Tag Archives: injury

A History of the Injury

Overall, I’m a positive person, an optimist. I set lofty goals, and work hard to achieve them. I’m a good news kind of guy. I like to share achievement, whether mine or others, and celebrate what human beings are able to achieve athletically.

I hate talking about bad news. Detest it. But sometimes bad news is part of life. It is a reality, and the best thing you can do is to stay positive and optimistic while going through it. That’s where I’ve been for the last year, and that’s where I am now.

When I changed doctors, I put together a brief timeline with a history of most everything that has happened. It was sobering to read, as this may very well be the most trivial and baffling cycling injury I’ve ever heard about.

The bad news continued on my mountain bike ride this past weekend. As great as it was to experience something new, around halfway through my ride, I began to feel a burning sensation in the groin. No worries, I’ve felt soreness before while riding and been able to suffer through it. I soldiered on, but the sensation became stronger.

I decided to make my way back home. Ugh, that was a hilly six miles away. The more I pedaled, the more it hurt. I took a couple breaks to massage my hip. Still painful. I made my way up the hills slowly, trying to put more power with my left side — not easy to do on a mountain bike with platform pedals.

With just a couple miles to go, I could barely pedal. I tried pushing the pedal with just my left leg. Not really possible. I had to endure the pain and make it home. By the time I was done, I was done. It was excruciating pain. I could barely walk, and had to use the cane again to get around.

This was a devastating setback, and the last thing I wanted to share on this blog. This most likely is going to lead to the next phase of my injury recovery, which I am praying will be surgery. Something is seriously messed up in my hip, and I need to get it fixed.

My Fall plans are most likely going to change dramatically. More on that as I get some answers.

I know, major bummer post. Not the kind I wanted to write.

For those who have not been following the entire saga, here is an updated version of the history I wrote for the doctor:

Climb Description
9/16/2012 Bridge to Bridge. Injury probably occurred. Mild hip pain started day after ride, got progressively worse.

9/25/2012

Saw general practitioner about hip pain. He thought it was tendinitis. Prescribed anti-inflammatory.
9/30/2012 Rode Six Gap Century with excruciating pain to begin with. Could barely move legs outward. Hip warmed up and no pain during 2nd half.
10/13/2012 Took two weeks rest. It felt a little better. Ran a 5k very slowly without much problem.
11/12/2012 Rested most of October then began training again carefully. Asheville climbing ride and it felt sore again the next day. It became worse. Got referral to Sports Med Orthopaedist, rested.
12/10/2012 First sports med appointment. Doctor thought injury was soft tissue in labrum. Got MRI.
12/17/2012 Diagnosed as stress fracture in femoral neck. Rest for weeks. Had to stop anti-inflammatory. Most of that rest was painful, took pain medicine on occasion and it didn’t help much. On crutches. Clicking and popping began during this period.
1/29/2013 Next Sports Med appointment. Still stress fracture not healed. Switched from crutches to cane.
2/19/2013 Another MRI, this time with an injection of dye. Stress fracture had healed. X-ray diagnosis: lateral labrum tear. MRI: Paralabral cyst? No visible tear.
2/27/2013 Doctor canceled appt. Saw PA instead. He gave green light to ride carefully. Clicking and popping continued. Back on anti-inflammatory.
3/27/2013 Saw doctor briefly. He thought I was getting better, can increase activity. Hip was very sore in colder weather.
4/16/2013 Broken rib. Fitness improvements, clicking and popping continue, mild pain. Doctor said get to get bone density scan.
5/10/2013 Bone density scan showed abnormally low density in femurs. T scores -2.1 and -2.3. Made diet changes.
5/21/2013 Assault on Mount Mitchell completed. Had quite a bit of pain during last several miles.
6/21/2013 Started physical therapy, gradually increased activity.
8/26/2013 After little improvement, got second opinion. He confirmed labral tear, suggested a couple other possibilities.
8/29/2013 Cortisone shot.
9/2/2013 Tour d’Apple. Slight setback afterward.
9/7/2013 First mountain bike ride. Major setback, taking break from bike.

Not So Fast …

The new ride

The new ride



After a long seven weeks off, I had been looking forward to yesterday’s doctor’s appointment. My expectation and hope was that we would X-ray the hip, see that it is healing, and move on to the next step towards my recovery.

