Introduction
The purpose of this post is to summarise the progress that I have made with my rehabilitation, starting from when I first returned home from hospital, and finishing six weeks after all the major surgery I required was complete. A period of 890 days. By no means was I able to work consistently at a full capacity during this time, but every day I have done at least some small thing to actively work towards a better body. By consistently making small iterative improvements, I have gradually been able to increase the amount of things I’m capable of, and I have made excellent progress considering my limitations.
While at its core this has been a solo journey, I would not have even come close to achieving what I have without the care and total support of my parents. The only way I have been able to stick to a consistent routine with such a ruined body is by waking up each day with nothing but rehabilitation on my mind, pouring what energy I have into training, and in doing so being incredibly reliant on them. They have seen how hard I work, how wearing each day is, and have been very understanding in shielding me from domestic duties and all the bureaucracy involved in being run over by a truck, for which I will always be grateful.
In truth, my progress began a year earlier when I came out of an induced coma and the physical challenge of pressing a button to administer pain relief was a workout in itself. After a few months I was able to start doing some upper body exercises with resistance bands while lying in bed. More time passed and I stood up for the first time and walked from my bed to the door with a gigantic ‘gutter frame’ and it was one of the most exhausting things I’ve ever done. It was only at this point that I began to truly understand the enormity of the task at hand.
As the months rolled by I worked with the physiotherapists at the hospital and built up the distance I could walk with the frame. They also performed lots of manual stretches, and with some interruptions for more surgery, I eventually got to a point where I was able to transfer to a dedicated rehabilitation hospital, roughly ten months after the accident.
There I spent a gruelling two-and-a-half months where I pushed myself to the limit six days a week under the guidance of physios and occupational therapists. I was soon able to use a less gigantic frame, then elbow crutches, and eventually I was deemed capable of managing safely at home (with some modifications to the house and a lot of support from my parents). Since returning home I have used a rollator frame around the house, and a combination of elbow crutches and a wheelchair for outings.
In the few months after the accident my weight dropped from 79kg to 53kg (I am 183cm tall), but by the time I arrived at rehab it had rocketed back up to 93kg. Once I got home it was down to 85kg, and by the time I got around to taking any photos I was 83kg. In retrospect, it would be interesting to have some photos of my body starting from when it was in its most feeble malnourished state, but I wasn’t really in a mindset to be thinking about that sort of thing at the time, and I didn’t start doing anything to document my progress until the start of 2014.
Progress Pictures
Initially it was hard to stand long enough for more than one or two photos to be taken without my hip complaining, so I don’t have as many shots from the early days as would be ideal. I also didn’t really have the balance or mobility to do much in the way of posing for quite a while. Over time I’ve slowly managed to do a better job of documenting things, and in doing so grown to appreciate just how nuanced an art flexing actually is.
Here are two photos that most dramatically portray the improvements I’ve made since arriving back home:
And to more accurately highlight what a slow, gradual process my recovery has actually been:
These do a better job of showing just how terrible my posture was when I got home from rehab:
In all of those photos I was doing my best to stand as straight as possible, and the posture I was holding could only be comfortably held for around thirty seconds before I started to lose balance. I would use my frame to straighten up (without any visual aid), and then put it to the side and do my best not to fall over while my mum took the photo.
Progress Overview
What follows is a description of how my rehabilitation progressed, as I can remember it, with each year split into quarters. In each period I will provide the distance that I could walk in six minutes using two elbow crutches, which was the main metric used by the physiotherapists to measure my improvement.
January - February - March — 2014
During this period my body was still an utter mess. Just getting around the house with my frame was a task that required a great deal of effort and concentration. All the muscles in my legs and hips were incredibly tight, and I had to be very careful moving to avoid aggravating my dislocated hip. My pelvis still had fractures on the right side, and between that and the nerve damage my right leg was incredibly weak and could hardly take any weight.
My posture was atrocious due to the angle of my pelvis and complete lack of core strength. I had significant tightness throughout my entire upper body, and a large imbalance between my right and left side (the muscles in my right arm and shoulder had wasted a lot more than the left due to a fractured scapula).
I had physio twice a week where we’d work on my walking and do various exercises targeting my legs and core. At home I focused on using an arm-cycle, some dumbbell work, a few stretches, and practising walking outside with my elbow crutches. I was also working on losing the excess weight I had accumulated in hospital.
