The krazy life of triathlon

Injury

Ironman UK – Game On

So a few days after the last post, I was back in the doctors for yet more x-rays (I’ve had more than my fair dosage recently!) and to get the results of my MRI. I had my elbow x-rayed, which came back looking nice and calcified and well on its way to healing. The MRI results, however, put a big dent in my hopes for getting fit. Upon reading my report, my Doctor called in another specialist to come and take a look. I had done a number on my wrist, that’s for sure! The full report is below, but the short version is I fractured two bones (my triquetral and hamate), bruised two other bones (trapezium, which is what was originally a suspected scaphoid with my symptoms, and my capitate). The main problem was that the MRI had picked up a tear in my TFCC, which (correct my if I’m wrong) is a group of ligaments and cartilage that holds the radius and ulnar arm bones together and allows the forearm rotation, and essentially holds the wrist to the arm. Combined with my radial head (elbow) fracture, this is what is known as an Essex-Lopresti fracture, which essentially meant I was in the splint til it had healed. The fact that it was non-displaced and the radius and ulnar were still in the right place and the different fractured wrist bones was the confusing part, which is why the other specialist was drafted in. They were trying to work out how I actually landed (I had no cuts or grazes anywhere on my arm…)  as apparently a non-displaced fracture of this type is very uncommon. The plus side of the non-displacement meant I was not going to need surgery on it to put it back into place, the downside of it was I was in a splint until it had healed; any further tearing and I was risking having the two bones pop apart, which would be surgery and in a cast for 3 months – not good!

For once, I was actually good with my recovery, and stayed in the splint religiously to allow it to heal. Running was still off the cards as any jolt risked tearing the TFCC further and swimming obviously was a definite no-no with half my range of movement in my elbow still missing.

3 weeks on and the injuries are finally starting to heal, after a couple of weeks of not much improvement. The last week, things have rapidly fallen into place (which, I would like to think coincides with return to some sort of normal training, but unlikely). My legs were slowly coming back on the turbo, I was back running and still running pretty well thanks to avoiding the kitkats and excessive meals whilst injured and I even ventured into the pool once most of the movement in my elbow returned.

The first swim back was an interesting one! Tubigriped-up to the max, I tentatively pushed off with my arms in front and attempted some single arm swimming. So far, so good. I then picked up the kickboard and even that was fine until it came to turning around (one arm holds the board, one arm grabs the edge to turn, either way, my fractured wrist was going to have to do something!). After 15 minutes of single arm and kick, and no pain, I decided it was time to try using both arms…and it was ok! I had absolutely no strength, which is a really weird feeling, but it didn’t really hurt! So happy!

The only concern I had was that in the evening, when for some completely stupid reason, I decided to see if I could lift myself up out of my chair with my arms (really, don’t ask) to see how my wrist was. I had forgotten I had a fractured elbow. With new-found mobility thanks to my swimming, I was fine until my arm was straight enough that the fracture was rubbing against my humerus….OW! Felt like I had refractured it again, what a complete tit! Thankfully the pain was short-lived and went, and what muscles I had left rallied around to prevent me doing it again and restricting my movement to pre-swim levels.

The other concerning issue was when I was brushing my teeth. At this point I was trying to live life as normally as possible (a check-up a week earlier showed everything was still in place, the TFCC had almost healed and I was allowed to start getting movement back) so I was brushing my teeth with my busted hand. When looking in the mirror I saw my ulnar protruding so prominently I nearly carted myself off to A&E there and then, worried I had knocked it out of alignment. Calming myself down, with no pain during arm bending and wrist rotation, I could at least wait a few days til my next check up. It wasn’t until I showed a friend at work, and they noticed how much smaller my arm was compared to the other one. It had never occurred to me but my muscle atrophy was shocking. If you bend your arm, you have a nice lump of muscle running down the upper arm to the lower arm – mine is completely flat and non-existent, even now after getting back in the pool and normal use! The reason my ulnar was so prominent was because I now had arms skinnier than Bradley Wiggins!