My hopes were dashed by the results. Unfortunately there were no signs of healing.

Stress fractures are strange and perplexing injuries. They often will not show up on X-rays. Mine didn’t show up initially, and we didn’t know it existed until I had the MRI. When a stress fracture is healing, there are visible and distinctive signs that will show up on the image. Mine showed nothing, which means I’m not there yet.

The fact that there were no signs of healing does not mean I am not healing. I know just from the way I feel that the hip is improving. All we know is that the process is a little bit slower than we had hoped. The fact that I am still experiencing soreness, walking with a limp, and having popping instances, all show that the healing process is still ongoing.

The doctor advised me to take another month off. As he put it, I need to ‘respect’ the hip. He looked at my walking gait, and found it to be unnatural. “Is that how you normally walk?” he asked. Nope. Even though crutches are no longer necessary, he suggested using a cane just to keep weight off of it.

While this was disappointing, it was somewhat expected. I could already tell a couple weeks ago that healing was taking longer than I had hoped, which was the reason I canceled my plans in France this year. That turned out to be the correct move. This is a process that I have to be patient with. I’ll follow the doctor’s orders, and hopefully everything will continue to improve.

This sets back some of my spring plans. My heart is set on completing Mitchell, and I will optimistically register next week. However, if the news is not better in a few weeks, I may have no choice other than to be smart and back out.

I can’t complain too much, as there is always someone out there facing tougher odds. Today I heard about Christian Haettich, who is taking on both Haute Route challenges. And by the way, he’s missing an arm and a leg. By comparison, coming back from a measly hip injury seems pretty insignificant.

Time heals all wounds, and this one will be gone eventually.


Breakthrough Week

It has now been nearly seven weeks since my last ride. The time off has been a roller coaster, sometimes with extreme pain, sometimes with absolute boredom. Fortunately, it looks like I am finally closer to the end of my recovery than the beginning.

After two weeks of making hardly any progress, major strides came this week. On Tuesday, I noticed that something felt different. I had more flexibility, mobility, and less soreness. A dull ache existed, at times worse than others, but it was drastically better than it had been a few days before. That was my first breakthrough day. It became even better on Wednesday, Thursday, and then Friday. It feels remarkably better now.

I’m not out of the woods yet. On Monday I will visit Dr. Ekman again, probably get an X-ray, and a direction for treatment. It is possible I’ll need another MRI (Ugh!). My guess is that the fracture has mostly healed, but there are some other soft tissue issues underneath the labrum that still need to be dealt with. There is some lingering soreness, and I can tell that my hip still is not quite right. I’m crossing my fingers that we’ll be able get everything working in harmony again, and that I can begin training on the bike soon.

In two weeks, I will register for the Assault on Mount Mitchell again. That seems like a bold commitment at this stage of the year, but one I am prepared to make. Even if I cannot train like I have the last couple of years, this is the ride I want to do every year. I’m banking on having enough carryover fitness to make it to the finish line, however slowly, without focusing on time. Any training I can manage until then will be a bonus.

Speaking of Mitchell, my friends in the southeast might be interested to know that I am now blogging for the 2013 Assault. The first post is up now, and more will follow. Much of my material will not be new to readers of this blog, and a few things will be cross-posted over the next few months. I’ll be an editor of sorts as well, working with a few others for different perspectives and tips, varying from beginners to professionals. Even if you do not ride in the Mitchell event, you might find the material useful to prepare for any sort of endurance event.

Finally, I’d like to give a couple shout outs. It was a tough decision for me to bail on this year’s Haute Route plans, even if it was the right decision. I want to thank Wes for backing out with me. We had planned to do the ride together, were going to train together, fly together, and be roommates during the entire event. We both deferred our registrations and plan to participate in the 2014 event.

The final shout out is to the Vicious Cycle team. Wes and I left them in the lurch by backing out. Fortunately they were able to find a couple replacements rather quickly. Keeping in the spirit of internationalism, they added Julian from Edinburgh, UK, and Patrick from Sydney, Australia. They now have a great looking kit, which I’ll be following for this year’s event.


The Plans, They Are A Changin’

logo_alps

Today I made a big decision. The Haute Route is not going to happen, at least not this year. It was a difficult decision, but ultimately the right decision.

