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Training after injury

Old 06-23-19, 08:41 AM
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Training after injury

How did you approach it, what was your schedule for a full come-back? My pulmonary doctor said that running or not is mainly a matter of the pain and not a hazard for the recently broken ribs and deflated lung. I know that the Orthopedist is going to advise against biking because of risk of falling, but not detrimental to healing the collarbone if you don't put much weight on it. So, that said from the medical experts (or will be), that leaves a lot of latitude. I haven't been on the bike yet because I'm not taking that risk with the ribs.

Not trying to play the tough guy or hard man, yet I just turned 60 and I can't afford to let it slide for too long. I'm just over 2 weeks out, last week I walked for about 15 miles total, and then tried a really slow Greenway jog for 2.5 miles. It was OK, bearable, the next day was OK, so yesterday I tried a treadmill run of 5K not quite as slow but only a 10 minute pace. Already a lot of ground to make back up. I'm thinking just more of that daily, maybe with a compression shirt.

I know, ideally bike rides would be low impact cardio, and if I hadn't been through an unusual trauma with the breathing tube I'd probably do that, but as it is I'm really cautious about it this time around. Stationary bike is uncomfortable and I don't see that as part of my regimen.

If you've been through it, how did you ramp back up and what were your challenges?
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Old 06-24-19, 03:21 AM
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You've probably read some of my descriptions of recovering last year from being hit by a car (dislocated and broken shoulder), then discovering from images taken during that diagnosis that I had thyroid cancer. So after May 2018, the rest of that year was recovery.

Even at age 61 now, that was a longer recovery process than I'd have expected. Yours may go more smoothly, despite the seriousness of your injuries. You were already pretty fit, which makes a huge difference compared with recovery for sedentary folks.

Biggest challenges for me were pain -- the injury hurt a lot worse for a lot longer than I'd have anticipated -- and exhaustion from the wonky thyroid. I'd planned on surgery for the shoulder within a week after the injury, but that had to be canceled because my trachea was so distorted and compressed from the swollen thyroid that I couldn't be safely intubated. And it took months to transition from an unsatisfactory health care system to a better one. By the time the thyroid issue was resolved (surgery to remove the cancer, which hadn't metastasized) it was too late for shoulder surgery.

And my endocrinologist took a very conservative, slow approach to adjusting my levothyroxine. They were concerned about other complications, including premature osteoporosis, and wanted to avoid messing up the remaining parathyroid glands on the half of the thyroid left after surgery. So for months I was struggling some days just to get out of bed. It's only been the past month that my energy is beginning to come back to more or less normal.

Despite all that, I managed to retain about 75% of my cardio fitness, which had been the best shape I'd been in since my 20s just before the injury last year. It was hard as hell but I didn't want to lose those gains.

For the first six weeks after the injury I walked, usually 2-5 miles a day. That helped some. Then a friend gave me his old Cycleops trainer, so I used my road bike on that trainer 3-5 times a week, usually an hour per session while binge watching TV series. I grew bored with training videos so I mostly watched Orphan Black and the first couple of seasons of The Expanse. Once a week I'd do interval training, using an app as a timer. I'd check my BP and HR with a cuff. I didn't get a heart rate monitor until recently, but it hasn't told me anything I didn't already know. I could have saved the money and kept using the arm cuff, or a phone app that uses the camera flash/steady light for heart rate measurements.

I did a few outdoor rides in July-August, but was easily exhausted from the heat so I did those only once a week or so. They thyroid thing was getting worse and by August I was back to doing almost nothing but some walking. I could hardly get out of bed some days. That was caused by a low thyroid level, and bad advice from my previous health care provider.

By September I was able to ride outdoors again a couple of times a week, mostly using the hybrid outdoors because it was easier on the injured shoulder. I did indoor sessions on the road bike.

By early 2019 I could tell the shoulder pain wasn't getting better, despite X-rays showing it had "healed". So I've been back in physical therapy for six weeks. It's helped a lot. We're concentrating on the neck, shoulders and upper back, which have years of neglect to undo. (A 2001 car wreck also broke my back and neck in six places. I had no insurance and those were basically neglected for years.) There's significantly less pain and better strength and flexibility. I'm set to see a chiropractor soon. I'd rather see a masseuse, but I'll take whatever my insurance will cover.

