It's been a really long time since I've added any content to my blog and decided that with all I have learned in the last six months I wanted to get this information out to anyone who may be researching what recovery is like for an athlete who has suffered a trimalleolar fracture. My accident was on July 15th 2014. I was out for a run on a 90 degree plus day when a cyclist hit me full force from behind. When I landed I knew i was not going to National Chammpoinships (triathlon olympic distance championships were less than 4 weeks away) this year as planned. The cyclist called the ambulance while I tried to hold my composure as I looked at my left ankle which was dislocated and facing the wrong direction. If you live in NYC area, I highly recommend Bellevue for their trauma center. I was in Brooklyn. When the ambulance arrived I insisted on getting me out of Brooklyn, I wanted NYU but I got Bellevue. I won't go into the details of the rest of that day but x-rays showed three fractures in my left leg. two on the tibia and one on the fibula called a trimalleolar ankle fracture. I could see from the images how my ankle was clearly unstable and I would need surgery. They splinted and used a soft cast and sent me home.
Surgery was set for seven days later (7/23) at NYU. Swelling needed to go down before surgery could be performed. Prior to surgery I was told I would need 1 or 2 perminent metal plates and a screw. I could expect to be fully recovered in a year and would be able to run again, but not at 100% of my former capacity. I was told it would take about 6 months for the bones to completely heal which meant no running until February. I ended up with two plates and a screw. My main concern was that I was never going to be a good runner again, or perhaps that pain would remain and I wouldn't want to compete anymore. POST SURGERY- WEEKS 1-4 If you are suffering from this or a similar injury you must be patient. This is not my strong suit, and I was miserable sitting around during my favorite months of the year missing out on just about everything. I was able to perform my personal training work. I simply mmodified my client programs so that I could remain either kneeling or sitting throughout our sessions. I think between the injury and surgery I took off 5 days of work. Pain during the day wasn't too bad, it was nights that were usually pretty bad. Getting around on crutches was not an option. I needed to be more mobile than that so I rented a kneeling scooter for about 10 weeks.
Within a week of surgery was my grandmothers 100th birthday. My surgeon said I could fly but didnt recomment it. I'm so glad I rebooked my flight for two weeks later. I was in a cast post surgery for 2 weeks. That was by far the most uncomfortable time. Its very difficult to address swelling with icing when you are in a cast so elevation was key. The the stitches were then removed at two weeks and I was placed in a boot but could not bear any weight at all for aonther 6 weeks. The surgeon showed me my xrays and I almost cried. I had so much metal in my ankle. I had not imagined all the screws that would be needed to hold the two plates in place. The positive at this point is that the boot could come off at night and when I was resting, which made sleeping a little more bearable and icing more effective. I was also encouraged to move the ankle around. Drawing the alphabet with my toes when I was resting with my foot out of the boot. Also massaging the area, icing regluarly, and keeping the leg elevated as much as possible.
I continued to use training peaks to log all my workouts. I just wanted to have confimation that I was staying active and keeping a plan of some sort. Every day I had to play things by ear. Note, I did get approval from my surgeon to do the workouts i'm describing here. The more time I spent with clients, the more sore the ankle was and the more time I had to lay around with my foot elevated and read books.
Five days post surgery I started doing some workouts. It varied from just mat/core work to open chain leg movements like leg extensions and leg curls. Because my gym is in my building I was able to go in the middle of the day when I had the place to myself and just take my time. Lying chest press, lat pull downs, lots of upper body in seated or lying positions. Again the scooter was a great help. I focused on slow movements with lighter weights for about the first two weeks. My body was fatigued, I was not taking any pain killers during the day but understood my body's need to heal and listened carefully. The first month after surgery I was not myself at all. My body felt terrible, I was tired, took naps, was depressed, but kept to as much of my regular routine as possible.
WEEKS 5-12 It took about five weeks post surgery for the surgical area to heal (stitches were on the inside and outside of ankle) which meant I was approved to start swimming. I was really looking forward to taking that step and found swimming extremely beneficial to my recovery over the next 5 months. The bones were less sore so I was able to increase the weight on my leg extensions and hamstring curls. Right after surgery I took tape measurements of various parts of my body. My left thigh and calf had lost an inch of muscle in just two weeks. So with my leg feeling much better I focused on putting time almost daily in strengthening the legs. Hip abduction, lying glute bridges, superman (back extensions) along with any variety of leg extensions and curls I could think of (even just body weight).