My final check-up was Tuesday, and the x-rays showed my wrist was still stable and the fractures looked good. With my elbow giving me more grief than my wrist, I requested another x-ray on it, which showed that it had not completely healed. The fracture had fused, but the fracture line was still visible in the x-ray, meaning it still had a little bit to go, probably at the top, which is why I don’t have full extension yet. However, he referred me to physio so I could ‘start and get everything moving again’. That was good enough to me, I had told him I was back swimming, cycling and running again, and he didn’t raise his eyebrows too much. It didn’t hurt, so he was happy with that, and didn’t tell me I shouldn’t! I neglected to mention the fact I was planning on doing my IM on Sunday, but that was permission good enough for me! Game On!

Yesterday morning saw me start to switch my body clock to IM time, and an early start saw me back in the pool 10 hours after leaving. My swim on Monday lasted 45 mins until my elbow died, but it felt OK yesterday morning. My replacement helmet also arrived this week, so I ventured out on the roads at six yesterday. It felt very alien, and very weird after 5 weeks exclusively in the TT position, but being back out on my bike made me so happy! I just have a few days now to get stregth back in my arm, and have been spending lots of time in the pool to try and build the muscle back, as well as trying to use it normally, including typing and playing xbox and guitar (definitely a medical recommendation that…) This morning was my final day of proper training, and saw me getting up at 5 for a run, cycling to the pool, having a good pool session where my arm is really starting to feel strong again, and cycling home. The grief my arm gives me seems to switch between my elbow and wrist. I think the elbow fracture has just about finally healed, and full extension has almost returned and the muscle is helping to protect it, I just hope it holds for the swim. My wrist is still very weak, so will be strapping my wrist up rugby-style, as well as wearing a double tubigrip. Day-by-day it is getting back to normal, I just hope my legs remember how to work now!

My MRI Report:

REPORT:
      Sequences  obtained:
      Coronal  STIR,  T1,  T2*,  sagittal  STIR,  T1,  axial  STIR,
      T1
       
      Scan  findings:
      Marrow  signal  is  intensely  increased  within  the triquetral  on  STIR,  with  associated  intense  signal increase  within  the  trapezium  and  to  a  lesser  extent within  the  ulnar  border  of  the  distal  capitate  (images 07-10  of  series  eight).
       
      There  is  preservation  of  radio/ulna  carpal  joint  space  and  alignment.
       
      The  TFCC  is  of  altered  signal,  with  evidence  of  a partial  tear  of  its  distal  attachment  to  the  capsule. The  scapholunate  ligament,  lunotriquetral  ligament and radioscaphocapitate  ligaments  are  intact.
       
      The  flexor  extensor  tendons  appear  normal.
       
      The  median  and  ulnar  nerves  appear  of  normal  signal and  calibre.
       
      There  is  marked  ulnar  sided  synovitis  seen.
       
      Interpretation:
      1.)  Undisplaced  fracture  of  the  triquetral,  and  the dorsal  aspect  of  the  hamate,  with  no  significant  displaced  fragments.
      2.)  Associated  dorsal  synovitis,  that  may  mask  a  small  avulsion  fragment.
      3.)  Bone  contusion  of  the  trapezium,  and  ulnar  margin  of  the  capitate.
      4.)  Compromise  to  the  capsular  attachment  of  the  TFCC with  ulnar  gutter  synovitis.
       
      For  clarification  of  the  morphology  of  the  fracture  of the  dorsal  triquetral  and  hamate  further,  a  CT  may  be useful.


