Category Archives: Recovery

October 12, 2014

Them Bones

stronger-bones

I’ve talked plenty about my bone density issues and speculated where they may have come from. We may never know completely why and how this came about, and what place it had in the perfect storm of the freak injury history of the last couple years. From now on, this is the going to be not just the primary focus of my recovery, but a major focus for the rest of my life. More on that and how it will impact my next few months in a moment.

I’ve posted this New York Times article ‘Is Bicycling Bad For Your Bones?’ before, but it is worth revisiting. The topic is controversial. I’ve talked to many who completely disagree and insist that my problems were due to other issues. They may be partially right, and I cannot blame cycling itself, but I can pinpoint where in my process that I started neglecting my bones and urge others not to make the same mistakes.

It has become clear that I most likely had some bone density issues before beginning to ride. Some of this probably has to do with diet. My worst habit has been soda products, most of which are not good for bone strength. Even now I find it difficult to cut them out completely, although I drink a lot less than I used to. Calcium has not been a major staple of my diet either. I don’t handle milk well, and tend to avoid fattening and high calorie dairy products just to keep slim.

Weight bearing has also been an issue. Even though I’ve dabbled with running and walking, cycling has been my sport of choice for years. Since I have worked at an office job and gone to school for the last several years, I’ve been off my feet a lot.

During the few years of intense cycling, I barely ran or even walked. The extent of my weight bearing was occasional strength exercises, but even those were not appealing to me. I preferred to develop strength on the bike. Climbing probably puts a little more weight on the leg muscles, but most likely not the hip. Proper cycling form minimizes the use of the hip. The flexors are being used to spin the pedals, but the quads and glutes do the heavy lifting.

When I wasn’t riding, I was recovering. That meant sitting on the couch. Sometimes I would do active recovery with short, easy rides, but I was not adding any weight bearing. After a tough mountain century, I would generally stay on the couch for the better part of a few days.

I was shocked when I had a scan last year and found that I had osteopenia in my hips. In hindsight, given my habits and training practice, I should not have been so surprised.

A couple weeks ago, we had a re-scan. I expected the numbers to be a little worse because I had surgery this year and a lot of recovery time. I’ve been on the couch a lot more in the last year than maybe the previous five years combined. The initial numbers that they gave me were discouraging. It sounded like the hip had gotten worse. On top of that, I was actually in osteoporosis levels in my hip joint. After receiving that news, I wondered seriously if I would ever ride again. I had even drafted a post basically ending this website. I have not and will not publish that one, because as has been typical with this roller coaster injury, the news got better.

When comparing my scan from April of last year with the one from a couple weeks ago, it turns out that my hip bones have actually improved by about 15%. That is significant enough for me to be encouraged. The osteoporosis is in my actual hip joint, the same one that was operated on in January, and it is barely at the level. The test last year did not scan the hip joint. Why would they? So there was nothing to compare, but I’d say the odds are that that bone was weaker last year than it is now.

The picture becomes clearer. What have I done differently? I’ve eaten dairy products, and over the past couple months have tried to walk around as much as possible. Over time walking has become less painful, which might be due to the bones strengthening along with the injury healing. The weight bearing will continue, but for now, any riding, running or jumping will not, at least for a couple or few months until my bones strengthen. The good news is I’m almost guaranteed to ride again and likely at a high level, but I will have to do things differently.

This is where I encourage all cyclists to learn from me. Implementing some form of weight bearing is important. Eating a balanced diet is important. A lot of us hate running. I’ve had a love/hate relationship with it, but know that eventually it will be a necessary evil. Strength training isn’t my thing either, but it’ll also be necessary. That can be squats, leg presses, or even upper body exercises while standing. It is important that some time is spent on a weekly basis doing some sort of weight bearing.

Things are again looking better for me, and I’m keeping a positive attitude. As far as pain goes, I am feeling better than I have in two years, and I cannot begin to express how liberating that feeling is. I’m able to get out, explore, see and experience things. I’ve been to three concerts in the past three weeks. I hadn’t been to a concert in years prior to this summer. It’s good to get outside. The couch is a brutal prison.

Standing near the front row for two hours felt amazing and not painful.

In the meantime, I’m going to keep walking and eating calcium. My doctor said that I shouldn’t worry about the calories, and that adding a few pounds would not be the worst thing. It might even help strengthen my bones by giving me more weight to bear. And I know I can lose it later. As I get more comfortable on my feet and finish up with some other priorities, I’m going to mix up my training regimen. The idea for now is to start P90X3 in December. That will give me upper body strength and hopefully will turn some of that fat into muscle. It may not be the lean, climbing body that I strove for last year, but it’ll still be a functional and healthy body. I’ll be careful with any of the flexibility and jumping exercises that interact with my hip, and I’ll probably start easy.

