Recovery after a Broken Hip

Triathlon Forum
1

2 weeks ago in kona i had a little problem navigating my way through the highway reflectors on the queen k and i crashed my bike. resulting in a intertrochanteric fracture of my hip. I ended up having emergency surgery that day to repair it - with 2 IM nails into the shaft and neck of my femur.

I’m am optimistic everything should be ok after as the joint itself was not damaged. my goal is to be back for IM USA next summer, in hopes of qualifying again for Kona, but I am little worried if i will not be able to get back to where i was before - especially with running. I am 35 years old, and am a physical therapist, so I used to working with patients with broken hips - just not who are younger than about 55 or who are planning on trying to run a competitive marathon on them. I’m hoping some other people on here may have had a similar injury and they could give me a little advice or at least put my mind at ease by letting me know how well they have managed after such an injury.

any assistance would be greatly appreciated
cheers

2

Hi -

So sorry about your hip! I broke mine 3 years ago in a bike wreck. I ran in water every day, which I think helped tremendously. I broke it in Sept and in Dec I started running again. My coach had me run frequently, but short for several weeks. By June I PR’d in a run off the bike in a half ironman. I did my first ironman in Lake Placid in July and qualified for Kona, which I just completed 2 weeks ago - the run was the best part of a miserable day!

3

Tough break - you have my condolences.

FWIW, when I was 30 I broke my right femoral neck in a bike crash, with the injury repaired using a Richard’s compression screw very much like the one shown on the left here:

http://www.ortho.smith-nephew.com/nl/Category.asp?NodeId=345

Aside from a DVT, my immediate recovery was uneventful, and approximately 14 mo later I had the hardware removed, or at least all of it except for the ‘barb’ that is buried deep into the bone. In between, I could ride and lift weights just fine, but could not even jog on a soft surface due to bone pain. The second surgery solved that problem, and a few years later I was able to build up to running ~60 mi/wk with only very minor issues. Now, almost 20 y later, mostly what I am left with is a scar, a ~5% strength deficit (due to muscle damage/loss) during knee extensions, some limitations on internal rotation, and a few bad memories. There are days, however, when my hip does ache enough to cause me to take some non-prescription pain relievers. In the past, this usually resulted from too many days without exercising, but now even working out regularly does not keep things fully “in check”. I therefore suspect that I am developing a bit of osteoarthritis, as a colleague at the time who was a PT warned me was a possible long-term complication. I have also struggled a bit lately with low back pain, which again I was warned could result over the long haul (due to muscle imbalances…although I have minimal evidence of a Trendelenburg gait).

As for my actual athletic performance ability, aside from the strength deficit mentioned above there has been no effect. In particular, my life-time bests for VO2max, LT, efficiency, power, etc., were all established post-injury, even though I had been racing bicycles for 15 y before breaking my hip.

4

Hey Powerbarjunkie.

First of all, want to say that I’m sorry to hear about your crash. Keep the faith. With diligence, you will get back to your former fitness

I had an intertrochanteric fracture after a bad bike crash in October 2006, IM nail, pins, the whole bit. I was 30 at the time of the crash.

Due to the hip and some other injuries, I was in a wheelchair for the better part of 3 months.

My experience:

  • Most of my fitness loss was not due to the crash itself, but the 3 months of immobility. I would seek a doc who has worked with impatient athletes to get a realistic appraisal of when light weight bearing can begin.

  • The first 8-12 weeks after weight bearing are all about getting ROM & basic strength back. It can be both discouraging and amazing to see how much strength and flexibility you lose, but equally amazing to see how quickly it comes back. It took me ~3 months to get back to somewhat normal function and ~12 mths to get back to equal R/L leg strength.

  • I did a Half Ironman 9 months after the crash. It was a triumph to be out there again, but I was 40 minutes slower than my PR (5:30 vs 4:52). Again, this was more a function of the time off and just getting back to normal function before starting real ‘training’. I still managed to get 530hrs of training done in 2007, but I was definitely not in shape for an IM. One of the toughest thing is accepting being a ‘slow’ athlete again. I went from being a local top 5 finisher to MOP fodder. A hefty dose of humility! A side note, my bloodwork was screwy through 2007, I’m guessing due to the blood lost through the crash. I had to start iron supplementation after feeling chronically fatigued at ~10hrs/wk training!!

  • This year will be my first IM since the crash (25 months post). I am in better shape than I was for my last half but still not back to normal. My 2006 training volume was 788hrs. As mentioned, 2007 was 530, this year is looking to be ~670, so still not back to normal load or performance. I am expecting next year (2009) to be a return to my normal load and sub 5 half times.

