Static exercise set mark 1

Here are some details of my initial 'floor' work outs. All of these can be done without any equipment. I started doing these workouts as soon as the pain allowed me to get onto the floor. I aim to do at least 15 minutes of these a day. I'm now adding in additional workouts that I will include in each subsequent blog.

Issue one: getting down onto the floor.
This can be surprisingly tricky if you're non-weight bearing on one leg. Here's a video of how I managed it. It took me a while and I could only manage this once the pain had eased sufficiently (if I'd tried this in the first 10 days the jolting would have been too much to bear). Once you're on your front, you can then flip over onto your back. I'm limited by the fact that I can't kneel on my good knee either due to the soft tissue injury on that side.

floor sets for core:
Abdominal crunches - you can do these with legs in full extension. you may need some help to stabilise your legs for comfort, but this can be done with no supervision as you become more confident. If like me you're in a Donjoy brace, you may find it helpful to lock it at 0.


Full sit ups - these required a slight flexion in my leg before I could manage. It helps to have someone with you at first to stabilise your legs for you whilst you work to engage your core.

Leg raises - lying on your back, and using your good leg to support your bad leg, raise both legs simultaneously off the floor and lower again. Again, with a Donjoy, it helped me initially to lock it at 0 until I got used to


Abductor set - Lie on one side and raise your upper leg (It was incredibly liberating when I realised just how much mobility I still had in my bad leg. My quads were limited, but everything else could still function very well. Abductors have been the most helpful, particularly in getting into and out of cars.


Static quad - sit upright with legs out in front of you. With your good leg, press the back of your knee joint into the floor. Now try to repeat that with your bad leg. You should see your kneecap moving upwards as the quad muscle comes into play. You can play around with this exercise. Try engaging the muscle and holding, or doing a set of reps where you engage then release.

0-70 in 10 seconds

I reset my brace!

Since my operation I've had:
weeks 1-2 leg locked in extension
Weeks 2-4 knee flexion limited from 0-30 degrees.

Now, my brace is set to allow movement from 0-70 degrees for the next 2 weeks. After that.....well, that all depends on what my 6 week follow-up appointment brings and how the fixation looks on my 6 week xray. I'm really hopeful that at this point they will say it's ok for me to start working in the pool.

So my knee had been allowed no more than 30 degrees of flexion for the past month. It's still very swollen, the joint isn't really recognisable as a knee yet. The swelling extends around the whole circumference of the joint so the tendons along the back of my knee joint are barely palpable. I knew the swelling would limit my knee movement.

With the brace set at 30, the movement felt quite free and I thought that once the brace was set higher the extra flexion would come fairly easily. But it really didn't! As soon as I tried to flex, my knee pretty much just stopped at 40 degrees. It's a weird sensation, it wasn't exactly pain that stopped it, it just stopped, like something was blocking the joint. I've spent the day gradually easing the joint through the extra degrees of flexion, which has been painful. I've probably overdone it a little, as the joint is feeling pretty hot and tender now. But I can now flex from 0-50 quite freely. The extra 20 degrees require me to ease into it and work at it. I'm going to give it a rest for the evening now and try some ice on the joint to ease this swelling and heat.

As another exciting distraction I got another new bit of static exercise kit today in the form of a hand bike. It sits on the table and you turn the pedals with your arms. I worked out on it for 20 minutes (limited as my shoulders and wrists are suffering a bit from my crutches) and I managed to work up a bit of a sweat!

Next blog will be more details of my current workout sessions for anyone who's interested on how to exercise whilst sitting on your arse!!

Victories:
Not being despondent when my knee didn't instantly flex to 70 degrees, but working the joint slowly until it did.
Being sensible enough to know when to give it a rest.

70 degrees of freedom

Again, the feeling like being a toddler on Christmas eve...
Thursday is the day I get to set my brace from 30 to 70 degrees of flexion.
'Progress!!' my mind screams, and I feel one step closer to running the moors again!

I need something like this this week.. It's spring. Autumn and spring are my favourite times of year to run. The changing weather and with it the changing trails give me a feeling of joy, peace, happiness and makes my soul feel open to the world. It's one of the very few times that I feel part of anything, like I belong to the earth.

