cycling, injury, and the bigger picture

[vqdriver]

ever since i broke my wrist last year, i've not put nearly the miles or time into cycling that i used to. it just hurt to be on the bars for more than half an hour at a time. interestingly, i've found that road and mtbing is less painful than "gravel" (wince) rides. i attribute this to road rides being mostly smooth, and the suspension fork and different hand position of my mtb. but on my fireroad rides, i have a similar position as my road, with no cush on the front end other than 35c tires. the fireroads here tend to be rutted hardpack with hard edges so that can get fairly harsh pretty quickly. i'm sure the choice to go with a segmented fork (vs carbon) doesn't help. that part's a real bummer because i received and built up my geekhouse shortly before the wrist break, so it sits largely unused in the garage. in the interest of simply riding it, i've ridden the geekhouse on road with the fatter tires which does help a lot with smoothness, but does nothing for positional pain.

thinking that after a full recovery, things would be ok, i stayed off of bikes because i felt that perhaps i was slowing down the recovery. but randomly i'd head to the garage at night to tinker with the bikes. cleaning the dust off, lubing things that didn't need it, refilling tires, etc in the hope that 'hey, maybe next week i can get in a ride'
the hope was to heal up and get back on any bike, but after 16 months, i wonder if this is simply the new normal.

i have the option of a second surgery that involves rebreaking the wrist and grafting some bone from my hip. but surgeons are quick to say that there's no assurance that it would make an appreciable difference. maybe, but no guarantees of course.
my mileage (and fitness) has plummeted over the last year or so and i wonder if i just need to find something else. as mentioned, i can still ride, but i end up fixated on hand position and trying to mitigate the pain for most of the ride. the answer can be to have a second surgery and cross my fingers at a better outcome.

mostly just posting to get it out there. but i wonder if anyone has had an ortho surgery redone with success? thoughts? suggestions?

[ctcyclistbob]

Sorry to hear of your wrist troubles, and I wish you a better 2017 and a healthy future, hopefully involving lots of cycling.

Best of luck with whichever course of action you decide to take ...

[kevinvc]

I'm really sorry to hear about your troubles. These "maybe they'll help, maybe they won't" surgery decisions are really tough and I'm certainly not in any position to give you advice.

As far as possible options, have you tried something like a Jones Loop-H bars that would allow multiple hand positions? Or, if any gripping is hard on your wrist, maybe a recumbent bike would allow you to ride on paved surfaces.

Best of luck to you. I know this sort of injury can be as taxing mentally as it is physically.

[thwart]

http://i.ebayimg.com/00/s/MTYwMFgxNjAw/z/tFUAAOSwLVZVpCT6/$_35.JPG

Just a thought... they're out there.

[FlashUNC]

When I was rehabbing my broken elbow, my physical therapist gave me some context in a particularly low day when I didn't feel like I was making the progress I should.

Her words: "You broke your elbow. Elbows we can fix. Shoulder? That's not good. Shoulders are tough. Wrists? Wrists are the worst. I have a friend who broke her wrist, she's had four surgeries to try to get the fracture to heal. Too many small bones and too much delicate movement down there. Elbows are just a simple hinge. So be glad you broke that and not something else."

Not the best anecdote ever, given your situation, but an acknowledgment that the wrist is a tricky business.

[Ken Robb]

I would pass on more surgery since it seems your only problem is SOME cycling activities. Isn't there is always a chance that more surgery might make things worse? I would try getting the bars up high enough that there is very little weight and pressure on my hands. I would try every different bar that looked like it might provide one or more comfortable positions. I would ride fat tires with or without a suspension fork. Heck, I've had some fun cushy rides on my FS mtn. bike with smooth tires on pavement. It sounds like rough stuff off-road should be skipped.

After my big Ducati wreck my surgeon repaired my shattered scapula and clavicle. After lots of PT I regained most of my range of motion and rarely feel any pain under normal circumstances. When I asked the surgeon if my repaired joint/bones were more prone to breaks in the future he said probably not BUT: If you break them again the pieces of bone would probably be too small to screw together and attach to metal plates again.

My analysis of risk/reward has changed forever. I'm almost 74 so I guess it was time to be more cautious anyway. :beer:

[R3awak3n]

I am really sorry to hear. I broke my ankle 2 years ago, its still wonky and I have come to the conclusion that it will never be 100%. Its at 90% and sometimes its at 80% and it hurts, more when it rains and some times just a random pain if its in a weird position for a certain amount of time. I am lucky that it feels pretty good on the bike, its funny because I rather be on the bike than walking, after a lot of walking the ankle hurts but I can ride for a long time and only sometimes I feel pain in it. Run? forget about it but I hate running anyways. I also think it is getting better, very very slowly but it feels much better than a year ago so my hopes is that in 10 years it can be at 95%.