As most of you know, I’ve been recovering from a stress fracture for the last several weeks, and had trained on it for a few months prior. The sports medicine doctor had told me that the potential recovery timeframe could work with an event of this scale, but at that point, the injury did not seem as bad as it was. The thought was that I would be relatively pain-free, not need crutches, and get to cross-training (swimming) fairly quickly. None of those wishes came true.

Although there has been minor improvement, and the crutches are no longer necessary, the healing has been slow. The crucial moment was just a few days ago when I swam for the first time. Everything went well during the swim, but soreness lingered for a couple days afterward. The doctor advised me that I could continue swimming, but only with a careful amount of rest in between.

With each week, I have been losing valuable training time. Since I’ll have to resume slowly and carefully, it will still be awhile before I can really push the intensity. The reality is, a lot of training is required to succeed at an event like this. It is not the considered the highest and toughest cyclosportive in the world without reason.

I will heal, and if I pushed, I could complete the Haute Route event this year. The only problem is, I would not do nearly as well as I would like. The experience would be more suffering than it would be otherwise, would take more time on the bike, and simply not be as fun. Not to mention, my team has been training this entire off-season, and most likely would be well beyond me come August.

Most everyone I have talked to agreed that this was the right move. As Coach Bobby put it, this injury is most likely a one-time thing that needs to heal. At some point I will bounce back and be strong again.

As of present, I am looking into my options, but most likely I will defer my registration to the 2014 Haute Route. This gives me the comfort zone to focus now on my recovery without worrying too much about the training I’m missing, while not ruling out this amazing event for the future.

As for the rest of 2013, I have no doubt that plenty of adventures are waiting for me. There are lots of cycling playgrounds in the world. We’ll definitely have another big vacation, possibly another sojourn to Colorado, maybe a trip to France, maybe California, or maybe somewhere else entirely. And of course, I will spend a lot of time in the Blue Ridge, hopefully exploring some new areas.

For now, I’m being smart.


Taming the Tiger

As I’ve said before on this blog, I have one speed — GO, Go, GO! I’m my own worst enemy, as evident from this injury that has forced me on the couch for the last several weeks. That’s the tiger within me, screaming to get out and devour what it desires. For me, I yearn to devour the nearest mountain, conquer it and plant my flag.

More on that in a moment.

This injury has been confounding and unpredictable. There have been days where I have felt amazing, and others where I have felt like it would go on forever. Just the other day, frustrated with my lack of progress, I decided to just stay shut down until my next doctor appointment.

As it turns out, I spoke too soon. Seemingly from the moment I pressed the publish button, things began to turn around. They continued to improve dramatically during the week, which culminated with some amazing news yesterday.

I am FREE! The crutches are gone. I am walking.

Yesterday was my first day walking under my own devices. At first I walked gingerly, favoring my left side. Even with that, my right leg became sore just from the inactivity of the last few weeks. At times it felt like I might need the crutches again (they were in my car, just in case), but as the day progressed, it felt better and better. Not only am I walking, but I am walking without a limp. A day later and I can say with certainty that the crutches are gone forever, at least for this injury.

I also received some good news from the doctor. I’m allowed to get in the pool and get some exercise. I can swim or water walk.

This came at the perfect time. The time off has not been enjoyable, but as of late, it has really taken a toll. That tiger has been growling incessantly. When I don’t work out, I get stressed more easily, and am generally not as happy.

Tom, a good friend, gave me some terrific advice:

Aaron, having worked for 12 years as a Personal Trainer, be careful – there is a huge difference between a traumatic injury (crashing) and an overuse injury. Just remember “overuse” is very subjective. An extreme example asking a person that walks everyday, than to run even a mile. You will of course get better – but don’t go get better than your body can. Just knowing you, that’s all. I learn a long time ago a coach is not there to tell you to do more – but to hold back. It’s the fire in us sometimes it helps if it is held back.

Tom does know me. He has seen that tiger roar as it climbs over a mountain. Others have echoed that sentiment. Chill out, Aaron, they say. Let yourself heal. Baby steps. They are absolutely, positively correct. I have to go slow with this recovery. My friends may have some epic rides planned that make me drool, but I will need to stay at home and ride 20-30 miles. I’ll live vicariously through them until I am able. And when I am able – Watch Out!