About 6 weeks post surgery was my second follow up with the surgeon including a series of xrays. Now I could start physical therapy and start bearing some weight on my foot. I got all excited thinking I could go right to using a cane. No such luck. Really painful to walk and at first could put maybe 30% of my weight on the foot. So now I had to use crutches. I used the scooter around my home and in the gym environent with clients as it was much safer and I could move around more freely. But whenever possible I would walk with crutches, then just one crutch, and about three weeks later just a cane. I continued with my weight training, still all single joint work for the legs (squats and lunges were out of the questions) and got into the pool at least 3 times a week. Now I could get on a bike as well but had to be a stationary bike with the boot. Not very comfortable as the boot is neoprene and ick!
Prior to getting approval to start PT I did my research and figured out where I wanted to go. I couldnt walk far, couldn't use the subway so choose NYU Langone PT center. I was able to take the ferry, basically from my back door to 34the street, and scoot or walk up 2 blocks to NYU. Perfect. Plus the selling point here was they had an Alter G anti gravity treadmill that had my name on it. I was so happy to see that machine. Had read about them, but never seen one in a PT center. A tip I will share also is that in metropolitan areas good PT centers are quite buisy. I knew before getting my prescription for PT that I would have to wait two weeks for an opening at NYU. Before I saw the surgeon for my 6 week post op appointment I asked that he submit my script so that I was all set up in the system and could make my appontments! So week 7 I started PT. Just like with personal training it starts with assessments. I worked with a team of two who monitored me very closely with notes. The first couple of sessions they just massaged the area, worked on blood flow and mobility of the joint. Then we got into stretches, some strengthening while bearing some weithg, but mostly only slightly painful mobility work. All of this I was able to do at home with bands and was diligent with my daily PT.
11 weeks post surgery felt like a big leap for me. My ankle was genearlly no worse than a 4 for pain on a 1-10 scale (10 being what I experienced about 36 hours post surgery). I was able to ditch the boot and just use a cane for added support (mostly crowd control). Could go to concerts, and generally had less fear of falling. I started seeing an accupuncturist which was helping with blood flow and swelling and therefor pain. Physical therapy incoprorated body weight balance challenge exercises where I saw progress about every 5 days or so. All this lead to a better mood and feeling of wellbeing.
WEEKS 13-20 Swelling and mobility are good enough now that I can wear my cycling shoes so I added work on my indoor trainer. Varied my workouts depending on how the ankle felt while on the bike. Some days I could handle lower RPM sets and other days I had to keep the resistance light and focus on leg turnover. Also a good time for single leg drills focusing more sets on my left/ injured leg. At this point, not including PT I was putting in about 7 hours of training between weights, bike and swimming. My therapist has been very happy with my progress and I know my diligent work is paying off. Whenever I had a bad night sleep, i knew I had to plan for less stress on the ankle that day. Basically that is how I judged my progress. The night pain wasn't terrible, but if I wasnt sleeping well it was because my ankle was bothering me.
Week 15 I met with my surgeon. Initially I was told 6 months from surgery before I could start running. That day I got the approval to start running. This was based upon NYU having the Alter G anti gravity treadmill. First attempt was 25 min at 70% of my body weight at 6.5 MPH. Could feel the support I was getting from the air but also the enclosre around the hips helps stabilitze laterally. I was sore going into the workout but not additionally sore finishing. The second run was 48 hours later at 80% and felt a little better. I recognize now that I need to do more hip (glude medius and minimus) on left side. All daily activities I feel pretty balanced, but when running I feel the hip drop on the left and integrated more isolated strength work for hips.
Week 17 I went on vacation. Scuba time! Had been anticipating this vacation since August but didnt actually book it until October because I wasnt sure what I would be capable of. Spent a little time on most swims the last 6 weeks working with fins to buildup ankle sterength with fins. Also choose a destination known for easy diving, not much current, drift diving mostly, and short rides to the dive sites. Turneffe Resort about a 90 min boat ride from Belize city was exactly what I needed. Basically I rested all day except for the 2-3 tanks of diving. Having built up the biking and adding the running I was ready for a recovery week.
Upon resuming physical therapy I was able to run at 90% of body weight then had to back down again. There were a couple of trying weeks where I was not recovering very well from the running, was anxious to get on a regular treadmill but still not ready.