The krazy life of triathlon

Posts tagged “fractured elbow

Ironman UK 2012

After some initial nerves at the expo, it took until I went to bed for me to get remotely nervous. I was staying with Howard and Nina for the night, and we had a nice evening meal, and Nina kept commenting how blasé I was about the whole thing. I got to bed pretty early and only then did I have trouble falling to sleep, though I think this was more to do with excitement of being back in the game again. Once asleep, however, I didn’t have any issues and slept solidly through to half 3, waking up feeling fresh just before my alarm (I wish I could do that during the working week!). I wolfed down a couple of bowls of cereal, though I wasn’t particularly hungry, mixed my drinks and left for Bolton.

The coach from the Reebok to T1 was a sea of nervous first timers looking like they were about to go to the Gallows. This only got worse once we arrived; of the 1500 starts, 900 were first-timers! Lots of worried faces and questions, but good to see. I slowly went through the routine of setting up the bike, which quickly came back to me, with the exception that I had put my cycling shoes in my bag to put on in T1 instead of having them on the bike – with my dodgy elbow and weak wrist, I wanted to put these on sat down, rather than struggling whilst on the bike. The wetsuit went on over the layers of tubigrip I had put on my arm and I lined up for the start, after having to get 2 people to zip my suit up…should probably get back down to ‘full-time’ weight, or get a bigger wetsuit! We were rushed into the water, and I got in gingerly and swam to the start line. No, grumbles for the arm – so far, so good. I put myself quite near the back, with the aim of clear water to protect my arm and waited for the start.

The Swim

With seemingly no warning, I heard the start horn and set off. Within about 30s I hit a problem. I felt good and was swimming strongly, and despite trying to hold back as much as possible in the hopes of keeping the arm for the whole swim, almost immediately hit the swimmers I had been behind. I moved over to the left and slowly overtook the pack I was stuck behind. After about 10 minutes, we hit the first buoy. As I was trying to protect my left arm from the fights, and the course was anti-clockwise, it meant I was swimming on the inside, so when we hit the buoy, it was time to suck it up and accept my punishment. Thankfully the beating wasn’t too bad, and I emerged unscathed and then had a fairly good swim for the rest of the lap. I came out of the first lap in 38 minutes, rather pleased with myself, and had to stop myself getting carried away one the 2nd. This was the longest I had swum since my crash, and certainly the longest I had swum continuously since my last IM nearly a year ago. However, it felt good and held up well. By now the pack had thinned, and I only got one or two bashes on the turns and all on the right side. Coming towards the halfway point of the 2nd lap and my elbow let out its first few grumbles as it got tired. I found that if I dropped my elbow (going against every technique lesson I’ve ever had) I could take the strain with my tricep and remove the pressure off my elbow, so that’s how I swam for the rest of the swim! At the last buoy I decided to pick up the pace  to my normal IM pace and see how I held up and I felt really good, which made me think that I probably could have pushed a bit harder, but nevermind, out of the swim in one piece with my arm still intact in 1:18. Job done.


T1 was a fairly leisurely affair for me, as I had no time goals. Wetsuit off, bike socks on, bike shoes on, chamois cream, helmet, sunglasses, race belt. Stuff arm warmers down the side of my trishorts in case I got cold and replace wet tubigrip with dry one. With a quick detour to use the toilet, I jogged over to my bike and set off. Felt very odd running in bike shoes!