Fortunately Coach Bobby believes in this sentiment. He will push me when needed, but he will also make sure I get my rest. My goals this year are to heal, climb Mount Mitchell and then become an official finisher at Haute Route. If I let that tiger out too early, none of these will happen.


The Freakish Femoral Neck

First off, thanks to all those who reached out to me after the injury news. I received a lot of encouraging comments here, on Facebook, Twitter, and a lot of text messages and emails. Whether the comments were simply well-wishes or constructive advice, they were all appreciated.

Now that the shock of the diagnosis has worn off, I’ve been able to come to terms with the injury.

One thing I discovered pretty early is this is a freak injury for a cyclist. I scoured the internet for examples from others, but found only a legion of runners. Unlike running, cycling has no impact whatsoever, so it is boggling that any type of broken bone can occur. Even though I had run a couple times leading up to the climbing events, it was not nearly enough to suffer an injury of this nature. There is no other possibility than for this to have happened while climbing, probably out of the saddle as the doctor suggested.

Here is the best description I found of the injury.

Another common subject that came up when I talked with others was that I trained on the stress fracture. While it would be easy for me to brag about riding around with a broken bone, it really was not as impressive. The symptoms of the injury were more like tendinitis. When my body warmed up, I often would feel very little, if anything. There were only a few situations where it hurt during the activity. Six Gap was notable. Beyond that, it often hurt quite a bit after the events, but would improve with rest.

Speaking of rest, that’s what I’ve been doing, and will be doing for the next number of weeks. Kelli worked with me to find the best vitamin recipe to get the Vitamin D, Calcium and Magnesium to help heal my bones. I’ve been making it a point to eat things that are richer in nutrients, specifically calcium. I’m also walking around with a crutch for the time being. I could function with a slight limp, but the doctor thinks it is best to keep weight off the hip as much as possible.

I feel pretty good about the recovery process and getting back on the bike. So far I have not noticed a significant difference, but that’s to be expected. Bones are slow to heal. One thing I noticed when reading a lot of the testimonials from runners is that it is difficult for them to return to activity. Fortunately I will not be running. I found many examples of runners that will cycle to get their legs into running shape. Even though the doctor hasn’t told me this, I’m pretty sure I’ll be able to start some light pedaling after the initial healing process. That’s a good thing. Climbing may have to wait awhile.

On the brighter side, my friends at Vork Cycling showcased their amateur Photoshop skills to make light of the injury. This was hilarious.

aaron recovery


Diagnosis: Broken Hip

hip_stressfx_anatomy01

Today was the day I would get the results of the MRI. After doing plenty of internet research, I figured that the best case scenario was further inflammation of the same hip flexor strain that my General Practitioner had diagnosed months back. The worst case scenario would be a tear somewhere in my hip labrum. Depending on the severity, that could require surgery. Whatever it was, I was looking forward to getting an answer and starting the path towards recovery.

It turned out to be neither of those.

“How does the hip feel?” the doctor asked. A little sore today, but not as bad as this last week.

He came right out and said it. “You have a Femoral Head Stress Fracture.”

Wow, I thought, not really understanding what he said. It turns out the fracture is in the plate of my hip, the right side, not far from the socket (labrum) that connects to the pelvis. He said that the labrum is also off, which points to another injury. Whatever I did to that poor hip, I did it real good.

He asked questions about my activities, trying to figure out how this happened. I never noticed a snap or any moment where this could have happened. He said that it’s more common with running because of the impact. When we discussed some of my rides in a little more detail, he said that it could have happened when riding out of the saddle on a steep climb. That is when I would be most at risk for this type of injury. That jives with my Grandfather Mountain theory.

The only prescription right now is rest, and lots of it. I will not even think about treatment for the next six weeks. The only activity that is at all acceptable is swimming or upper body exercises.

My first question was whether my plans in France are still possible. Yes, he said, with some work. We’ll revisit this again at the end of January, and I’ll work myself back into shape slowly. The goal is to resume training sometime in March. Since the event is in the late summer, my recovery fits within the training timeline.

Even though this is somewhat of a bummer, I am relieved. Finally I can stop training and aggravating this injury, which to be frank, has not been a lot of fun. The next time I ride, it won’t be on a broken hip, and it’ll feel a lot better.

Whatever happens, this story ends in the Alps.