Thursday, 29 November 2018

Blood, sweat and fears Part VI...

Not everything that can be counted counts, and not everything that counts can be counted. Albert Einstein

Continuing the theme of discussing things that are partially rehab related but worthy of wider interest and consideration, a recent article on Rating of Perceived Exertion (RPE) got me thinking (yep, I know that's always dangerous isn't it!). People often turn their nose up at RPE; afterall all it's been around for ages, it's really simple, doesn't involve tech and therefore it can't be of much use... or can it? In an age where we are obsessed with technology and gadgets it's actually quite refreshing to consider something really simple. If we are so inclined we measure everything from how well we slept, how stressed we are, how many steps we took and where we took them GPS tracking and then we share this to compare and contrast with others and put it out there for debate, encouragement, motivation or just to swell our egos. Ultimately technology does everything but run, cycle or walk for us. This does seem somewhat ironic given it is that same modern technology that has us tied to our desks and enables us to lead such sedentary lifestyles too. Does any of this sound familiar? The chances are you have a Strava account, no? Just saying...!

Wearable technology - nothing new but ever advancing

Don't get me wrong, I embrace this technology as much as the next person and I'm always interested when another gadget is launched, but often from a point of view of can it really measure that metric accurately, does it add anything to a previous iteration or more importantly can it add value to health, wellbeing or training. There are perhaps two groups of people out there - those that like to track information and those that don't. For those that don't the challenge is to get something down on paper, for those that do the goal is to keep track of what is actually meaningful and think about how it adds to the bigger picture.

RPE makes things naturally simple (unless you overthink it). It's literally rating how you feel when you cycle, run, swim, sprint, canoe... Harness that memory - the sooner this is done the better, I'm sure we can all relate to struggling through a really tough session on our hands and knees but after a hot shower, a cup of coffee and a slice of cake we're rejuvenated enough to think that it wasn't that bad afterall.

RPE on a 1 - 10 scale

There are several iterations of RPE scoring out there and there is nothing wrong with choosing one over another - as long as you are clear about what the numbers relate to and use them honestly. I've previously used the Borg Scale of 6 - 20, which primarily maps against heart rate - 6 = a resting HR of 60bpm (so no exertion) and 20 = a maximal heart rate of circa 200bpm (maximal exertion). I have found that people often struggle to report an accurate number against this, especially if they are new to exercise, find it hard to quantify how they are actually feeling or are perhaps embarrassed at how hard they are finding it.

Professor Carl Foster put forward a range from one to ten, which for some might be simpler. For example on a scale to one to ten, easy exercise would be around one to three, threshold would be eight to ten, and tempo and Sweetspot would been the middle. Obviously this will change over time - when you are starting out and perhaps attempting tempo for the first time it might actually feel like eight out of ten or even higher. The key is what is normal for you. The simplicity of RPE means that you can track it alongside other variables, for example power output, heart rate or pacing in running. If after a twelve week block of training your heart rate is 10bpm lower for a given power output and you are reporting two points lower on the RPE scale then you've achieved some aerobic adaptation.

Achieving flow state 

It might also change how you feel out on a ride, especially during the off season, its a nice opportunity to bank some base miles and build your endurance back up without constantly having your attention pulled to your Garmin every couple of minutes. If you know that an endurance session should feel like one to three (realistically nearer three) out of ten then the odd glance to check that your heart rate is where you would expect it to be should suffice. Why not give it a try; go and see if you can find that flow state, enjoy pedalling in your surroundings and appreciate what is happening around you rather than making yourself unnecessarily 'busy' by watching the numbers. It's a really important skill to be able to ride on feel, practice pacing and appreciate the art as well as the science of a good session. Afterall, there may be a day when technology fails you - the only lost session is the one that you didn't do. Yes, it's disappointing not to have that data to reflect on, especially if you think that you executed something particularly well or nailed every interval but your body still did that session and nobody can take those physiological benefits away from you!

Exploring new places is a great way to put riding to RPE into practice

Friday, 23 November 2018

Blood, sweat and fears... Part V

Storms make us stronger, Bear Grylls

To supplement, or not...

