I don’t believe in fate. We create our own outcomes and make what we want out of life. We make a series of decisions that guide what we do, and the rest is up to plain old luck. Sure there are outside influences, we can’t choose our parents or where we grow up and what degree of privilege that affords us, but after a certain point we steer the ship. This is another long non-bike related post, you’ve been warned.
I’ve always walked and ridden bikes looking at the ground to be sure i don’t step on any insects. I remember learning of Jainism in high school and feeling like I had something in common with those monks and that belief system. I’m not spiritual in any sense of the word anymore, but when I saw the Jainist monks walking and making a concerted effort not to kill anything in their path it resonated with me. Since then, as much as it’s practical, I have tried to walk my path avoiding causing pain and suffering in other creatures. When you do this you notice a lot of other things using that same ground as you, and how much their life is left to luck. I do my best to avoid them but inevitably I’ll step on something, an ant or beetle or spider… and i always feel bad. If I see them I will help beetles cross the trail, literally. I see some ants heading back to their nest with seeds, other ants with crushed compatriots or other insects, some many times their body size. Ants are pretty badass. I see those ants and the other insects as individuals like myself, or my dog, just trying to make their way. I’m sure in the time of dinosaurs humans would be a casuality of a foot as well, but I doubt T-rex would have cared much. Each of those ants or spiders or beetles I step on without even trying to is no longer alive because of basic bad luck. I don’t try to step on them, in fact the opposite, but i will eventually fail and ride or step on things that I didn’t want to. This is the way of the world. So no matter how much I plan to not get hurt, use the right ski bindings, ski the right slopes in the right conditions…a lot is left up to luck. Knowledge and skill only go so far, we can only control so much. Bad people get rich and many times live long happy lives; good people sometimes die early of cancer or being hit by a car…there’s no hierarchy based on karma, it’s just what we deem good or bad luck.
It’s been awhile since i posted an update and it’s been FIVE months since i got a plate and 7 screws installed in my tibia. Honestly, i was hoping i’d be further along by now – jogging and riding my bike a lot. But as my surgeon said last Friday after the latest round of X-rays, i still have a long way to go because of the nature of this fracture. By 9 months i should be feeling fully recovered and about a year until i’m back to doing what I was doing before the injury.
For anyone finding this blog by Googling “Tibial-plateau” surgery or “Type 4 tibial plateau surgery recovery” I’ll try to offer some insight on where i’m at. I know how much i’ve googled for information over the last 5-1/2 months on what to expect at each month of recovery and haven’t found as much as i’d hoped other than in message boards which tend to have the worst case scenarios. Each person’s recovery will be unique to them since everyone’s injuries are a bit different. As I write this I am hopeful on making a complete recovery that won’t affect my active lifestyle but I worry about regaining full range of motion, and not knowing if i have any ligament or other soft tissue damage that will need repair down the road. I also know this type of break usually results in some sort of arthritis and pain at the location of the plate. I’m 49 now and don’t know what all of this means for the future in returning to long bike rides and backcountry ski tours but I imagine I’ll at least be able to ride a bike for the rest of my life and hopefully XC ski.
My latest visit to my surgeon was last Friday, May 13th. Bone has not displaced, it’s healing, the main crack that started at the tibial plateau and went down to the inside of the tibia has closed and the other cracks all show callousing – indicating it’s healing (bone growth on the outside of the tibia at the site of the break). The external fixation device holes have finally all closed up but are still visible. The lowest one on my shin wasn’t closing up and got a Staph infection about 6 weeks ago which resulted in my 3rd surgery of this injury since December 17th when it all happened. The doctor put in an antibiotic cement of some sort to plug the hole and a few weeks after the wound had closed and now looks almost like the other pin holes.
I’ve been going to Physical Therapy 3x a week and doing PT 6 days a week for at least an hour a day. The Rx from the surgeon is for range of motion and “light” strengthening work, and only “closed-chain” exercises (no running or hopping stuff). I’m up to 162lbs from 158, before the injury I was 175 lbs. The swelling has gone down but is still noticeable especially around the joint and back of the knee. I’ve tried wearing compression socks, leg sleeves, and knee sleeves, which help with swelling and pain while walking or standing but usually result in increased swelling at the edges of the sleeves and some discomfort if I wear them too long. Hard PT sessions or standing up with a lot of back and forth in the workshop irritate the knee joint and make it swell and can affect my ability to walk for a few days if I’m not careful with taking a break every few hours and icing/elevating. The shin near the fracture still looks bruised. Some days new areas will look bruised (back of the knee) I guess indicating internal bleeding from healing and irritation of the soft tissue &/or bone from PT or overdoing it. Not really sure.
