Me and My IM Nail (Part 8) – 3 years on

by Jake McMillan

<<< Me and My IM Nail (Part 7) – 2 Years on

Three years ago I broke my tibia (see X-ray above) and fibula and the brand new term IM Nail (Intramedullary Nail or Rod) was introduced into my life … and my leg. Three years on I can still remember the pain, thankfully I don’t have that any more. Since the accident I’ve been blogging about my recovery as there was so little  information about it on the internet.

Unfortunately, three years later, there still seems to be very little information out there. However! One positive has been all the people who have taken the time to get in touch with me and comment on this blog to share their experiences of going through the recovery as well. A massive thank you to all who have commented and especially those who have said kind things as I really did not expect anyone to read my long posts about limping and pictures of scars and hairy legs.

For those who are not aware or have not yet filled it in, I have put together a short survey and will produce and share the findings with everyone. I’m just waiting until there are a 100 responses, with 80 people having filled it in so far (at the time of writing).

Scars and bruising
Over the three years the scars and bruising have gone down, but have not completely disappeared. Being a hairy-legged man helps cover them up.

So, three years post operation how is my leg doing generally?
It’s very similar to being a normal leg, it just has niggles. For example, if I leave it in one position it feels stiff/sore and kneeling on it is not comfortable (but is a bit better compared to a year ago I feel). There are some days it feels better than others, but generally speaking I can walk about, run and dance as badly as I ever did.

I am still cautious when it is raining and slippery, as if I expect my leg to cause a problem and always feel relieved when it is perfectly fine. I was in Singapore in March last year and I was wandering around, exploring after it had been raining and on a slippery stone I managed to fall straight down to the ground on my bad leg. It was just a case of poor grip, but I was so happy that I hadn’t hurt my leg or broken or bent my IM Nail I actually forgot the embarrassment of falling over in front of lots of people.

I haven’t done a lot of sports or exercise this last year but that has nothing to do with my IM Nail, it is been more me not making the time and effort to do it. I fully aim to do much more this year (we all say that don’t we?).

Last Sunday, I went to Richmond to meet some friends and I did so with some trepidation as it was a repeat of the exact same activities I did three years ago that ended up with me breaking my leg on my way home at Clapham Junction Station. I’ve been to the station and walked through the underpass (where I actually fell over and broke my leg) many times before so it should not really have been a big deal.

However, a friend made a joke over Facebook that they would break my other leg. They did not mean or intend any malice by this, just making a joke, but I did not take it in my normal good humour and realised that breaking my leg, the operation and its recovery was still a big deal. Apart from the pain and discomfort of the main recovery period, I was self-employed and it meant I couldn’t fulfil a contract that January or go for one the following month. I almost went bankrupt and barely managed to get by. My attitude remained positive, but it was a really tough time that I would not want to go through again.

In Clapham Junction Station Underpass

As I walked through the underpass at Clapham Junction station last weekend I remembered the time laying on the ground 3 years ago whilst my friends decided that I actually did need medical attention (I had told them to leave me and I would hobble home to bed). I hoped I would not have a similar fate that evening. I am pleased to report that on my journey home I had completely and utterly forgotten about the accident and that it completely escaped my mind. Although, to give full disclosure, I had realised I was totally desperate for the loo and that was utmost on my mind. Nevertheless, although it’s something I still think about, the whole incident is very much in the past and the ongoing niggles of my leg don’t affect my life or bother me that much.

Will I have the IM Nail removed?
I have given this some thought and have still not yet arranged an appointment with a consultant to discuss this. I will do this as would like to know more information and will, of course, share it here. I would like to remove the IM Nail as would prefer it not to be in my leg, I think most people feel this way, but the question is whether it is worth the risk of further complications and pain. It does worry me what happens if I have another accident, how the metal might cause more damage, but then I cannot predict how bad that accident would be anyway? Some have had very successful removals and I know others where it has not given the desired result and caused further pain and problems. As I don’t get much discomfort and it doesn’t really prevent me from doing anything I think a consultant would say there is not enough justification to do it.

