Injury

My story of injury is not about various aches and pains associated with training - I tend not to get those - but two serious fractures from bicycle wrecks. I have fully recovered from the first, and hopefully will report the same for the second.

The Spine Fracture
On the evening of November 1st, 2004, I was pedaling across base about midnight back to my office after a helicopter flight, I swerved on a patch of dirt on the roadside, and did an �endo� over curb. Hitting the ground on my back I knew immediately something was wrong as I could not sit up. Being a busy base at night, some guys soon saw me, and called the ambulance taking me to Eglin AFB. After a long early morning in the ER, was diagnosed with a T12 burst fracture and right scapula fracture. I shattered the twelfth thoracic vertebra and cracked the length of the right shoulder blade. I fortunately had no nerve damage. I spent two weeks in the hospital and then two weeks of home convalescence. The first week was flat on my back before being fitted with a custom fit thoraco-lumbo-sacral orthotic (TLSO). This plastic shell encompassed my entire torso from armpits to hips and was secured by Velcro straps. I could only take it off when supine in bed � so essentially wore it all the time. The second week was learning to be stable on my feet.
I walked some every day. The day before Thanksgiving I walked the base Turkey Day 5K in about 51 minutes. At week six I started swimming with my brace on. Without spine movement my shoulders took extra load, so couldn�t really do training sets - mainly swam easy and did lots of kicking. I joked that �Most sea creatures don�t have a spine� just the fast ones.�
I got the brace off at three months, February 1st. The best word I can use too describe how I felt with the brace off is �gimpy�. The first month I started light free weights and stationary cycling and continued swimming. At two weeks out of the brace I ran with real effort my first mile in 7:53 on a track. I progressed with running, swimming, pedaling, and lifting over the next few months. I ran a 10K in 44 minutes on March 19th. I ran my first triathlon, a sprint in Tallahassee, on March 26th. Granted I was only 3rd in my age group, and 11th overall, but considering that was first time on a bike since my accident, I figure not bad two months out of a back brace. I cried with an indescribable elation crossing the finish. Just five months before, I was not sure if I would walk, much less race.
I got stronger and faster in spring training with some great races including St Anthony�s triathlon in St Petersburg in April. This performance proved that I could qualify for the Armed Forces Triathlon in June at Pt Mugu, Ventura, California, a race that I have raced for six years. I did qualify, and raced the fastest international distance triathlon ever in my life. I must admit this was a draft-legal race (ITU rules), but I did place similar to the previous few years. As if simply racing faster in my life eight months after a debilitating injury wasn�t enough, I qualified for the World Military Triathlon as a master. Usually the US don�t take a master�s team to World�s, but since we were hosting the event at the same location a week later, three men and two women comprised the master�s, in addition to the top six men and women overall for the main team. The week before the race was like �living like a pro triathlete� - nothing but riding, running, swimming, eating, and sleeping. In the World Military Triathlon championship race a week later, I dropped four more minutes off my time. My feelings were indescribable, but the sense of triumph � for not just my efforts, but for those who took care of and encouraged me. See 2005.
From then on I have had no back problems. I finished off the 2005 season just having fun. I had the opportunity to work at McMurdo Station, Antarctica, again for several weeks as I had done in 02-03. The 2006 season has been going great, especially as I dropped three more minutes off my time at the Armed Forces Triathlon from last year. It is the same course, so times are comparable. I also won the Beaches Fine Arts Sprint Triathlon three-race series at Ponte Vedra Beach, Jacksonville. See 2006.

