Evidence of Improvement

Those who know me will not be at all surprised to learn that I keep meticulous records of my bike rides! At the outset of my cycling recovery, which started in January, I decided to ride a few routes which I could use at subsequent points in time to measure how I was improving. These rides would not be long - they couldn't be because I had to be able to do them at the beginning! But they would be reasonably all-out efforts, on as similar equipment as possible.

I now have data for three rides on two of the routes, and here is one of them, I call it Torkington Road Loop CW (clockwise). Briefly it is the descent and pull up from my house to the A6; the A6 to Hazel Grove; Torkington Road to Hawk Green and then Marple back to New Mills via Strines. It's 14 miles. There is a long descent between Disley and Hazel Grove, and a long ascent between Hazel Grove and Hawk Green. Here is a map:

Map of test route Torkington Road Loop CW.
I use the program myTourBook for recording my rides offline and Strava for online.

I did this route on January 15 2013, it was the fourth ride I did after returning to action, on my old mountain bike. I did it again on April 14 and again yesterday, August 18 2013.

The numbers in the following table come from my GPS and from Strava. The speed, power and heart rate are the averages for the ride. Weight is the weight of everything out of the door, i.e. me plus bike and stuff in pockets.

Date	Moving time	Weight (kg)	Speed (mph)	Power (W)	Heart rate (bpm)
January 15	1:12:17	97.7	11.7	167	175
April 14	1:02:05	93.5	13.6	212	179
August 18	0:54:12	93.0	15.6	253	171

To be honest I wasn't really expecting such a big change yesterday. I felt pretty tired straight out of the door from the ride I did on Saturday. I knew on the gradual ascent between Hazel Grove and Hawk Green that I was a lot stronger though - the first time I did this ride that road seemed very hard. Yesterday it was not as bad and I managed to push all the way. I didn't use the small chainring at all yesterday. I knew I would knock off a few minutes but I'm surprised and very happy it was 8. That's over 30 seconds per mile :)

I think it's also interesting that my average heart rate is down as well. You can also see my body changing from the following histograms. Not sure what a sport scientist would make of these, but to me it looks like a pretty significant improvement when taken together with the times and power outputs.

Ride with Brad nerves

Well, I just looked over the 100km route again on the map, I think I know where the worst bits will be. Then I made the mistake of reading a few blog posts from last year's event and now I have to say I'm nervous. "Brutally hard" stands out. Even my friend John 'irontwit' Sutton found it tough and he knows those roads! The blog posts reminded me that it did rain a lot last year so that probably didn't help. Pray for clear dry weather this year.

I used to know for sure that I could muscle my way up anything. I don't know that for sure right now. On the ride I did on Saturday, there was one hill which in April I had to get off on, but on Saturday couldn't understand why as even though it was steep, it was so short. I know I'm stronger. However I also know there are still some roads round here which I haven't dared attempt on my road bike yet. It's Tuesday today, and the ride's not until Sunday, so I could still go and test myself on those roads. But do I want to know? Obviously if I get up them it'll be a big boost, but what if I don't? This attitude is annoying. I keep telling myself it'll be OK if I just relax. I often find on a climb that I get a bit too excited sometimes and then it becomes very hard. If I can force myself to relax and concentrate on one pedal after the other, one at a time, it's usually fine. I know from my elevation vs time plot on Saturday that I'm still limited on the hills. Oh if I could swap my compact chainset for a triple just for one day!

Of course there is also the comforting knowledge that in spite of my leg, I am sure I will not be the least fit person on this ride.

Jeffrey Hill, Longridge Fell. I expect to suffer. 

I also realised that I have ridden some of these roads before. I knew I'd been to Waddington and Chipping on my Slaidburn weekend adventure in 2010. I've actually been across Longridge Fell on the road out of Waddington through Higher Hodder. It was up there somewhere where a deer was in the road! And I remember turning left at the Newdrop Inn before descending into Ribchester. Also that weekend I rode between Dunsop Bridge and Newton which I will do on Sunday in the opposite direction. Small stretches in common, but in common none-the-less. And it is a beautiful part of the country, that's for sure.

The Non-linear Path of Physical Recovery

Wow it's been a long time since I wrote here! Nearly 6 months! Time flies.

