HOW I RECOVERED FROM A BROKEN HIP
(originally written July, 26 2010)
Searching for my own answers, I’ve been inspired by a few others who have told their own story (links below). Their information has helped greatly in my initial confusion and my eventual recovery. I am in no way an orthopedic or soft-tissue expert, but my hope is that someone can use my experience to help clear away some of the fog they may be in. I doubt anyone is going to have these exact issues, but utilizing a few different articles and further research, one should be able to put their personal puzzle together just as I did. If you recently broke your hip, you’ve got plenty of time for research and to sort it all out.
Advantageous for my rehab, I was probably in my best physical shape at thirty-four years of age when I had my accident. Luckily, I’ve always been a fast healer while physically abusing my younger body with numerous sportbike accidents, snowboarding injuries, and dumb stunts. As I’ve grown older I have better calculated my risks, eaten healthier, drank a little less, learned what lifting exercises my body responds to, and have become less and less apathetic towards cardio. More than two years prior to fracturing my hip, I became an avid mountain biker and eventually added a road bicycle to break up the monotony of running. My hip seems to have healed at a rather fast pace, and I imagine I owe a lot to all of these factors.
It was Mother’s Day afternoon and they had to call in an orthopedist to do my surgery ...I almost had to wait until morning with the awful pain. The accident was at 1:30pm but I was finally being prepped sometime around 5:30pm. I was awake again and feeling many times better by 11:00pm. My doctor ended up doing another surgery immediately after mine since an older guy on a cruiser bike broke his shoulder after I went in. That pretty much set the standard on my one-on-one time with the doctor. I doubt I saw him a total of ten minutes during my four day stay at the hospital. I had broken my ankle on a sportbike in 1999, but this turned out to be a lot different. Not only did I not know what questions I should have asked at that time, but I also felt I wasn’t made aware of certain things that might have helped later. At the time, I didn’t feel so lucky, but it could have always been a lot worse. To my surprise, I was up doing minimal physical therapy on a walker at 1:30pm the next day. Therapy wasn’t fun, but I knew I had to stick through it and reach the goals they set in order to get the hell out of there. A lot of the recovery had to do with willpower and persistence to get better and work beyond the pain those first few days.
the emergency room - prognosis: stuff is screwed up!
the alignment shots used during the surgery
these are the post-op and two week check-up x-rays
I never had an MRI done and found out once I became a little more mobile that I had some muscle issues around my right knee. A few days of lightly testing my knee with more weight got the blood flowing again and they soon healed themselves up. I would later apply this knowledge to my other dormant soft-tissue problem I immediately became painfully aware of when I started trying to walk: torn groin muscles. The doctor did not mention anything and I never considered it, but it might have been a good idea to get an MRI done of the area to prevent any surprises and delay the recovery. I also seem to have some scar tissue in my right buttocks that causes discomfort when my leg is positioned at different angles while sitting. The more mobile and normal-walking I become, the more this issue seems to resolve itself. I imagine this scar tissue will slowly work its way to nearly unnoticeable over time. Early on, I noticed that my thigh and pelvic areas appeared abnormal (looked almost shifted as if my bones were disfigured in areas) apparently from the swelling and scarring. After a few months, everything settled back into where it belonged - it now just looks like I have slightly larger muscle tone where the appliance lies under the skin when compared to the unbroken side.
Prisoner in my own house
Friends and strangers kept recommending different things for me to keep busy, but I didn’t dare break my lazy-multitasking habit (except for visitors or the occasional outing) for fear of slowing the days down again. I had just read two books the week prior, so I had booked myself out when I could have used it the most. In the end, two months didn’t seem nearly as long as I thought it would be. My tender-feeling fragment really caused me to be overly cautious earlier on, but by this time I was finally comfortable getting out of the house to do things. I eventually found out that I could put a five dollar deposit on a wheelchair at the mall’s information desk, so that was quite exciting after spending so much time in the living room. I never had much interest in it prior, but the 2010 Tour de France also ate up a lot of time as I became aware and fascinated with the interesting strategies and mind games those guys play for three weeks. All that confinement really opened my eyes and has urged me to eventually start volunteering for those that may never be able to leave a hospital bed.