2 Weeks On

So 2 weeks on from my crash, and I am slowly remembering how to live life one-handed again, although I am typing this out OAP-style, using one finger on my broken hand (though don’t tell my doctor!). It’s rather amusing looking through my old blog posts detailing my last break, and seeing how my recovery compares, and it seems that physically at least, the bone healing is following a roughly similar timescale, albeit slowed down a bit, which is hardly surprising as I don’t have the opportunity to sit in the sun all day, and sleep for 14 hours a day! Mentally, the bad moods hit me a lot sooner due to a variety of reasons. When I broke my collar bone, the aim of the season was to finish an Ironman; I had the opportunity to focus everything in my life on getting healed up as quickly as possibly, and concentrating on it 24 hours a day; I was surrounded by my friends in a place that I loved (and had significantly better air quality!) and I had an excellent doctor who understood me and wanted to help me achieve my goals.

Compare this to my current situation, where I have this annoying work thing taking up my day(!), seem to spend most of my spare time on tubes and trains living a London life, and I had a doctor who, to be frank, couldn’t seemed to have care anymore had I been a health and safety notice on his wall, and was more interested with getting me through as quickly as possible. I’ll be the first to admit I am one of the most difficult patients an orthopeadic surgeon will come across, as I try aqnd push my recovery as much as I can, but this one wasn’t interested in the slightest.

It took me a week to get an appointment at a fracture clinic (compared to a day with Manchester…) and I turned up, he looked at my hand, said yes it’s broken, go and get a cast fitted and come back in 5 weeks. No x-rays to confirm the wrist fractures, no advice on management, and certainly no help to get myself fit again quickly. Given my Ironman was 5 weeks away, this is far from ideal and I tried to push for a closer time, but both him and the receptionist said I wasn’t allowed, and it could only be 5 weeks or later. Great. I also heavily pushed to stay in my splint, as though although it wasn’t the most comfortable and giving me the best support, I could at least wash, manage my own recovery as pain allowed, and most importantly still train. He didn’t seem to be too bothered, as long as I didn’t ever take it off in the 5 weeks, so at least I could still train.

A few days later, I got fed up with this, and decided it was time to get a 2nd opinion, and time to make the most of having private medical insurance through work. After sweet-talking the receptionist at my local GP so I could register, see the nurse and then see a GP to get a referral all in the same morning, I found myself at London Bridge Hospital at lunchtime to see a specialist, who was great and understands type of patient I am! I had X-rays done, which showed the elbow healing nicely, but the wrist x-ray was inconclusive so a few days later I was being squeezed into an MRI scanner to get a more definitive answer. Certainly making the most of my insurance, and the £3 a month I pay to remove my excess is paying off in spades, but I have to say that MRI scanners are not designed for people who can’t straighten their arm! I had to lie down, with my arm straight and wrist clamped into a cage, not ideally comfortable! So meant it stopped me having a kip during my scan, but at least I know my arm can just about straighten! On the plus side, between me, my specialist and the physio I saw to get my fancy, custom splint fitted, I think we know which of my wrist bones are actually damaged, none of which the fracture clinic doctor suggested!

My swanky custom thermoplastic splint

Having had a look through my MRI results, I think I have found the culprit bones, though I can’t really tell what is a break, and what is just detail from the cross-section! I am off to see the specialist again tomorrow, so I can found out what the damage is, and hopefully I should get a better timeframe for my recovery, as opposed to just ‘come back in 5 weeks and we’ll see how it is’.

Some cool images from my MRI – spot the fractures!

My elbow recovery has gone well and is starting to slow down, so it must be nearing completion. There is still a bit of pain when I force the movement in the bone, so I reckon another week until the bone has finished fusing. I have about 75% of my movement back in my elbow, with more and more of it now comfortable and pain-free and can be achieved unaided. There is still a little bit of swelling left preventing me from full extension, but I am confident I should be able to get full movement back in a couple of weeks with the help of my sports therapist once I get the all-clear from the doctor to do so. I am trying to get back to normality and use it as much as possible, as long as it is pain-free, and can now do little things like put my toothbrush underneath the tap! Still can’t reach the back of my mouth with that arm… But arm is getting happier at least and thankfully my shoulder has fully recovered and moves properly, it must have taken one hell of a hit when I crashed as I couldn’t raise my arm above my head for a week, was getting worried something else was broken! The whole arm can’t be that bad any more, I have left the house having forgotten to put my sling on, on more than one occasion!