Since then I've done some biking, though not as much as I would have liked, or as I had planned to in fact. I've been back for a couple of X-rays, which showed little change really - you can see a bit of the gap filling in, but only if you squint at it. The bone hasn't moved though, so it's probably fair to say that the tibia is stable now.

There's still some frustrating setbacks happening though, mostly with my ankle and foot. It seems like you slowly go some way forward and then quickly come a way back again. The other week I manipulated my ankle joint again - manipulated is what they call it where you move a joint that hasn't moved for a long time basically further than you've moved it before. It takes a lot of force, like a stumble or something. Well, it takes more force the more often it happens, if you see what I mean. In the long term these manipulations are good because you are increasing the range of movement of your joints, but in the short term they are incredibly painful :(

Thus is was that in May I was very happy that I had managed to be off crutches for 6 weeks - I had even uttered the fate-tempting phrase "I'm off crutches now" - I did wait 6 whole weeks before saying that, and then a week later I was back on two crutches again! Last week I couldn't really walk, and depressing though it was I stayed at home all week - I can work at home but it's not really the same. Cabin fever sets in. Now I can just about manage hobbling around the house and down to the shop, but it's really frustrating because 2 weeks ago I was even starting to walk without really thinking about it. That's something that I now know you really take for granted, not having to think about every step and how much it's going to hurt or what angle the pavement is at or being careful to put your heel down first etc etc. 

Anyway I know it'll come back, and I know it'll come back better than it was before, but you have to go through these miserable steps backward to go forward again. I've done this to my ankle once before, it swelled up in exactly the same way, hurt exactly as much, and came back better. I did it to my foot too, a massive 'crack!' when I was hobbling up a steep street - hurt like anything for a month, then got better and my foot was springier, all good.

Biking: managed to do 50 miles on the road bike in early May, mostly flat but with a really hilly bit about three quarters of the way through to test the thighs. Hard work but managed it. The other day I went and did 3 miles on my mountain bike and found it very difficult. Non-linear. My physio says biking will be good for my ankle at the moment, might help it loosen up and the swelling go down. I have realised that I have to be more serious about my exercises, because they will make it harder for me to hurt myself! Didn't think of that before, but I have now, so at least I'm learning.

I'm supposed to figure out and write down my goals (short, mid and long-term) for my physical recovery this week, before my next appointment on Thursday. When I've done that I'll post them on here! I'd like to start swimming again too - now I think I could make it to the pool without needing help or crutches, I should go and try it - I'm sure that would help.

When I can step back from the fact that it's my leg and ankle and foot and I'm connected to them 24/7, I can see that things are getting better, and that the non-linear nature of the recovery is actually quite interesting in it's own way. However sometimes it is not easy to be so detached and then you're thinking the usual "why me?" or "what did I do to deserve this?". I need to stay in control of that because it makes it worse. Before this latest setback I was starting to believe that hiking might be possible again, in fact I was almost ready to try it, and the biking, while not as frequent as I had imagined it would be, was going in the right direction. I'll get back there, I know. But it is hard to construct a plan or put times to goals when you don't know and can't predict these manipulations, setbacks. It feels a bit like a process where on a given day there's an x% chance that there will be a setback. That starts me thinking whether that's not actually always the case - you could hurt yourself any day, which would set you back. I guess when you're in the middle of a recovery like I am that chance must be greater, or you have to do less to encounter one. So making a plan like "I'm going to do a 100 mile ride by July" is, I think, a good thing, but it almost certainly has to be tempered by the knowledge that July might have to change to be August or September.

People were saying to me the other week that I'd "overdone it" - that's my Mum's favourite way of putting it. Well, if going on my mountain bike and having to put my foot down, or walking up a street or going to the shop is overdoing it - guilty! But there isn't another way, I don't hurt myself on purpose. 

It'll be 3 years soon.

Targets

Today I went out and made my cycling target for the week, which was 30 miles. This month I'm aiming for 100, which looks possible. What I'm trying to do at the moment is build up a selection of routes which I can come back to in the coming months to monitor progress. I've been looking back over my riding history from 2007 - 2010, and I am quite surprised how infrequently I repeated a route! There are a couple which I can use to see some progress with my fitness, but it would of course be easier if there was at least one route I did regularly with the same equipment.

