Adventures with Internal Fixators – there IS life after ORIF!

If you’re reading this blog post, you’re probably a roller derby athlete and/or a runner with a broken leg. At least, that’s my hope. Wait, allow me to rephrase that! I don’t wish broken limbs on anybody – but if you’re already broken, then you’re likely searching the web for tales of other skaters or runners who have been bolted back together. You want to know what your future with your newly bionic leg looks like. You want to know if you’ll skate or run or jump rope again. You’re probably even wondering whether to throw out all your high heels. You have questions! I may have answers.

I found myself in similar circumstances in June of 2007, when my left tibia/fibula shattered in 11 places. You can read about it here. Long story short: I have 2 plates, 17 screws & a stabilizing rod in my left ankle/calf. Due to the severity of the damage to both bones, none of that jazz can ever come out. I know some folks who have had plates or screws removed later in life, but this is what I’m working with for the long haul.

Pyrobot

My surgeon said that I’d probably always walk with a bit of a limp, that running was out of the question & that I certainly wouldn’t be able to play derby anymore. Looking back on it now, I think he was intentionally challenging me to prove him wrong.  It worked. I played derby for 5 more years and have run two marathons, twenty-three half-marathons and around fifty shorter races since. I’ll never be a pogo stick champion and I’ll always be able to tell you when the weather’s about to get cold, but overall, I’m a better athlete now than I was before I was injured.

It’s been 8 years since my surgery, so I feel like I have a pretty decent grasp by now on what works and what doesn’t for recovery and beyond.  Your mileage will vary, obviously, depending on your pain threshold and willingness to work beyond it.  My observations:

While you’re still in your wheelchair or on crutches:

• Take your pain pills on schedule, but only as long as you have to.  Try alternative therapy if you can. There are plenty of natural pain relievers that won’t damage your body the way that NSAIDs and opioids can.
• Sleep as much as humanly possible, then sleep some more – your body needs so much more sleep when it’s trying to heal.  Your body also heals much more quickly if it’s not full of alcohol or crappy food, so don’t crawl into a bottle of whiskey like I did or eat your bodyweight in french fries.
• Stay active so your general fitness level doesn’t slide completely off the rails. Unless you also have an upper body injury, you can lift weights while seated or lying down.  Here’s the series I did during the three months where I was allowed to put zero weight on my left leg:

Seated: front and lateral arm raises, alternating hammer curls, single-arm concentration curls, overhead press, overhead tricep extension, bent over rows and bent over flyes

Lying on back on a yoga mat or bench: chest press, flyes, alternating rows, pullovers, isometric straight-arm holds

• Start a journal or blog if you’re not keeping one already.  Write about your entire experience while it’s fresh in your mind. You’ll someday be a completely different person than you are at this stage in your injury, and your story will motivate and inspire others if you choose to share it.
• Stay involved with your league if you intend to return to derby. Volunteer as an NSO, brainstorm sponsorship opportunities, take notes for coaches on the sidelines.  Even when it’s hard emotionally to watch others get to skate when you cannot, please know that you are setting a good example as a productive member of your league.  You’re still making a difference.  If you were an “I just want to skate” type before, maybe it’s time to rethink that mindset.
• Now’s a good time to finish that book (and start a new series) or to learn how to crochet. Treat this less active time as a way to exercise your brain. You won’t get quite the same endorphin rush as a tempo run or a scrimmage, but your synapses will fire a lot harder if you’re doing something productive with them.

Stuff to expect during healing that is completely normal:

• Pain: I mean, obviously. But weird nerve twitches, random stabbing sensations, foot cramping, scar tenderness & general discomfort are all to be expected. Totally normal.
• Peeling skin: your foot is going to shed at least once, probably more. It’s going to be really soft & tender by the time you can put weight on it again.
• Cankle that lasts for months post-injury: the trauma to the soft tissue means it’s going to get & stay swollen for awhile. It’ll affect range of motion & temporarily get worse as you get into PT/rehab. Icing & elevating help, but time will be the best cure for the edema.
• Completely overdoing it on your first day off crutches & having to use them again the next day: completely expected & totally normal.