Given my recovery is taking far longer than I'd ever anticipated I thought I would continue the theme of sharing tips and nuggets of information that either I've come across, found useful, researched or where I've at last started to implement my professional skills on myself. Yep, you know that well known phrase 'do as I say, not as I do'? Well, I'm as guilty as the next person of looking after everyone else and dishing out helpful advice when actually I should be taking my own advice! Did I hear some of you say at long last?!

I'd like to have a brief delve into nutrition and supplementation... A contentious subject at the best of times but also a really interesting and important one. Not least because we all eat food so therefore we are all experts, uh hm! I came across this nice little infographic, below, a while ago and although I would add 'Performance Nutritionist' alongside 'Dietician' (if not substitute where sports nutrition is concerned) it sums up the issue really nicely. If you wanted professional advice or assistance on almost another other issue you would seek out the appropriately qualified 'expert', however it comes to nutrition and it seems that we mostly take leave of our senses. 'My friend says', 'that magazine article', 'the Sunday supplement reported' and so on. Unsurprisingly, along the way the right information gets lost or diluted. Don't get me wrong there's a place for anecdotal reporting and supporting others through shared experiences but it's always best to check with the right sources first. Anyway, the purpose of this post isn't to have a bit of a grumble about all of the poor information out there, it's to share some useful information to consider in times of illness or injury.

The convoluted path that people take for nutrition advice

As athletes and in particular cyclists, weight is never far from our minds - the better our power to weight ratio the faster we will be... However in times of injury or illness weight is often pushed even more to the forefront of our minds given the main device for weight maintenance - exercise - might be limited or totally off limits. You might feel that there is a need to restrict what you are eating, particularly carbohydrates*, count calories, change your food habits etc in a bid not to lose the athletic physique that you've worked so hard for. However, whilst it's important to be mindful of your diet overall, you probably don't need the added stress of something else to worry about. The most important thing is to ensure that you are giving your body as many nutrients as it requires to heal, so at its simplest don't underestimate the 'eat a rainbow' a day message.

*It's really important not to completely relegate carbohydrates from your diet. Carbs are often seen as the enemy and are the first nutrient to be reduced or removed from the diet during a period of injury or reduced training in fear of gaining body fat. However, this is actually counterintuitive as chronic energy restriction and/or energy deficit can inhibit the bone remodelling process - potentially increasing the period of injury time. This isn't to say that tracking diet and weight isn't important, especially in long term injuries when training might be disrupted for many weeks or months, just that it should be carefully managed. The body needs the right fuel for the work required, so perhaps eating good quality carbohydrate sources would be better than a surplus of lower quality foods (yep sadly that's the biscuits, cakes etc).

A rainbow a day will provide a diverse range of nutrients

I am very much an advocate of a food first approach and by that I mean if you can fill your diet with as many different sources of energy and nutrients before you consider supplementing then you are likely to be better off. A simple rule that I like to use is that if there is an ingredient on the packet that you've never heard of or can't pronounce then the likelihood is that your body won't be able to process it. If you just can't be bothered to eat fruit or vegetables on a regular basis then supplementing  Multi-vitamins isn't going to help you! Equally if you are supplementing with x, y and z because your teammate does then this isn't really an appropriate rationale either. Half of the reason that nutrition is so complicated is that we are all different, have different needs and respond in different ways.

There is an excellent quote from Professor Ron Maughan on supplements:

"If it works it is probably banned and if it isn't banned it probably doesn't work!"

This is a pretty good place in which to start considering supplements, so it's always best to err on the side of caution/cynicism in this area. However, there are occasions where there is evidence for efficacy and supplements can be a useful addition - both to athletes in our diet and nutritionists in our toolkit. 

For me this mainly falls in to two areas - 

  • To correct a deficiency (Vitamin D or Iron status)
  • To prevent illness (pre/pro biotics)

However, before I go any further, there is one logo that you always need to be mindful of if you are competing at any level:

Things to consider when you are injured

Vitamin D3
Living in the UK we are unlikely to see adequate sunshine through the bulk of the Winter months and as cyclists most likely do not do a huge amount of weight bearing exercise. The absolute way of qualifying this on an individual level is to have frequent blood tests (baseline - supplementation - follow up). Or, you could consider a good quality Vit D3 supplement (1,000 iu or 4,000 iu depending on your starting levels) as a precaution. The recommended dose for athletes is at the higher end of the scale.