6 minute walk test: 175m
April - May - June — 2014
By this point my general fitness had improved quite a bit, but for all intents and purposes it was still terrible. I continued to lose weight, and by May I had reached 72kg. I got a treadmill at home, and by June I had managed to do twenty minutes straight (at a very slow pace, taking a lot of weight through my arms). Around late May I managed to start doing a more comprehensive upper body strength routine, and started trying to bulk up. It was hard to stick to it with any consistency on top of the physio sessions due to my complete lack of fitness and my body’s propensity to succumb to weird 24-hour fevers at the drop of a hat. Despite this, I managed to keep at it when I could for around 6-8 weeks and made noticeable progress.
It was around this time that I was first told that I shouldn’t expect to improve much more until after orthopaedic surgery. At the time it was hoped that this would happen within the next six months, but that proved to be wishful thinking. Fortunately I knew there was plenty of room for improvement, and continued my training unfazed.
6 minute walk test: 205m
July - August - September — 2014
In July I injured my left shoulder by doing pull-ups without adequately warming up. It was a fairly minor strain, but it took a couple of months to properly heal. I think this was because it was hard to rest it properly since I relied on my upper body so much when walking with my frame and crutches. I put the bulk on hold, and I kept working on my lower half at physio while doing a lot of mobility work at home, mainly targeting my shoulders. By the end of September, I was over the shoulder injury and had managed to resume the upper body strength training.
At some point around this time I started using a pilates reformer at physio to do resistance training targeting my legs. Among other things, a reformer allows you to lie on your back on a spring-loaded platform with modifiable resistance and perform a squatting-like motion. The position it put me in made it possible to do this safely despite my dislocated hip. Initially I used two legs at once, but I eventually switched to one leg at a time. Being able to do proper resistance training like this allowed me to build muscle in my legs to an extent that was impossible before, and it became a core focus of my physio sessions.
6 minute walk test: 235m
October - November - December — 2014
This period was the first time I managed to really stick to an upper body routine without much interruption. Two days a week I would have physio, and three days a week I would work on pull-ups, dips, rows and push-ups, doing 3x5-3x8 of each exercise with five minutes rest between sets. I would do three weeks straight of this, after which I was completely exhausted and would have a week with no heavy upper body work as recovery. In retrospect my form in all the exercises was absolutely terrible. That being said, by being cautious and ensuring I was properly warmed up, I was still able do them without injuring myself, and the strength in my upper body increased a lot. I gradually improved my form, which made the exercises harder, so I didn’t increase the amount of each exercise I did by much.
By this time I had also improved the mobility in my lower half enough that I was able to start using an exercise bike at physio. If it wasn’t for all my upper body efforts this wouldn’t have been possible, as my arms had to do most of the work in supporting myself. I also had to have my right foot anchored to a stable support using a resistance band. This was to prevent it from falling inwards and catching on the pedal (a side-effect of the angle of my pelvis and having no control of my foot), and is something I still need. I had to be extremely cautious at first to avoid aggravating my hip, but the muscles around it gradually loosened and I was able to slowly increase the amount and intensity of my pedalling. While still painful, pedalling caused less impact to my hip than walking and it was possible to do it for longer periods.
6 minute walk test: 295m
January - February - March — 2015
This period was much like the preceding three months. I continued to put on weight and stick to my strength routine without much interruption. I got an exercise bike at home, so I was able to start focusing more on that. I would ride it five times a week, usually just for ten minutes both at physio and as a warm-up before strength training. I did do the occasional longer ride though, and managed to do forty minutes straight at one point.
6 minute walk test: 325m
April - May - June — 2015
I decided to end my bulk at the start of April at 83kg and then did a two month cut during which time I kept at it with the strength training and bike. Progress was slower while losing weight, and it was mentally tougher, but it felt like I didn’t lose any strength. By mid June I had reached 77kg. In May I stopped going to physio twice a week and switched to a check-up every 6-8 weeks. I celebrated with my first sixty minute bike ride. I was in the process of acquiring a reformer to use at home, so I focused on High Intensity Interval Training (HIIT) on the bike in its place.
6 minute walk test: 350m
July - August - September — 2015
I started bulking again, but this winter my compromised immune system (I have no spleen) made it hard to string more than a few weeks together without getting sick. When this happened I would feel terrible for most of a week and not be able to do much, count it as a rest week, and then jump straight back into the strength routine once I was better. In retrospect I should have given myself a bit more time to recover, as after a couple of months of pushing myself through three separate sicknesses I was feeling incredibly burnt out.
In August I decided to get a urostomy, and I was told that I would most likely have surgery within three months. I had a two week break to let my mind and body recover from the winter’s toil, and then cut back to doing a full strength routine twice a week to avoid further burn-out. I started doing a more core-focused workout three days a week to increase abdominal strength and thereby reduce the chance of developing a hernia after the operation.