Likewise there aren't many routes from previously that I can use now to gauge where I am compared to then. On the road bike, many of the routes I did before are too long or go up roads I don't think I could muscle my way up at the moment. On the mountain bike, many of the routes go on trails that I don't feel my ankle would like very much at the moment. Although I could try some of them, I suppose.

Hence why I'm trying to be more systematic now. I guess before I was just riding purely for fun, with no specific target in mind, whereas now I want to get back to being able to do the longer rides, races and cyclosportives I feel I need some kind of programme.



Last week I did however repeat a route that I did once before, on February 15 2009. This was the Chinley Loop, out from the house via Thornsett, left at Birch Vale, right at Hayfield, over Peep O' Day, right into Chinley, through Buxworth, onto the A6 and home. It's 11.7 miles. In 2009, moving time was 50 minutes, last week it was 1h 3m. Most of the difference was in the climb up to Peep O' Day, which isn't that bad really, but I'm quite unfit at the moment! It is quite a long steady climb, good for training. In 2009 my average heart rate for this ride was 168, last week it was 177. I've been doing a bit of investigating into this with my historical data, and it definitely seems that my average heart rate goes down when I've been training. I guess this is all well-known stuff to coaches and so on, but I found it quite fascinating to be looking at that in my own data. The program I use to record my rides, myTourbook, lets you see a histogram of your heart rate with time for each ride, colour-coded by heart rate zone. So I can compare my heart rate in zones between these two rides:

Last week.

Compare with 2009.

On the face of it they look quite similar, but if you look at the distribution through the zones, you see that in 2009 the percentage of the ride I spent in zones 3:4:5 was about 21:43:29. Last week it was 4:49:45. That looks quite significant to me. Hopefully I'll be able to revisit this route over the next few months and compare some more!

Back in the Saddle

So far this week I've ridden 24 miles in two rides. Last week I did one ride of 12 miles. This week my target is to do 30 miles and this month, 100. The weather in December was really awful - lots of rain - so I didn't get out much. But now it feels like the training has started properly. I'm really unfit of course - it feels like there's nothing in my thighs at all, especially the left one. The right one I get a burn in quite quickly, but so far I haven't felt much in the left. I'm swapping between my road bike and my newly modified mountain bike, depending on what route I choose to do. There are some hills around here which I doubt I could get up on my road bike at the moment!

With these leggings on you can barely tell there's been anything wrong!

It's been snowing this week and is trying to lay down a covering right now but hopefully I'll be able to complete my weekly target tomorrow afternoon or Saturday morning with a short-ish ride. I'm trying to establish some routes that I can come back to every month to see any improvements.
My physio thinks I'm crazy because I like measuring and recording everything. But she is very good - I'm seeing her once a week now and she's working mostly on my foot, ankle and calf, trying to get some mobility back in my ankle and loosening up the muscles in my foot and calf, which apparently have been very very knotted up. It is really helping - I always feel much looser and better after my appointment there. I guess I'll be seeing her for the forseeable future!
At the moment I can readily believe that I will get back to where I was before on the bike. There's an issue with my ankle - every time I change gear or go over any kind of bump, it hurts. So I think proper off-road riding is off the cards for the time being. After the rides my ankle is very sore and I am hobbling around worse than usual for the next day, but I hope that will subside and in any case I can tolerate that if it means I can ride properly again. It will take time, but I can see building up the strength in my quads and calves and achieving my target of being able to do a 'proper' ride of 90 miles or so around the Peak District by June/July. Then the plan will be to enter the Bradley Wiggins Sportive on August 18, for my return to 'competition'.



Where I will end up walking-wise though, I really can't say. I knew a long time ago that I'd be cycling again way before I was able to walk, and so it is proving. I can manage a short walk to the shops without crutches, but by the time I'm back my walking pattern has deteriorated a lot because of fatigue. It's going to take a long time and a lot of work before I can go up Kinder Scout again unaided... Right now, weather not-withstanding, I could probably take the Glossop bus up onto the hill and walk across the moor with one stick. I should do that soon because I really miss the moors! Maybe I should look into getting a walking pole - something I swore I'd never ever have, but now maybe it would help. Or I could get a more traditional walking stick - how cool would I look then?!