You might also consider a structured training program. Depends on your past habits, routines and motivation. Do an honest self assessment. I'm a self starter when it comes to bike riding and training, but not with other physical therapy. I do better when I have someone coaching and helping to motivate me in the gym. That's one reason why I retained my basic cardio fitness last year despite injury and illness, yet made little progress with physical therapy for the shoulder/neck injury. My self-motivation extended only to riding the bike, not to full body exercise.

Finally, addressing pain, depression and anxiety were major issues. Due to the mostly hype-manufactured "opioid crisis," my first health care provider kicked me to the curb. There was a six month waiting list for their "pain management clinic." I'd already had experience with them, as my mom's caregiver before she died last year after a long bout with dementia. The pain management clinic had deteriorated from professional, compassionate and effective to indifferent, even rude and mostly an insurance scam over a period of a few years.

I didn't want prescription pain meds for daily use. I already had those. They make me drowsy and lazy. I wanted anti-inflammatory injections locally and a treatment plan. That would enable me to continue exercising, which helps a lot with pain, depression and anxiety.

After discussing and studying credible information as much as I could, I tried CBD and kratom for pain control. Both can be very effective and don't hinder physical activities. But it's not easy to find good quality CBD that's really effective for pain (I highly recommend Lazarus Naturals, specifically their high potency full spectrum oil -- the isolates did nothing for me). No negative side effects. But it's expensive, even the least expensive brand with a generous discount for veterans. Some folks report it helps relieve anxiety. For me, any relief from anxiety is mostly due to the pain relief.

Kratom is cheaper and stronger, but has some side effects for me. It tends to elevate my heart rate and blood pressure, so I use it as little as possible. But it's very effective for pain and anxiety. I think it has great potential but should be researched by medical scientists to identify and isolate the effective components. It's very effective, but I'd urge using sensible caution. I don't consider it to be a strong addiction risk, probably comparable to caffeine. But the effect on my HR and BP concerns me. And it should be pasteurized or heat treated (there are occasional reports of contamination from salmonella and e coli, same as with US produce), and taken sparingly. Etha Natural Botanicals and Mitragaia are reliable vendors.

I also found bromelain to be a remarkably effective anti-inflammatory. It's just an enzyme extract from pineapple. But it's been more effective than my prescription diclofenac for joint and sinus inflammation. I'm usually skeptical about "natural" and alternative medicines but this one really works for me.

Short version: controlling pain will go a long way toward recovery, not only physical but mental. It's hard to cope with anxiety and depression when we're in constant pain. If I can reduce the pain just enough to get on the bike or in the gym for PT, the exercise itself will provide effective relief from pain and anxiety. It all goes together toward healing.
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Old 06-24-19, 06:38 AM
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Dealing with a cancer is way beyond my challenges. Like you I really dislike prescription pain meds and I'm taking Ibuprofen. For some reason pain has never been the challenge with me. Losing conditioning that I might never get back, vs going to far and damaging something is my main concern.

I upped my pace yesterday, and tried a compression shirt which helped a lot but hurt so much taking off that I'm seriously thinking about cutting one side and sewing in a velcro strip. Heart rate when I finished 5K was 20 beats higher than after a normal steady run which would also be a mile further as well as 90 sec/mile faster. And more out of breath yesterday which is concerning So it feels almost like starting over, tho I'm still hopeful that it's more about healing than the endurance.

Nothing inherently wrong with running slower though, or cycling slower when the time comes. But will the end results differ - it's one reason why this thread. Also the obviously reduced lung capacity, can it be brought back and the optimal method. Other than the inhaler toy they give you for deep breathing practice - I think that it can only go so far and moderate to strenuous exercise has to be more effective.
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Old 06-24-19, 08:31 AM
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Originally Posted by wphamilton View Post
Stationary bike is uncomfortable and I don't see that as part of my regimen.
What about an indoor trainer? Would it still be uncomfortable if it was your bike you were riding?
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Old 06-25-19, 04:06 AM
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Yeah, I had so much difficulty last year with a new compression top that I gave it to a friend. I couldn't take it off without excruciating shoulder pain.

I also switched to full zip jerseys. Huge improvement while my shoulder was healing.