Fortunately, as my buddy Gordo is fond of saying, I play a long game :slight_smile:

When it comes down to it, I just can’t imagine not training. It was all I thought about when I couldn’t. If this is your experience at the moment, rest assured that this passion will carry you back to (and beyond) your former levels of fitness.

Feel free to email me at any time w/questions or if you just need a sounding board.

Heal up!!

Alan Couzens, MS (Sports Science), CSCS, PES
Exercise Physiologist
Endurance Corner Human performance Lab
Boulder, Colorado
alan@endurancecorner.com
http://alancouzens.blogspot.com

5

I had an intertrochanteric fracture after a bad bike crash in October 2006, IM nail, pins, the whole bit. I was 30 at the time of the crash.

Due to the hip and some other injuries, I was in a wheelchair for the better part of 3 months.

My experience:

  • Most of my fitness loss was not due to the crash itself, but the 3 months of immobility. I would seek a doc who has worked with impatient athletes to get a realistic appraisal of when light weight bearing can begin.

  • The first 8-12 weeks after weight bearing are all about getting ROM & basic strength back. It can be both discouraging and amazing to see how much strength and flexibility you lose, but equally amazing to see how quickly it comes back. It took me ~3 months to get back to somewhat normal function and ~12 mths to get back to equal R/L leg strength.

  • I did a Half Ironman 9 months after the crash. It was a triumph to be out there again, but I was 40 minutes slower than my PR (5:30 vs 4:52). Again, this was more a function of the time off and just getting back to normal function before starting real ‘training’.
    By way of comparison: since my only injury other than the broken hip was a bit of road rash (I actually claimed my free lap and tried to get back in the race, despite my leg flopping around a bit when I attempted to pedal), I was back to pedaling an ergometer in about 2 wk (albeit with the seat much too high - even by ST standards! - due to surgical adhesions and limited flexibility). Still, I didn’t train very hard between my two surgeries (no point, since I wasn’t competing), and I felt that it took me a good two years after the 2nd surgery before I was really fit again.

6

Sorry to hear about your hip.
I had surgery to repair a fracured femoral neck 12 months ago.
I was back on the bike pretty much immediately. 1st on trainer- then outside. Had/have much of the same complications that AC describes.
I was able to get fit again quickly but seemed to lack the power and depth that comes from really strong muscles. I did gym work for a few months but went back to full time riding by February. I had a couple ok road races here and there. When I would go to a stage race I would get worse every day.
Now I am even weeks into a gym program and feel as strong as I ever did. When I started gym and bigger gear work this fall it felt like I was weak at the hip flexors, lower quads (vmo), hamstring on the ide I broke wa lazy at the bottom of the pedal stroke. Much of this feels 100% better.
I also started running- no pain, but I started running and gym at the same time- it made my joints ache so I topped running for the time being. Funny thing- I broke my left leg and it was always my strong, dominant and longer leg- now both of my legs feel about the same length and running actually felt more even and faster than pre-fracture.
So as a PT you know everything to do- maybe just plan to spend more time in the gym than I initally did.
AC- why did you have your hardware removed?

7

Actually- now that I think back, walking without a limp was the hardest thing to overcome.
As you know all the soft tissue adaptively shortens and weakens. I had issues with hip flexion (thigh to torso)- discovered that it was more from tight glutes and TFL than hip flexors. Got used to walking by raising the whole side intead of just raising forward.
Might want to think about some ridng as rehab- maybe even powercranks (sorry AC)

8

AC- why did you have your hardware removed?

Two reasons:

  1. while the orthopedic surgeons I spoke with were of mixed opinions, the younger (more recently trained) ones favored removal just on principle, i.e., “we don’t really know the long term consequences of having metal implants in your body”, and

  2. as mentioned, I had pain due to the hardware, which often left me in a bad mood (think constant toothache) and limited my normal daily activities (e.g., if I was crossing the street and a car appeared, it was painful to have to jog out of the way).

Within 24 h of the 2nd surgery, I decided that I had made the right choice…and that was even before I was out of the hospital.

9

While I was on a trianing ride in 2002, I got hit by a teenage driver who was talking on a cell phone. I had almost a complete separation of the femoral head. X-rays show it hanging only by a splinter. Because my ortho surgeon knew how much I was into cycling, she decided to screw it back together rather than doing a hip replacement. There was a higher risk of things like avascular necrosis, but if it worked, it would be a better long-term solution. It worked.

