Friday, June 25, 2010

Muffin Top

I began physical therapy and limited weight bearing this week. Both have pushed the swelling level way up in my ankle. Guess it is par for the course. At my second therapy session, my therapist noted I already showed significant improvement in range of motion. One of the hardest things she had me do was control a wobble board with my left ankle while seated. No weight, no risk of falling or injury, just control and range of motion. It was exceedingly hard to do and mildly painful. It was like I completely forgot how to use my ankle stability muscles.
My therapist was quite confident I'll be walking without crutches when I go back to orthopedist on July 12. This will be in the boot cast, of course. It is one thing to walk with ankle entirely supported, another without any external support. I guess it is a pretty big leap to walk unassisted. For this reason, my therapist doesn't think it is very likely I'll be able to ride a bike a month from now. I at least need to be able to walk on my ankle before I can safely ride a bicycle. This bums me out. This could put me into August before I can ride again, a full three months from when I broke my ankle.

Indoor training was nice at first, as I wasn't tempted to do stuff outside and it certainly was better than staring at computer screens 15 hours a day. But it is already getting old as I ramp up hours and intensity. The doctor cleared me for limited weight bearing, 30-50% of my body weight on my left leg this week, then weight as tolerated after that. 50% means standing with equal weight on both legs. I can now use a proper, standing position on the SkiErg. As expected, power levels have dramatically increased, along with aerobic intensity to maintain it.  I can drive my heartrate to 90% max in very short order and hold it there, punching up to >95% max in my final interval. I was not able to do that while roller skiing last fall. The arms couldn't support it. The question is, as spinning volume increases, will I lose interested in the SkiErg?

Typical workout, spin with boot first 36 minutes, then 12 minute
all-out interval on the SkiErg for 12 minutes. My max HR is
probably around 180bpm right now.

The doctor also cleared me for bootless spinning workouts with the understanding I keep the intensity below what drives pain or swelling, and no clipless pedal for my left foot. My first spin without cast lasted 10 minutes with zero resistance. I had no control of my calf muscle and could not maintain a steady fore/aft foot angle without banging into rails of pain. Foot would wobble back and forth trying to maintain a normal flat position relative to ground. I know I lost about 70% of my calf muscle, but I think even more is going on here, a mental/neural thing. I went so long without firing my calf muscle to protect the injury, so my brain hesitates to finally do it now. Plus, I probably lost a good deal of neural-muscular connection. It all adds up to loss of control.  I was somewhat torn by this, as I was already able to put out good intensity when wearing the boot, but to make progress, I'm going to have to take several steps back and build the calf muscle back up.

My second workout on the spin bike lasted 13 minutes with light resistance. It made my ankle hurt, but I also had more range of motion afterwards. Improved range of motion does not come without pain. My third workout felt much better, and I went 36 minutes, approaching tempo pace for a short bit at the end. Last night I went 48 minutes, touching into threshold regime. So yeah, it is coming back fast. I don't think I will put the boot on for intensity again, as long as the swelling that goes along with these workouts is gone in the morning.

I did notice an interesting phenomenon with my bootless spin workouts. I take long, soft sock off and don a cycling sock which fits snugly over my enlarged ankle. I've read about compression sock and using compression to control swelling from injuries. My foot tends to be swollen at the end of each day, and I can barely get it into an old, oversized sneaker I have. Yet when I finish my spin session, the swelling in my foot seems to be reduced. The improved blood flow is part of this, but the snug sock is another part. My lower leg muffin tops over the lip of the sock. The swelling went down under the sock and stayed the same above the sock.  I now wear one of these socks when I ice my ankle afterwards. I should probably invest in a real set of compression socks.

Left leg after spin.  My right leg did not muffin top.


plum said...

We all need goals Doug.

So here's your goal:

build up these monsters again

rick is! said...

nice progress doug. keep it up!