When I’m on the other side of that, the bike will be waiting for me. So will the sneakers, and so will the leg press machine. It’ll be about balance, but if I’m smart, I’ll climb higher and stronger than ever.

4 Comments | posted in Injury, Recovery

September 23, 2014

Tunnel to Towers, Columbia, SC

By aaronwest

It has been a little while since I’ve checked in. It is hard to believe that the injury first occurred over two years ago. Finally I am able to live life and stay relatively active without pain, and after this messy ordeal, that’s a good thing.

I’ve been reluctant to jump back onto the bike until I’m sure of having no setbacks, so instead I’ve been doing a whole lot of walking. Most of the time walking is not exactly interesting (with some exceptions, like a gator story I might tell someday), so the blog has remained dormant for the time being. Fortunately I found a walk that’s extremely interesting and highly personal, so I thought I would share.

Last week I heard about a 5k run to commemorate firefighters who passed during 9/11. Tunnel to Towers is specifically designed to honor the sacrifice of Stephen Siller, who ran from the Lincoln Tunnel to the twin towers in full, heavy firefighting gear. He is a true hero and is worthy of being honored. Yet, for some reason, I hadn’t heard about this event.

Let me backtrack a little bit here.

9/11 is the day in our generation that everyone remembers vividly, sort of like the Kennedy assassination for the baby boomers. I was working from home and didn’t have the TV on. I left to grab some breakfast around mid-morning, and when I ordered, someone at the counter said “Can you belief that we’re under attack?” The first plane had just hit the tower. I rushed home and watched the news and kept it on for hours, shocked and saddened by the tragic events as they happened.

Later in the day I visited my family. I have three younger half-siblings, and they were much younger then. The oldest was 10. They came from my father’s second marriage to a nice lady from Staten Island, NY. This was the ideal step-mother situation, as we got along splendidly nearly from the first time we met. Today I consider her to be a part of the family.

She had three brothers who were all firefighters. One of them was even a Battalion Chief. When we learned that the towers had collapsed and firemen were down there, she was worried that her brothers might have been caught in the wreckage. She made phone call after phone call, trying to account for their whereabouts. She got in touch with two of them, but neither had heard from Jeff, her youngest brother. The night passed, and in the days following, she continued making phone calls trying to find him, to no avail. She heard from her brother that his unit was one of the first in there, and it looked grim.

Jeff didn’t make it. We’ll never know what happened, but we do know that he passed away while saving lives, just like Stephen Siller did. Here is a little more about him.

I had never met Jeff, but because of what happened, I felt like I knew him. He was a young buck, in his mid-twenties, a good boyfriend to his girlfriend who was going to law school, and he and my step-mother were very close. He was a guy I would have liked to have met, and probably would have if that tragic day had never occurred.

It was tough on the kids. They knew Jeff and loved him. I did what I could to comfort them, but they didn’t truly understand.

Since then, the thought of Jeff and the memory of the grieving family has dominated my memories of that tragic day. It’s strange how people react, and I’m not an outwardly emotional person. I hardly ever cry in movies for example, but for awhile, anything 9/11 would strike a chord with me. I avoided movies and documentaries about the subject just because of how painful those memories were.

Time has a way of making things easier. When we visited the 9/11 museum, I made it a point to look at the memorial for Jeff. There were audio recordings from his mother, my step-grandmother, who I have met several times and is a sweet, dear person. It was touching to hear such a familiar voice talk fondly about her lost son.

One day we accidentally walked by the NYFD and stumbled upon images of all the lost firefighters. Jeff was in the picture.

So when I heard about the 5k, I jumped at the chance.

The crowd was massive. 5k strong!

Even though I’ve been walking for exercise, I was reluctant to sign up for a 5k. Sometimes my own worst enemy is myself and my competitive drive. If I start at a race with the intention of walking or jogging slowly, I may change my mind when people start passing me. This one was safe for a number of reasons. First off, it was massive. Approximately 5,000 people participated, and many of them walked. Second, part of the thrill of the event was the camaraderie and the tribute. I was able to experience plenty while walking around and looking around than if I had run.

Still, I was nervous and I prepared to go slowly. As I began to walk, groups of marching military groups would pass by. At first they walked, and as they got to the starting line, they would jog. They kept a call and response cadence, some of which were serious, others fun and lighthearted. I felt privileged to walk among them.

The most special event came a short while later. As we made a turn, we saw a line of people holding up pictures. I immediately recognized them from the NYFD. I made my way across the street between the marching military columns and looked at each of the signs in order to pay tribute. Then lo and behold, Jeff’s face showed up. I stood dead in my tracks. “That’s my uncle-in-law!” I shouted to the nice young lady. I was moved and even choked up when I saw him there. I asked if she would pose for a picture, and of course she obliged. Later I found out that these were all USC students who stood out there holding the signs. Thank you, students.