My wrist seems to be improving rapidly after a couple of weeks of not much improvement, and having said about my one-fingered typing at the start, I am now typing happily away almost normally now with hardly any pain. The latest thinking is that I have fractured my hamate (physio and doctor’s thoughts) and my trapezium (my thoughts, undetected pain in that region, which was originally a suspect scaphoid fracture, but that has been cleared). How I have managed to fracture these two bones, and avoid the scaphoid (again!), I have no idea! They seem to be healing well though, and I am finally getting some strength back in my wrist. I did some serious ligament damage, which is going to take some time to heal, but movement is slowly beginning to return and strength is coming back. I can even hold my phone in my hand now with no splint or tubigrip!

So whilst my recovery is progressing, training isn’t going to well! Being unable to run or swim, my life is confined to the turbo, which I hate on the best of days. Unfortunately I can’t just sit up on it like I could on my road bike as it puts me very forward and there is a fair old. Holding myself up with one arm gets rather tiring rather quickly! If I take my splint off, I can sit in the TT position, but with a broken elbow I can only take putting weight through it for so long before it begins to hurt. Mentally I am also fed up, so bailing out is happening far too often. I am hoping to get the go ahead to start running this week, and I just need to build up on the turbo. With 4 weeks til IMUK, there are going to be some rapid increases in training load, and I am going to have to train full-on up until the week if the race. At least I have managed to keep the diet pretty much under control, so haven’t put on too much weight so my return to running shouldn’t be too painful.

I am still hopeful of making it to the start line. If I can do that, then I know I’ll finish.


A Little Update

I have been meaning to write an update for a while now, as a lot has happened since the last, but it was always one of those things that got put off as life got in the way. It has taken (another) accident on the bike to get an update.

So, as many of you will now know, I have a fall on my bike at the weekend crossing lanes on the road onto a bike path, and I didn’t see the ridge for the stupidly designed junction and hit the deck. I’m not quite sure how I landed, but my left leg is pretty torn up and my hip and shoulder have some nice bruising. I think I landed with my arm outstretched, but I haven’t got any cuts on my hand or arms, which is odd. However, my wrist and elbow were severely painful and I knew right away something was broken. I walked the few miles home (barefoot..), dropped my bike off and walked to A&E. I was seen quickly and x-rays confirm that I have a fracture in the radius head and they suspect a fracture in my scaphoid, which apparently takes a few days to show up on x-rays.

To say this is frustrating is the less colourful term I am using now I have calmed down. After a couple of years incident-free, it seems I am back to ruining my season after two previous bike crashes at almost identical times of the year. I can come up with hundreds of what-ifs, first and foremost was my stupidity of ordering brake cables instead of gear cables, as I was on my way to the bike shop to pick up the right ones. However, what is done is done, and I have to find a way to move forward.

Obviously this means I am missing IMUK 70.3, which I am absolutely gutted about. Not only do I have so many friends racing who I would have loved to have seen, I was the strongest I have been across the board. I have built on my massive swimming improvements from last year, and my stroke was greatly improved with times dow; a recent bike fit at Freespeed put the icing on the cake on my bike strength; and whilst my running has been hampered by a shin injury, I am the quickest I have been and was confident of putting in a PB for the half marathon. Whilst I don’t have the endurance from last year, with my greater speed and strength, I was confident of at least getting a roll-down slot for the World Champs in Vegas. It also means I will unlikely to be racing at Liverpool 5150, which world have been fun as I had another pro slot and the opportunity to line up against an amazing field, including Macca (and Joe Skipper ;))

This also puts my participation for IMUK in doubt. Whilst a ‘home race’ would be good, I don’t have anything left to prove for rocking up to an Ironman unprepared. I will have to wait and see how long I am going to be out before making a call. I will be back on the turbo once my elbow starts to fuse, but I won’t be running for a while, and certainly won’t be in the pool for a long time, and that assumes I don’t have any issues with mobility and a full range of movement, but I already have a good sports therapist friend ready to help with rehab.