The Bike

Once I was through the swim, the bike was the next thing I was apprehensive about. For the first 10k me and another guy swapped turns leading out of Pennington before I let him go. I was feeling very weird on the bike: first off, outside and riding, a bit different to the turbo! Also, as my turbo is slightly at an angle, my I was a lot further down that used to, and had to crane my neck to be able to see! It’s a lot easier to just put your head down for a minute on the turbo! However, despite the unfamiliarity I felt pretty good. By the first time up sheep house, I had made up a good few placings and finally dropped the chain into the smaller chainring for the ascent. Having spent the last few months on the turbo and riding around London, the climb came as a bit of a shock! It wasn’t quite the ‘oh, is that it’ that last year’s daily rides around the Peak District produced. The wrist felt weak, but I could climb out of the saddle pretty well, though did think I probably pushed it a little too hard. 6 IMs and I still get carried away…

By the time the end of the first lap had come around, my fortunes took a turn for the worse. I was on good pace, and hit 60k in a little over 2 hours, but my lack of strength was beginning to show. My wrist was now extremely weak by this point, and holding myself up on my bike was becoming a challenge, so I spent most of the time in the aero position. However, having only had one ride outside on the bike in the new position, I was not used to it, and my core strength was rubbish, so my back soon followed the wrist, followed by my neck from craning up to see the road in front of me. For now the pain was bearable but over the next 40k, it only got worse. The 2nd ascent of sheephouse really put my lower back out for a while, and the bumpy descents did nothing to help my wrist.

By 100k, I was in trouble. Trying to lighten the load on my fractured wrist as much as possible, meant taking most of my weight on the right wrist, which is bad enough at the best of times, having fractured that a few years ago. I could take the weight off both and sit on the aerobars, but my back was not happy, and neck was burning from looking up constantly. Add to this the vibrations of the road sending pains up my fractured elbow and it was not looking good! I couldn’t sit comfortably in any position on the bike, and I also couldn’t eat or drink anything as I couldn’t hold myself up on the bike with one hand.

The final 80k of the bike went as follows: Get off bike at aid station, (possible loo break), grab food and drink from aid station and wolf down, stretch back, drink more, stretch neck, drink more, flex wrists, eat and drink more, get back on bike, feel really good for 5 mins, wait for back and neck to go again, sit up, wait for wrist to go, swear at road and body until the next aid station and repeat. It’s difficult to describe how much pain I was in for the last 80k of the bike, everything hurt, and it wasn’t your average dull ache, this was severe eye-watering pain that I could do nothing about with shard shooting pains every bump and vibration. I have never been in so much pain in my life. It hurt less to roll my shoulder back into place when I had fractured my collar bone and I would wake up with it sticking out and I would have to manoeuver it back into position. I have never had tears in my eyes during a race til now, but both wrists were screaming in pain. I usually zone out after the 100k mark of an IM and just get on with it, but I had a constant reminder of what I was doing to my body as my computer clicked down agonizingly slowly. Annoyingly, when my back and neck wanted to play ball, my legs felt pretty good! But my average speed soon dropped off and I rolled to the 7 hour mark. After a crash course in dealing with pain, I somehow I made it to T2 and after a bit of shuffling managed to get off my bike.


I think getting off my bike for T2 ranks up there as one of my happiest moments of my life! My mood lifted instantly and I made the most of it. I fell into the chair and emptied my bag. Thankfully a kind volunteer asked if I wanted some sun cream, having gotten off the bike I suddenly became aware of the burning on my shoulders – probably a bit late for cream but would certainly help! Blister plaster on, shoes on, fuel belt on (annoyingly missing one bottle I soon realised) and visor on. I stopped for some coke, even queued for the toilet, before putting my splint and sling on and set off.

The Run

As my muscles began to relax I felt pretty good. My elbow had stopped hurting almost immediately so I took the sling off and just tucked it into my race belt. The crowd were incredible on the run, lining all the streets to the start of the laps and it provided a much needed pick-me-up. After half an hour my legs started to return and I actually managed to pick the pace off and run pretty well! I knew it was a matter of time before my lack of eating or drinking anything, and my lack of any long runs hit me, so I wanted to make the most of it.

I played little games with myself, promising myself a walk once I hit the laps, then pushing this to an hour, then an hour and a half, and then two hours. This soon turned into walking through aid stations to allow myself to get some food on board but running the rest, and I lasted a pretty long time! Coming through town on the 2nd lap I saw Howard and the rents, and the crowds were incredible. On the way out of town, up the hill that I (and I’m sure many others) had nicknamed the ****, I saw another friend from uni who doused me in water which helped with the cooling.