I had three large screws placed to re-attach the femoral head (they’ve never been removed). I was completely immobile (the leg) and non-weight bearing for six weeks, but I did everything I could to invent exercises I could do in the bed and the chair to which I was confined. At six weeks I began rehab and, because I was in such great shape, recovery was quite rapid. I did all the work they prescribed and then some. I pushed the envelope.

I was allowed to start spinning on an indoor trainer with no resistance at about 8 weeks. By 10 weeks I was adding resistance. By 12 weeks out I was outdoors on the bike. Seven months out I did a century ride with 10,000 cum feet of climbing. It’s a ride I’d done every year for several years. I did a personal best and finished with the lead couple of guys at just under 5 hours. I attribute that to a) tremendous enthusiasm for just being able to be back out there and b) the deep rest my body got during the recovery after a number of years of hard training.

My time frames would probably be longer than yours because my injury was so much more severe. Also, I shattered my ankle at the same time and had hardware it that. The ankle was more of a limiter than my hip was.

I was a cyclist and not a triathlete when this happened. I was told that a hip replacement would probably be in my future because of osteoarthritis eventually setting in and that running might make that happen sooner rather than later. So I’ve elected not to be a runner. I’ve dabbled with it a few times, but I also shattered my kneecap (same leg) in a separate accident a few years earlier and it quickly flares up and gives me problems, so I just don’t fight it. Neither the hip, nor the ankle ever gave me problems when I tried to run.

Dr. Coggan has achieved more than I have, but like him, I’ve had my best performances since my accident. I’ve gotten into time trialing and have a few state championship titles and have won some other TT series. A few weeks ago I did the bike leg for a relay team at a HIM on a rolling course and did 2:13:50. Not bad for an old guy (I’m 52). I’m looking forward to my first Iron-distance relay next Saturday.

SO … keep as active as you can and push the envelope. But at the same time, know that your body is getting a nice, deep rest that may actually be of tremendous benefit. I’ll bet you’ll come back sooner than you think and be very strong. I can recall how the ordeal seemed endless. It’s not. It’ll be a fading memory before long.

Good luck!

10

I have no advice but wanted to send you wishes for a speedy recovery.

tc

11

I was told that a hip replacement would probably be in my future because of osteoarthritis eventually setting in

Two words to memorize, Bob: hip resurfacing. :slight_smile:

12

I forgot about that part. I think my wife kinda misses what she called my “soulful strut” that I had for a long while into my rehab. That WAS hard to overcome.

Also, I’ve ended up with a 1/2 inch leg length discrepency. Until just this year I didn’t worry about it and I just figured I’d always be living with low back pain. This year I decided to try a shim between my cleat and shoe on the short side and now all that pain is gone. Cleared up within ten days of starting to ride with it.

But I stray.

13

Yeah- I had a “good time charlie” walk too. Probably lot some leg length too- but as I said, I broke my long side- I think they are pretty much even now!

14

I broke a hip in Feb 2002 at the age of 33. Spent 3 days in the hospital and then a week in a rehab facility. They didn’t quite know what to do with a young whipper snapper like myself. Everyone around me was >60 and a mix of stroke, heart attack, hip, etc patients. I did some basic lift exercises there, but honestly what helped me the most was what I did when I got home. I suffered quite a bit of atrophy in the affected leg in just 1.5 weeks.

I asked my ortho if it was OK to get on the exercise bike (I had a cheapo recumbent at the time). He gave the OK as long as it was on the lowest setting (basically free spinning). The first day hurt like heck as I was breaking down the scar tissue. Each day I’d at 5-10 minutes. After a couple of weeks of that I was on the hardest setting for an hour+. I needed a better training tool, so I bought a used Computrainer. I was still on crutches, so the CT was a great way to safely work the leg and also provide feedback on progress. By May of 2002 the doc gave the OK to ride outside. I was walking with a cane by then so I was extremely cautious. I could not stand up and sprint on the bike, and I made dead sure my “good” leg was unclipped well before a stop as still any significant body weight on the affected side hurt.

While using the cane, I had consistent pain in the lateral direction (the plane parallel to your torso, not the walking direction). Once I got off the cane I continued to have this pain. I just didn’t have strength in the muscles to give me lateral stability. At the 6-month mark I was given the OK to run. That strengthened those muscles to the point where the pain went away in a few weeks.

I asked several times about getting the metal out - ortho said no. I wish I had it out as to this day I’m spooked by having it in there. I am not worried from an infection perspective, but as a structural engineer I figure the titanium or stainless used is much stiffer than the bone. As such, any crash will induce quite a load into the metallic part and potentially make for a nasty stress wave into the bone.