My earliest concern was my inability to get good sleep thus inhibiting my body’s ability to repair itself during that time. With the extended period of inactivity, my urination became very frequent as I maintained my normal water intake in hopes of promoting healing. More often than not in the afternoon, I was going every thirty minutes. I would also wake three or more times a night for the bathroom. Aside from the awful sleep interruption, this was a lot of extra movement that my fragment could deal better without. It nearly drove me mad as it certainly was never a full bladder amount and yet I was unable to hold the sudden urges. After a few weeks, I stopped drinking at 9pm so that I could void my bladder and sleep through the night. Once I got active again, this problem resolved itself …but not after a wasted visit to the emergency room that referred me to the urologist. Oddly, it never crossed his or my surgeon’s mind that this was only a problem of circumstance due to over-hydrating combined with greatly reduced activity.
Once I became fully aware of the fragment, I was much more careful and deliberate with my movement. The large fragment tenderness gradually became less noticeable at about the three month mark and felt like it was mending. After three months, the x-rays showed that the gap was starting to possibly solidify. I admit, when the physical therapist got me out of bed fourteen hours after surgery, it gave me this false sense that I was going to heal only slightly slower than Wolverine. The fact that my past broken ankle required plating and over a month in a cast was forgotten and I seriously thought I’d be walking within four weeks and jogging within eight weeks. In reality, not having a cast really meant I needed to be even more careful, which I didn’t start doing until about four weeks in. Instead of just avoiding discomfort, I started avoided as much movement as possible at that point. This is kind of the opposite of what your body needs in this state. The muscles needed to be very lightly exercised to boost blood flow, prevent healing defects, and prepare for the eminent restrengthening (I have since successfully used this method to heal minor sprains and injuries). It seemed to be a fine line between scarring and repairing - this became even more apparent when I was actually capable of walking and the groin problem came out of hiding.
at six and ten weeks from the accident, it is looking like the large gap is not going to fill in
however, the inner area of the fracture is showing substantial improvement at the ten week mark
Three Month Update
over three months and it appears that the gap is finally starting to fill in
Rehabilitation of Muscles
Before I was off the crutches, I was on my bicycle. I would use my road bike for support as I slowly wheeled it outside, loaded it, and leaned on the car while hobbling to the driver’s seat. Once at the paved trail, I would very gingerly swing my bad/right leg over the seat and clip my right biking shoe to the pedal. It turned out that the pedaling motion of the bicycle did not aggravate my leg in any way. As a matter of fact, for the first time I could actually feel my damaged/weak muscles getting a workout and without any feeling of stress during or afterwards. I firmly believe that biking practically every afternoon accelerated my muscle recovery and made short work of the knot in the quad where they cut through to get to my femur. I felt I was healing at a much faster rate and this gave me the confidence to get back into my home gym for my weekly upper body workouts, which prompted me to do the very important stretching on a daily basis. I also realized that before I could go back to work (bartending), I would also have to build up some endurance to standing again. So I started going to the venue, still on my crutches, during shows just to stand there where I could lean if I had to. I did this about three times yet fatigue still strained my legs and lower back my first and second night.
I eventually tossed the crutches in lieu of an adjustable cane. Finally, I could carry things! It gave me just enough stability and support to alleviate what ended up becoming the most complicated part of my recovery. My groin muscles were apparently slightly torn from my femur and I didn’t know this until I tried to rely less on the cane - I would put my arms out for balance and looked like an orangutan coming at you. I still went back to bartending, being careful to keep most of my weight on the good leg and pivot on it. However, whenever I stepped with my bad leg, my groin would force me to hobble …and the fragment/tendon issue was probably making matters worse. This really worried me and I decided to take the next weekend off to let it heal. However, it dawned on me that my groin had already had over eight weeks to heal …it didn’t make much sense. So I did some research and came to a conclusion: I needed to be patient, yet persistent; I had to go easy, but force nourishing blood to those muscles torn to boost the healing process; I had to gradually build up my strength without working them too hard. Although I had less trouble with stairs, I also realized that my mind and body were strangely reluctant to walk normally because they naturally favored/guarded the bad leg. I eventually came up with a simple little exercise that repaired my leg’s muscle memory.