Sharing Your Experiences
Please keep doing this, I will continue to keep updating this blog and it really does help others to hear about as well as give support to others going through the same or very similar experience.

Thank you again to everyone who has contributed to the blog and wishing you all the very best with your recovery!

Jake

Me and My IM Nail (Part 6) – 1 year on

<<< Me and My IM Nail (Part 5) – 6mths after the accident

Me and My IM Nail (Part 7) – 2 Years after the accident >>>

12 months ago on January 2nd 2010 I had a silly but little drunken fall at Clapham Junction Station (London) and somewhat inextricably broke my tibia and fibula resulting in an operation to have an IM Nail inserted. However, I prefer to tell people the “official” story that I broke my leg jumping on to the train tracks to save a pregnant woman, a blind man and an endangered panda.

I was told it would take 6mths to recover and as I couldn’t find much about people’s healing experiences with IM Nails on the interweb highway I thought I would share mine just in case others found it useful or possibly reassuring. My last update was at the 6mths stage and so now is time to bring it up to date.

12mths since IM Nail Op - I still have bruise from where I broke the tibia and minor scarring from the operation

Still some scarring on the knee from the IM Nail Operation

Up until a couple of  months ago I was still concerned that I was getting a fair bit of soreness from the area just below my knee. If I sat in the same position or cross-legged it would be quite sore when I stood up and walked. Kneeling was also not something I was comfortable doing. This has changed quite a lot since then and the soreness is still around but is quite mild now and kneeling is much more comfortable than it was.

Walking down stairs I barely notice anything different with my ‘bad leg’, but do from time to time. Lots of friends have asked me if cold weather effects me and say surely there must be expansion and contraction issues? Well, it’s been a bloody cold winter here in the UK and I didn’t notice any particular problems when I was out in the cold.

I have experienced one issue though … and that is with my good leg (the right one). I was trying to get back into jogging and was going regularly to the gym and running only on the treadmill (i.e. no hard surfaces). I was careful to build up the amount of running I was doing very gradually and had not quite reached being able to do 40mins of jogging (3 runs a week). Two days after a gym visit I walked off to a meeting and my right leg suddenly had a shin splint pain that was quite painful.

I thought my 2hr meeting would be ample time for it to rest but as I walked home it got really really painful. Like someone had stuck a knife in the centre of my shin and left it there. I have had shin splint problems before (prior to my accident) and normally rest will cure it and the worst case before it had been 2 weeks. However, this shin splint pain went on for about 5-6 weeks and I think has only just gone away. I was not able to walk for more than 5 mins without it getting really very painful.

My GP confirmed it sounded like a classic case of shin splints plain and said I should rest and take ibuprofen (for its anti-inflammatory effects). This did seem to help but I am not sure yet if it has fully disappeared and will be visiting the gym later this week to find out. Well, if I can get over 4 solid days of celebrating New Year that is.

Ironically, it gave the situation that my bad leg (the left one with the IM Nail) was actually my better working leg and I think somehow this has been good. It was a little bit like my right leg had said “enough with all attention and care on the left leg, what about me? Why do I always have to be the good one?”. My left leg was up to the task and has actually been like a normal leg!

If you’ve recently had an IM Nail or Rod, I wish you the best of luck with the recovery. Set short-term goals for your recovery rather than looking at the longer path and you will get there. It will be painful in the beginning and dominate your life, then it will be more frustrating and really testing your patience, as in “can it just get back to normal already?!” But it will get better.

Me and My IM Nail Part 5 – 6mths since the Op

<< Me and My IM Nail Part 4 (5mths on)

Me and My IM Nail Part 6 (1 year on) >>

In January 2010 I broke my left tibia and fibula and had an operation to have an Intramedullary Nail (IM Nail) inserted. The doctor at the time told me, I thought rather vaguely at the time, it would be “6 months before you could do the things you want to do”.