Once I know whether I can race Bolton, I will have to decide what to do if not. I could be tempted to leave it for a year and just race short, something which I think I will do next year, with Ironman Arizona at the end of 2013. Right now, however, I just need to pick myself up and get healed. Thanks for all the well-wishes, that have been coming in, I just can’t believe I’ve had another season ruined by fractures.


It’s Not About The Bike

So yet another long break between posts! Mainly due to the combined incompetence of myself, BT and O2, I know finally have internet in my new house, nearly 2 months after moving in!

It has been a time of ups and downs since the last post. I have had a spate of bad luck. First of all, I got a foot injury about 4 weeks caused by running in my FiveFingers with absolutely dead legs and doing a tempo run. For some reason my leg just didn’t seem to want to work, and 25 minutes in, my foot started slapping against the ground. Being and our and back run, only way home was to run, so 25 minutes later, I hobbled home with a foot strain. This now appears to be a 6 monthly occurrence as I had one the exact same time, this time last year! Though that one was from standing on a plug… With 6 weeks to prepare for an ultra-marathon, it wasn’t exactly the best preparation!

The other bit of bad luck was a bike crash. As part of my training regime (more later) I was out with University Of Manchester Cycling Club and there was a touch of wheels in the group, someone went down in front of me, and I went over the top. Thankfully, I escaped with only a bit of road rash, but unfortunately my beloved Specialized didn’t fare so well, with a crack straight through my downtube:

I am looking at getting this repaired, and hopefully I can, but in the meantime, it means I am training on my old commuting bike, which is proving to be a great winter trainer, as it is bombproof, as also weighs a ton!

Tour of the Peak

So last weekend I set off in the dark, and freezing cold to take part in the Tour of the Peak, which I did last year. However, with my ultra less than a week away, I opted to go for the short version, as I know how I felt at the end of the long one last year! I had a great ride, and really showed my improvement on the bike from 3 big rides a week. I rode constantly within myself, didn’t walk (and that was TOUGH lugging the brute of the commuter bike up Winnats Pass!) and had an enjoyable day. I finished in 4:45, which put me 36th out of 350! Not bad for a rusty bike! It was also nice to do a sponsored ride, as I enjoyed stuffing my face with Soreen at the food stop, and finished the ride with more gels than I started the race with!

Training

Despite my foot injury, training of late has been great, and I am really enjoying being back in Manchester. Despite being the off-season, I am putting in consistent big weeks, and feeling fine for it. My weight is also much better than it has ever been at this time in the season, which is encouraging. In cycling and swimming, I am surrounding myself with better people so I have to up my game. I have joined the Uni Cycling Club, which gives me 2 hard rides a week on Wednesday and Saturday, which generally involves smashing each other for a few hours, and I am seeing the benefits of another year in my legs. Average speed and endurance are all up, and the amount I eat on rides is all down! I also ride with the Tri Club on Sundays, which is more controlled and a chain gang effort, giving me the option of having another hard ride, or switching to a recovery ride.
If you include commuting, I haven’t had a day off the bike since sometime in September! Thankfully I feel fine, and am just enjoying being back in training.

In swimming, I am enjoying being back in squad swims, which really forced me to sort out my technique and up my game from a year of plodding up and down the local leisure centre. Whilst there is still a lot of work to do on my stroke, yesterday I got 500m into the set before I was told to move up a lane. This now puts me in the same lane as the winner of the Outlaw and in the lane next to people who were basically born into a pool and professional triathletes! I have basically as many swims a week as I want, and will put in an endurance set once I switch back to triathlon training after my ultra, which should see me go close, if not under the hour for Roth.