First bike ride for 895 days.

OK, today I had to wait for some Christmas presents to be delivered, but the plan was, weather and light permitting, to get out and ride. Finally.

By two o'clock all my parcels had arrived, so I quickly put my lycra on :) and got myself sorted out, water bottle etc. gps, heart rate monitor, pumped up bike tyres to about 90 psi, basic toolkit in pocket just in case, phone, keys, looked at the roads - a bit damp but looking OK - and, nervously, I went.

After one failed attempt to clip my right foot in (it's been a long time!) I was riding my bike down the road outside the house. It's like riding a bike, you never forget. I had thought carefully about this ride. Going right out of the house means there's a flat bit for a few hundred metres. All other directions are a hill. So I gave myself 30 seconds for something to go wrong and it still be flat. So far so good. Nothing went wrong. Felt very strange after all this time. I was worried something on my bike would snap or the tyre would burst or something else equally unlikely was going to happen. It didn't. After the few hundred metres the road goes down a bit so no pedalling required - again, good. At the bottom it's flat again for a bit, maybe 400m, then there's a hill. A molehill, not worth speaking about.

As soon as I started up it, I knew my plan wasn't going to work for this ride. This hill suddenly felt like a major climb. I never really noticed it much before, sort of a warm up before the ride starts properly after the first few miles. Oh dear. Are my legs really that weak? Is that really the lowest gear on my bike? It used to go lower than that! No, it didn't. Lots of things have changed, but the gear ratios on my bike are still the same.

After that hill, there's another downhill section and then another uphill, perhaps not as steep as the first, and certainly another that I'd never really noticed, but I did today! At the top of that, at Birch Vale, the road meets the Hayfield road, I turned left. This bit is flat until the junction with the Glossop - Chinley road. There I had planned to go right and go over the hill to Chinley. That was the hill I talked about last time. What actually happened was I had a rest. I'd known since the first uphill that this wasn't going to be a good idea. When I stopped and unclipped and put my feet down, my legs were feeling so weak like they might give way :(

I dismounted (also difficult as it happens), and walked back across the road. I decided to go back exactly the way I came. The Chinley loop, for which I have pre-accident data, will have to wait a bit yet. Tijl and everyone was right - it was too much for the first ride. I hate being wrong. I hate failing, not achieving what I set out to do.

I retraced my steps along the Hayfield road - I could've gone straight on and back to New Mills going up Union Road, but that's a climb too, and it's the town's main street so there would be people around to witness my pathetic struggle in the granny gear. So I went back the back way, to avoid being seen as much as possible.

It didn't seem quite as bad on the way back, possibly I had resigned myself to just going slowly and pacing myself up the 'climbs' like I would normally have done on something much more severe. It worked, but when I got to the front door I had to wait a few minutes before I dared swing my left leg over the saddle to get off. Courage needed. You won't fall. But it feels like I might. You won't. Just do it.

What have I learned? It's going to be hard mentally as well as physically. I know what I could do. I just can't do it now. Didn't I know it was going to be hard mentally? Yes I think so, but I honestly thought I'd set a realistic goal today. Now I see I hadn't. I never thought I my legs could feel so weak on a bike as that. 

I was also quite nervous about being clipped in and generally handling the bike. I put this down to physical weakness as well as lack of even a shred of specific fitness. The more I get out on it now, the more that will return I'm sure.

Positives? Absolutely. 2012 will have bike miles! After 895 days, I did 5.6 miles.

Not much mechanical pain, at least not that I could notice next to all the pain from lack of muscle and fitness. Ankle not moving doesn't seem to cause much problem. I didn't try to stand up on the pedals going up the hills - I think that would've finished me off completely, my legs just didn't feel strong enough for that.

Will my strength for this recover. Of course it will. I just needed to get out the first time and set a benchmark for my mind and my body. On the way back I think my body was already starting to remember how to suffer and where to get the extra energy from. Or maybe I just think that because I've relaxed and recovered a bit now...