I understand that pain will ruin your ride and that is a huge problem but maybe it will get better, I would not give up on it just yet.

[pcxmbfj]

Every case is unique so mine is different from yours.
I just turned 69 and in April went down on the bike and broke bones in the scapula, ribs, and pelvis.
Also reinjured the ACL in right shoulder, this side is where all the injuries were.
When I left the hospital I couldn't walk without crutches.
When I finished home rehab I went to a PT and a personal trainer weekly.
The only activity I could do was swim.
My trainer took a holistic look at my wanting to recover to cycle and we worked on overall strength and flexibility.
I worked up to swiming slightly more than a half mile a couple times weekly.
Got to get on the bike after six months, released to full activity after seven.
Continued strength training and stretching and in better overall physical shape.
Just rode local park trails and was able to set the pace for the group.
It will come.

[Seramount]

When I was rehabbing my broken elbow, my physical therapist gave me some context in a particularly low day when I didn't feel like I was making the progress I should.

Her words: "You broke your elbow. Elbows we can fix. Shoulder? That's not good. Shoulders are tough.

interesting to hear about others that are working thru various injuries...maybe that's in the 'misery loves company' category tho...

still nursing a shoulder from a hit/run incident in Aug.

I can swim and ride with it, but it's constantly sore, weak, and makes awful noises that are indicative that it's pretty far from normal. no broken bones, all ligament, tendon, rotator cuff stuff...

no advice, just hang in there...do what you can do.

[vqdriver]

thanks guys.
always nice to know when you're not in it alone.

i've asked for PT, but the underlying issue seems to be that the radius healed a bit shorter than the ulna leaving a bone protrusion that some bundle of tendons/nerves/ligament mess has to go around. since that path is now a hair longer, that bundle is under constant tension when gripping a handlebar. some positions more than others. this is not something that can improve with PT since exercising it just creates more inflammation and exacerbates the pain.

i'm trying every month or so to see if i can tolerate more and more time in the saddle while keeping a second surgery in the back pocket for now. it's not a preferred solution since there's always a chance of complications/infection/worsening.... but if it's something i'm going to do eventually, i'm better off doing in sooner rather than later.

flashunc, that pretty much echoes what my hand surgeon said in that the wrist joint has to bend, twist, rotate around itself and grip with strength. we ask a lot of it without ever thinking about it.

on the bright side, it's excruciatingly painful to bend it back with any pressure on it, so no more push ups for me. :D

[R3awak3n]

would different bars help? you could build a bike with say some jones bars for now till hopefully the pain gets less or goes away entirely.

[vqdriver]

re different bars, i suppose it could help. the least painful position is the hoods. bar tops aren't great but curiously mtb flatbars are better, i'm thinking maybe because my mtb geo puts me farther back with less weight on my hands. keep in mind, i haven't found a painless position yet, just differing degrees of pain. some take more time than others, while others induce numbness and weakness rather than pain. nerves are weird.

[pcxmbfj]

Also, a few years ago I cracked left hand scaphoid (bone in soft area between thumb and finger) could only ride a tri-bar with barend shifters.
Most weight was on my forearms and shifted with right hand.

[shovelhd]

I look at it this way. You are barely riding now and even so, with pain. Something as simple as bending your wrist back is excruciating. It's been 16? months. It's not going to get much better.

I'd get a second opinion on surgical options. If they concur, even if they use a different approach, what have you got to lose? If the odds are 50/50 or better for relief, you lose another year of cycling in pain. What is that worth to you?

My situation is a good example. I shattered my left collarbone into six pieces. My doctor used a removable rod and bone grafts to tie it all together. The odds were 90% that it would all work out. I have full strength and no pain. On the other side, I have a grade 3 separation of my right shoulder. There is only one tendon left holding it all together. I could have opted for a surgical solution, but two doctors gave me a less than 50% chance of success. I chose not to operate. I have lost strength and have occasional pain, but nothing excruciating. I chose to live with it.

Good luck with your decision.

[soulspinner]

Heres to you finding the right path/people to enjoy this thing we do. I know how hard its been to be off the bike, watch my fitness crash, actually feel some depression not being on the bike. Here is to 2017 being pain free for you.

[Tandem Rider]

Sorry to hear about your wrist issues. I know that wrists take longer to heal than just about anything else. I have broken my right one once and my left one twice, most recently about 30 years ago. I do still have some issues with it on rides, have to keep moving my hands around. I was not kept off the bike from it though, never that painful.

What is the medical prognosis for further improvement if you do nothing?

It sounds to me like it's time for a second and maybe a third opinion from specialists. If it gives you that much trouble riding, it's going to affect other activities too. It's winter, you've already lost one season.