The break did me good, and with a fully rested body I was able to perform five dead-hang pull-ups for the first time, which was the first major goal I set myself when I got home from rehab. In retrospect I should have chosen something a bit easier. I got through September without any issues, and made reasonable progress in all areas with the combination of two full workouts and three core workouts
I acquired a reformer at home in July, but amidst all the sickness I struggled to use it with any regularity. In the end, with surgery looming, I talked myself into not using it until after the operation and instead focused on everything else.
6 minute walk test: 375m
October - November - December — 2015
In October I realised by accident one day that I could walk unaided. I had previously been unable to take enough weight through my right leg, but now I could. At the time I put it down to the increase in core strength, but I suspect this was actually a result of my pelvis finally stabilising. Although walking was possible, it didn’t feel as though I could safely practise without a long set of parallel bars, so rather than risk a fall I decided to stick to the aided walking until after my orthopaedic surgery.
The urostomy was booked for early November, but the hospital was full, so it was cancelled at the last minute and rescheduled for late November. I went back to the same routine for a few weeks while I waited. Surgery actually happened the second time, and I was in hospital for two weeks. They had to cut out a segment of my small intestine to use in the procedure, so I couldn’t eat at all for the first week, and by the time I got home I still wasn’t eating properly and had lost six kilograms.
It didn’t take long for my appetite to come back and I gorged for a couple of weeks over the Christmas break to help my body catch up. I had to take it really easy for six weeks post-op since they cut through my abdominal muscles during the procedure. I had been advised to walk as much as possible to help with healing so I put what energy I had into the treadmill.
6 minute walk test: 400m
January - February - March — 2016
By the time the six weeks were up, I was walking just as well as before the operation. At my first physio session back I equalled the time I’d previously set for the six minute walk test.
I started to ease back into some more involved training, but my body was still feeling the effects of surgery and I had to be very cautious. It was a full three months before I was able to tentatively resume doing anything overly ab-intensive like planks and l-sits or compound moves. I did a lot of shoulder-focused dumbbell work in my recliner chair to compensate. By the time I would have been able to resume a proper strength routine, it was only a month until the next operation, so I decided it wasn’t worth the effort, and instead went back to doing the core routine I had done in the build-up to the last operation, but five days a week and with more dumbbell work. I also tried to push it five times a week on the bike to get in as good cardio shape as possible so that I might hit the ground running post-op.
On top of this I was using the treadmill every morning with the goal of breaking my walk test record at the next physio session. Given that it was the last chance I’d get to do one with a dislocated hip I felt that I had a point to prove. This preparation went well, and I even managed short periods of 5km/hr on the treadmill. When I casually told my physio that I thought I could add another fifty metres to my already impressive record, she was very sceptical and urged caution. Six minutes later I was able to give her a cheeky “told you so” while she sat there blinking in disbelief.
Spurred on by the amount of muscle mass I’d kept despite losing six kilograms in two weeks I decided I may as well lose a bit more. I found out late February that my orthopaedic surgery would happen mid April, so I decided to cut until the end of March and then eat slightly over maintenance for a couple of weeks to make sure my body was ready for surgery.
6 minute walk test: 450m
April - May — 2016
Things went well in the build-up to surgery and I kept focusing on the core routine and exercise bike five days a week. I was surprised with how little conditioning I’d lost after the last operation, and managed sixty minutes on the bike, five days in a row, for two consecutive weeks. This was a significant improvement over anything I’d done before.
The operation ended up being more of a setback than I thought it might be from what the specialist had said. To any relatively fit crippled young people out there: if your surgeon tells you a hip replacement will bring about an immediate improvement the day after surgery, don’t listen to them. I almost started laughing at the absurdity of it when I had to be helped out of bed only to perform a few shaky side steps to the physios’ enthusiasm. Still, the fact that it was possible to walk at all the day after having the entirety of my hip replaced is a testament to the marvels of modern medicine. These days they don’t even need to cut through any muscle during the procedure, and the sooner you are up and moving the better in terms of recovery. I was on hip precautions for six weeks, during which time I had to be very cautious and avoid certain movements so that I didn’t re-dislocate the new hip.
