I was never a slouch on the bike. A veteran of 5 full Ironman triathlons (I say full, as now half is often talked about as Ironman), countless long course triathlons, a few long fund-raising cycling events, a few weeks ago I found myself in my first Aquabike race (long course triathlon with no run!) experiencing what it was like to be at the back end of the race with not a lot of fuel left in the tank. However, instead of feeling despondent, I was grateful even to be competing, although I do use that term loosely – it was more like just ‘going around’. Here is my anecdote of clawing my way back to some form of competition, and how being a good patient has paid off.
During the last 18 months I underwent three separate orthopaedic surgeries. Two for my left shoulder related to a fractured clavicle and one for my ‘good’ knee. Or should I say ‘slightly better’ knee. I had always been superwoman, running and cycling well into pregnancies, bouncing back from injury and knee arthroscopes, however being over 50 now, the healing process was very much slower. There are many reasons we don’t heal as well when we age, and these include, but are not limited to, age-related loss of muscle (this is called sarcopenia) and changes in the quality of our collagen – this happens especially women in the perimenopausal age bracket (me).
As ‘superwoman’ I had previously dealt with my own injuries, with the odd squeezed-in physiotherapy treatment or massage – a bit like the old saying “Physician heal thyself”. I had always been very diligent with my bike fits (thank you Lyndon), which help immensely as your body changes with age and injury, but this time I needed to do more. So, with the help of Joe and Stephanie, the physios at Hip Sport Spine, I booked in my appointment times, and began the long process of rehabilitation.
It was discovered during the knee surgery to remove an osteophyte that had become wedged into the joint space and locked the knee, that I didn’t have an ACL (anterior cruciate ligament). Hmmm, that was probably due to the mountain bike crash I had late in 2019, when I wasn’t supposed to be riding as I had a metal plate in my clavicle. See, I was never a compliant patient. Based on contemporary evidence, I decided not to have the ACL repaired, but to push on with conservative rehabilitation.
Following the knee surgery, I could barely stand up from a chair without pushing off with my hands, couldn’t walk properly, and my first attempt at getting on a bike left me struggling to ride up a small hill. Joe has managed my knee with manual therapy and exercises over the past 12 months, and I have been very obedient with my home programme, which Joe has progressed. A year later the knee is very much improved. I’m able to cycle pretty much unencumbered, although I am certainly not as powerful as I was a couple of years ago. The foray back into competition by entering the Aquabike event (2km swim, 90 km ride) was a stimulus for myself to get back into the pool and also to start to cycle regularly again – sometimes we need those goals to push us otherwise it is easy to wallow in a bit of self-pity and/or frank laziness.
Surprisingly the shoulder has done well with a self-directed programme of strengthening and returning to swimming. The big limiting factor now is my achilles tendon, a grumbly old injury which has flared and
become tendinopathic partly related to altered loading, due to the (other – slightly worse) knee. Stephanie and Joe have used our real-time ultrasound here at the clinic, to measure the thickness and swelling of the tendon, the appearance of the tendon, and the amount of neovascularity (increased in blood vessels) in the tendon. The latter is thought to relate to the pain in the tendon. Since December Steph and Joe have regularly imaged the tendon and measured it, using ultrasound. The swelling and the neovascularity have reduced. Having the measurement tool of the real-time ultrasound has certainly helped to design the progression of my home programme, and sticking to my home programme and my regular appointments has allowed me to make progress.
My plan? I am hoping to be able to resume walk-runs, then short runs in the middle of the year. The goal is the Noosa Triathlon in November. If I am unable to run 10km by then I will switch to a team event and have a runner, but I will still compete in the swim and bike legs. Now, achilles tendons sometimes never fully recover, so if I am limited to Aquabike events and cycling in the future then so be it, and my goal will be to become the strongest cyclist I have ever been. And I will continue to be a compliant patient when required!
Three weeks ago my other knee (the original ‘worst’ knee) had a similar incident when an osteophyte became dislodged – yes, off to my orthopaedic colleague to have the osteophytes remove – however this knee has resolved very well as it still has an ACL and the other parts of the knee look relatively okay, and I’m back on the bike with less pain than I’ve had for a long long time. My goal is still Noosa in November!