When you’re back on your feet (and you WILL be, I pinkie-swear):

• If you have the time/money/insurance to devote to physical therapy, I highly recommend it.  If you are more of a DIY kind of athlete, then schedule your rehab exercises into your calendar and treat them  like they’re PT appointments that cannot be missed. Yes, it’s boring and unpleasant, but rebuilding your balance and strength is crucial to preventing compensatory muscle imbalances (that can jack with your kinetic chain for years to come).
• Single leg barefoot balance exercises are great for restoring your balance on foot, which will get you back on skates faster.  (As soon as I can get somebody to take some pictures for me, I’ll post a balance workout that can be used to improve anybody’s single-leg strength and stability)
• Strengthen your core.  Not just your abs, but your hips too – your hips are part of your lumbo-pelvic hip complex (LPHC), the group of  29 muscles that make up your true core – where your center of gravity is located and where all movement originates (and in derby, it’s your wrecking ball). Weak hips will increase your risk for knee and (more) ankle injuries, and your kinetic chain is already working at a disadvantage now that your muscles/tendons/ligaments have to reform around foreign matter.  I recommend bridges, planks, hip abduction (I lay on my side and do Jane Fonda-style leg lifts) and hip extension (supermans and scorpions factor heavily into my core workouts).

Returning to skating:

Since my injury, I’ve seen many skaters come back faster than I did, and I am always impressed at those who can flip that switch in their brain again so quickly.  You know – the one that takes us from mortal to human wrecking ball. If you’ve been broken, you know that switch doesn’t flip as easily anymore.  That is completely okay.  Let me repeat that.  IT IS OKAY TO BE SCARED TO PLAY DERBY AGAIN. It is wise to have a certain degree of fear/caution, because it helps you protect yourself as you heal.

Hopefully, your orthopedic specialist understands enough about your sport to have given you a realistic timeframe on when you can return to derby. (I give bout tickets to all of my doctors/trainers/PTs so they can see exactly what we do). My surgeon prescribed a month of non-contact skating before letting me jump back into contact.  I had been so impatient to get back to blocking, but I found that I needed another four months for my scars to heal before I could stomach getting kicked in them.  I reffed until I found myself craving a solid hip check. My league was very cool about letting me jump back into drills at practice when I was ready.

Talk to your trainers (and your doc and PT) when you’re ready so everyone understands where you are physically and mentally. Honest communication keeps expectations reasonable on both sides of that equation.

Returning to contact:

• Getting kicked in the plates HURTS. I wore a neoprene brace for about a year – not because I felt it was protecting me from further damage (that metal isn’t going anywhere), but for the cushioning it provided in my skate boot and the extra layer of protection against contact to my scars and hardware.
• Your metal ankle needs to warm up before you start skating.  Do an active off-skates warm-up that includes some ankle circles, pointing and flexing, etc.  Repeat these with your skates on, rolling on your good foot while you roll your bionic ankle around to let it get used to the weight of your skate.
• Inflammation is normal – for over a year, my metal ankle became a cankle every time I worked out. All of those soft tissues are still trying to settle around the new hardware. Ice, anti-inflamatories and elevation are absolutely the best ways to handle this.  Going to the bar with your teammates after practice will not help. Go home and take care of yourself. Sleep.
• If you have nerve damage, some of that stuff is going to eventually reroute and wake up in unpleasant ways.  Buzzing, tingling, burning and throbbing are all normal. About 4 years after my surgery, I developed a neuroma near the bottom of the inner plate.  It was basically just an angry little ball of hate that would bring me to my knees if you whispered near it. I experimented with a topical prescription numbing cream, got a few unspeakably unpleasant cortisone shots and eventually had a cobbler cut the side of my Reidell 395 low enough so that it didn’t rub Hateball.  It took nearly two years for that intense nerve pain to go away, and I frequently looked back on the dead-nerve time period with an odd fondness – I’d take numb toes over searing pain.  If you’re living with an unbearable neuroma, please go get it checked out and explore your treatment options.  Or tough it out and see if the nerves finally reroute normally, like my stubborn ass did.  I’m clearly no authority here.

The inner ankle of the left skate is cut low enough to fit below the implanted metal

Speaking of skates:

Your boot may not feel right anymore, and styles you coveted before may be wrong for you now.  I thought Antiks would help support my ankle, but the high collar was excruciating. I had limited success with a Reidell 195, but the super-low ankles combined with my narrow heels made me curl my toes too much to try to grip, especially on crossovers (I jammed myself right out of my left skate once – so weird to adjust mid-crossover to having one sock foot). What eventually worked for me: Bonts. Oh, how I adore my Bonts. They’re like running shoes with wheels attached.