I also got to post a ride on Strava, which I've been dying to do - and I see there are some segments of even the short ride I did today which other people have times on. Amazingly, I haven't posted the lowest time on any of the three of them that are there! Almost in one case (78th out of 81) but look, I haven't ridden my bike for 29 months. Oh, and did I mention I almost lost my leg?

Look for yourself. The mechanical bone/tissue rebuild may be over, the rebuild of everything else starts here.

First weeks of Phase 4

OK I don't know why I numbered the phases the way I did, but Phase 4 is now, leg unsupported and in principle able to recover without further intervention.

To recap, the other phases have been: Phase 1 - external fixation post discharge (August - December 2010); Phase 2 - leg in cast post frame removal (December 2010 - March 2012); Phase 3 - leg rebroken and in external fixation again (March - November 2012). So I guess Phase 0 was June - August 2010 when I was in hospital in the beginning.

Deep breath - Anyway, the frame was removed, and honestly, I couldn't have hoped for it to feel this good this quickly. Of course, there's still a way to go until I can use it without thinking, until I'm completely off crutches etc., but it does feel pretty good! I realise now how much pain I've been in the last couple of months, because it's relatively painless now - I still get sharp twinges, especially if I'm putting weight through it, but it doesn't hurt hardly at all now when I bend my leg - so that pain was definitely due to the frame. I should've remembered this from December 2010 when they removed the first fixator, because it was similar with my knee back then, but I think you don't dare hope it'll not hurt, so, when it doesn't, it's a nice surprise.

I also thought there would be much more of a psychological issue about putting weight through it without the frame - even though I knew for the last few months the frame wasn't supporting my leg (struts unlocked) I thought there would be some effect. Well, apart from the first day or half-day, I've not had a problem with that! Maybe I'm just too sick of hobbling around and I don't care anymore? In any case I've been fine with it, just one-crutching around like before. It really just feels the same without the frame as with, stability-wise. I think this completely vindicates erring on the side of caution re. taking the frame off. I think it probably would have been OK to remove it two months ago, but this is much better - worth the extra months of difficulty to not have to go in a cast for an undetermined amount of time. I feel good about not begging for it to be removed as soon as possible. 10 points to me :)

A few days after frame removal, looks a bit less swollen? 

The itching bandage too much, I took it off, here's what was underneath.

The pin sites healed quickly - the small ones where the wires were had healed up the first time I took the bandages off. The bigger pin sites took a few more days before they dried up but it didn't take long. What a difference compared to last time! No infection in bone, no MRSA (I guess). Big difference. So I could have a bath again :) Crikey I missed having a bath. I've had one every other day since I could - still not had enough. I've not been able to wash my left leg properly since March, so there was a lot of dead skin and mank to soak off of it (nice if you're eating your tea, I know). Most of that has gone now and it looks clean again, kind of.

The first close look, the pin sites mostly healed up.

Swelling, yes, still quite a lot. Last time, being in the cast no doubt helped to reduce the swelling because of the pressure. I think I'll ask my consultant if there's some kind of strapping I can get to speed it up this time. It definitely looks different in the morning when I wake up to when I go to bed at night. It's still a bit unsightly, and of course it'll never look normal, but it seems to work. That was always supposed to be the deal.

A few days, and a few baths later, looking much better :)

Clothes - I had all my jeans and trousers out which I haven't worn for 29 months. The intersection of the set of trousers I can get over my leg with the set I can fasten around my (now much bigger) waist contains but one member, and even that pair is on the tight side. So, I either need some bigger, looser pairs or I need to slim and get the swelling down quickly.

These, the only pair of jeans I can get over my leg and around my waist!

Which brings me on to exercise. Last Friday I had my first physiotherapy appointment since the frame removal, and I was looking forwards to it because I've known for some time that physio would only start properly when my leg was unsupported - which it hasn't been at any point since the accident - until now. So, I expected to be able to do a few more exercises than before. I wasn't disappointed! Of course I have a lot of stretching to do to try to free my ankle a bit because it still doesn't move very much. I probably have just about enough dorsiflexion (that's moving your foot towards you) to walk, but obviously more would make it easier and more natural. I have more plantar flexion (moving foot away from you). I've got some exercises to do with a step - stepping up and wdown in all possible combinations of which leg first forwards and backwards - and also lowering (well, trying to) my ankles over the edge of the step. The hardest is stepping up onto the step backwards leading with my left leg. At the moment I can do it if I first do it a few times holding on to something. I think that must just be a case of trusting my leg. I also can't walk downstairs without holding on to something - that is going to take a long time I think! Stretching is also tough because my ankle is really really stiff. I'm supposed to bend my knee towards a wall from a stretch position with my foot flat on the floor. Of course I can bend my knee freely, but seemingly not at all with my foot flat on the ground. Hmmm. Work needed, patience too I suspect.