Jeffrey Stark, hero

As I continued walking, I made it a point to look at every other sign. I could only afford a quick glance at each, but that was enough. These firefighters were all heroes, and they all had families like mine.

Another benefit of walking was I was able to share pavement with many of the firefighters who were walking in full, heavy gear. I cannot imagine how difficult it was to walk with them. As I passed them, I made sure to let them know how much I respected what they were doing.

Along the entire course were onlookers cheering us on, giving us high fives as we passed. Many of them carried American flags, and they contributed to both the excitement and the patriotism of the event. Even though we were paying tribute to a tragic event in history, the mood was jubilant, patriotic and everyone was full of resolve. The time for mourning has passed. We were celebrating their heroism.

I found out later that someone had officially run for Jeff in the New York event of this race. Next year I will make it a point to officially run for Jeff here. And next time I will run.

1 Comment | posted in Blog, Recovery

August 27, 2014

The Last Two Miles of Recovery

By aaronwest

Can you believe that as of a couple weeks ago, this injury began two years ago? It’s weird just thinking about it. Just a few weeks ago, I wondered if I was weeks, months, or maybe even years away from the end of this thing. The breakthrough came when I was walking around the streets of Manhattan, of all places. A few weeks later and the end of this journey is almost within sight.

I’ve learned not to blog about every single little healing point, because sometimes they can be fleeting or temporary. Before getting carried away and telling the world, I want to hear from someone smarter than myself. I heard that news today.

Just to backtrack, we discovered not too long ago that the majority of the setbacks were scar tissue related. Prednisone wiped them away temporarily, and then they came right back. Walking around New York helped too. The smoking gun was found when I had an injection into my pelvis. I was fortunate to work with my favorite radiologist, who I have seen an unbelievable three times. As he was performing the injection, he took an x-ray and used an ultrasound tool to see inside my hip joint. There it was, clear as day, a bright, think white line that enveloped my hip joint from end to end.

It was scar tissue alright, but it wasn’t the end of the world. The problems I had been dealing with were a result of tendons passing over the scar tissue and getting caught. That would result in inflammation and felt oddly similar to how things felt before surgery. It was a different form of hip popping syndrome, only this time it was not due to a torn labrum. I found myself recalling the philosophy from True Detective — “Time is a flat circle.” The line barely made sense when I watched the show, but it made perfect sense when I was getting that last injection.

For the first few days, the hip hurt. That was nothing to worry about. It was supposed to hurt. Then it would get a little better day by day. Sure, there were a couple bad days, and there will probably be a couple more, but the momentum was in the right direction.

Today I saw my doctor again. The good news is this scar tissue is manageable. It will never truly go away. My body will just adapt to it, and will re-build itself to accommodate it. It will probably give me a little bit of trouble in the future, but nothing like what I’ve dealt with over the last two years.

What is important is that I continue with regular, light activity. Walking works, as I’ve already found, and I can burn a few calories while I’m at it. For the next couple months, I’ll be doing a lot of walking, and maybe a little bit in the gym. That’ll break up the scar tissue and get my body to start getting used to it.

I decided to stay off the bike for a little while longer. I know I could ride right now. In fact, I would absolutely love to ride. There’s a chance that it would be no problem. The issue with me and riding is that I have only one speed. When I get on the bike, I want a workout. Rather than risk going too hard and setting myself back again, I’m going to slow it down. Now that we’re almost to September, the year is pretty much done anyway. I’ll give myself a little more healing time, and hopefully during the offseason I can gradually transition back. What’s important is that I remain patient and don’t push myself.

My doctor said he absolutely, positively expects me to get back to endurance sports again. The question is when. That depends on my body. Probably the earliest would be by the end of the year, and the latest next spring. All that matters is that I’ll be back.

Nice bridge view from the Roanoke Mountain lookout.

Don’t go anywhere, mountains. We’ll meet again soon.

I’m Walking Here!

By aaronwest

Before heading to New York City for a non-riding vacation, I was wary. It’s no secret that to really experience New York, you have to walk for miles and miles. A couple weeks ago I was dealing with nasty scar tissue that kept me on the couch. The doctor gave me prednisone that helped clear it up temporarily, but once I got back on, the pain was starting to come back. It was gradually becoming worse last day or two before flying out.

Today is the 6th day in New York before flying back on Sunday. I’m happy to report that the trip has been an unquestionable success. We had a busy first full day, doing both the Statue of Liberty tour and the 9/11 museum. I was on my feet a lot, either walking, standing up in subways or ferry boats, or worse, standing in line. The lines were the toughest part. If I kept moving, the hip wouldn’t hurt so bad, but it could be agony when I stayed still. Anyone who has been to the Statue of Liberty knows that half the trip is waiting in line.