The Shoulder Fracture
On July 15th, 2006, a week after winning the Beaches Series, while turning into my neighborhood after a Saturday morning ride, I collided with a pickup truck. I severely fractured the head of my left humerus. It took three orthopedic surgeons and two physician assistants four hours to repair the break at Eglin AFB that night with a plate and ten screws, one K-wire, and a broke-off drill bit. I also lost three units of blood during the procedure. Sunday I was pretty groggy, so mostly ate and slept. I was up and about pretty well on Monday (watching the Tour de France each morning) taking lots of cat naps, and went home Tuesday. I was back to work Wednesday with little pain. But I cannot move my shoulder, maybe for several months. So the arm is in a sling. I can move my elbow, and my hand works, but I am effectively one-handed. Running, biking, and swimming are out of the question for several months. This is a very serious fracture, and there is very real chance that it may not heal, the bone will die, and I�ll need an artificial joint. In fact, if I was older, they would have put one in primarily. We won�t know if it heals for several months. If it does, I�ll have months of rehab, and eventual removal of the hardware. The nerve that controls the biceps muscle often doesn�t work after such shoulder surgeries, and that is true for me. All other muscles, nerves, and bones were fine according to my orthopedist. The bike is bent enough to be unrepairable. I put some noticeable dents in the truck�s fender and hood. I am encouraged as after one week I have essentially no pain, not taking pain meds, and feel good when floating in the pool.
I still plan to move to San Antonio in September. It will be impossible to load and move boxes, so my father will probably accompany me during the move. The Armed Forces race isn�t until next October, so I have fifteen months. I am not presuming anything right now. I am following my doctor�s orders. My legs still work. It�s just going to be another long road back to the fish pond. Pray that my bone heals.
Six week check-up (29 Aug 06)
Had my first official check-up with my orthopedic surgeon at the six week point. Even though all signs were encouraging to date (sleep, pain, return of slight biceps function), the radiographs did not show any new bone growth. The hardware was in place without any displacement, and my doc says that it may still be early to see any changes. He started me doing physical therapy which now is working on regaining range of motion and muscle strength. When a shoulder joint is immobilized for any reason, especially a fracture, it will rapidly �freeze�, that is, loose free range of motion. So now a short-term goal is regaining that range or motion back. The physical therapy technicians who are cranking may arm around know what they are doing, but certainly take you to a point of �discomfort� you wouldn�t take yourself. I am also stretching and strengthening on my own.
With the lack or healing changes seen we are still very concerned that we may be seeing avascular necrosis, or the dying of the bone. Another colleague physician suggested hyperbaric oxygen (HBO) therapy, and my orthopedist concurred. This is not a usual use for HBO, but this is not a usual fracture. So I began the daily 90 minute sessions in a monoplace chamber. It is basically an eight floor long acrylic tube that 100% oxygen is pumped into at one atmosphere (33 feet sea water). I watch TV (through the acrylic) or doze while lying there. I�ll get another check-up at nine weeks.
As far as exercise, I hop in the pool daily and kick a half-mile. Takes me about 30 minutes, but does feel kinda� good. So for at least for now, that�s it for formal exercise. Any sort of training is still months away. I move to San Antonio September, so my next update will be from Texas.
At nine weeks after 20 HBO sessions, radiographs show now bone growth. I moved to San Antonio, continued the HBO treatments at Brooks City Base at the School of Aerospace Medicine, and checked in with the sport medicine orthopedic surgeon at Wilford Hall Medical Center. He focused on working on range of motion and strengthening later. He did not seem to talk about joint replacement. I plan to complete 40 HBO sessions and see the orthopedic surgeon in November.
3� month check-up
It�s early November, and I�ve now passed the 50 HBO session mark. As there is not much science or experience with fracture treatment with HBO, some studies suggest that longer treatment regimen may be beneficial. I am going out to 60. The HBO docs argue that with minimal risk, and the fact that we only have once chance to heal this bone, it is reasonable to continue out to 60 sessions. Only cost is the daily trip to the chamber and time away from work. I am now doing a few leg weight exercises every day. I don�t have enough shoulder muscle strength to warrant running, much less biking or swimming. But I still hop the pool daily, mostly kicking, but doing a few laps of an ugly breaststroke/dogpaddle. And can get some good range of motion stretching in the pool. Also have another set of films; no problems, nothing great, but heading in the right direction. It seems that this will take many months before some level of normal (for me) activity: swimming and being able to do push-ups and pull-ups.