So, the recent change in weather, the lengthening evenings, the sprouting plants, the buzz coming up through the earth...and being unable to run on it...it's driving me mad! Like a terrible itch that I just can't scratch, or a glass of water that is just out of my reach!  So far I've been trying to deal with this by burying my head in the sand, keeping the curtains closed, ignoring the sunshine and cursing the singing birds every morning. My weekly alcohol intake has definitely increased as I try to numb the call of the trails.

I've been trying to scratch the itch with my evening workout regime. I've got some pretty good sessions going now, with the help of Jason as a sparring partner. Getting my heart rate up a little and breaking out into a light sweat, it does make me feel a little better and takes my mind off my loss.

But, nothing replaces the trail.
So yesterday I went for a walk. Well, a hop. Off-road. And it was.....well, it was wonderful. I put my long-distance playlist on my MP3 player (lots of hypnotic music. Gregorian chant, Byrd, Tallis, John Tavener and Arvo Paart.). I left the road through our village and I went up one of the trails and through the fields. I got stuck in the mud, I sat on a gate and watched the birds, I washed my crutches in the stream.
And so I discovered that I can find peace and contentment, even when I'm not running. I can even get a fleeting sense of the meditative state that I feel during an ultra. It's a very, very valuable lesson to learn

Always there for me. 

Stuck-in-the-mud

Now, to 70 degrees of flexion, and whatever the next stage of my recovery brings!

Victories:
Learning that I can find at the very least a shadow of my running contentment by being in the right environment, at the right time, with the right music and the right frame of mind.

Things you shouldn't say to an injured runner - warning, sense of humour failure!

Below are a selection of comments I've had from a few *less than* thoughtful people since this happened (none of whom are at all likely to be people who would read this blog which is why I'm happy to publish them!)

In each case what I really wanted to do was to pull the person inside my mind and let them feel my pain and loss at not being able to run, and the effect their comment has had on my psyche. Or maybe to invite them to witness me sobbing uncontrollably during my designated 'sadness' times. Then maybe just think a little.


1. 'It's the worst patella fracture I've ever seen. This is going to really affect your running.'
This statement comes under the headings 'blunt' 'thoughtless' and 'stating the bloody obvious'. Yes, my entire knee is going to function differently. And you think that will impact on my ability to run? Wow, you frickin' genius.

2. 'At least you'll lose that terrible gaunt runner physique, and become more womanly.'
So I'm going to be unable to run, AND I'll get fat? Double whammy saying this to a runner who used to be anorexic!

3. 'All that training and you won't be able to compete this year'
Yes, I had realised that, but thanks SO much for reminding me.

4. 'Well that's your cardiovascular fitness out of the window. No amount of weight training can maintain that without your running'
And my resting heart rate used to be 45 and is currently 70. How about you give me another kick while I'm down?

5. 'Hey, tried running yet' - followed by a wink and a laugh
No. No I haven't. I'm not weight bearing, my knee is only flexed to a max of 30 degrees, and I know that it's going to be another 4-6 months before I can even contemplate this. But, hey, GREAT joke!! What do you mean, 'sense of humour failure'?!

Each of these comments has elicited the same response from me. 'Yes, it is terrible. But it could have been worse, I could have cracked my skull open or snapped my neck'.

In short, we runners are a physically tough but sometimes emotionally sensitive breed, and sometimes, just sometimes, it's better to think about the impact of what you're saying on a delicate and endorphin-deficient mental state.
Rant over.

Short and SWEET!

Oh by all the Gods, I just managed my first straight leg raise!!
And then managed 2 more!!!!

It's the little things that are now a massive deal to me!
I'm going to have a beer to celebrate!

Quads-r-us!

The beginning of the end of the beginning

Delayed publication due to police investigation.
This is a long blog, documenting my recent accident. I've written in detail.

Over the Christmas period I had suffered from a depressive episode, which had really taken its toll on every part of my life. It also resulted in me having to cancel my plans to travel to Sierra Leone, as I was not in any fit mental state to manage such a major change. I had to come to terms with how my plans would have to change. I was still able to run, but I was getting very little joy out of it because of the exhaustion that comes with depression and I knew I was doing it more to preserve my little remaining sanity. Endorphin chasing to take the edge of the misery. By the middle of January I was more settled on some new medication and was starting to feel small tendrils of hope pushing up through the mud. I had plans for courses to go on,  races I wanted to do, aims to get selected to the GB trail team again and a bit of traveling I might manage if my mental state continued to improve.