This can be consumed in the diet from dairy products and dark green leafy vegetables. However, if your injury involves a broken bone for example, the body is trying to remodel this in addition to normal bone turnover. It might be wise to consider a calcium supplement in this instance - depending on how rich your diet already is in calcium.

Research shows that collagen can support bone, tendon and ligament remodelling by increasing the availability of collagens within the body. There are no known negative side effects if you wanted to consider this. Recommended dose: 15mg per day (ideally 1 hour before high intensity exercise, but if your athlete is injured and not taking part in high intensity exercise then any time of day will be fine).

Vitamin C
This can support collagen formation. Consuming foods such as dark green leafy vegetables, kiwi fruit, melon, pineapple, bell peppers, sprouts etc is likely to be beneficial. If the diet is lacking in Vitamin C then a fallback could be to supplement at 1 - 2 grams per day. Remember, food first though!

I have no allegiance or declaration of sponsorship from Healthspan but their elite range of supplements are reasonably priced, contain what you need (rather than a load of baking agents) and importantly are batch tested and Informed Sport trusted. As time has gone on, even with a mostly well balanced diet, I have been supplementing Vit D3 and collagen alongside a balanced diet to try and support my body to heal.

If you are unsure please consult an appropriately qualified professional (not your mates, unless they are suitably qualified!) Sadly, many GPs may not be able to give appropriate advice to highly trained athletes in this area, you are likely better consulting an experienced Performance Nutritionist working in your field. 

Monday, 22 October 2018

Blood, sweat and fears... Part IV

'The very things that hold you down are going to lift you up' Timothy Mouse, Dumbo

So, today marks a whole six months since a certain car driver sent me flying across the road. It's long enough for normality to feel like hospital and Physio appointments are a way of life! However, given the RTTC National Closed Circuit Champs were also held on Sunday (21st October), the 2018 racing season is pretty much over for everyone, well other than those brave souls giving it full beans up Pea Royd Lane next Sunday in the RTTC National Hill Climb. Now that is one race that I'm happy not to be contesting!

How we as athletes deal with injury depends on so many interconnected factors that Marshall & Paterson (2017) describe the theoretical models that attempt to make sense of this area as 'looking like spaghetti and meatballs'! Marshall goes on to describe the general injury roller coaster; where some days athletes are calm and accepting and others more akin to a psychotic Medusa with a passive aggressive streak. I'm sure anyone who has been injured can relate to feeling grouchy, having the odd mood swing, some level of frustration, depressive tendencies or social withdrawal - particularly if your social life is/was actively taking part in the sport in question. Meanwhile your significant others are treading on egg shells wondering what the best thing to say is... Its fair to say that injury can bring fire and brimstone even to the most optimistic and positive of sporting households.

As much as I know all too well how lucky I am to be alive, that my injuries could have been far worse and the damage permanent (we hope that it isn't), I still have plenty of 'what if...' moments. Ranging from what if I hadn't gone out that morning, what if I lose all my fitness (that much is pretty much granted already), what if I do regain my range of movement and strength, get back on the bike and get hit again...

The obvious difference for me this time around is, it's not an overuse injury (I've ignored the warning signs on a fair number of those previously in my running days) - this is something that someone else has done to me (whether intentionally or not) resulting in an acute impact trauma. Plus the actual consequences of this have been far greater. Its not just been a lost racing season, which lets face it is ultimately just a very enjoyable but time-consuming hobby, it's also been additional worries and concerns over very real issues: Time off work, cost of treatment, transport to appointments (I haven't been able to drive since April), loss of confidence, loss of a social life and to some extent the level of social support to get through the tough times. It's really hard to empathise with someone if you've not been in that situation before, so it's very easy for friends who've perhaps had a more straightforward 'off' to gloss over it and expect you to be back training within a couple of months. Little do they realise that I've been busily 'training' to grapple with using cutlery to eat dinner rather than trying to turn everything into finger food!