Despite the fact, I have the Pembrokeshire Coastal Challenge in 3 days now, my run training hasn’t been as much as I would have liked. I did however manage nearly 2 hours, half off-road yesterday, so I am confident my foot will hold together. With being used to 2 hard, consecutive days on the bike now, I know my legs recover fairly well, so maybe there is hope after all! I will put another post up just before, outlying training, aims and kit.


The Final Build

Wow really has been a long time since my last post! Well since then, my stomach started working again after a few days, though it took a week to get back to normal, I went to Manchester for a stag do, end of exams party, and general mental refresh, and I have hit training HARD!

The week after the last post (so 2 and a half weeks ago), I started my final build for Switzerland. What was planned was 3 and a weeks of intense training, followed by a mini taper for Llandudno Triathlon to recover, a couple of final main sessions, then my final taper. So far it has been interesting, with mega bike hours, good swim sessions and a running injury…

Week 1

The first week went pretty much to plan, with around 22 and a half hours done. Totals were:
Swim: 9k
Bike: 295k
Run: 54k

I felt good and the long rides after the office really started to help, and I began to see improvements. Having an easy office ride on the tuesday, and a long, hilly ride on Wed has given me vast improvements in my bike, mainly with fuelling and stamina. They have helped me be able to ride for long hours on little food and still feel fairly good. Also I have been riding pretty knackered recently, so hopefully when I am fresh I should fly!

Swimming was plodding along nicely, and I was getting my feeling back for the water, and times were improving. I also upped the distance to 3.5k so the full swim should be fine, and leave me with plenty left in the tank. My running had a big improvement in mileage, and I was beginning to feel it click. I did my long run after work on the Friday (due to a wedding on the Sat) and again had little food, but felt great. I was running smooth, light footed, and my endurance was good. Unfortunately it went wrong in week 2.

Week 2

So having had a big week, I decided that having done a weights session in the morning too, that I would do a speed run session in the evening! This was a 20 min run, 10x 1min on, 1 min off, 20 min run. Given that this was the first speed work I had done for a long time, and my legs were knackered, meant that by the last few reps I wasn’t exactly running light-footed! The Newtons don’t offer too much support or cushioning either (deliberately, and this is how I like it), so my feet were slamming into the ground. The end result was some sort of tendon strain in the outside of my left foot between the heel and arch. I couldn’t walk, let alone run, so I didn’t run again the rest of the week!

However, this did allow me to put in a mega bike week. Hitting nearly 450k for the week, including a 230k ride on Sunday really boosted my confidence for the IM. Granted it wasn’t exactly quick, but now I know I can ride 50k over the distance, with tired legs (and having been out the training before, no drinking of course!) puts me in good stead. I just have to wait for the fatigue to lift in my taper so I can push harder.

So totals for the week, 26 and a half hours:
Swim: 10.5k
Bike: 445k
Run: 12.6k(!)

Coming Up

So entering the third week of my ‘supercompensation’ training, and I am beginning to feel it! I had a good massage last week, which cleared out a lot of the knots, but exhaustion is beginning to set in. Part of the problem is a calorie deficit, the weight is dropping off me with all the training, a big part is lack of sleep; I seem to have an inane ability to go to bed late, with training late and working long hours so I have been lacking in sleep lately (hopefully will help correct that tonight!). But the biggest reason is I am putting in more hours than some pros do! I haven’t built up to it gradually, more using the crash training approach, which works for me. Hopefully with my foot on the mend, I can start to ramp up my run training up until Llandudno next weekend, and afterwards I will have a swim week, as this takes the shortest to taper, hopefully with a trip to a lake at some point, one long bike session, and a longish run before I scale it way back to recover. Meanwhile, I am doing the Manchester-to-Blackpool bike ride for a bit of fun with the office. I am mixing it up though, I riding to the start (I live nearish to Blackpool), doing the ride, then riding home! This should give me another big day of cycling, and as this one starts early, hopefully I will have time to run after!

Hopefully will get around to writing a blog before Llandudno as my training scales back!

Train safe,

Tim