I started with the R.I.C.E. method (rest, ice, compression, elevation). I continued using my heating pad and also developed a light leg routine I put together with ideas from Kevin’s blog (linked below). I took two days off with minimal mobility and then started by applying the heating pad for twenty minutes to my quad, the scar tissue in my right buttocks, and then my right groin. Once I wrapped an ace bandage around the injured groin muscles the best I could, I began my regular stretching routine then went through a short list of light exercises that built strength and increased muscle control. Afterwards, I would hit the recliner with a bag of frozen peas on my right groin for twenty minutes where the bandage remained with my feet up. The results seemed so dramatic that I was tempted to do this more than once a day and also bicycle, but I kept in mind that too much work could potentially do more harm to the torn muscles than good (although the biking never seemed to bother the groin). I patiently stuck to my plan of one light workout per day for five days, growing noticeably stronger and more controlled of the movement each time. I would take a few steps after a workout and there was always less effort than the day before. Again, I am no expert, but without the help of some other non-experts simply writing of their experiences, it would have certainly taken me longer to recover.
Returning To Work
I returned to work after that one weekend off without bringing the cane. Each day, my groin felt a little sorer and by my first day off, I was using the cane again because it hurt to walk and to allow the muscles to recover. Again, I would ice my groin muscles following work and then use the heating pad in the morning to loosen the muscles up. I would continue to use the cane to get around the house for the first few days off of work until the muscles healed. The next weekend started off really well without the cane, but the shifts were very long again that weekend and I was comparatively only slightly less sore by the end of it. I continued to ice after shifts and use the cane the first few days off. I was doing the rehab routine only on days that my muscles didn't hurt from work. It wasn't until after my fourth week back that I finally felt more mobile and on my first day off, I was able to walk fairly normal without requiring the cane to do so.
It certainly took a while because I was taking two steps forward in my muscle strengthening from the increased activity, but taking one step back to allow for recovery from the extended amount of time doing so. I believe returning to work was actually for the best, but it was just bad luck that those weekends entailed longer shifts. Ideally, a couple shorter/normal shifts each week would have been more beneficial as to allow my muscles time to heal themselves. The fourth weekend was also when I stopped doing my special rehab routine and began riding my road bicycle frequently again. I no longer felt that I needed to ice or heat my muscles at this time, as well. Aside from a tiny bit of favoring of the bad hip (and the inability to jog), everything was undoubtedly returning to normal at the three month mark.
One of the best things for me, I felt, was milk and not because of the calcium. Your body can naturally move calcium from healthy bones to the broken ones if it has to, so you do not need to drink gallons of milk for that reason. Milk is a great source of nutrition and it became extremely convenient between meals, especially when I couldn’t get around well. The milk I drink is Smart Balance’s Lactose Free and/or Lactaid's Fat Free. I personally chose to stop drinking dairy milk (substituted with soy milk) or eating cheese a few years ago because of the phlegm produced by regular dairy became an annoyance while biking and running. I eventually decided to drink dairy milk again, but the lactose free stuff doesn’t seem to produce the phlegm problems. These brands also have plenty of extra protein and vitamins perfect for recovery.
I ate a lot of brown rice, green beans, sweet potatoes, and pan-fried chicken cutlets marinated in italian dressing or dry-rubbed with Old Bay once I could cook again. Prior to that, my friends prepared a few things like burritos that could be frozen or a meatloaf that could be easily heated up along with some frozen vegetables. Stir-fry was also something that was an all-in-one meal that could go in the microwave. Humus wraps ended up being very convenient to prepare for myself quickly and able to carry in a bag. Breakfast was either plain oatmeal with a little bit of peanut butter, some milk, and a banana -or- Mini Wheats and a banana. Junk foods are pretty convenient, but I was able to stifle those urges and snacked on healthier crackers, yogurt, and fruit. My friend also found a little fabric basket with handles that she tied a short string between. As silly as it sounds, this could go around my neck and it was just big enough to allow me to carry my bowl of cereal or soup while still using the crutches.
