If you have also been told that it is at least 6-8 weeks for the bone to heal, but you might not walk properly for 6 months and you may never do sport at the same level again, I am here to tell you that may not be the end of the story.
I am not a medical professional, you should not use any of the following as justification to ignore your own medical advice.
I am a 41-year old, age-group international triathlete. I broke my ankle while out for an easy run the day after getting my selection notice through for Team GB for the ITU Aquathlon World Championships in June 2018. So I was in good condition when I did it and I was willing to put myself through an aggressive recovery plan,
20/12/17 - Ankle fracture during an easy run.
Transverse fracture of tibia at medial malleolus, tear through syndesmosis joint, and oblique compression fracture of fibula at mid-length. Immediate closed reduction performed by self, but the damage to syndesmosis joint is already done. Ambulance, x-rays, backslab cast fitted. Entonox is good, morphine was barely useful, lots of codeine and paracetamol are best. Overnight in hospital.
21/12/17 - Issued crutches and lots of good drugs (codeine, paracetamol, dalteparin). Sent home for a week for swelling to reduce. >23 hours per day with leg elevated.
27/12/17 (7 days) - Surgery. ORIF (Open reduction internal fixation). Two screws installed. Original backslab cast refitted overnight. more x-rays. Another overnight in hospital.
Not the best photo of the tibia fracture, and the fibula fracture is out of screen to the top.
03/01/18 (14 days) - Two weeks from original fracture so I should be through the initial phase of bone healing. I am not, there is still occasional but evident grating of the fibula at the break site. Last night on the codeine after only paracetamol during the day.
05/01/18 - No notice of the grating feeling at my fibula break for 24 hours. First test of using my leg to balance while I brush my teeth. Painful, despite no real weight loading. But eases immediately. Painkillers are now down to 2 paracetamol a couple of times during the day and a couple to help me sleep.
07/01/18 - No painkillers at all. Quadricep muscle atrophy is now visibly evident. Wife estimates 30% compared to left side. Difficult to measure against pre-injury levels as the left quad has had three weeks of atrophy as well.
At this point I found some scientific articles indicating 'weight bearing as tolerable' supports faster recovery. I make no bones about cherry-picking those articles which said what I wanted to hear. Again, I am not a medical professional, but there is plenty of study work out there supporting this approach.
I also watched some videos of rehab patients trying to walk again. They are less encouraging in general. But there are some outliers with faster recovery to walking at least.
08/01/18 - Tested balance using wii. As evenly as I could test it at tolerable levels of weight bearing my left-right balance is currently 77.6% - 22.4%. Quadricep muscle loss is extensive.
10/01/18 (21 days) - Fracture clinic. Cast removed, stitches trimmed. New x-rays show the screws are holding everything together nicely. Fitted for a supportive boot for 4 weeks. Told not to swim yet and minimal weight loading, but I can do upper body and core work as long as I am careful. Don't try and work on ankle mobilisation yet. Back in 2 weeks.
With the new boot instead of a cast I can now manage stairs so I moved back to sleeping upstairs.
Muscle loss in quadricep is ridiculous, calf is worse. Swelling in ankle is pretty bad. My left thigh has lost some muscle through not training, but you can compare against my right leg which is giving up every protein it had available to rebuild the bone.
11/01/18 - In my continuing dismissal of any advice that I don't particularly like, I drove home from lunch. I have an automatic car, and before my accident I was already a competent left-foot-braker. Between left-foot accelerating and the cruise control it was actually fine. I am not planning to drive again, but it is very comforting to know that I have that level of freedom back. I have about 50% ankle flexion when I take the boot off, but I doubt I would have enough control or strength to pedal the car with my right foot.
14/01/18 - I am now hobbling around the house in the boot without using the crutches or leaning on anything. I am occasionally hobbling around the house without the boot but with a general lean on whatever is nearest or a couple of hops between supporting structures. Ankle is still very swollen and surgical scars are still scabbed over but the bruising on the rest of the leg has now cleared.
On visiting my granny today I borrowed a walking stick and ditched the crutches, which I was barely using anyway. Wii-fit now has me at 59.8 - 40.2 for L-R balance at tolerable levels of weight bearing but it took a few attempts to measure it as that much weight on the weak leg is very shaky.
I started back training with my first core session today.
