Coming Back from Serious Injury

You may recall that I broke my pelvis in a bike crash back in early April (be careful around car doors that may open!). Since then I've received several emails from other athletes who have also had serious injuries and wondered how I was doing. I appreciate their well wishes. I suspect part of their reason for writing is that “misery loves company.” Returning from an injury is probably as much of a mental issue as a physical one--perhaps more so.

One such email came in today that is especially interesting given the serious nature of his accident and his desire to get back to racing again soon. Here is his email (I removed his name) and my reply. Hopefully, you won't ever have a need for such information, but I thought you may be interested in one person’s view of coming back from serious injury.

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The email...

Hi Joe,

In early April I crashed my bike and spent the next two months on a couch with a concussion. I spent June getting back out on the bike and building up an aerobic base. My goal is to race in the state championship 40k ITT in early September and a sub 6 century (no crits for me this year, doctors orders :-). I'm also doing a 40k ITT July 31 to get a baseline and set a more specific goal for September. This is my first year racing and competitively riding my bike. I'm 28.

I've been following your blog with even more zeal than usual after your injury earlier in the year. I am very interested in your approach to your A races this year but I haven't really seen much follow up. What do you do when you've lost so much time? Do you spend less time on base and jump into doing anaerobic intervals? I noticed you were at least doing zone two rides early in your recovery, so I've followed your lead and done the same.

I'm buying a PowerTap and signing up for TrainingPeaks hoping to more be more precise about my workouts and maximize the time I have left. I plan on spending the next 3 weeks essentially in base 3. That leaves me with 6 weeks to build and taper. It's a tight schedule.

Thanks for any advice.

(Anonymous)

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My answer...

Hi (anonymous),

I’m sorry to hear of your setback. That must have been a serious accident. It happened about the same time as mine so we’ve been on much the same healing schedule, I expect.

I’m not sure there is a right or even a best way to return from such a serious accident. But I’m happy to tell you what I did. My instructions from the doc were to do whatever I could tolerate. There were four breaks in my pelvis but none of them were displaced. So for the first 10 days I didn’t do anything at all. I was at a camp in Spain. Getting around on crutches was enough of a challenge. Then when I returned home I began lifting weights (upper body) and spinning very, very easily on my Wattbike. Power generation gradually increased but I could tell it was going to be a long time coming back to anything even close to normal.

Three weeks after the crash I was starting to do zone 2 intervals alternating with weights as I couldn’t take being on the saddle for long periods of time. A week later I was on the road riding, somewhat tentatively, and still almost entirely in zone 2. With all of the aerobic threshold training I noticed that my decoupling was within a good range. I just needed to extend my time at that effort.

By 6 weeks post-crash I was doing 2-hour rides. My hip was feeling great (thanks to physical therapist Wolfgang Oswald at Endurance Rehabilitation in Scottsdale). At 7 weeks I did a CP30 test to see where my fitness was. My FTP was down 12% from just before the crash. But this result was complicated by doing the test in Boulder at an altitude of 5500 feet (1800m) instead of in Scottsdale at 1200 feet (400m) where the pre-crash test was done. At this point I knew it would be a long time until I was ready to race. In fact, I wasn’t sure I’d race at all this season. I really don’t enjoy racing if I’m not at least somewhat competitive in my category.

I stayed in the base period doing long zone 3 intervals mixed in with zone 2 aerobic threshold rides for another 4 weeks. At a camp in Switzerland I did my first climbing and felt pretty weak. Now that I’m back from the Swiss camp and starting to do quite a bit of climbing in the mountains near Boulder my FTP is rising. This is partly due to improved fitness and partly due to altitude adaptation. It’s hard to know which is having the greater effect, but my FTP is now about 8% below the pre-crash level. It’s typically about 4% lower in Boulder. My CTL (from WKO+ software) shows that I am at 90% of my pre-crash, general fitness. So I still have a good ways to go.

Last week I started block 4 training, which in terms of classic periodization is about the same as build 1. This involves a lot of FTP-range efforts on climbs and on the TT bike. By the end of July I hope to be ready for block 5 (like build 2) with more racelike training. I won’t taper until the week of the first race.

At the rate I’m going I think that by late August I will be race-ready for the first time this year. And that will be my last opportunity as I’ll be traveling in September to do clinics in Italy. So for now I am aiming at just a couple of races. But it may not happen. We’ll see.

So to summarize and specifically answer your question, I spent about 6 weeks in what might be called base training. I would have liked that to be longer but with only a couple of opportunities to race this year, in late August, I needed to move on to more intense training. By late August I will have had about 6 weeks of increasingly race-specific workouts. I’m not sure 12 weeks is enough to race well, but that’s all I have.

I hope I answered your questions. Please let me know if there is anything else I can tell you. Good luck with your return to training and racing.