At the aid stations, I generally grabbed a couple of cups of water to dunk over myself, some coke and a banana. It was starting to get seriously hot out there, and with no ice or sponges at the aid stations, the families that lived on the course that had set up a hose were gratefully received and helped cool us all down. At the end of the 2nd lap I had my first stop for a loo break and to change my socks as my blisters were starting to flare up with my shuffling style and lack of time in the shoes.  After over 2 hours of running pretty well, the exhaustion began to set in and the pace dropped off. Finally on the penultimate leg into town, I allowed myself a walk up the long draggy hill from the far end. Coming back out was mentally pretty tough, as I kept telling myself ‘just one more hour’. It went slowly and for the first time I was reduced to walk that didn’t involve an incline or aid station. After what seemed like an age, I was trying to jog down the **** and back into town and I finally hit the finish chute:

I didn’t feel anything as I ran down, though I managed to summon up the strength the high five the crowd. The overwhelming sense of relief as I crossed the finish line did nothing to set off the fatigue. I was spent and out of it, but I had finished against the odds, and ticked off Ironman number 6.

The Aftermath

Ironman is what defines me and my life centres around the challenge and has done for the last 4 years.  I am yet to fully understand why I do it to myself, but I am always searching for my limits and seeing how far I can push myself, wether it be trying to perform the best than I can, or attempting stupid challenges like 3 in 10 weeks or racing with 3 fractured bones. I have to agree with one comment, that it was lunacy for me to even be on the start line, but I had something to prove and was determined to show it was possible. In hindsight, it probably wasn’t the best idea, but I wouldn’t go back and change it. I do, however, think I have found my limit for what I am prepared to put my body through in an Ironman. At no point in the race did it ever cross my mind that maybe I should stop or give up. Not once. It may come back to haunt me at some point in the future, when I do myself some serious damage, but it never even occurred to me. I never doubted my ability to finish the race, even from the moment I crashed to be honest. I was just missing the will to finish, which was given to me when my doctor told me I wouldn’t be able to. I have a complete belief in my body; I know what I can do, and what I am capable of. Sure, I don’t know if I will ever qualify for Kona, or if I can ever knock on the doors of sub-9, but finishing – my body will probably give up on me before my mind does, quitting is never even a thought. I suspect this is why I didn’t get nervous once I had no time goals as it was never in doubt. It may also be why I didn’t get any satisfaction from the race or any sense of achievement. Even now, when speaking to people (my physio’s jaw dropping on the floor when I casually mentioned I did an Ironman at the weekend when having my fractures assessed for example), I still think “Meh, no big deal”.

For the first time ever in a race, however, the thought of ‘Never Again’ crossed my mind. I believe I have found the limits of what I am prepared to suffer, and don’t think I am prepared to put my body through another Ironman untrained like this one, fractures aside. As the pain has subsided, I still want to compete at Ironman but need to achieve something, which I can’t do without the training. So I am going to take (most of) next year off and race middle-distance and below, something I can race without having to worry about life getting in the way. I am currently planning on racing Ironman Arizona in November, but if this doesn’t happen then I am happy not to race Ironman at all in 2013. I believe I know now what I need to do to achieve the level I will be satisfied with, and the one thing this race has done for me is to get my hunger back to train properly and get motivated again, something that has been missing since before Henley last year.

In other news, my fractures are slowly on the mend and if anything, actually did a lot of good for my wrist as it was effectively a 7 hour strengthening session! Not recommended though! My elbow fracture is taking a long time to heal (admittedly not helped by this…) but is slowly straightening out, but the winter will see a lot of time in the gym getting my strength back and working on my flexibility and the core.

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:

      Sequences  obtained:
      Coronal  STIR,  T1,  T2*,  sagittal  STIR,  T1,  axial  STIR,
      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.
      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.