A good news story about my ankle!
It is getting onto six years ago that I suffered a devastating injury to my left ankle. The damage to the bones, tendons, ligaments and cartilage was such that my sporting career was over. Of that, I did not dispute. You could say that I had enough metal in my ankle to hold down a Wellington roof!
I then set about my rehabilitation. "If anyone knows about ankle rehabilitation, that has to be Gary Moller", is what I told myself! The weeks turned into months, and the strength and mobility gradually improved. Finally, I found I could ride a bike without impeding the healing, so I rode. I rode so well I went on to win two UCI Masters Mountain Biking World Championships. All the while, I was meticulous not to have any "unplanned dismounts".
The main issues with my ankle were twofold: firstly, damage to one tendon that appeared irreparable and, secondly, tearing the ankle cartilages. At my age (60's), any hope of these kinds of tissues (cartilage and tendon) fully healing seemed remote. But that made me all the more determined to win, and win I did. Cartilage, in particular, is so slow to heal that it is considered capable of repair, especially in older people. So I took the strategy of putting 1001 factors in my favourites such as:
Optimising the stress-recovery cycle.
Ensuring there was a rich supply of nutritional substrates for cartilage and tendon repair.
Encouraging the production of growth hormone.
Optimising stem cell production.
Reducing systemic inflammation.
Exercises to improve strength, mobility and agility of the ankles.
Massage to soften and mobilise damaged tissues.
Different tissues heal and repair at differing rates with cartilage being the slowest, best measure in years rather than months. The problem with this is most people are far too impatient: they end up stressing the damaged tissue far too early, thus causing reinjury.
The idea is to stress the damaged structures, but only sufficiently to stimulate the anabolic processes, such that the structure(s) grows a little stronger (super-compensates). It is only when this super-compensation is complete, that the stress is reapplied, perhaps slightly greater since the structure is now a tiny bit more resilient. During this process of patiently rebuilding structural strength and resilience, it is critical not to do even one session that overdoes the stress.
This slide illustrates what happens if someone overdoes the stress during a rehabilitation/exercise session, or does not include sufficient recovery between sessions.
Pain is your friend - not the Enemy!
Pain tells you when to proceed and when to back off. Without pain signals to guide us we hurt ourselves and, ultimately, we die from the damage.
"No pain - no gain", does not apply to effective rehabilitation. However, there is more to pain than just this sound bite of advice. It is a little complicated:
Pain that intensifies as exercise proceeds is best avoided.
Pain that interferes with good form (biomechanics) is best avoided.
Pain that reduces as exercise progresses is usually okay.
Pain that stays the same but is in the background is usually okay.
If the pain stays about the same while function improves with your rehabilitation, then you are making progress.
Find activities that you can do without aggravating the injury or slowing your recovery, and make these your main sport and recreation pursuits for as long as it takes.
What about pain medication?
If you have to take medication to get through an exercise session then that is terrible. You either must back right off on the intensity and loading, shorten the session, or stop completely.
The only times to take medication is if the pain is interfering with sleep or making life miserable. If you are feeling miserable due to the pain, and despite medication, you must review what is being done medically. Don't just take more medication or try to ignore the pain; figure out what is the underlying cause and get it sorted out.
Where I am at today
Walking was problematic for me, so I hardly walked at all for the first four years, taking the bike instead. I resumed running at around four years and have gradually ramped it up while mainly sticking to soft, off-road trails. As of today, I am now walking and running freely. While I still have some tendon pain, this does not inhibit running, and my joint cartilages feel perfect. I'm running over rough terrain and now feel almost back to my competitive best. I feel like this is a miracle. However, the reality is that being patient, comprehensive, systematic and very smart has yielded the fruits of success. No miracles are needed, and none included - thank you very much!
I entered the King of the Mountain race, scheduled for late November, to celebrate my rehabilitation, which I last raced in 1978, coming 2nd behind the local running legend, Chris Ray. I did put out a challenge to Chris via the organisers for a "Winner Takes All" rematch, assuming he is still alive and kicking. However, that is not to be due to the Pandemic disrupting the race. The idea was to run the race then write this article. But, since there is no race to report, I thought I'd write this anyway and hope this Pandemic is over by this time next year.
The most important takeaway lessons are these:
Take your time.
Do not rush.
Keep within your limits for as long as it takes.
Small amounts at a time.
Eat good food.
Take your supplements.
Be the turtle and not the hare.
Got the idea?