Next, I have to try to drop down to only using one crutch, all the time, because using two now will hold me back - I think I was expecting this, so my physio confiscated one of my crutches and I left the appointment with just one. That will be a struggle for a while, but the idea is I will walk again without crutches, so my strength and stamina for that has to be built up. My crutches have become crutches, it seems :) Of course I do have more crutches at home in case I really need two at any time.

BUT by far the best news since they told me they could reconstruct my leg and not have to amputate it, is that I have now been given the green light to go swimming and, wait for it, to ride my bike outside. I wasn't really expecting to be allowed that yet, but my physio said "why not?" when I asked him meekly. "You need to reclaim your life." Yes I do. That was last Friday, today is Wednesday. So far I haven't been outside on my bike. Hold on, hold on, I hear you cry - you've been waiting for this for two and a half years, what's wrong with you! Yes that's right, I say, but I also say, I've waited 29 months, so I can wait a few more days until I get my head around the idea and feel comfortable about doing it.

Rebecca grabbed this cheeky picture of me suffering.
First time on a bike for 29 months.

On Sunday I rode my road bike on the trainer properly for the first time. I set a target of 10 minutes. 2 minutes in, I was knackered, thighs burning, heart rate at maximum. Maybe I should have just turned the pedals for 10 minutes, but that's not really my style, so I pushed it, and pushed through the 10 minutes. It was so hard, but it felt so good to be able to feel the burn again. It was a bit tricky for my left foot to stay in position on the pedal, so I have reattached my clipless pedals to fix that little niggle. I posted my 'ride' on the Strava site - something I've been dying to use. The trainer is not a good measure really for a number of reasons but mainly (I feel) because you can't really have a rest and free-wheel like you would on a descent on the road. And you don't have fresh air and scenery to keep you happy. But it is good for pushing you :) Needless to say, however much I try to convince anyone otherwise, or however much they try to convince me, I am hopelessly unfit. But, I have a data point now, for the progression back to where I was. Joy of joys, that process can start.

Yesterday I sorted out my road bike so I can take it outside. This wasn't the original plan - that was to use my old mountain bike, but I found to my dismay that the fork has rusted :( Maybe if I take it out and batter it a bit it will come loose again, but I don't really want to 'batter' it at the moment in case I batter my leg in the process. So, road bike it is. It took me a little while to check and clean and everything but I think it's good to go now. I'd have gone yesterday afternoon if the weather had been better, but it's November now and rainy season appears to have started in High Peak. But it's ready, when time and weather permit.

I have, however, decided on a route to do first of all, to put down a proper marker. I looked back in my ride log from before the accident, and found a loop I did once around here, which is not very long (11.7 miles) and which contains a long, reasonably hard climb about halfway round. I think this is perfect. Of course, the first time, I will be horrified at how hard it is and how slow I am (won't I?), but it will mean I can see exactly where I am with respect to where I was, with the added bonus that it was in February 2009, fully a year before I reached my 'peak' in Spring 2010. Naturally I have other rides I can compare with later on, but they're all further and harder and I want (need) to start small. I probably need another 10 mile route, 2 x 5-mile routes and a 25 mile route too, to break up the training a bit more properly. I am so pleased to discover that my enthusiasm for training and testing and riding has not diminished. I didn't seriously think it would have, if anything, it would get stronger, but you never know. This experience could have killed it completely. It hasn't.

Last night I spent some time on the internet looking for a new helmet, the only thing I really need before I can go out. I will also replace my nutrition products which I had to bin because they went out of date in 2011 :( And I found some new overshoes for the weather and probably I need a second pair of long-legged bib shorts too. Ah, you see how it goes! I love this stuff :)

The best thing: 2012 will not be 0 bike miles :)