Winter
Completed 60 HBO in November; now got o work every morning instead of the chamber. From November to February I slowly increased my activity. I began running on Thanksgiving; ran a New Years� Day 5K in 20:54 - still work to do! Drove to Florida on Christmas holiday to visit family and friends and pickup furniture (oh, moved in condo right before Thanksgiving.) In January I added breaststroke and backstroke to my kicking, stroking a 1/2 mile daily. With the activity, mainly pool, am increasing range of motion, so by February can reach overhead with difficulty, but not enough for pull-ups or military press exercises. Learned the Armed Forces Triathlon is in July, not October (that�s Worlds), so the next few months are critical. Not to mention I need a training bike! (Riding around on my new fat-tire.)
7 month check-up (12 Feb 07)
Another visit with the orthopedic surgeons. Great report, no problems. Xrays show good �knitting� of bone. Only restriction is push-ups (on paper), but the doc said I can try them carefully. See photos below of range of motion - still not fully normal, but fairly functional. Adding more freestyle to daily swim, so by mid-March can swim freestyle over a half-mile. My stroke technique still �ain�t pretty,� and not very fast, but I see rapid improvement.
April 07
Continued pool and gym time has brought me to where my arm is strong enough to swim and hold bike handlebars to race. As of early May, 1 duathlon and 2 international distance triathlons are history. The du on 25 March reassured me that I could bike race, and in my first tri a week later on 1 April I was third overall; first age group. Granted it was the smallest tri I have ever raced, with only 20 men in the international length, but the only two guys who beat me were 24-year-old pros from Mexico! On 22 April, I had an even better race at the Battle of San Jacinto Triathlon, placing 4th overall, taking Masters. Even with 3 foot chop in Galveston bay on a windy morning, I held my own in the water. Have the real big race CapTexTri at the end of May, and maybe a few local adventure races on tap.
After many weeks of assisted pull-ups, my first unassisted pull-up was in mid-April. Now I�m up to six. I also can knock out a few pool-lengths of butterfly. Again, with time I will increase that. I think those are my last hurdles as far as shoulder function goes � will slowly build from there.
Summer 07
I have deployed to Kabul, Afghanistan for six months, so that means the arm is good to go, as far as the Air Force is concerned. Before leaving for six weeks of Combat Skills Training at Ft Riley, KS, I competed in an adventure race at Canyon Lake and two XTERRA off-road triathlons. Barreling down hills on my mountain bike may not have been the smartest thing to do (lest I crash�) but sure was nice to be able to do them! Even won the adventure race, kayaking and all. The Ft Riley training pre-empted the Armed Forces Triathlon this year, alas. I did get in one last sprint tri at Ft Riley, taking second on a borrowed knobby tire.
I keep my daily 30 minutes in the gym working the shoulder and arm muscles. I am almost (>95%) back to where it was before, strength-wise, expect for overhead military press. And that�s mainly because of limited range of motion. The plate might be responsible for some of that limitation, but it�s pretty minor, and can swim normally. So I�m no hurry to get it out.

�Health is like freedom, once you�ve had it taken away, you appreciate it that much more.�
Or �You don�t know what you got until you ain�t got it.�
Or, �Never complain about doing push-ups!�

Observations as a Patient:
� PT is something you �do,� not �get.� For that matter, all medical care is that way.
� I have little leeway for whining, especially for back pain and sore joints. I�ll give you plenty of pain drugs for the acute phase, but you�d better be up and moving real soon.
� Exercise is good for ALL conditions: not just musculoskeletal injuries. Include internal diseases and even psychiatric disorders. Try to name one condition or diagnosis that exercise does not benefit.
� Pool exercise is the best. Even if you aren�t a swimmer, you can do water aerobics, shallow or deep water running, etc.
� If you can�t find a pool, walk. God made your legs to do one things very well. Walk. They also are pretty good at running, climbing, kicking, riding, pedaling, etc.

Injury
Or, How Not to Train for Races Starting Line | No Whining