On the plus side I have become what Marshall & Paterson (2017) describe as an 'active patient' rather than a passive patient. Sadly not in the sense that I would usually term active, but by constantly researching pain management, shoulder instability, funky exercises, whether hydrotherapy would benefit me now or later... Most of the time the answers are as diverse as our individual responses to injury - it varies greatly! However, even if my efforts don't actually impact my treatment or recovery pathway I'm sure they help with navigating the emotional journey, even if only by means of distraction.

Top tips to support yourself/someone you know through an injury:

1. Empathy not sympathy! One of the most natural things is to dole out the sympathetic platitudes 'you'll come back even stronger', 'don't worry, you'll be back in no time'... Although well intentioned, these are seldom helpful. If you don't know what to say, why not take the time to listen by opening up the opportunity: help me to understand what it feels like to... [have to deal with this], you must be feeling... [pretty overwhelmed], [anxious], [frustrated], it sounds like you're... [worried about...] [frustrated by...] etc

2. Injury dependent, you may be able to focus on something that has gone by the wayside due to lack of time or another focus in training. A regular sports massage for tight muscles might be suitable as long as it doesn't jeopardise your present injury recovery. Or there might be another weakness that you could hone in on - visualisation for pre-race anxiety perhaps. Maybe something totally unrelated to sport or your injury might be better, for example a good book...

3. Social support plays a big role in buffering the emotional effect of injury. As a friend, family member, colleague or teammate you can play a really important role in helping to ensure that your injured athlete doesn't become socially isolated. If you know of someone else who has been through something similar, then putting them in touch might also be useful. Imagine how you'd feel if you were sidelined - you probably wouldn't want to hear all about how well someone else's training is going or perhaps you would!

4. Don't be tempted to ask others how someone is, why not ask them yourself? They are likely to feel much more valued that way.

If you are sidelined or on the sidelines trying to be there for someone who is, hopefully there might be a useful tip or two amongst my latest ramblings. If you've something to share I'd love to hear it and even more so if it relates to shoulder recovery!

Thursday, 11 October 2018

Blood, sweat and fears... Part III

"Fear is a reaction. Courage is a decision" Sir Winston Churchill

When rehab hasn't really progressed things and the NHS seem to want to send you down the slow route whilst noting that you are a long way off having a fully functioning shoulder, there is really only one route to explore. When you are talking shoulder injuries it seems pretty unanimous that there is only one person to consult - Professor Len Funk aka The Shoulder Doctor. An MRI scan confirmed his suspicions - that my shoulder was not going to improve on its own! Given how fast the private healthcare system operates (no pun intended), no sooner had we agreed for 'The Prof' as I affectionately call him, to do his thing then it was operation fix Fiona day.

Looking a little peeky after a couple of hours in theatre
I'm not the calmest patient at the best of times and given the experience of being sedated with Ketamine back in April (see blog post Blood, Sweat & Fears: Part I) was still all too fresh in my mind, I walked down to the anaesthetic room with trepidation. Going for surgery always creates mixed feelings - you know that (all being well) you are going to come out the other side with a far greater chance of improvement having been 'made better', however you know there is a whole lot of discomfort to come in the meantime. Dr. Hundle, the anaesthetist, helped to settle my nerves; he went off to get a surgical hat to cover my long locks and then proceeded to put it on over my eyes (you had to be there to find it amusing!). Anyway, no sooner had he told me that he needed to set up the cannula in my hand and got me on the subject of breakfast cereal (he happened across one of my pet subjects!!) then I was coming around in the recovery area.

Hospital Hair: the result of plaits for a week! I'd highly recommend it when you can't reach your head .
It was a far more stressful experience for Paul than it was for me. Whilst I was in theatre there was a thunder storm rolling around outside, disrupting the power. I was gone for 1 hour, then 2... Obviously there was no power disruption in the hospital but when you are anxiously waiting for someone to return it's easy to over-think the minor details.

I'd taken the advice of The Prof and Dr. Hundle and had a brachial plexus nerve block, so when I came around I couldn't feel anything from my shoulder to my fingertips on my left arm. It sounded slightly scary in that there was a small chance of it going wrong and my arm being paralysed. However Dr. Hundle assured me that he does in excess of 800 of these every year and would not consider having this type of surgery done himself without one. That was enough to convince me!

