Training Board

On June 1st, 2003, I broke my right tibia and fibula while hiking on a wilderness trail near the middle fork of the Pigeon river, in Haywood County, North Carolina. It was a nasty spiral fracture that surgeons repaired with a very cool piece of body-technology, a titanium “nail” that went right through the center of the tibia, and three screws to hold it in place.

Once my leg healed, it was deformed, certainly, but strong: the nail never held me back from snowboarding, skateboarding, surfing, running, or working out. There was, however, always some pain. Now, at the suggestion of my doctors, I had the top (aka the “proximal”) screw, the one near my knee, removed after about 6 months. From the beginning, it had caused me pain and irritation; that pain went away once the screw was removed. But, for years, I have lived with the dull ache caused by the titanium nail itself and two lower (aka “distal”) screws that held it in place.

Like I said, that pain never stopped me from doing the things I loved. But, a little more than a year ago, CrossFit came along and challenged my body in a new way. After about 8 months of working out in CrossFit style, it seemed like something was different in my leg. What had been aches before became shooting pains. What had been discomfort became intolerable.

My hypothesis about the new pain is as follows: intense exercises like sprinting and jumping, not to mention dynamic, heavy Olympic lifting, were pitting the flexible but naturally strong bones and tendons of my lower leg against the super-strong and super-rigid titanium metal inside my tibia. In that contest, the titanium wins. And the nerves and tissues react, and not in a good way.

The doctors had always said, if this hardware ever bothers you, we can take it out. Once the bone is healed, you don’t need the hardware. This advice had always been in the back of my mind. But I never felt overly inconvenienced by the pain.

But at some point, around December, I reached the end of my patience. I had even tried a hiatus, an 8 week hiatus, from running. But it wasn’t working. So I went to a trauma surgeon here in Asheville, NC, Dr. Michael Frisch at Mission Trauma, and asked for his advice. He did advise taking it out, although he didn’t promise that the surgery would solve all my problems with pain and discomfort. One reason for removing the hardware, besides the pain I was having, was that highly active older people sometimes actually rebreak their bones around the implants. Apparently, older bones get softer, and more brittle, but titanium just stays hard forever.

The hardware they removed from my right tibia.

After my surgery, recovery went really well. As the blog entries over the past few weeks testify, I was feeling really good after two weeks. Pain was reduced, swelling was reduced. There had been ZERO seepage on the wound over my patellar tendon. I had full range of motion back in my knee… although not without some pain. And so, against medical advice, I was a bit more active than I should have been. I had completed a total of 5 workouts in weeks 2 and the first half of week 3 after the surgery. Admittedly, I was taking it easy in the gym, but it felt good to stay in my training cycle.

Then, after 2 and a half weeks, I had my staples out. It was very exciting. Very cool. I figured that I was in the clear. A few more weeks and I’d be back in full force.

Then came last Friday, Feb. 19th. I had a good workout, my sixth since the surgery, that morning. Everything seemed fine. Then in the afternoon, while standing at a podium in a meeting, I pulled over a chair and kneeled on it with my bad knee.

There was no pain, but after a while I noticed something funny. My knee was wet! I looked down, and there was a puddle of fluid around my knee, and my pants leg, I discovered, was soaked. I pulled up my pants and looked at the wound. It looked fine. I had some tape on it, to protect it, and the wound didn’t look like it was leaking. So, I decided (wishful thinking) that someone had spilled water on the chair!

Later, when I got back to my office, I realized that my knee was leaking plasma all over my leg and shoes and the floor. It was disgusting. I went to a pharmacy, got some supplies, and cleaned and carefully bound up my knee. I called my physician’s office — he wasn’t in of course — and they said, “don’t worry about it, these incisions sometimes open up a bit.” I said, um, yeah, it’s gushing fluid everywhere. But she said I’d have to go to the ER to get anyone to look at it. I decided to take care of myself over the weekend and see how I felt. But that night, while talking to my dad, a knee surgeon in Oregon, it became clear that a doctor would advise that I take this re-opened wound very seriously.

Over the weekend, I kept the wound clean and taped up. But it was definitely looking gross.