Like the last operation, the recommendation was to do as much walking as possible to aid in recovery. Initially this was just doing a few very slow laps of the hall with my frame, but soon I was able to tentatively restart on the treadmill and I gradually built up my pace. I’d received mixed messages about whether the treadmill would be appropriate while recovering, but in the end I trusted myself to know what was reasonable and I didn’t have any problems with it. It definitely wouldn’t have been suitable for an old lady, but since I’d spent the last two years on it and could take all my weight through my arms if need be, I felt confident that I would be able to avoid disrupting the new hip, and it was nice not having to turn my frame around every ten metres.
While my hip was still sore from the operation, after a few weeks walking didn’t have the same cumulative effect on my pain levels that it used to. By the end of the recovery period I had reached a peak where I managed around fifty minutes of walking spread out over four sessions throughout the day. This was very draining — just as much on my arms as my legs — but I was determined to lose as little fitness as possible, and the pedometer I bought had its intended motivational effect.
And at last we reach the present tense! The end of hip precautions: the light in the darkness. I’m still not moving as freely as I was before the operation, but I’m getting closer. It’s hard to say how long it will take until I’m back to where I was. An optimistic estimate would be two weeks, but it could be longer. All things considered I think the recovery from the operation is going well, but it will take at least a few more months and a lot of physio before I can start to get a feel for how big a difference the new hip will make in the long-term.
Retrospective Thoughts
While it’s easy to think of various things that could have been tweaked along the way, it’s also easy to forget just how terrible condition my body was in at the start of this process. While there are plenty of small adjustments I can think of in retrospect, taking everything into context, I don’t think I could have progressed much quicker than I have.
The main thing I’d change if I get run over by another truck is to hold off a few more months before trying to incorporate pull-ups and dips, and instead do a mix of rows, push-ups and the dumbbell routine I’ve been doing in recent times. I think focusing on the dumbbells would have done more to improve my mobility while also building some strength, and I probably would have avoided injuring my shoulder. I also would not have tried to bulk so quickly. At the time I started my first bulk I don’t think I was working out at a high enough level to make the most of it, and it would have been better to spend at least a few more months eating at maintenance or slightly over.
One thing that I vastly underestimated was just how terrible the mobility in my upper body was. When I got home I mainly focused on my right shoulder, since that is what was injured, but I should have paid equal attention to my left side. While it was better than my right shoulder in some movements, it was still severely restricted, and had its own unique shortcomings thanks to my terrible posture and all the fractured ribs. As of today both sides still have inadequacies, and my right side is actually better than my left in some movements.
I wonder if maybe I should have focused more on mobility and less on strength in the first year, but it might not have made that much difference. During that time I had a very limited amount of energy to devote to training, and I definitely wasn’t doing as much mobility work as would have been ideal in the last half of 2014 when I was primarily focused on building strength. On the other had, it felt like the strength I gained then was a prerequisite to being able to do more effective advanced mobility work. It is possible that two days of strength training and one day of more intense active mobility work would have been a better balance.
I would also try and force myself to regularly use the reformer once I got it at home. Since I got it amidst sickness and in the lead-up to surgery, it was too easy to justify letting it fall to the wayside while I worked on everything else. It was much less mentally taxing to focus on the parts of me that weren’t extremely handicapped, and winter had weakened my resolve. If I had been in a state where I could have been disciplined enough to use it, I would have an extra few months of leg gains that would have only helped from here.
All things considered, I’m really happy with how much fitness I’ve been able to maintain during the last six months despite the two major surgeries. Even though I’ve only had one month of working at a reasonable capacity since December, I have avoided losing much muscle or conditioning, and actually improved the strength and mobility of my upper body by a significant amount in some areas. The countless hours spent in my recliner doing abstract dumbbell manipulations were definitely worth it. It’s hard to do pulling movements from a recliner chair, so my pull-up numbers might have suffered a little bit, but I think all exercises will be improved in form if not repetitions when I resume training. A good diet has no doubt also helped to maintain my fitness, and it was definitely a good idea to coincide the first operation with the end of a bulk so that I had plenty of fat for my body to cannibalise.
The Year Ahead
I won’t be up to instantly resuming a full-on training regime, but I’m aiming to do so as soon as possible. I was starting to feel pretty burnt out just from pushing myself to do as much as possible after the hip replacement, so I’ll have an easier week before trying to ramp things up over a two week period. There is the worry that last winter will repeat itself and sickness will make it hard to keep momentum, but in the worst case I would hope that by September I am capable of working at maximum capacity for extended periods. Ideally it will be much sooner than this.