I'd never realised how heavy a 'dead' arm was until now but I certainly wasn't complaining as the main benefit was 12-14 hours of no feeling and therefore no pain! Having been in constant pain since that fateful day on April 22nd this was actually a fantastic experience - it was a shame I was so feeling so dopey after the general anaesthetic, or I could have capitalised.

Important to start moving gradually within 24 hours
Prof Len came by to see us later in the evening to say that he hadn't found anything unexpectedly 'nasty' when he opened up my shoulder, which is always a relief. He and his team had done their bit so it was down to me to follow his instructions for the next 3 weeks... The first few days were definitely the worst, I've never tolerated general anaesthetic particularly well so I knew to expect being very sick. I had forgotten just quite how sore the tubes make your throat though - this all made taking a veritable pharmacy of tablets more challenging. Both Prof Funk and his Pain Specialist Assistant kept tabs on me over the first few days which was nice.

Step by step rehab on Shoulder Doc website
The Shoulder Doc website is an excellent resource for both shoulder patients and physios alike. I was to work my way through level 1 exercises over the coming weeks. There is a whole host of articles, shoulder animations and other interesting shoulder related stuff - it's a hub for medical professionals as well as a comprehensive patient resource. If you know someone who is struggling with a shoulder problem then it is definitely worth a browse.

There are a few basic but really useful things that I learnt that might be handy to share:

1. Managing Pain:
The art of pain management lies in being one step ahead. Despite being nerve blocked for 12-14 hours and therefore having no pain during this time, the anaesthetist explained that it was important to accept pain relief so I had plenty on board. It is too late once you start to feel pain as you will have already entered into that vicious circle of playing catch up. I had a variety of painkillers, some of which were 'staple' meds and some were to help manage that 'breakthrough pain' when some of the painkillers are starting to wear off but it's not quite time to take the next dose... We all respond differently to different groups of painkillers but prior to surgery I was struggling to tolerate Tramadol so the anaesthetist switched me onto oral morphine. I was dreading taking it as I'd already decided that it was likely to taste vile - as it happened, it was more like the cough medicine Benylyn so not unpleasant at all. A potential result there; pain killers that taste ok and actually do what it says on the tin (or bottle in this case)... as long as it is spaced far enough away from the other opiates, or combined they also make you feel sick. Who knew taking analgesics was such an art form, definitely not me until recently.

It was also instilled in me that pain management is an equally important part of rehab and recovery as Physio, rest and follow up appointments. After all, if I'm in pain I'm unlikely to be able to tolerate the Physio exercises and risk regressing or at least not getting the most out of the surgery. Clearly my hitherto attitude of try and get by on as few pain meds as possible was not going to cut the mustard!

2. Managing Medication:
When you have a host of different medications to take, e.g. multiple painkillers, anti-inflammatories, anti-sickness etc they inevitably need to be taken at different times of the day, some without food and some after. Whilst initially you might think it sounds straight forward you soon realise that this is actually far from true. However, making yourself a simple Meds log makes it a whole lot simpler to remember. It needn't be complicated; just the date, time and what you've taken should suffice. It will alleviate that 'was it 8am or 9am when I took those painkillers', 'can I take the morphine yet'...? Even if you usually have a good memory, the after effects of a general anaesthetic, lack of sleep, and having different medications with different requirements that you're likely not used to taking all work their magic to confuse you!

3. More is not Better:
Whilst this also applies to meds, I am actually referring to rehab exercises! When your exercise sheet says do 8-12 of these x 3 a day, the athlete mindset kicks in and you think well, surely if I do 12-14 x 4 day I'll get better quicker... WRONG! Pushing myself to the limit and trying to squeeze in as many little exercises as I could muster, I thought that I must be helping myself. In fact I was doing the exact opposite - creating more inflammation in the area and slowing down the healing process, not to mention increasing the pain levels and then having to take increasing amounts of morphine to try and settle it down.