17/01/18 (28 days) - I had a bit of a scare in the afternoon when I moved and thought I felt that scratching feeling of the pieces of my fibula grating against each other.
21/01/18 - I managed to walk to Asda and back today with just the boot and no stick or crutches. That was about a mile round trip. Bones felt fine but a lot of stabilising muscles in my quads and lower back were struggling with the effort level.
This was also the first night that I have needed to go to the toilet in the middle of the night since I moved back upstairs. I managed up and down the stairs without the boot, but with a lot of leaning on the bannister.
22/01/18 - Finally managed to arrange a return-to-work medical. They have agreed that I should go back for 4 hours per day for the next fortnight and ramp up from there.
23/01/18 - Spent 4 hours at work. Slept all afternoon to recover from that effort.
24/01/18 (35 days) - Fracture clinic. Different Consultant this time and this one is much more cautious about the syndesmosis joint healing. He has put me back on crutches rather than the stick and told me to stop weight bearing as much as possible. On the positive side he has allowed me to get back in the pool. Swimming carefully with a pull buoy to start with. No breast-stroke or aqua-jogging as he wants to avoid vertical loading through the ankle joint. He also agreed to fast-track my physio if I wear the boot for the duration.
[Note from July; this never happened, I have had to do pretty much all my own physio and rehab work beyond two short appointments where I was just given standard lists of exercises to work on].
25/01/18 - Swimming. First day back in the pool. Did 20 minutes steady arms-only front crawl with a pull buoy and some very careful touch turns pushing off one leg. Getting in and out of the pool was a bit of a faff and the 5 weeks of not swimming meant my timing and feel were a bit out, but good to be back doing something.
29/01/18 - First signs of inversion / eversion mobility in the ankle. Not a lot, maybe 20%, but until today it has only been flexion, and that has been about 60% since the day after the cast came off. Ankle is still very swollen so no surprise that mobility is limited.
31/01/2018 (42 days) - 6 weeks in and I am getting properly impatient now. I am still using the crutches for anything more than 30 feet but I am using the stick and the boot as much as possible for short trips, and within the house just the boot, and at bedtime no boot, just the handrail on the stairs and a bit of a hobble.
03/02/2018 - I started adding tumble turns at swimming. Still being careful to push off with just my good leg. It is actually more comfortable on my ankle to turn that way rather than the lateral drag forces on the ankle from trying to do touch turns.
07/02/2018 (49 days) - Another trip to the fracture clinic. Lots of good news. Crutches are done, stick is optional if I am tired enough to need it, and I can get on with walking around with just the boot. I have taken that as approval to begin aqua-jogging as it is less impact than that walking around. I started with 20 minutes of just learning how. The basics come quite quickly but there are some tricks to it, mostly to avoid cheating by using arms to swim as that is making it too easy and missing out on the effect.
08/02/2018 - Second attempt at aqua-jogging. 30 minutes this time and it definitely is a good workout once you have the knack. I followed by going straight into a steady swim session, without the pull buoy, but still using only one leg for pushes out of turns and a very light flutter kick.
14/02/2018 (56 days) - My first 8 hour day at work.
15/02/2018 - First 10,000 step day. That includes 40 minutes of aqua-jogging and 10 minutes of swimming. They account for just over half of the step total. The other half are walking around in the boot. I feel I should be walking around without the boot now. I do a little around the house. I feel like the boot is hindering me from using my ankle properly and rebuilding it now. I am still doing what I was told by the Consultant and wearing the boot as much as practicable.
16/02/2018 - Walked a slow (1km in 14 mins) test loop of the local park without the supportive boot. Big limp at the start, still a little bit of a limp but the end, but definite progress.
21/02/2018 (63 days) - Less regular updates as nothing much is changing. I am managing to swim and aqua-jog on a daily basis. Going to work full-time. Wearing the boot whenever I am out of the house. At 9 weeks though the boot is starting to be more of a hindrance. I feel like I could get around without it. I am still following the Consultants advice for another fortnight though.
24/02/2018 - Covered the equivalent of 12,000 steps (a normal day for me) for the first time. That consisted of swimming in the morning, an hour long 1.7 km of walking around collecting Pokemon, and 50 minutes of aqua-jogging reps.
28/02/2018 (70 days) - 10 weeks and I am now past bored with the boot. I am still wearing it to work and trips out of the house, but not around the house and not to drive with. I can walk better without it in supportive shoes, and about the same in unsupportive shoes. I am going to continue wearing it for another week, but only because of the deal I did with the Consultant 35 days ago to continue wearing it in return for upgraded physio.