It’s now been 6 months since the operation and I can confirm the doctor was right. I can do the things I want to do, but the leg does not feel like it is completely normal and back to full strength and capability. This is not the end of recovery; there is still some progress to be made.

The leg is really starting to feel like a normal leg. I have finally lost my limp and this was confirmed by my physio and friends are very impressed with how easily I’m walking about.

Me with a couple of friends as I am stretchered away from Clapham Junction where I had the accident

I started jogging 2 weeks ago. Not on the treadmill, but proper jogging in my local park, Clapham Common. I just did 10mins and it was at a very slow pace. When I finished I felt so elated to have been able to do this and my leg felt fine as I walked home.

My physio recommended, after hearing of my initial 10mins run, to do 3 runs of 10mins every other day (to give the leg time to rest) to see if the leg was able to cope without any problems and then to slowly build it up from there.

I didn’t quite follow her instructions and have increased each run by 2.5mins and yesterday did a 20mins jog. I’m a lot slower than I used to be, at the moment, and it takes me 11mins to reach a marker I used to do in 10mins. I’m really quite unfit as have not been to the gym in ages, but in a way this is good as if I was fitter I would be tempted to run for longer and maybe push the leg too hard too soon.

My visit to the physio last week ended up being my last visit, touch wood, as she gave me the all clear. I still have physio exercises to do:

• 3 sets of standing on tip toes 15 times on my bad leg and once this is quite easy, to start hopping
• One-legged (on bad leg) lunges or rather lowering my body through bending my left knee
• Using the wobble cushion (see below)

My physio recommended buying a wobble cushion as she said the receptors in your ankle basically go to sleep when they aren’t being used for some time and standing on a wobble cushion helps wake them up and will prevent you from falling over when on uneven ground. This type of rehabilitation is sometimes referred to as proprioception or proprioceptive re-education.

Firstly, you stand with both feet on the cushion and try to maintain your balance. Hopefully you will find this quite easy. To make it harder, try closing your eyes whilst doing it. It’s amazing how much you rely on your eyes for balance. With your eyes closed it just the receptors in your ankle giving information to your brain about how to stay balanced. Then try it with one leg (the bad one) on the cushion and then with your eyes closed.

I still have my scars and bruise from the accident and kneeling on my left leg is not really an easy thing or comfortable thing to do. A friend of mine who went through the same thing just over 18mths ago thought perhaps he would not be able to kneel properly ever again and then gradually he was able to.

Walking down stairs is easy but I am still very aware of my leg’s limitations and it doesn’t feel quite natural.

As it is 6mths since the operation I thought it might be useful to reflect on the recovery period so far.

I feel I worked really hard and put a lot of effort in the first 3-4 months, but after that either my will or energy seemed to diminish. Once I was basically able to move about (although with a limp), work and socialise I stopped trying so hard. It wasn’t a conscious decision, it just sort of happened that way.

I think I was really trying hard to beat the 6mths recovery time and when I realised I wasn’t able to, particularly when the physio told me I shouldn’t start running yet, I lost some of my motivation. But this could be a good thing in a way as I know others who have pushed themselves too hard and that has ultimately led to a delay in their recovery.

However, I am pleased to report to anyone else who is or about to go through the same thing that after 6 months I really do feel quite good and, as the doctor told me, I can do all the things I want to do.

In January, now (as in July) seemed so far away and I didn’t want to think about all I had to go through to get there. Although the pain largely goes away, it is still sore and you are reminded of your leg problem pretty much the whole time, in every step you take, when you lie down, having a shower, etc. That is not the case anymore, thankfully. Yes, I am still quite often physically and psychologically aware of my leg’s limitations, but this seems to lessen by the day.

My advice to those recovering still remains the same, you should be very short sighted and set yourself small goals to achieve, try not to look a long way into the future.