That first day was pretty tough, and we decided to go easy the second day. Then, after having an anniversary dinner and a beer in Eataly, my wife asked “wanna go to Times Square?”. Why not, I thought. The reason why not was because all of the walking, but I went on undeterred. We ended up getting a little lost, then wandering around the core of Times Square, then all the way over to Radio City Music Hall, and then back to Grand Central where our hotel was. I’m not sure the exact distance, but it was miles. And I felt alright.

As the week progressed, I kept walking more, and the hip kept feeling good. The strongest medicine I had to take has been Aleve, and even then I’ve felt okay for short periods without it. Now that we’re about ready to go, I’m pleased as can be that the hip feels better than it has for months.

So walking has been a breakthrough. I did not ride here, although I was tempted since this is such a terrific bike city (more on that later), but I didn’t want to tempt fate. Just being able to walk at this capacity gives me one more thing I can do when I return. I will be walking some for exercise, to put more pressure on my surgery-recovered hip, to create more bone density, and to simply get outdoors. I’ll also be able to ride sporadically, although I’m not going to push that. For some reason riding tends to inflame the scar tissue, so I’ll need baby steps to get there.

When I get back next week, an anesthesiologist will inject some cortisone into my pelvic region, which will further break up the scar tissue. I’ve seen him before pre-surgery and even then when I had a torn labrum, I noticed results. This time there will definitely be some results, but I will have to take a few days off after the shot. No complaints since I’ll need some recovery from the vacation.

Little by little, I am coming back.

Here are some NYC shots while I’m here.

Freedom Tower can be seen almost anywhere, and it is a beautiful structure.

This is where the ball drops on New Years in Times Square.

Lady Liberty

“Starry Night” by Vincent Van Gogh.

Recovery: Smooth as Sandpaper

By aaronwest

This sums it all up!

When I was at the Ride of Silence the other day, a friend joked that watching my recovery from afar was like watching a roller coaster from the ground. At one moment I’m up, and the next moment I’m back down. That analogy was appropriate, and would come back up again. The image above (used with permission from Adam at The Sports Physio) sums it up perfectly. We expect everything to go as smoothly and perfectly as possible, but in reality, the process can be chaotic.

After the recent setback, I had my orthopedic appointment bumped up just to play it safe. As always, he gave me some terrific advice. I cannot say enough about how much I lucked out getting Dr. Guy as a doctor.

First was the issue of the setback. We went into detail about what happened in physical therapy, and he said that absolutely shouldn’t have happened. My injury is a lot different from what therapists usually see with hips, and it has to be treated differently. Usually running in water would not be so harmful, but when I told him the low water level, he rolled his eyes. When I told him about using the recumbent step machine rather than an stationary bike, he practically gasped. Those are impact exercises. I’m not ready for those now, and there’s really no timetable for when I will be. I’ve heard as early as 6-9 months from surgery, and as late as a year. Aside from casual walking, there shouldn’t be the slightest bit of impact exercise at 16 weeks.

He also likened this experience to a roller coaster. He frankly reminded me of how he surgically went into my hip and tore into my bones and cartilage. As he put it, he made big holes so that they could fill in and heal correctly down the road. Every time I do some exercise, smaller wounds are created and they need to heal during recovery. Light exercises like swimming and spinning a bike in a low gear will do slight damage to my hip. Impact exercises will do a lot more damage, and that takes longer to recover from. That’s exactly what happened with the setback.

That’s where the roller coaster comes back. When you do a little damage each time, the hip’s condition will drop slightly after each workout, and eventually after recovery it will continue upward. The trend line will resemble the left side of the image above. If you do too much at once, the condition will plummet like a roller coaster and have to slowly climb a longer ways back.

The goal is to progress slowly and steadily. As I exercise and do a little damage, it’ll heal and the next time I can do a little more. I can swim 5 laps the first time, and then maybe 7 laps the next time. If I keep progressing in a steady direction then I will eventually get to 20 laps without pain. If I go from 5 laps to 20 laps, then I my body will take longer to recover and I’ll need rest. Without that continual progression, the recovery will take longer and the body will need more rest. That’s exactly what happened after the run and step machine. I’m now where I was shortly after I first started walking.

The doctor said that I should absolutely do no running or any impact exercises. He wants me to do a lot more swimming, which is the least impact I can put on my body right now. The next best thing is cycling. I can ride in little gears, but nothing aggressive. I’ll start with a few laps and miles, and inch my way forward. One day I’ll be recovered and can give some impact a try, but that is far from here.

I know that I have a history of being naive optimist with this injury, but after seeing the doctor, I’ve never been more confident that the trend line will continue to progress forward as it should, and not be a jumbled mess like the right hand column of the image above.

There is good news this week. It took me about three days to be pain free after the step machine. I felt no pain when riding, and no pain the day afterward. As long as I’m smart, I won’t need to cause unnecessary suffering and setbacks.

10 Comments | posted in Recovery