For basic cardio, consider getting a Cycleops or similar trainer. Made a huge difference in my recovery last year. I was able to maintain most of my cardio over the summer, so there wasn't a big transition getting back on the bike outdoors.

The biggest challenge was recovering that intuitive bike balance and handling. I switched from using the front wheel support to just stacking a few magazines to get the front wheel level with the rear. The front wheel wiggles around under the stack of slick magazines, which kinda sorta mimics part of the bike riding experience. I still do that. I don't bother with elevating the front wheel to mimic climbs -- it never feels like real climbs. If I did elevate the front wheel it was just for comfort while my shoulder was healing.

Main motivation that kept me using the indoor trainer was skipping the boring training videos. Instead I binge watched Orphan Black, The Expanse and Hannibal. I set a rule for myself -- no watching those shows unless I was on the bike trainer. That motivated me to do a few marathon sessions, watching 3 or 4 consecutive episodes.

At first I didn't set any fitness goals or use any meters. I just moved my legs. As the shoulder healed I'd add some interval sessions. For those I did use my phone app as a timer, and my bike computer sensor on the rear wheel. For intervals I'd do something like maintain a steady 12 mph, then 30-second sprints at 20-22 mph one gear harder, 30 seconds easy, etc., for five minutes. Then pedal easy and steady for five minutes before repeating the intervals. The speed wasn't relative to anything or a substitute for a power meter. Just a rough gauge to differentiate between easy and harder pedaling. And I'd check my heart rate and blood pressure often during indoor trainer sessions.
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Old 06-25-19, 07:14 AM
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Originally Posted by OBoile View Post
What about an indoor trainer? Would it still be uncomfortable if it was your bike you were riding?
I would definitely try that if I was accustomed to one, but the learning curve to balance that and be smooth on a trainer probably rules it out. I am avoiding large core movements for a few weeks.
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Old 06-25-19, 07:24 AM
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Originally Posted by wphamilton View Post
I would definitely try that if I was accustomed to one, but the learning curve to balance that and be smooth on a trainer probably rules it out. I am avoiding large core movements for a few weeks.
I meant something like a kickr (or more likely a cheaper one), not rollers. So, kind of like an exercise bike except that it's your bike so it fits and you're used to it. No real need to balance and no real learning curve.
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Old 07-01-19, 12:02 PM
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It was about 4 weeks post MI that I started cardiac rehab. I pulled out "my wife's" trainer (https://www.biketiresdirect.com/prod...uid-2-trainer) and did some10-15 minute efforts during physical therapy (to help regain my balance) in the meantime. 2-3 weeks after that I convinced the rehab nurses (they were pretty easy) and my wife (she was tough) I could get back on a bike. I think my first ride was 5 miles, on a deserted-except-for-the-cops-taking-a-break street with virtually zero traffic. It took close to 30 minutes (!), and my wife parked in the middle so she could watch me.

Two months later I started doing one-way, 10 mile bike commutes to or from work (driving the other direction). It took about a month until I had regained the stamina to ride both ways every day. By that time I was rebuilding fitness, not trying to maintain declining fitness. My cardiologist, a cyclist himself, has been supportive all along.

By last summer, 16 months post MI, I was able to ride 420 miles during the week of Cycle Greater Yellowstone.

I'm a bit frustrated that I haven't been able to complete a century, or a 200k, for more than 2 years now. Part of that is that I don't handle heat well, whether that's caused by getting older or becoming a cardiac patient I can't say. This may be my new normal, or perhaps I need to build more speed so I can get around the course in cooler weather with shorter days.

So, my non-medical-professional advice:

1. Get yourself a doctor who'll work with you.

2. Have patience with yourself. You didn't have a punctured (collapsed?) lung before your last 10k run.

3. You know all those articles that say, extend your long run or ride about 10% every week? Apply that to your 2.5 mile longest run. (Spreadsheets are wonderful, you can "run" 10% further every week until you're running all the way across the country if you don't run out of rows.

4. Consider getting an indoor trainer like the Cyclops to get back on your bike with virtually zero risk. (Sprint during TV commercials.)