Monday AM I thought I felt fine. I went in to work out as I usually do, although I knew I would have to try not only to avoid using my leg, but even to avoid jostling it or bending it. I quickly realized that I couldn’t work out at all. A kind of fearful malaise had set in. I talked with my friends, Drs. Tom, and Rustan, and Dan, and all of them thought my wound was a serious concern. Tom demanded to see it, and made me take off my tape. Looking at the gaping hole in my leg, Tom pulled out his hard-ass doctor “bedside manner.” Matt, he said, (I am paraphrasing), you are a fucking idiot if you don’t go see your doctor right now, this morning. And I hope he yells at you, because you really fucked up here. That’s an open wound, it’s going to get infected, and then you’re going to be fucked.

Long story short, I took Tom’s advice to heart. I saw my doc that morning. And we decided that I might need some antibiotics, in case any sign of infection showed up, and we considered two options: (1) sewing it back up and taking our chances, the downside being that there was a lot of fluid coming from the wound, or, (2) leaving it open, packing it with strips, and letting it heal “by secondary intention.” I didn’t like the sound of option 2, so I asked the doctor to at least close the wound slightly. He put in two stitches, and told me to contact him if there was any sign of infection, like, fever, redness, pain, swelling.

I had a fever of 103 by that evening. My wife got the antibiotics for me. And I started taking them. The next morning my knee was the size of a cantaloupe. And very painful. A damn infection.

Next day, Tuesday morning (yesterday), I went back to see Dr. Frisch. He took out the stitches, and a stream of nasty yellow fluid literally squirted across the exam room. And he sent me home with the craziest treatment plan I’d ever heard of. Pack the wound with sterile, antibacterial strips, wrap it, and let it heal by secondary intention.

Turns out, my dad informs me, this is the gold standard of care for wounds like this. But the trouble is, it means I have to let that wound heal for as long as it takes. And it could take a month.

Is it gross and weird? Hell yes! Check out the photo set I put up on Flickr illustrating what I have to do twice daily: http://www.flickr.com/photos/mcbalz/sets/72157623497367140.

The Training Cycle and Wound Repair

It took a full day for it to sink in. I realized today that this means that my training cycle and routine really have been interrupted. No duh! Ok, so I didn’t really acknowledge that fact after the surgery. Why? Because it fell right at the start of the final week of one of my cycles, a rest week. And by a week later, I felt ready for light workouts. My recovery would span two training cycles that would be lighter than usual.

But this setback has led me to realize that sometimes, yes, you have to embrace a period of forced rest and recovery.

So, what is my plan? The doctor says this wound could take 30 days to seal up. More than 4 weeks.

This week is a total hiatus, while I adjust to the demands of this leg, and recover from the bacterial infection I developed in my leg and knee. Week 1/4 (4th week after surgery).

Next week, I may try to incorporate a couple of strength workouts on my pull-up bar here at home. We’re talking, like, three workouts such as: 5×5 pull-ups and 5×5 ring dips (mon), muscle-up practice (wed), 5 x max-reps push-ups and 5 x max-reps sit-ups (fri). Week 2/4 (5th week after surgery).

Following that, I may try to return to CrossFit Asheville (March 8th, 10th, and 12th, 15th, 17th and 19th), but will simply NOT do any workout activities that involve bending my legs! Will that suck? Yes, it will. But I miss everybody and I only haven’t been to one workout so far this week. That’s Weeks 3/4 and 4/4 (6th-7th week after surgery).

At that point, I should be healed up. The following week, of March 22nd-26th, will be the 8th week after surgery, and my 5th week of healing this wound. I should be able to return to the squats and unweighted lower body exercises I was doing before the surgery.

Then, beginning on Monday, March 29th, at the start of the 9th week following surgery, I should be able to return to FULL ACTIVITY, including weighted squats, running, and jumping. I will have to do so gradually, and not try to go all out from the beginning. We’re talking: slow running on the sprinting, low weights on the bar, low boxes on the jumping etc. But it will be “normal.”

Beginning April 5th, the 10th week following surgery, I will begin maximum effort training again, AND, add in a serious attempt to return to distance running.

Gotta train for that Warrior Dash: May 22nd, 2010.