Speaking of shoes:

I had to rethink footwear after my surgery.  Range of motion is limited in my ankle and every degree of angle change equates to more strain on my metal.

• Stilettos and narrow, tall heels are out for me now, as they’re not stable enough.  However, I have had excellent luck with Pink and Pepper heels – they have a wide base and stable ankle straps. Wedges are a better choice, but honestly, flats are probably going to feel better from now on. Whichever heel height you’re comfortable with, a cushioned insert can help absorb some of the impact you’ll feel  on the metal.
• Running shoes were also a trial and error experience for me – it’s hard to find shoe salespeople who are familiar with the special needs of the bionic runner. (I really should look into product testing for shoe companies – I think I’d be a good candidate and I could write reviews that might help other athletes)  I used to be a minimalist runner, but my old Adida Adizeros and Nike Free didn’t have enough padding to absorb impact.  Nike Lunarglide was a better choice,  but then I found Hoka One One & never looked back. They’re maximal running shoes & they are the bomb-diggity. The extra cushioning absorbs the  impact that causes the pain of the metal vibrating inside the bones, which means I can run farther and faster without pain. I am actually able to sprint in these, and I never thought I’d sprint without pain again! I prefer the Cliftons for half marathons or shorter distances & the Stinsons for anything longer – I also like the Stinson ATR or the Mafate for trail running.  The Conquest is pretty good for long distances too but it feels a bit heavier than the other models.

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  Not pictured: the Bondi B, which was my first pair & were worn to death before retiring

Returning to running:

As with skating, returning to running was a slow process for me. Single-leg balance exercises helped strengthen my atrophied muscles, but it took awhile to get used to the sensation of impact.  For the first mile, I can tell you exactly where every screw is, particularly on cold mornings.  An active warm-up routine (instead of static stretching) before you run helps tremendously.  Build mileage slowly and ice after you run. Increasing my distance too quickly resulted in strained tendons around the outer plate (and that neuroma popped up around the time I increased my mileage, so take from that what you will).

Other adventures – what works for me:

• Yoga has been one of the best things to ever happen to post-surgery me.  Yoga helped me restore my physical balance, gave me an emotional outlet for my frustration and made me more aware of what my body was capable of doing if I focused my energy.
• An elliptical is a fantastic low-impact way to get your cardio in as long as you’re not on autopilot. Sprint intervals are more comfortable on an elliptical than a track when you have internal fixators.  I like setting the ramp on mine to the highest incline so that it becomes a stair-stepper.  (I miss climbing stairs with my travel teammates, but my knees can’t take the impact these days)
• Swimming and water running: I spent a lot of my recovery time in my mom’s pool, walking through the water or running while wearing a floatation belt. (okay, it was my kid’s alligator floatie. Don’t judge.)

What hurts a bit but I do anyway because I love it:

• Aerial silks: footlocks around scar tissue are unpleasant but worth the discomfort. Some tricks that involve spinning/turning to wrap the silk a few times around the ankle are a little ouchy but again, worth the discomfort & I’ve become desensitized over time.
  

  Yes, my Dark Angel is crooked. It was my first time! I was just happy to be able to invert into it!

• Kickboxing: I have to be careful how I kick the bag with my metal leg. I wear minimalist shoes for boxing (Puma Pulse XT) & we do a lot of plyometrics work in between bag work, so I’m working on landing lightly to offset the impact.
• Crossfit: I can jump rope, but it aches during and after. I can still do squat jumps and box jumps, but I land harder on my good foot to offset impact. Plyometrics are never going to feel great on a metal leg, but you get used to it & you find ways to adjust.
• Tennis (side-to-side, quick movements aren’t friendly to rigid ankles)
• I still do agility ladder training, but I land as lightly as possible, and I’m slower than I used to be.

Bottom line: You have to decide how much you’re comfortable hurting. If you’ve made it this far in your recovery, you’re probably pretty good at handling pain by now. Challenge your limits, but don’t beat yourself up if you move more slowly than you used to or can’t lift as much as before. You’re moving, and that’s pretty damn awesome.
Many thanks to you if you’ve made it through this ramble!  Please feel free to ask me any questions about recovery/rehabilitation and whatnot. I’ll answer them in Life After ORIF Part II: Mom of Steel. I’ll also address some specific derby concerns, like re-learning to snowplow with limited range of motion.  I’ll also talk about getting tattoos on top of scars/hardware, since that’s an adventure in itself.