Bones are like muscles: the more you work or put stress on them, the stronger they will be become. Your body recognizes when specific bones are subjected to more strain and it will make those areas more resilient than others not under stress. Conversely, the same is true for a bone that was once supporting your body weight but now has a plate to strengthen it. In my scenario, the bone density of the area near the plate (not necessarily the entire femur) will lessen since the plate is helping to do some of the work. This isn't entirely bad, it's just the body's way of evening everything out along the bone. It is also part of the reason crutches are a good precaution after removal since there is so much weight being placed along this area. I suppose there are two theories here: one that implies that extreme impact can cause the bone to break where the harder plate ends midway along my femur; and one that implies that the different sections of bone adjust so the strength of the plated area is not that different than that of the naked area, thus reducing the plate's effect from the same impact. My gut feeling is to lean towards the first theory, but I'm not convinced removal is truly going to prevent chances of a future fracture any better. I was pretty sure I was going to have it removed just as I removed the plates and screws in my ankle back in 1999, but I'm not sure now. I guess it depends on whether or not I have the time to crutch around for a month and what problems, handicaps, or annoyances the appliance develops during employment or sports.
Nov 15, 2010: Currently, I still feel very slight stress on the inner groin muscles with certain movements and/or heavy lifting. Aside from MMA practice, there's nothing I can think of that I would hesitate to do at this point. I actually crashed pretty hard riding my mountain bike on October 8, 2010 with my refurbished hip absorbing a large amount of the impact and pedalled away with only a bruise over my surgery scar. I believe that by the end of the year (almost 8 months from the accident) I will have made a complete recovery.
February 1, 2011: Only nine months after and sometimes I forget that I broke my hip as discomfort from my inner thigh/groin (where most of the pain had been during the later stages of recovery) has become very minimal. It could be due to the fact that I have learned how to avoid aggravating it. I'm still not sure I would be ready for muay thai/grappling practice or snowboarding yet if my schedule allowed it, but the amount of weight I can squat is back to where it was prior to the fracture. However, I have opted to stop doing my 4-mile run in favor of road or mountian bicycling 12-miles (I could probably run fewer miles, but I don't feel that's pushing me enough aerobically). The running is still a little too high-impact for me - seems a bit of pain radiates from my hip joint after a run. I've decided it is just better to err on the side of caution and continue with the low-impact workout the biking provides for now. My quad is healing nicely and the scar tissue that was built up in my right buttocks is gone - I had actually forgotten about it until re-reading this. I am not sure if 100% recovery is possible but I'd say I am at the very least at a modest 95% right now. I could easily say I am lucky/happy with 95% and I think most people would feel they had made a "full recovery" at this point, but I know each month I am gradually getting better ...even if I don't realize it.
August 21, 2011: Can't believe I forgot to update on the one-year anniversary. Most of the blame has to go to my schedule, while the rest goes to the fact that it predominantly slips my mind that I was unable to walk a year ago ...a testament to how well my hip is doing today. Although I'm sure I will be sore until my body gets used to it again, I'm going to start jogging this coming week since I seem to be hitting a plateau on my road bike. The only "problems" I still encounter are related to the inner groin and quad muscles - the great majority of which occur in that intentionally-severed quad but are nothing to slow me down, just enough "irritation" ("pain" is too strong a word) to make me take notice. Over the early summer doing individual leg exercises, I noticed my problem leg tended to fatigue earlier, but that has become less of an issue. I also became aware that my good leg was doing more than half of the work on the bicycle - I had to consciously force my legs to fix that problem. Ultimately, I feel confident enough to take on any physical challenge without apprehension. There is some minor numbness along the scar area I certainly won't get back at this point, but I doubt I'm ever going to really miss that. If I had to put a number on my recovery today, 98% would be it only because I wouldn't consider 100% possible with the numbness. I'm sure there will always be something holding me from reaching that final 99%. Of course, I feel very fortunate to have made it to this point considering the destruction.
October 30, 2012: Everything is still going great. But I've realized that if I don't keep a regular strength routine going, I will feel pain in my problem quad during strenuous activity. I was basically so preoccupied with modifying my Jeep for two months that it left little time for my CrossFit workouts. In everyday life, my hip is a non-issue - sometimes I forget it even happened. But as a firefighter, there are days I'm hauling around equipment and I'm reminded of the injury with a dull pain as the once-severed quad muscle works. I am fairly confident that once I get back into a regular "gym" schedule, I'll notice this less.
(DISCLAIMER: I am not a doctor, these are merely my experiences and opinions)
CrankyGypsy (established 2001)