02/03/2018 - First attempt on the exercise bike. Very light 15 minutes. Actually easier than aqua-jogging.
07/03/2018 (77 days) - 11 weeks. No more boot. First physio session. It is built of squats, calf raises and a little bit on the wobble board to start with and takes about 14 minutes to run through the full set. I also added a ~15-minute lunchtime power-walk to every day from here.
09/03/2018 - Having misplaced my ID card and therefore my access to the gym I decided instead to get my bike miles on an actual bike. I went for an easy 4 miles in the mountain bike. Clipping in is easy, unclipping wasn't, the muscles required for twisting my foot out of the cleats are amongst the most wasted.
12/03/2018 - First attempt at running on an underwater treadmill. The first 5 minutes was uncomfortable but once I got used to it I managed to turn the speed up it was actually surprisingly good. I think I am very rapidly going to run out of speed on the machine though as I had it at 6.2km/h after 15 minutes and it only goes to 6.7 km/h. It is tougher than aqua-jogging but definitely more like real running, I should probably have been at this 3-4 weeks ago.
14/03/2018 (84 days) - 12 weeks. Second session on the underwater treadmill. Straight into it this time and up to the maximum speed on the machine. Still went aqua-jogging in the evening as well.
17/03/2018 - First outdoor jog. Very slow jog with Dexter (dog). Less than 2 miles in 25 minutes.
21/03/2018 (91 days) - 13 weeks and I did my first uphill cycle commute. Still problems with swelling after exercise.
23/03/2018 - Managed to cycle to work, and back as well. 7 miles each way. Tough day, and lots of ankle swelling after second ride.
25/03/2018 - Two consecutive days of jogging 5k each. Back under 11min/mile (just).
28/03/2018 - (98 days) Trip to physio for a check-in. She seems happy enough with progress. I left with some additional exercises to do.
13/04/2018 - Slow progress for the last couple of weeks but finally managed to get a proper run in at 8 min/mile pace for two miles.
17/04/2018 - 1500m Swim Time Trial. 26 mins 03 secs. That is my fastest pool 1500m ever. So as far as swimming goes I am totally recovered.
01/05/2018 - 10 mile cycling Time Trial. Almost 4 minutes off my pace from a normal year but first race out of the way.
05/05/2018 - 5-mile run at under 9 min/mile.
08/05/2018 - 32 miles on the bike. Split over a 7 mile commute and a couple of 12.5 mile rides to and from a marshalling job in the evening.
12/05/2018 - North of Scotland Championships. Attempted 400m Hurdles - was shocking and painful, but survived (and won). Attempted 5k - first kilometer in 4 minutes before hamstring tightness meant I stopped as a precaution.
14/05/2018 - Sports massage. Huge improvement after massage. Ankle feels almost normal for a the rest of the day but gradually stiffens up again through the week.
22/05/2018 - 15 mile cycling time trial. Less than 3 minutes off my pace from a normal year. Definite improvement over the three weeks since my first TT attempt.
30/05/2018 - Fracture clinic discharge appointment. Screws are still intact so I will need to come back in August but apart from that they want me to now get on with everything I can.
07/06/2018 - Run to work. 7 miles in 67 minutes. Not exactly fast, but longest run so far.
13/06/2018 - Another run to work. 7 miles in 64 minutes. Still not fast but can't complain about gaining 3 minutes in a week.
24/06/2018 - First running reps session. Not fast, but definitely a pace change from the runs I have been doing.
27/06/2018 (189 days / 27 weeks / ~6 months) - Since about week 11 it has been agonisingly slow progress. I am still in pain at some point most days, and the ankle swells up and stiffens if I still still for more than about 10 minutes after any exercise. It isn't stopping me from doing anything now, it is just slowing me down a bit. I am still booked to go back in to the fracture clinic in October for them to decide if they are going to remove the two screws or not.
06/07/2018 - My 42nd Birthday and I fly out to Amsterdam for a long weekend before travelling on to Denmark for next week's ITU World Aquathlon Championships. I am under no illusions about being competitive. I expect to swim about the same as a normal year, but the run is going to be a case of pushing as hard as I can, and trying to limit how many places I lose.
No comments:
Post a Comment