On 20th of January I fell whilst training on the coastpath, splitting my knee open on a rock. The cut went right down to the bone and needed suturing, and the knee itself was very swollen and painful. Dad told me that I wouldn't be running for a couple of weeks at least. I limped around in a bad mood for days, snapping at family, whinging about how I was going to get fat. By day 9 I tried to go for a run, got 3 steps and was stopped by the pain. Huh. Well, at least now the wound was closed I could swim. And with the AoA a definite no-go, I was pretty confident I would heal in time for Transgrancanaria in March, which was my first A-list race of the year. I could not wait to hit those mountains!

On 30/1/16 I went for my first swim. 3.5K later and my knee was feeling a lot looser and I was feeling a lot more optimistic! I spent lunchtime cleaning my road bike and then late in the afternoon I decided to give my knee a try on the bike. Setting off up the hill from home I felt a little stiff, but my knee handled the rotational movement well and so I carried on down through Horrabridge towards Tavistock, planning to do a loop of the town and head home again.
I worked hard down the hill from Grenofen as it was raining and I didn't want to get cold by just coasting. I wasn't thinking about anything in particular.
What happened next happened so quickly, but the time involved also seemed to become stretched out. I saw a car pulling across the road into my path, turning off the far lane into the car park of Lidl. Directly into my path. Seemingly moving so slowly. In my mind, I knew I was going to hit it. I was cycling down the road with no reason to stop, and had not been slowing for any reason as I had right of way, I was probably doing between 15-20mph, and now, here was this car, in my path. I thought briefly about what I could possibly do to avoid this. But these thoughts were fleeting, I think I screamed 'No No No' and in my head I was just thinking 'NOT now, this CAN'T be happening.  Everything is just starting to get better'
I don't remember impacting the side of the car, rolling over the bonnet, cracking the windscreen on my way. I don't remember landing on the road on the far side of the car. What I do remember next is intense pain in my right knee and an overwhelming feeling of despair at what, even at the point, I knew were going to be serious injuries. I started crying uncontrollably, screaming and screaming, rolling around in pain (I never understood that phrase before...I do now) while people tried to calm me down and protect my C-spine. I remember hearing a lot of screaming children and people trying to get my details off me while I continued to scream and cry and shout that I just wanted Jason. My knee was in so much pain and I felt it would be more comfortable if I flexed it, but couldn't move it. Wave after wave of despair and fear washed continued to wash over me, and I started to shake uncontrollably. Someone told me everything was going to be ok,  and i just sobbed back 'why this now? Everything was just starting to get better'. When the ambulance arrived I was scooped off the ground into the back, and given entonox for my pain. The paramedics put all the heaters available on, but I was still shaking violently and the Entonox did little for the pain, but did make me hyperventilate. As we reached Derriford I came close to passing out.
In resus I was met by one of the ED consultants 'Hi, I'm Higgy, I'm one of the ED consultants'. I responded it 'Hi, I'm Sarah one of the medical SHOs' at which point he recognised who I was. Jason arrived and I began to calm a little, partly due to the bolus of morphine that I'd been given on arrival. I stopped sobbing and tried to think 'ok, it'll be fine, I'll look stupid because all this is just going to be bruising'. Higgy examined me, cleared my C-spine, my thorax and pelvis. He checked out my left knee, which had a gaping open wound over it. Asked me to straight leg raise, which I could with no problem. Checked my right knee, minor abrasions to the knee surface, asked me to straight leg raise.....and I couldn't. He poked around my kneecap for a bit and then said 'you've broken your patella'.
5 minutes later he had to ask me to try to calm down. The waves of despair and fear were back, and this time they were a tsunami. I knew the implications of a patella fracture for a runner. I went for imaging, and when he had reviewed that he had more bad news. It wasn't a simple fracture. It was smashed into lots of bits. Pretty soon after that I was seen by Mr Stitson the orthopaedic consultant who painted a doom-and-gloom picture of the extent of comminution, difficulty of fixation, potential need for a partial patellaectomy and uncertain long term function. I asked if I would be able to compete again in the future, but all he could tell me was 'we'll just have to wait and see'. The draw-back of having done 8 months of orthopaedics is I have a good understanding of what was going on in my knee and why they were being so pessimistic. I spent the rest of the evening trying to think of the positives; I'm young, I'm very fit, I don't smoke, I have no other health issues, it's not an open fracture and my bone-stock will be good due to the impact exercise I do.
So, Saturday evening left me lying in bed, waiting for my operation on sunday morning, and trying to come to terms with how quickly my identity had changed, and just how different 2016 was going to be compared to what I had planned out. No TGC. No world championship trials. No race to the stones/race to the King double, and no West Highland way. And, most of all, no opportunity to represent my country at the sport I love the most.
Maybe I will still get these chances in the future. Maybe it will only be as a finisher and not a winner. Maybe it won't happen at all.
In the words of  Mr Stitson, "We'll just have to wait and see."