A useful guide - if you think of a visual analogue scale (VAS) where pain is 1 - 10 were 10 is excruciating, you should not be jumping up by more than 2 points when you are doing your exercises. So, if you were a 6/10 before you started, you might find yourself at 7 or 8/10 during your exercises but within a few minutes of finishing you should be back at that 6/10 again.

Don't forget, we are all different and every mechanism of injury sets us off on a different path or rehab trajectory, so just as we wouldn't share prescriptions for pain medication don't be tempted to share exercises that aren't prescribed for you either.

Good luck to anyone else on a rehab journey, don't forget to use the support around you, be honest with your Physio if things aren't going as you'd hoped but be honest with yourself too! x

Friday, 7 September 2018

Blood, sweat and fears... Part II

"Trust the timing of your life. Stay positive, stay calm, stay determined, stay focussed, and most of all trust your journey"

So, it's been a while but so much has happened; although somewhat disappointingly I don't feel a huge amount further forward! I must admit it's become all too easy to focus on the negatives, so this post is all about the positives, of which there are also plenty.

I love the sentiment of Kintsukuroi

The big positive and perhaps the most unexpected was that the shattered segments of my humeral head actually healed really well, despite still being visible on x-ray and MRI. I think I'll have a personal jigsaw puzzle of a shoulder for quite a while to come. With that box ticked, we could start to look at the soft tissue... not so good! To cut a very long story short the bones and soft tissues needed opposing rehabilitation - one requiring immobilisation and one gentle movement. With the latter not possible, the shoulder capsule started to heal in an extremely thickened manner, disrupting the coraco-humeral ligament along the way. Think pencil line becoming a medium sized DIY paintbrush and you are getting somewhere near - essentially a traumatic 'frozen shoulder' or adhesive capsulitis on top of the damage. This did little for my confidence as frozen shoulders are more generally found in an older, inactive population; so it was a connotation I felt that I could do without. However, thankfully, they are not an uncommon side-effect of a more serious injury, hence being referred to as of traumatic origin (cue feeling less old and lazy!)

Being keen to avoid the major surgical route for as long as possible, I elected to try a hydrodilatation procedure. This involves the shoulder capsule being flushed out, under pressure, with antibiotics, steroids and saline - with the aim of 'pushing' the capsule away from the adhesions that have formed. I can certainly vouch that, despite the very cheery approach and skill of Richard Collins (@LinearProbe); its darn painful!!

Ultrasound guided hydrodilatation

Whilst this helped to regain some movement, it wasn't as successful as I'd hoped - I was still well below 90 degrees in any direction and below 30 in some. There was one last option to throw at it conservatively - a week of intense rehabilitation at The Fire Fighter's Charity. As a serving member of Fire Service staff I am fortunate to be eligible to access the services at any of the three UK centres - Harcombe House, Devon, Marine Court in West Sussex or Jubilee House in Cumbria. I opted for the latter simply because it was the most straightforward train journey for me. They offer 3 - 7 day stays which are either physical or psychological focussed as well as nursing care. The ethos at every centre is that of a holistic, multi-disciplinary approach. Although our programme was physical injury focussed, we also had sessions on sleep, pain management, meditation, mindfulness and coping with stress. The concept that we were introduced to early on and that I struggled with the most was adjusting to 'a new you'. Not the New Year Nonsense that we are exposed to annually just before 1st January (that deserves a whole blog post of it's own!) but a new 'normal' whether that be movement or pain restricted or both. I have only ever seen 'this' as a temporary blip in proceedings, although clearly there's been many things that I've been unable do since April - so perhaps in some ways I am more accepting than I think...

Prehab week at Jubilee House, Cumbria, held together by SPORTTAPE

As the week went on, it became clear to me that it was more 'prehab' than rehab. The staff were fantastic, the facilities excellent and the location perfect, so although my shoulder wasn't up for 'playing', it was a great experience and I met some super people. Spending time with others who are also struggling with a variety of injuries at various stages of recovery always helps to normalise the things you can't do. At dinner one evening, without a moment of hesitation, Gordon, the chap I was sat next to offered to cut up my chicken, knowing full well that I was unable to use a knife and fork at the same time. That made a pleasant change from feeling like you are under peoples' gaze for appearing 'different' on the odd occasion that you venture out. 