Thanks to a difficult winter followed by two major operations, it has been a whole year since I’ve actually felt like I was working to my full potential. There has been far too much sitting around and waiting for things to heal in the last six months, and I’m longing for an extended period of uninhibited training like I had back in Q4 2014-Q1 2015. During those months it was the easiest it has been to be at peace with myself throughout this entire ordeal, collapsing into bed early each evening exhausted, knowing there was nothing further I could be doing to improve my situation.
My strength, conditioning, and especially my mobility have improved enormously since then, and if I’m able to work at my full capacity for most of the next year then improvement should come at a comparatively rapid pace. Over the next six-to-eight months I will try to put on ten kilograms while I put my body to the test, targeting its entirety in a fully integrated routine for the first time since the accident. Now more than ever I need to keep pushing myself week after week if I’m going to get where I want to be, and it feels like the last two-and-a-half years have been nothing but a precursor building up to this one point.
Like a subterranean rocket gathering momentum I have slowly powered forth, and as the daylight finally appears ahead, it feels as though I will either cast off my shackles and ascend with increasing vitality towards some form of self-actualisation, or — in spite of all my efforts — the thrust of a new hip and stabilised pelvis still won’t be enough to reach escape velocity; the gravity of my injuries will prove to be too strong, and I’ll flounder in a final heave only to become trapped in their orbit for eternity. I’m sure reality won’t be quite so dramatic, but if I don’t make significant progress with my lower body in the next twelve months I will have to start to question whether it will be obtained at all.
I haven’t decided on an exact routine yet, but I’ve got a basic outline in mind that I’ll finalise once I have a feel for what I can manage. Initially I will try to go back to doing a full upper body strength workout three times a week, only this time I will also incorporate leg work using the reformer on the same day. Previously I have had to do legs on a different day, but now that my hip isn’t dislocated I’m hoping this will be manageable.
I could keep doing leg work on a separate day, but it will give me more time for recovery if I only have to do intense strength work three days a week, and then use the other days to focus on mobility and the exercise bike. I’m hoping that riding the bike won’t be anywhere near as taxing on my hip as it previously has been, and that I’ll be able to do a reasonable ride in the morning on the days I do strength training, and then a longer ride twice a week. I would also like to incorporate some HIIT on the bike, but I’m not sure exactly where I’ll fit that in on top of everything else.
I don’t really have many specific goals with my upper body. The main thing I’m working towards is being able to do 3x8 pull-ups and dips with perfect form, but I’m not really sure how long that will take. I think a pretty standard three days a week full body routine will serve me well for perhaps another year, but eventually I’ll have to think about switching to more complex intermediate programming. The longer I can keep things simple the better given all the specific rehabilitation work I’ll also be doing.
I will need to do more hip-centric exercises than I have done before, as the muscles around there are still very weak and inflexible. I haven’t been able to target the left hip very directly until now, and it will no doubt take a long time to relearn how to use all of the muscles around there properly. I’m hoping to incorporate most of this work on my off days as a part of my mobility sessions, but I might also see if I can add some of them to my main strength workout.
It is quite possible that I will resume going to physio twice a week for a while, in which case I will focus on the hip stuff there. Ideally I won’t do this for too long though, as I have all the equipment I need at home. Once I’m confident that I can do everything myself, I think I’ll be more productive if I don’t have to worry about travelling to and from physio.
On top of all this, I need to try and do as much walking as possible, and see if I can start to wean myself off my frame and crutches around the house and eventually elsewhere. I will be getting a carbon fibre orthosis for my right leg in a couple of months, and the added stability and return of force this will provide should be a great help in this regard. That being said, I’m not going to set many walking-specific goals for now. While being able to walk unaided and be independent is the end goal, what is most important initially is that I’ll finally be able to focus on improving the strength and flexibility of my lower body without such severe limitations.
I won’t be worried if there’s not a drastic increase in what I can manage in day-to-day life in the near future. I will try and avoid thinking about my recovery in those terms for a while yet, and remain as focused as possible on just improving my overall fitness. I think that for the next twelve months life won’t be that different than it has been since I returned home. I might surprise myself and in six months the prospect of doing anything other than working out and recovering won’t seem so daunting, but given how things have played out so far I think it’s sensible to be pessimistic in this regard. I will be working harder than ever, and it’s hard to imagine being anything other than constantly exhausted while I do so.
Generally speaking though I’m feeling pretty optimistic about what the next year holds. As long as there are no major setbacks, I should be able to make an incredible amount of progress when compared to the last two years. I feel as though I know exactly what I need to do, and I have in place all the things required to do it. The fear of always being severely disabled still drives a discipline that I know will not waver, so it should just be a matter of letting the days pass by and fulfilling my destiny, whatever that proves to be.
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