I asked the surgeon if I could ride outside and he turned the question around to me…”I think so” i said, and he said the same, “I think so too”…which didn’t come across as super confident but i’ll take it. “Just don’t fall or get hit by a car.” No problem! At the Physical Therapist this week I was measured to have 131 degrees of flexion and -4 degrees of extension. I’m close but not where I should be: 135 and above is considered good to go, and 0 degree extension is needed for normal gait and is the more important of the two to get right. But it’s also the hardest to get. At this point one PT thinks I may have something blocking my extension like scar tissue or a flap of meniscus, preventing the knee from full extension. I can get to zero degrees of extension but only through massage work followed by pretty aggressive passive (and painful) range of motion exercises where the heel is placed on a foam roller and the knee is bent back and held there. This works for a few days to “open it up” but the knee slowly goes back to -4 deg and stays there until the next extreme extension session. Nothing I do at home can mimic this type of PT so I hope over time it’ll just stick to having flat/full extension.
Things I can do right now: fall asleep without my leg keeping me up because of discomfort, this has been the biggest relief! I can sleep comfortably through the night and sleep on my side without a pillow between my knees. I can get up to pee at night without much pain (I was using a commode for the first couple of months then a pee bottle so i wouldn’t have to get out of bed). I can drive legally and safely. I can walk my dogs in the morning totaling a mile or so. I can finally ride a bike outside as long as the hills aren’t too steep and i have easy gearing. I still feel very tentative on the bike outside and don’t like dealing with all the cars on the road, even more now. I can stand and walk around for a few hours in the workshop without too much pain or swelling afterwards. This has been great for feeling productive and getting bikes built. I didn’t realize how much i walk around in the shop, back and forth, stopping, turning and swiveling. This is probably the hardest on my knee unless it’s when welding a frame sitting down at the table. I can balance on my bad leg to put on pants, I can go up stairs but still have some pain in the knee joint when doing so since my quad muscles are still weak.
Things I can NOT do right now: jog, jump, walk fast without a big limp, squat, kneel, lunge more than a little, walk down steeper hills or go down normal height stairs (and when I try to there is pain in the knee joint). I can’t stand up while cycling or go up steep hills on the bike. Most of this is probably due to not having full extension but also because my hip and leg muscles are still not very strong or flexible. It’s incredible how much range of motion and strength the body loses in just a short time of doing nothing.
The positives of this ordeal have been hard to find. The biggest one has been friends and people I hardly know offering words of encouragement and rooting for my successful recovery. The internet has its issues, but it helps a ton in these types of situations. Thanks to all you that reached out and asked how I was doing. I missed a weird but fun looking ski season and bike riding in an endless spring of pleasant temperatures that haven’t heated up much until this week. I’ve got lots of negatives that are pretty obvious but there are a few positives I have tried to focus on. Our older dog Izzy was suddenly acting older about 3 months ago and we thought she had a brain tumor. After a lot of tests she came back with nothing wrong with her muscular-skeletal system and no tumors anywhere…but the neurologist noticed a change in her brain structure that is affecting her eyesight and balance. She sleeps a lot more and isn’t her bratty monster self as much but has become very sweet and cuddly wanting us to be nearby. When we were figuring this all out I was able to spend a lot of time with her on the couch and just enjoy the time sitting with her in the yard basking in the sun. Now that I’m able to walk, we go on rambling strolls and it’s good for both of us to just go slow and be outside. That doesn’t stop her from seeing one of the many feral cats and trying to get me to run after them with her though!
On these walks I can focus on my walking gait somewhat and it’s not easy to NOT limp. I also have been walking on a treadmill where i can focus on how I’m walking and see what I’m doing differently between the legs. That along with a 30 min spin on the stationary bike has made up the last month of exercise.
Several people have asked if i’ll ever ski again. I really hope so! I’m not scared off of skiing even though this has been a horrible injury and recovery. Most skiers have an assortment of knee injuries in their pockets, i feel almost lucky that this was my first. Lindsey Vonn has broken both her tibial plateaus and once recovered she continued racing. My type of skiing isn’t that aggressive and now will be even less so, so I’ll be back since it’s part of who I am and what drives me. On the day i went skiing and broke my leg, it was just bad luck. It could’ve been prevented but that’s so easy to say after the fact. My binding could have released, that would’ve been nice, but it didn’t and it’s probable no binding would have released under the circumstances. I could have zig-zagged down the mountain because the snow conditions were variable and sticky and sludgy. Especially on my 3rd day out of the season without much ski fitness built up yet, this is what i should have done but I thought I could ski through the challenging conditions and not “waste” that last 1000ft of vertical. Never again, i hope i can now recognize that i should just stop and take a breath and survival ski down. Live and learn. It’s part of my process and this injury won’t define me. December 17th, 2021 was my day of being that unlucky ant, except that I survived and will come back stronger.