Fast forward a couple of weeks and rehab takes a huge step forward... but that is another post!

Friday, 8 June 2018

Sports Personality of the Year, 2018

No, not that one, The City of Stoke on Trent Sports Personality of the Year Awards!

The 2018 awards, looking back on the 2017 season, marked the 43rd occasion that this event has been held to reward amateur and professional sportsmen and women, children, teams, volunteers and coaches. It is a unique partnership between The Sentinel and Stoke on Trent City Council and is a fabulous opportunity to celebrate sporting talent from across the area, as well as those who nurture and support it.

The 2018 Sports Awards campaign highlighted tales of success, endeavour and commitment drawn from a variety of different sports. The magnificent Kings Hall was a fabulous venue to host such a special evening. It was a real privilege and an honour to be shortlisted amongst some of the 'best sporting talent' in the area, which included Olympic champions, Paralympic heroes and the three professional football teams.

The Kings Hall looking truly resplendent 
The irony of the 2017 season feeling like a lifetime ago and my 2018 season having not long been totally derailed wasn't lost on me (see Blood, Sweat & Fears Part I). I had to keep reminding myself that this was a celebration of the commitment, dedication and hard work from not just me but those around me along with a dream, a desire and a vision to make it happen. Even the current circumstances couldn't take this away from me; it just made last year's achievements seem a whole lot less repeatable!

I had been shortlisted in the Senior Individual category, alongside Danielle Wyatt and Adam Burgess. Danielle wrote her name in English cricket history in 2017 when she became the first England woman to score a Twenty20 century in the final match of the Ashes series in Canberra in November. Meanwhile Adam once again made his mark in the world of canoe slalom, climbing up the rankings and claiming his first World Cup medal (a bronze in Markleeburg, Germany).

Then there was little old me, definitely feeling my age when being directly compared to two talented athletes in their mid twenties!! The achievement that had seen me shortlisted was my silver medal from the UCI Champs, backed up by taking my first TLI Cycling National title underwritten by a 100% podium finish record. However you look at these achievements, whilst fabulous for me, I was clearly a country mile behind the talent and achievements of the other two.

Danielle was a very worthy winner of our category and went on to take the evening's overall 'Female Sports Personality of the Year' and to prove the strength of senior talent, Adam went on to take the Male equivalent. I was proud to have been shortlisted so that was certainly reward enough for me.

I hadn't expected either of these as Runner-up!
As always at such occasions where sporting talent is being showcased, you can't help but realise just how much sporting ability there is in the area. Not just from sports people but coaches and those who tirelessly volunteer their time and expertise to nurture others. The people working in the background generally make the magic happen but rarely get the limelight.

Thanks to everyone involved in the organisation of what was a really lovely evening, from the red carpet on arrival, fabulous food to the military precision of certificate and champagne delivery direct to the table. I was glad I was able to attend, even if in a somewhat reduced capacity! It certainly made a stark contrast to my more recent outings to the Fracture Clinic, Orthopaedics and Physio and actually marked the first time I'd braved any distance in the car.

Monday, 4 June 2018

Blood, sweat and fears... Part I

... when experiences change everything in a heartbeat and in the blink of an eye things are turned upside down (literally).

The tale of two comebacks and a season reboot, both before my (2018) season has actually got off the ground! An honest account of the last six months...

Sometimes life throws you a curved ball and occasionally that curved ball behaves more like a boomerang, in this case seemingly a boomerang on a bungee cord! For reasons I (legally) can't go into on here, and totally unrelated to cycling, my focus had to be elsewhere for most of the winter. All my energy and resolve was taken up dealing with the stress, pressure and worry of what was relentlessly going on. As this continued to build, training became one stressor too many - given cycling is as much my coping mechanism for the daily grind as it serves to satisfy my competitive instinct, this wasn't a decision taken lightly. However, knowing the plethora of reasons that exercise is good for both our physical and mental wellbeing 'mindful miles' were soon reinstated. In structured training terms this was realistically (delayed) 'base building'. However, at this point the thought of racing was one pressure too much. Those of you who know me, will appreciate that my attention to detail, commitment and relentless pursuit to be the best I can be drives my ambition and I knew deep down that I didn't have the reserves to fully commit to this at this time. As athletes we are generally our own biggest critics and when that sense of control disappears it is difficult to find the driving seat towards anything, let alone perfection.