And like the zero'th law of thermodynamics, baseline yourself from where you are today, or where you started exercising again. You're not as strong, or have the endurance, you can't throw a baseball, and you're not as handsome as you were -- 40 years ago. But you can get better. (Although the handsome might take plastic surgery...)
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Old 07-02-19, 03:34 AM
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When I cracked my ribs, I couldn't ride the next day. I threw up from the pain which wasn't very pleasant. So I waited a day and got back on the bicycle again the next day. And I rode my trainer a lot. I found the position on the bicycle really good for my ribs. I could breathe!!

But you had other issues along with your cracked ribs so you'd want to talk to your medical staff.
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Old 07-02-19, 09:12 AM
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You definitely want to buy a trainer. Something like the Kickr or a Kurt Kinetic. It's your bike and there is nothing to learn about balance or anything else except for the boredom of riding in your basement.
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Old 07-02-19, 09:40 AM
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Originally Posted by pdlamb View Post
It was about 4 weeks post MI that I started cardiac rehab. I pulled out "my wife's" trainer (https://www.biketiresdirect.com/prod...uid-2-trainer) and did some10-15 minute efforts during physical therapy (to help regain my balance) in the meantime. 2-3 weeks after that I convinced the rehab nurses (they were pretty easy) and my wife (she was tough) I could get back on a bike. I think my first ride was 5 miles, on a deserted-except-for-the-cops-taking-a-break street with virtually zero traffic. It took close to 30 minutes (!), and my wife parked in the middle so she could watch me.


I got my nerve up enough for a bike commute last Friday, and again this morning. Amazingly, to me, like @Machka said the position on my road bike actually feels better than sitting up. Except for the collarbone but that's rapidly abating.


Not doing any hard or long bike rides though.


Two months later I started doing one-way, 10 mile bike commutes to or from work (driving the other direction). It took about a month until I had regained the stamina to ride both ways every day. By that time I was rebuilding fitness, not trying to maintain declining fitness. My cardiologist, a cyclist himself, has been supportive all along.


By last summer, 16 months post MI, I was able to ride 420 miles during the week of Cycle Greater Yellowstone.


I'm a bit frustrated that I haven't been able to complete a century, or a 200k, for more than 2 years now. Part of that is that I don't handle heat well, whether that's caused by getting older or becoming a cardiac patient I can't say. This may be my new normal, or perhaps I need to build more speed so I can get around the course in cooler weather with shorter days.


So, my non-medical-professional advice:


1. Get yourself a doctor who'll work with you.


2. Have patience with yourself. You didn't have a punctured (collapsed?) lung before your last 10k run.


3. You know all those articles that say, extend your long run or ride about 10% every week? Apply that to your 2.5 mile longest run. (Spreadsheets are wonderful, you can "run" 10% further every week until you're running all the way across the country if you don't run out of rows.


4. Consider getting an indoor trainer like the Cyclops to get back on your bike with virtually zero risk. (Sprint during TV commercials.)


And like the zero'th law of thermodynamics, baseline yourself from where you are today, or where you started exercising again. You're not as strong, or have the endurance, you can't throw a baseball, and you're not as handsome as you were -- 40 years ago. But you can get better. (Although the handsome might take plastic surgery...)

The silver lining to handsome not happening is that scars don't really matter much. But for the rest, good point that where you start doesn't matter if you're adjusting even 10% per week. With a little patience it will compound to whatever level you're capable of.
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Old 07-02-19, 09:57 AM
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Originally Posted by Machka View Post
When I cracked my ribs, I couldn't ride the next day. I threw up from the pain which wasn't very pleasant. So I waited a day and got back on the bicycle again the next day. And I rode my trainer a lot. I found the position on the bicycle really good for my ribs. I could breathe!!

But you had other issues along with your cracked ribs so you'd want to talk to your medical staff.
One of my ribs poked my lung, which leaked fluids in my chest cavity. Some of which is still there, which is the only thing I'm really worried about but it doesn't impact riding or running.

The pulmonary doc is confident that running is not going to hurt the lungs any, if you can handle the jarring, so I take that as clearing me for it. When did you start running again?
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Old 07-02-19, 10:25 PM
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Originally Posted by wphamilton View Post
One of my ribs poked my lung, which leaked fluids in my chest cavity. Some of which is still there, which is the only thing I'm really worried about but it doesn't impact riding or running.

The pulmonary doc is confident that running is not going to hurt the lungs any, if you can handle the jarring, so I take that as clearing me for it. When did you start running again?