Me and My IM Nail Part 6 (1 year on) >>

Me and my IM Nail Part 4 (5mths since the op)

<<< Me and my IM Nail Part 3 (4mths on)

Me and my IM Nail Part 5 (6mths on) >>>

The end of my last post a month ago ended on quite an optimistic note with what I thought was a conservative aim of jogging for 20mins on nearby Clapham Common. A visit to the physio a couple of days later was a reality check and led to a readjustment of my goals.

The physio visit initially was going well and she said I had good mobility in my ankle and feet. She asked me to stand on one leg which I could do (although wobbly) and stand up down on tip toes which I have been able to do with ease for ages.

She then asked me to try going up on tip toes but just on my bad leg. My cockiness went as I thought, oh, I’ve not tried that. I couldn’t do it at all.

5mths since the operation and the bruise from the tibia break and scars from IM Nail operation are still quite visibile

IM Nail scars 5mths after operation (just below the knee)

She said that I should stop running on the treadmill as if I couldn’t go up on tip toes on just my bad leg (the left) I would be significantly over-compensating on my right leg and this would cause problems. She also suggested that when I practice going up on tip toes that I try to do it more on my bad leg as I had been relying, without realising, on my right leg too much.

I left gutted and annoyed that I wasn’t able to do this and for the next week I practiced a lot every day and it was so frustrating I couldn’t do it. Then, whilst at a work event where 2012 Games chairman Lord Sebastian Coe was visiting my client, I suddenly realised I could do it! Not very well, but I could definitely do it.

I really felt quite happy as I had worked hard for just over a week to be able to do this and also noticed that my limp seemed even less pronounced and was virtually gone.

The next physio appointment was 2 weeks later and felt I had improved although I had noticed in the week leading up to it that I was getting a shin splints pain in my good leg when I did the 15mins walk to my local London Underground tube station.

She came out to the waiting room and called my name and I walked with her to her treatment room. As I sat down I felt good that I had walked well. She had a very different view. She thought my limp had got worse! Whereas I didn’t think I had a limp at all?

Basically I had subconsciously got so used to walking with a slight limp that I had stopped noticing it. She asked me to walk slowly up and down the corridor and describe what pain/soreness I had that was preventing me from walking normally.

She identified some joints in the front part of the ankle that were rather stiff and tried to massage them a little without any effect. She stressed that I should try staying on my left longer as I would put my right leg down too quickly. She also suggested holding off from jogging on the treadmill until this was sorted.

My physio gave me a blue rubber sex aid to add to my collection

This was also very frustrating as I felt I had been impeding my own development by not realising I was still limping. So since then when I walk I really try to stay on the left longer. This means it feels sore but it is necessary to loosen up the stiff joints that are causing the limp. It really means concentrating as it so easy to slip back into limping.

I thought I had been doing well but my neighbour last week said she saw me limp back from the local shop whereas I thought I had been walking well.

In spite of these setbacks, just over a week ago I went for a 9 mile ramble (4hrs) with friends near Windsor. A ramble, for those unaware, is a fancy term to make walking in the countryside seem more interesting and dynamic.

The Long Walk to Windsor Castle

The first two hours went very well and I coped with it fine and my friends said I seemed to be walking normally. Stopping halfway for lunch caused my ankle to seize up a bit so when resumed I started to limp again, but this went (I think) the more I walked. As we got towards the end of the ramble, we walked down the aptly named Long Walk to Windsor Castle and I was starting to suffer a bit.

Windsor Castle - I made it to the end of the 9 mile walk

We got the train back into London and when I got off at Vauxhall station I realised I had a massive pain in my right foot (the good one), on the right hand side almost at the heel. It wasn’t a blister/skin type pain, but felt like a metal bar was digging into the bone every time I put weight on it. So I was in the odd position of now limping on my right leg and the left one was the good one!

It took a good 3 days of rest for the pain to go away on the right foot, but all is fine now. I have another physio appointment next week and hope to be given the all clear to run on the treadmill again.

So it is slow progress, but it is progress and my leg is starting to feel like a proper leg again.

