)

From this stage i have a few thoughts

Before this, while waiting in a&e all the time in the night to the op, i tried to find any information i could on the hip, on the types of surgery and the risks of breakage and surgery, that was a good idea.  If you read bad experiences, that doesn't mean it will end bad for you. it may not be what you want, but try to think about what you learnt, if it did go wrong for someone for a reason, what can you do for you now you know?

links that people sent me -  quite good run through, looks like a tough road,  you can find forum posts with people asking, but with well intentioned people who have not had experience replying. more opinion than experience exists. Remember every case is different.

I talked the surgeon and team and was clear about the outcome i wanted. It may be that I have to accept i won't get what i want, but i said if there are options i would like to be able to ride competitively again, so i said if we are using screws or fixings please can we think about that. The surgeons priority is to get you well, so there may be compromise. They did a great job and  because i was fit, 45 and had good bone strength in the femur i needed less screws in the femur. all positive. guess it will be a month before my follow up and x-rays so fingers crossed.

you should also be thinking of the next stage, looking after yourself in hospital, sleep and quality of food help recovery, think about how you are going to manage that.

next I'll cover recovery in hospital and strategy for long term recovery, plus hospital life with the senile.

Thursday, January 13, 2011

Broken Left Hip for racing cyclist - the start of more sports science

Sunday the 9th of January 2011, what a nice morning. after some horrible grey days, Sunday was brighter. I had a rest week after the last training block as it felt right. the quality of training was good and my level 2 watts at 141 heart rate were between 235 and 240 in tests done for nine minute sets on the A4.

Its always the times that things are going well you should be wary. so on Sunday after waiting  a little later to leave to meet Ian and Paul and a group, riding to Binfield cross. -  Disaster, at the Binfield roundabout the bike just went and down "bang on to the left hip. That brief moment and then you hear yourself shouting.

Experience from past events makes me react quickly . I dragged myself back out the road as far as I could to the kerb for fear of being run over. People turned up and asked me things, the reality of the pain kicks in, yes ambulance please, funny how i'm still polite while in great pain. I call the wife, Paul turns up, I called Ian he turned up. Paramedics who were great as ever. I knew the hip or pelvis had gone, when it happens you just know.

If the paramedic is bright they know too, they usually are, mine were great. Other experience is , no matter how bad the pain, try to give the paramedic the information and facts, others may perceive you landed where you are for example. and don't move the effected area, I had a triangle bandage round my knees, to hold the thighs in line and blankets under my knees to not move from my final position. ( 24 hours later those same blankets were in the same place on the way to pre-theater )

Gas and Air - strange stuff - more more more and then all of a sudden wow. if your fit and train probably more effective.

Bike ok, well as a rule - yes, i was not so, the bike is probably ok, it's due back soon as mike has kindly looked after it for me.

Allergic to morphine? surely you couldn't be that unlucky could you.. Red tracking is the clue, this can be if the cannula leaks  but lumps as well are a sign. right so what do we give you now.. more gas?

into hospital, I had a choice, Frimley Park i said. They always did a good job with my dad, so that was it. In hospital a heart rate of 34 was a bit worrying for the team, from my usual 46.  Long time in A&E - x-rays  - And  that moment - The A&E senior is saying to me "yes you hip is broken, you'll be having an operation and a few screws in....

It seems like an hour before I speak back to him.. I ask a few pointless questions, "what If I crash again with screws in place was one.. classic.. He's probably thinking .. "well if your crash is with a guy driving a Humber what will it matter"... If you look at the picture on the right a few screws doesn't quite describe the 110mm fixing - Perhaps in future I should be sponsored by Surrey Fasteners...

So i'll be posting my experiences about how i get on getting back to training in the hope that others who suffer a similar accident will have some information. I'll try to keep some relevant comments and if I learn things that will help that too. I'll also write the usual ironic stuff as what's the point if your not having fun.

so this will do for now as I'm tired and need more drugs.. More soon, thanks for reading.

Roll on through and savor every mile even the rainy ones

Tuesday, January 4, 2011


Winter for a racing cyclist always feels like 2 different seasons. Winter in the old year and winter in the new season, where all you race dreams will come true. So for me, while christmas can be a welcome break, training in December always feels like your working towards something far away. 2010 another winter wonderland for sledger's and snowman builders; was hard if you ride.

While there are some hard riders who believe your not training if your not suffering, it's important to consider the benefits that a warm cup of coffee. 1, you get to talk to people you train with in a 30 min coffee break more than a 3 hour ride. 2, You get some caffeine for the hardest part of the ride making you burn some fat that you would have been too tired to burn. 3 It gives normal people having coffee something to stare at.  4, your a cyclist, you are supposed to drink coffee ;o)

Well now we are in 2011, so it's the same year we will be racing in Yippee!  but.. I'll still be having coffee ;o)