Let's see ...

I cracked my ribs in 1997, I think.
I took up running in 2017!
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Old 07-03-19, 12:27 AM
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I had the same experience after cracking some ribs in a 2017 crash (self-inflicted). I was back on the bike in two days and felt fine... on the bike.

Worst part? You already know it if you've injured your ribs... getting in and out of bed. Just rolling over is agony. Lots of pillows to prop myself up. Fortunately I had a brass rail type headboard with lots of places to grab and grunt myself in and out of bed.

That was my umpteenth rib injury, between motorcycle and bicycle crashes, sports and foolishly sparring a heavyweight state champ when I was but a mere 132 lb lightweight. He took it easy on me but one jab to the chest felt like he'd introduced my sternum to my spine. And the guy really was taking it easy on me. He could easily have knocked me out with just a jab to the head, but he never took a shot at my noggin. I think he was mostly amused by a 5'11" 132 lb stringbean wanting to spar with him. There's a good reason why martial arts have weight classes.

In every case it took about 6 weeks to fully recover, or mostly recover with some minor occasional residual discomfort. The sternum thing from when I was 18 actually took about a year before my sternum quit popping when I'd take a deep breath.

Anyway, in wph's case, I'd mostly be worried about pericarditis. Happened to my older daughter after her micro-surgery to fix a wonky cardiac nerve. The scope and surgical instruments were introduced through the femoral vein (I think), and the surgery itself went well and fixed her erratic ticker. But she was back in the hospital within a week from inflammation. But you're past that danger point by now.
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Old 07-03-19, 07:27 AM
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Originally Posted by canklecat View Post
I had the same experience after cracking some ribs in a 2017 crash (self-inflicted). I was back on the bike in two days and felt fine... on the bike.

Worst part? You already know it if you've injured your ribs... getting in and out of bed. Just rolling over is agony. Lots of pillows to prop myself up. Fortunately I had a brass rail type headboard with lots of places to grab and grunt myself in and out of bed.

That was my umpteenth rib injury, between motorcycle and bicycle crashes, sports and foolishly sparring a heavyweight state champ when I was but a mere 132 lb lightweight. He took it easy on me but one jab to the chest felt like he'd introduced my sternum to my spine. And the guy really was taking it easy on me. He could easily have knocked me out with just a jab to the head, but he never took a shot at my noggin. I think he was mostly amused by a 5'11" 132 lb stringbean wanting to spar with him. There's a good reason why martial arts have weight classes.

In every case it took about 6 weeks to fully recover, or mostly recover with some minor occasional residual discomfort. The sternum thing from when I was 18 actually took about a year before my sternum quit popping when I'd take a deep breath.
OK, that's one to strike from the bucket list. No fighting with the heavyweight champ.

I'm ahead of schedule somehow; at least I can sneeze without much pain, move pretty freely and so on. But to be honest I haven't been on the treadmill since the 5K I mentioned earlier. Just something, subconsciously, is stopping me. I'll be taking it up again over the 4th holidays I think, to see where I'm at.
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Old 07-05-19, 02:11 PM
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Over 3 weeks out, if anyone facing this reads this thread later, a treadmill run went OK without a sling or rib wrap. I know, you see this same question in running blogs but it's always something like "I ran a track meet 3 days later and had a personal best, winning State" etc. For an honest assessment: the collarbone didn't really hurt, ribs are sore now but not while running. No particular fatigue or joints or muscle issues. The bad news is that wind was the limiter.

I'd been running 8 minute pace for my daily 4-4.5 miles, but 9 minutes was practically threshold today, with 3 miles about all I could do. HR at threshold levels also. Whether that's due to the rib and lung injury, or just age and a few weeks off I don't know, but there is a lot of ground to make up.
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Old 07-05-19, 07:02 PM
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The thing about leaning over to reach the bars and easier breathing is that in that position the chest cavity automatically opens up simply due to graityup without as much need of chest muscles contracting for the inhalation part of the breathing cycle. I have book on yoga anatomy which explains in detail how the whole breathing apparatus works. We have all likely seen competitive runners at the end of their event bent over, hands on knees catching their breadth. Furthermore, as a life long asthmatic, I found long ago that the only way to get to sleep during asthma episodes was on hands and knees which expanded the chest. The yoga book made clear why this was so. Being a mechanically minded individiual, I like knowing how things work.