I always say that breaking my hip was the best thing for my cycling. I became more regimented in my training and discovered training with power because of it. The long pole for you will be the running part, but you can build up plenty of the necessary aerobic fitness on the bike. I’d say get on the bike fitted on a trainer or an exercise bike ASAP.

15

I suffered an intertrochonteric fracture of my right hip at Laguna Phuket in Dec 2006 when some s^&*head riding behind me clipped my wheel. I was 48 at the time. Spent 4 days in the hospital. The hardest thing during the first few days was that I had to really focus on walking. Thankfully, the orthopede at the hospital in Phuket was first-rate and did a great job. I spent 6 weeks on crutches. Started swimming soon after getting rid of the crutches. Being so old, I didn’t race again until February 2008 at Geelong, AU. Have completed 2 other 70.3’s this year along with several OD races. The hardest thing I have found is that my transition from the bike to run is much harder as I have low level pain in the hip. This takes a while to work itself out, say 3-5km. I will be one of the MOP’ers in Clearwater in two weeks, but I don’t care. I’m just happy to be able to compete again(:

16

Ummm, I know this is going to sound like heresy for this forum but have you ever thought that perhaps cycling was not the best thing for your overall life, health, and well-being, when all things such as the constant crashes over the years are considered??? As a swimmer who has now done tri for 23 yrs and who has had 4 bike wrecks that put me in the hospital, including one that resulted in a broken femur, I am thinking seriously of just becoming a swimmer again who runs as a supplement to my swimming, and who takes his bike out a few times a year on sunny summer afternoons. Of course, I am unusual among former swimmers turned triathletes in that I still actually LOVE swimming. I never burned out on it completely like many swimmers have. I enjoy a nice 1.5 to 2 hr swim workout swimming all four strokes with a fair amount of kicking and pulling in the mix.

Anyway, this is an heretical, contrarian point of view but, in theory you could think about not biking so much and swimming and running more. Or, doing most of your rides on the trainer.

17

One should pursue their passions, and if that means racing a bike, then do it.
That doesn’t mean one doesn’t look for ways to mitigate risks but if riding a bike is part of what makes you, you, then I wouldn’t advise stopping simply because of a racing incident.

Crashes are part of bike racing. If your passion doesn’t outweigh the risk profile, then that’s your answer…

There is a new sense of achievement in making a comeback. I know for me, what was old is all new again as I take each step along the way.

I even finished a race today. :slight_smile:

18

Alex, you are a walking billboard for the spirit of coming back from a very serious injury that will affect the rest of your life. What you have accomplished since your accident is fantastic. Kudos on the race. I know it has been a struggle.

19

I realize this post is too late to be of help to you, but others who are interested in this topic might be interested in hearing about my experience of recovering from an intertrochanteric hip fracture, especially because of my age.
I am a 79-year-old runner/cyclist, duathlete who crashed my bike this past January of 2011 and fractured my left hip. I was rescued and rushed to ER at a local hospital. An x-ray revealed the fracture mentioned. I had surgery the next day and was released from the hospital two days later. I won’t give all of the details, unless someone should request them. The surgery consisted of inserting a 16" titanium rod into my femur. The rod was anchored at the base with a screw through the thigh bone, and a compression screw passed through the upper part of the rod into the neck and ball of the femur. I did not accept the home care or PT that was offered. I did my own rehabbing. I progressed from a walker to a cane to walking without assistance in about three weeks. Then, my rehabbing consisted of walking; stationary, recumbent bike workouts; and walking and jogging on a treadmill. Within about five weeks after surgery I began cycling with very little difficulty; the major problem was mounting and dismounting the bike. About two months after surgery, I began outdoor jogging and progressed to running. This was the task I found most difficult. However, about three months after surgery, I was back to running at a fairly good pace. This coming Saturday, fewer than four months since surgery, I plan to do my first running race. It will be only a 5K. I think I shall be able to handle it OK; however, I do not expect to come even close to the Alabama, age-79 record for that distance, a record which I set before my bike crash.

20

**Thanks for this post! very encouraging. **
**I’m currently reading this rather old thread in hospital after hip surgery and it’s great to her all encouraging stories. **
I’m a 40yr old triathlete that had a bike crash 2 days ago during a very wet 312k bike race in Mallorca and managed to break my hip. Had emergency surgery and a IM nail inserted in my femur with 2 screws to go with it.
As cycling is my passion, I am worried about the long term effects of this accident, but after reading your stories i can’t wait to get out of here and start my rehab!
Well done to all of you!