Me and my IM Nail Part 3 (4mths since the op)

<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>

Since the last update a month ago I don’t feel like I have made as much progress as I should have or maybe hoped for. When I was initially told there would be a 6 months recovery period, I really thought I would be able to beat that, but it seems I am exactly on track to meet that timeframe.

I’ve been a little disappointed with myself as there were a couple of weeks this month where I could have tried harder. Work and life meant I wasn’t able to get to the gym like I wanted to do, but even so I could have done more physio at home. However, reflecting on this now I realise I have been pushing consistently hard recovery-wise for over 3 months, so having 2 weeks where I wasn’t 100% focused on it was probably a good thing.

I won't be visiting here for another 4mths

I still have my limp, which I really hope would have gone by now, but it is much less pronounced than it was before and I can walk long distances (45mins plus) without it causing discomfort. So I know the limp is due to disappear soon, I just have to keep at the physio and going to the gym to build up the muscles.

Since the last update I have also been back to the hospital for another check up and the consultant is very happy with how I am healing with the IM nail. He even suggested I could probably start having a go on the treadmill. My physio has not suggested this so I was a bit sceptical but felt positive after the visit.

I hate waiting! It's normally over an hour for the X-Ray and then another hour for the consultant

I met up with a guy I work with from time to time who had broken his leg 18mths ago, but I didn’t realise he had an IM nail put in too. It was really good to quiz him about his experiences. The first thing you will be pleased to hear is that he is about to run a marathon in the next couple of weeks.

He is into his running and told me he pushed too hard when recovering and this actually set his whole recovery back by over a month. He was advised when able to start running again to start with 5mins and then to build it up one minute at a time. However, after a few goes he felt good and ignored the advice and ran a bit longer and then did a 40mins run but after that he couldn’t run again for a few days as it would be very painful and sore.

I went to the gym 3 times last week and felt good about that, particularly as last Monday I went on the treadmill to jog for the first time. That felt very weird! As you are not sure how your leg will perform. I took it very easy and did a 5mins jog at very slow speed. I was able to do it, which was good, but still ran with a bit of limp and was unsure whether that was right or not?

The observant of you will have noticed that the person above is not me ... I have better, but hairier legs

On Wednesday I jogged for 6mins at a slighter faster speed and then 7mins on Friday going slightly faster again. I haven’t felt any bad after effects from doing this and so can continue with confidence.

My physio gave me a new, stronger rubber sexual aid (Green) to continue with the ankle exercises which I have to be honest and say I have not really been doing, even though I do keep them near me when watching TV at home. The physio has also got me standing up and down on tip toes and standing on just my left leg (the bad one). I’ve been doing a lot of these as it is very easy to fit into normal life … whilst brushing teeth, making a cup of tea, waiting for a bus/train, etc.

Standing on one leg helps to build up strength and although I could do this before the physio asked me, I was very wobbly and it was hard to balance. Whereas now I can do it with my hands in my pockets without needing to put my arms out to balance. It’s not as good as my right leg, of course, and it still wobbles a bit (the muscles around the ankle and knee move about to maintain the stability of the leg).

Standing on tip toes is something  I’ve been able to do for ages, but a month ago I tried walking on tip toes and that was a very different story. I could barely manage it and it was similar to when I first started walking, or rather hobbling. A month later and I can now walk on tip toes better, but with a major limp.

The guy I worked with also recommended that I keep up with the rubber sex aids as when he was able to start running he gave up on the ankle exercises, but wished he’d continued.

I haven’t reached my goal of losing my limp, but have jogged on the treadmill for 7mins which is ahead of what I thought I would be doing. So I hope by the next update the limp will have gone and I will have jogged for at least 20mins on Clapham Common.

I also still have the bruise from where the tibia broke which I think is also a reminder that as much as you can push your physio and exercises, you can’t speed up how quickly your bone heals.

<<< Me and my IM Nail Part 1 (2mths since the op)

<<< Me & my IM Nail Part 2 (3mths on)

Me & my IM Nail Part 4 (5mths on) >>>