[2metalhips]

I've been using On-One Mary bars for 8 years on a rigid mtb, rocky technical terrain, very wrist and hand friendly. A more natural wrist position, similar to Jones bars. Might be worth a try. Good luck.

[merlincustom1]

if you haven't already done so, you need to see the best wrist surgeon in your area, or even out of area, Mayo Clinic, Hospital for Special Surgery in New York, etc.

[vqdriver]

just an update on this since the recent cold spell and rains had me set up the trainer inside. i've been able to do some incrementally more time on the bike. 30-40 minutes without pain. i can feel it, but it's not painful. honestly, the boredom of indoor riding gets me off the bike before anything else. i wonder if it's the warmth inside or the ability to sit up for longer periods, but it's encouraging for now at least.

[RC.]

Best wishes in your direction. I hope 2017 looks up on the injury front.

[stien]

With absolutely no knowledge of how or where you broke your wrist let me recommend turning your shifters inward towards the stem (slightly) on your road bike. It makes for a much more comfortable, natural (can I say intuitive, or does Sram have that word copyrighted?) position.

[vqdriver]

With absolutely no knowledge of how or where you broke your wrist let me recommend turning your shifters inward towards the stem (slightly) on your road bike. It makes for a much more comfortable, natural (can I say intuitive, or does Sram have that word copyrighted?) position.

hrm. interesting. haven't considered that, i'll give it a shot.
fwiw, wrist broke while sliding. think baseball slide with one hand down to catch yourself. fairly common break from what i hear. :rolleyes:

[Gummee]

If your wrist hurts on a regular road bike, try a TT/triathlon setup.

...it'll at least get you back out there.

HTH

M

[benb]

Best of luck.

All I did was "bruise" my Hamate bone in 2014, I didn't even break it, but I still think about it/deal with it every day. Sounds like a different kind of pain but mine is a PITA too.

I had a bunch of PT after I got out of the brace and off the meds (might as well have been casted), it helped but the brace + meds wrecked my forearms. Very weird but I ended up with problems in the other arm too. I swear the medicine they put me on did something.

I still get weird issues with weight on my left hand, the one I bruised the hamate on. Basically pressure in that area is still doing something to the nerve, I get these weird cramps in my triceps. Pushups cause it like crazy, bike causes it some, but I could sit there and do bench press or dumbbell presses all day long and it won't happen at all. I had tingling and stuff and that is mostly gone.. but it's taken forever to go away.

Massage at the PT always seemed to help with the muscle issues that came about as a complication. But then they just sent me home. Finally in the last 6 months I bought one of the mini foam rollers, 13" x 5" or something. I use that 2X per day on each side of my forearm on the ground and then use it against a door for my triceps. It's helped a ton, lots less wrist pain. I just wish the doctor and PT had told me to do that 2 years ago.

It could just be yours could take several years to continue healing too. Who knows. Things will get better. I had a great 2016 riding and I'm not really sure why 2017 would be worse.

[kunfuzion]

I'd look into non evasive methods before deciding on surgery. Try visiting a specialist to see if they can identify any underlying problems that can be improved through physical therapy. But in the end, I hope you're able to find a solution that allows you to do what you love.

I'm in a similar situation since getting hit by car and dislocating my shoulder. I'm just barely get my mobility range back but the pain and aches are always present, especially with all this cold weather. The loss of fitness has been the most frustrating since race season has started and I'm not used to not training.

Good luck to you!

[572cv]

There is a great article in last week's New Yorker : "Tell me where it hurts" by Dr. Atul Gawande. Any of you who have read his pieces before will know that his observations are most useful, good reading as well.

The gist of the piece is the particular value of incremental care in medicine, without taking away from the particular value of interventionist care, the later including surgery. Incremental care takes time and thought, adjustment, gradual change. Both methods have value, but Gawande discusses the pre-eminence in the public mind of interventionists- skilled surgeons,etc as heros. Most people don't have the patience for the slow approach, but it can achieve success when intervention cannot.

All of us go out on bikes and are vulnerable to the kind of injury you have suffered. We all dread the possibility, and commiserate with you on yours. But as you note, it may be that you have to change your expectations, extend your timeline, and look for incremental gains. If the vignettes in the article are any indication, it is well worth looking into developing a consistent but flexible program with a guide (doctor, therapist, etc) whom you can trust. It could even work. Best wishes on a solid recovery.

[Pierre]

Man, what a downer. I'm thinking a relaxed TT set-up over the short-term and as many wrist exercises as one can dream up for a good 9 more months. I would see where you land with that before contemplating a surgery that could arguably set you back to square 1 with nothing gained. Good luck, don't give up on biking just yet.

[shovelhd]

Glad to hear you are riding again.