Punching fate square in the face

Well, it's been 3 weeks since my accident. Actually, it's really been 2 and a half, but I'm counting it from the dates of my fracture clinic appointments.
I always like to have things to look forward to and focus on, it keeps me going when my mood drops. Before this happened I had some major points of focus in the coming few months, and my plan was this:

Interview for CMT in February
Transgrancanaria in March.
Skiing holiday over Easter
Expedition medicine course end of March
Hoka Highland Fling for the GB trail team trial at the end of April
MRCP exam in May
West Highland Way race in June
Race-to-the-stones and Race-to-the-king double over the summer (I had free places courtesy of Threshold events)
Spartathalon
I was planning on applying for Less-than-full-time training when I get my CMT position so that I could manage my running around work.

My current list of focus points is as follows:

25th of Feb - DonJoy brace gets set to 70 degrees of flexion!!
10th of March - 6 week fracture clinic appointment when I find out if I can start doing aqua-jogging and swimming!!!!
Thankfully I still have MRCP exam to focus on, and I have managed to postpone my CMT interview until March (it was originally due 1 week after the accident, and I was just in too much pain to manage). I may even make it to the May edition of the expedition medicine course so thankfully that isn't out of the window.
Maybe I'll even manage a 10km race at the end of the year.....

Funny how your plans can change so quickly. In the few seconds it took me to smash my knee I have managed to lose a whole years worth of plans, which were mainly focused around competition. I'm finding it a challenge not to dwell on this, and trying so hard to focus on my new goals and plans. In an attempt to manage this, I have set aside 15 minutes each day when I am allowed to sit, feel despair, cry and dwell on my losses. It sometimes spills over at other times, but it does help to have that designated time of misery.

So, back to the present.
I'm feeling so much better, physically. But I'm drastically limited by the fact that I can't put any weight through this leg. I was allowed back to work this week, which was wonderful, it was so nice to be doing something positive. It has been a bit strange having to repeat the story over and over as people ask me what I've done, and I have found it difficult when people have asked how it will affect my running. But I think it has also served to help me see my purpose beyond running. I love my job, and it was so good to be back.

Now I'm getting more mobile I'm desperately trying to find ways to maintain some kind of fitness. It is extremely challenging! My upper-body strength was pretty good before hand, but I'm now having to use my arms and torso to do any form of exercise, and so I'm finding my weak points very quickly! Our front room is starting to resemble some sort of mini-gym as I buy gadgets that I can use to help with fitness. I'm also lucky to have my own personal boxing coach (I knew Jason's Krav Maga lessons would come in useful one day, I just always assumed it would be to beat off muggers in the rough end of Plymouth!). I have also discovered that I can sit on my bike on the turbo trainer and pedal with one leg (thanks to Kirsten for that stroke of genius!). I'm still a little limited with this due to the pain in my 'good' knee which, although not broken, still took a heck of a smack.
So, my evening workout is currently something like this:
10-15 minutes on the turbo trainer (low intensity as I'm cycling with one leg)
10 minute push-up set on the Swiss ball
15 minute abdominal set (sit-ups, crunches, oblique sit ups)
15 minute boxing set with Jason (this is the only work out I can currently do which gets my heart rate elevated much. Basically, I lie on the floor, Jase stands over me with the pads, and I do sets of jabs, hooks and elbow strikes as dictated by him. It is exhausting, and brings me out in a sweat. I love it!!)
10 minutes bicep/tricep/shoulder/lat work with dumbells.
5 minute isometric quad exercises.

In short, I'm going to end up resembling Popeye. But, it gives me daily focus and a tiny endorphin hit, and so until the 10th of March, this will have to suffice.
If anyone who has read this would like more detail on how to do the exercise set I'm using, please drop me a line!


Take that, fate! Stand still while I punch you repeatedly in the face!! 

Victories:
Managing my sadness in a controlled manner
Finding ways to maintain some core fitness
Reconfirming to myself how much I love my job.