Now, if I could only figure out what that light in my car means that reads "CHECK YOUR ENGINE". The auto dealer doesn't know what it means either.
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Old 07-06-19, 01:59 PM
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I'm going to keep this up sporadically because there is not much out there for a 50+ (just turned 60) training come-back from this. Not a daily log obviously, but the trajectory might help someone later. To summarize, it was 3 weeks ago, 3 broken ribs, punctured/collapsed lung and fractured collarbone.

Same treadmill run today was much easier, finishing heart rate 10 beats lower and not winded, which tells me that at least some of it is knocking the rust off. The 9 minute pace still feels harder than a previous 8 minute pace. At 60 it takes more to bring yourself back than it does at 30 so it will probably be a week of that, only 15-20 miles total. Then we'll reassess.
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Old 07-06-19, 03:32 PM
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Originally Posted by canklecat View Post

Worst part? You already know it if you've injured your ribs... getting in and out of bed. Just rolling over is agony. Lots of pillows to prop myself up. Fortunately I had a brass rail type headboard with lots of places to grab and grunt myself in and out of bed.
Ugh - I am there, right now. Injury was on Tuesday; it seems to be just some muscle damage around the area, without anything fractured/broken this time. Riding the bike is easy. Getting on the bike is mostly okay. Getting in and out of bed is a seemingly superhuman task that I've got to be mentally prepared for. And please, don't make me laugh.
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Old 07-06-19, 03:39 PM
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Originally Posted by wipekitty View Post
Ugh - I am there, right now. Injury was on Tuesday; it seems to be just some muscle damage around the area, without anything fractured/broken this time. Riding the bike is easy. Getting on the bike is mostly okay. Getting in and out of bed is a seemingly superhuman task that I've got to be mentally prepared for. And please, don't make me laugh.
For me, without something to pull on, I would roll over onto the uninjured left side (which was painful but doable) pull my legs up, and then push up with my left arm rotating on my thigh to upright.
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Old 07-07-19, 07:23 PM
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Originally Posted by wipekitty View Post
Ugh - I am there, right now. Injury was on Tuesday; it seems to be just some muscle damage around the area, without anything fractured/broken this time. Riding the bike is easy. Getting on the bike is mostly okay. Getting in and out of bed is a seemingly superhuman task that I've got to be mentally prepared for. And please, don't make me laugh.
Ouch. Kinda makes ya wish for a hospital bed, or a dump bed that slides us gently toward the foot of the bed.
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Old 07-09-19, 05:25 PM
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For me, I start doing whatever training I can tolerate without much pain. Your body will tell you.

With my broken collar bone, I was back out on the bike in 2 weeks, riding a mountain bike on smooth roads only.

When I broke my hip, that was nasty. Surgery, followed by a 5-day stay in the hospital. Still, after 6 weeks I was able to get on an indoor trainer with my wife's help. Surprisingly, I could pedal without pain, even though I still couldn't walk without crutches. After a week on the trainer, I got back out on the road, carrying a folding cane in my jersey pocket (still couldn't walk). Then I just rode as often as I could.

Doctor's visit at 10 weeks...
Doc: You're healing well, so you can start biking again.
Me:
Doc: You're already riding your bike, aren't you?
Me: Yeah, for 3 weeks now.
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Old 07-10-19, 12:39 AM
  #23  
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Thanx Guys! In my situation its very useful answers.
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Old 07-10-19, 09:06 AM
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"Listen to your body" is definitely part of it, and I consider it to be the ultimate veto over whatever plans and goals we may have established for training. On a daily basis even. But I don't think it's an answer to training because it's so subjective and dependent on our internal awareness which can be misleading. Plus we all have different tolerances for pain.

I'm going to later put up a summary of the training schedule from the time of injuries until whenever it all stops hurting, under the assumption that what was possible for me - presuming no ill effects - would at least be a baseline that anyone could replicate or push beyond. I've kept a spreadsheet for this year for running and have a log for cycling, so I can know exactly how much I've pulled back or can improve to. Hopefully the detail can be of use to someone - I know that I'd have liked to see something like that.
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