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

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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 2 (3mths since the op)

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Me and my IM Nail Part 3 >>>

It is now April, 3 months after I had my accident and had an intramedullary nail (IM Nail) put into my lower left leg and 1 month after my original post. I’m happy to report that things are progressing well.

Two days after the last post I made it to the kitchen and back to my room without the aid of crutches. I was walking! Well, I say walking, it was hobbling and moving at the speed of a 150 year old man. I was able to put my weight on my bad left leg very briefly, maintaining my balance before my right leg would take over in a much more assured way.

Leg 3 Months on - I still have a bruise from the Tibia break and you can see the scars from the screws attached to the lower part of the IM Nail

I then made another attempt and I began to feel more confident in my hobbling. It was brilliant! Using crutches is so limiting and annoying it is extremely liberating to have both arms free and I have never had so much pleasure in making a cup of tea for my flatmate and was able to hold both cups of tea!

It wasn’t pretty, but it was technically walking.

Leg 3 Months On - The scars just below the knee are healing well but are still quite visible

Since that day, I have not used my crutches (except once to get sympathy from a delivery person). The progress was quite good the first week of walking and then has been slow and steady after that.

I initially practised walking around the flat and going up and down a couple of steps. The next test was to make it to my local shop and back (down 7 flights of stairs and a 50yrd walk) and it felt so good to be independent.

The next test was to go to my friend Alex’s house in Tooting (Yes American readers, there is a place in London called Tooting; British readers, Americans use the word tooting to mean farting) which meant a small walk and a bus ride. I passed both tests well and boy does that feel so good. You know you have a long way to go in terms of recovery but you know that you have got the worst of it over and you can resemble being vaguely normal again.

I'm not going to miss these

My mood had definitely improved and I was feeling very positive and could not wait to start my physiotherapy. This ended up being nearly 3 weeks after my last hospital visit due to some rather poor bureaucracy between St. George’s hospital and St. Thomas’s hospital. My postcode meant I would not have physio at St. Georges, where I had my operation, but would be referred to St. Thomas. I spent nearly a week chasing this up, not being able to get through to anyone who could tell me what was going on.

Then I got a letter from Kings’s College Hospital saying I could come into one of their open physio sessions on a first come first serve basis. I wasn’t sure why they had been in touch, but was pleased they had and was so looking forward to starting physio that I didn’t mind the hour and half wait to be seen.

The physio was really good and I was glad I had my x-ray photos on my phone as I was able to show him in detail what had happened and he said this was very useful. I was given a long bit of rubber (shown below) which looks like some sort of bondage sex aid. You use it to help strengthen the ankle muscles by pushing on it away, to the left, to the right, etc.

My Physio Aid

I mentioned to the physio I was a member of a gym and asked if I would be able to use any of the equipment. He said absolutely and seemed pleased I suggested the idea. He said that I could use the bike, the cross-trainer, the one where you push your legs together, the one that you push your legs apart and the one where you sit and push your lower legs up. He said not to go crazy, but it would all help build up the leg muscle again and help stop the limping.

He also suggested I slow down my walk as the quicker I walked, the more pronounced my limp was. He said slowing down the walk would get the leg used to walking normally (as a small part of the limp is psychological) and combined with the physio and exercises it would all help me lose the limp. The physio also said to listen to my body in the sense that if you are feeling intense pain, then stop and rest and don’t push it, but that feeling a little sore and having swelling is all very normal and part of the healing process.

I’ve been to the gym three times since the physio appointment and although I realise how unfit I have become it felt good to be able to do these exercises and be proactive in my recovery as the first 2 months I felt very passive as you have to be patient and concentrate more on healing and looking after your leg. I’ve had the flu unfortunately this last week so have not been to the gym, but I am still making progress.

Leg 3 months on - Scars below the knee

My walk still has a limp but when walking slowly it is not very noticeable, but I am able to get about just fine (buses, London Underground, stairs, walking about, etc.). I have found walking down stairs the most tricky and for the first couple of weeks I went down one step at a time (i.e. one foot on the step, then the other before moving onto the next step) but have progressed to walking down more normally but I do notice the transition from stepping down on my left foot to the right foot is a bit heavy and fast. There is still not quite the control and fluidity that should be there.

Walking long distances (more than 15mins) does take its toll. My parents came up to London for the day and I met up with them and we walking around for a couple of hours and although we were not walking fast, it did feel sore and my Dad noticed I was limping more by the end than at the start. My leg had swelled a fair bit and was sore that evening and the following day.

The improvement in the leg means sleeping is better as I can get into my more normal sleeping position, but still get woken up with a bit of pain if I have been lying on it wrong somehow.

I still have a fair bit of recovery to go, but feel good about where I have got to in 3 months, especially as I was told it would be 6mths before I could do all the things I wanted to do. I feel I have got over the halfway point.

Recovery does seem slow with only gradual improvements (e.g. you notice little things get slightly easier, like getting in and out of the bath shower, putting on trousers whilst standing and walking down stairs), but it is nice when friends notice you are walking better than you were a couple of weeks ago.

I have my next and suspect last hospital check up later in the month and it will feel very nice to give the crutches back. I will not miss them. I also think that I will be quite close to being as recovered and able as the guy I saw at my last hospital visit. He was able to walk quite freely and easily but had a very slight limp.

My next goal is to be able to walk without a limp at all.

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Me and my IM Nail Part 3 >>>