Joe

 

Comments

[Sfioritto]

Thanks for responding to my email. There is so little known about concussions, although we are learning more and more thanks to awareness being raised by the NFL. For example: I had no idea it could take months to recover.

So I put together a blog post to help other cyclists with concussions which basically outlines what I'm doing to prevent and how I will manage future concussions, (hopefully never again :-)

http://www.planningforaliens.com/2011/06/28/concussions-in-cycling-and-recovery-tips-and-tricks/

I basically never post to my blog so I promise, there is no self-promotion here. Just want to get the information out there.

[Reagan]

Hi Joe,

Glad to hear you are getting back on track. I just wanted to give a shout out to your partner at TrainingBible Coaching, Adam Zucco (and his lovely wife Lindsay) for doing a superb job at keeping me on track for my 1st Ironman this coming August even when I broke my ankle in late Feb. (requiring surgery)...I was back in the pool and spinning on the trainer within 2 weeks. I'm stronger now than ever! It was a new obstacle for all of us, but I am confident it will be a fantastic day based on my PB finishes in the few races I've done since coming back.

[Larry Tieman]

Glad to hear you are healing. I was hit by a truck on Lefthand Canyon Rd over the Memorial Day weekend. I was lucky. I was hurt but no broken bones. I am just now able to do light riding on a trainer and hope to be cleared outside in two weeks. Concussion. I am an ultra distance rider and an 63. I have no chance of doing any major distance rides this year. Would you recommend the plan in ths blog for me?

[Joe Friel]

Larry Tieman--I read about your accident in the paper. Glad to hear you are coming back ok. I'd suggest a very long and thorough base period--much more than i did here--given that you are not doing any events this season. Good luck.

[Madeleine]

Hi Joe,

It is wonderful to hear that you are not only back to riding on the road but also back on track for a race or two this year. Do you have any thoughts on the subject of nutrition for athletes recovering from musculo-skeletal injury while returning to race-training mode (e.g. changing the protein/CHO/fat proportions in daily diet)?

Thanks,
Madeleine

[Bob Kinnison]

Here's another resource for those of you coming back from injury: Carrie Cheadle, a Sport Psychology pro from the Bay Area with a short video about coming back from a crash. http://carriecheadle.com/blog/2011/07/06/regaining-confidence-after-a-bike-crash/

[Kevin Morgan]

Hi Joe,
I was wondering what you thought about distinguishing what I call 'good pain' from 'bad pain' during training or a race. Making the distinction, that I fortunately did in the 2009 Charlotte Marathon, which saved me from a serious psoas injury, whilst in the 2009 Lake Placid Ironman it helped me to avoid a DNF (http://goo.gl/ycFQr). Any pointers appreciated. I'm not sure which is worse, cars and their doors and wing mirrors, or our minds inability to tell good pain from bad when under pressure. This is where I rely heavily upon my coach most of the time.
Happy continued recovery.
-k @FitOldDog

[Joe Friel]

Kevin Morgan - That's a good question but one I have never even thought about before so don't have an answer. I'll have to ponder that one...

[Joe Friel]

Madeleine--Good question as usual. Without even trying I've found that at times when I am not training for extended periods the carb content of my diet decreases as fat and protein increase. This is in part due to less need for sugar and starch during and after workouts which increases carb intake considerably. I also tend to focus more on the protein content of my diet when injured so it probably rises in my situation from about 15 to 25% of total calories.

[gene raphaelian]

Hi Joe-

Congratulations on your comeback. I must say the advice your doc gave was far different from the advice I received after I suffered a single, non-displaced left acetabuar (lower pelvic) fracture 6 weeks ago in a rainy crit. He told me ABSOLUTELY NO weight on the hip/leg for 6 weeks and to slowly work my way back (no hills).

I started that process 1.5 weeks ago doing L2 rides w a bit of climbing (not much choice in S Barbara). Overall I felt good at first, with a feeling that I had lost muscular endurance, but relatively less aerobic fitness.

Unfortunately I've started to feel some pain in my lower left glute. My guess is its just unhappy soft tissue and I need to back off for a few days (or more) to see how it responds.

So to the person who asked the question above, am I feeling "good pain or bad pain", I would say we all know the good pain that we feel when we are pushing hard, and we all know when something is outside the boundaries good pain.

In my case I've never felt this glute pain before, and it tells me something is strained and I need to chill. The key is to be honest, which is tough, when you are addicted like many of us are. Sorry for the long post.

Best,

gene r

[Phoenix Truck Accident]

How inconsiderate of that car passenger/driver. I just can't believe there are people who does not look behind the car before opening the door. I always look what's coming up in the rear view mirror before opening the door locks when someone is alighting.

I don't know if there is anything that a cyclist could do except to be more careful when passing by a car door.