However, as time went on and with no clear end-goal in sight for the off-bike challenges, I decided that I didn't want any regrets, I was going to try to harness these difficulties to spur me on. I was also lucky enough to have the (ever patient) backing of the Pro Vision Race Team and it's sponsors; I didn't want to let them down.  My goals had been to build on my 2017 season; my last before joining the vet ranks and officially feeling old! I could try to lower my expectations and see where I was fitness wise... I didn't need Training Peaks to tell me I wasn't at peak fitness but I wasn't at rock bottom either. Then there was also the small matter of 'Percy' the P3 having been warranty replaced by Cervelo. This little saga took the best part of four months to sort out.

All things considered, on a sunny Saturday morning in late April, I pulled on my TLI Champs jersey (the first time I've actually worn it since the podium last Summer), found a lovely cycle path right on the doorstep and mentally pressed the reset button. That evening I just made the entry deadline for the A19/10 TT - I may as well put a marker down to build on! I had conveniently parked the fact that I still didn't have a built TT bike at this point but I've never been averse to turning myself inside out on a road bike, so there was always plan B. This was the start of my 'comeback'.

A comeback that lasted less than 24 hours before coming to a screeching halt with an almighty bang.

I was hit by a car at around 07:20 the very next day, early on a fateful Sunday morning. One second I was pedalling around a roundabout, just 20 minutes into my ride, the next I am lying in the road following what I can only describe as a bone chilling crashing sound as a car struck me. I was immediately aware of the intense pain radiating from my left side, both my left arm, knee and hip were throbbing and I couldn't feel my hand. My neck was pretty sore and one look at my left shoulder told me that it was certainly deformed, likely dislocated! I couldn't see my bike but it wasn't at the top of my priority list just then (sorry Hetty).

Back on the ward after shoulder relocation

The next time I looked up there was a sea of faces looking down at me, reassuring me that the ambulance was on its way. Luckily for me some passers by had stopped, a driver had shielded me from further injury with his car and a fellow cyclist had also come to my assistance, someone had placed a blanket over me - much kindness was evident. A police traffic car arrived followed by a first responder with gas and air (definitely not what it is cracked up to be) and finally the ambulance with the strong stuff (morphine). The journey to New Cross Hospital, Wolverhampton, strapped on to a spinal board, felt never-ending. Every bump in the road, change of speed or direction was transmitted through my left side. Little did I know that this was nothing compared to the pain of trying to be placed in a position to enable the radiographer to assess the damage! The Resus team needed to know what they were treating and any more pain relief was on hold until they had a plan of action.

Blue circle = shattered fragments, green arrow = where humeral head should sit

Sparing you the gory details, I woke up later on having had my shoulder relocated and strapped to me, my wounds cleaned and repeatedly asking Paul where I was and what had happened. Anyone who has been sedated with Ketamine will know that it's not the most pleasant experience, quite why anyone would take this for 'fun' is definitely beyond me! Granted, you are totally unaware of what is going on around you but I found myself so far from reality that I wasn't actually sure whether I was still alive or not. Perhaps the best description I have is that of feeling like I was travelling around, like a cell, in a 3D version of my own blood vessels at the speed of light; except everything was blue rather than red. Trying to string words together was very difficult and faces and images looked very distorted - it definitely wasn't an experience that I'd want to repeat any time soon.

Anyway, my humeral head (the ball part of the ball and socket joint that form the shoulder complex) had partially shattered with the force that had dislocated it, so it was going to be a waiting game to see whether the bone fragments would start to heal themselves (I understand it's not possible to pin or plate this).

Very glad to be recovering back at home
After a pretty uncomfortable first few days without much sleep but feeling ever grateful that I hadn't sustained more significant injuries, it was review time with the Orthopaedic Consultant. More x-rays to assess whether my humeral head was still sitting where it had been relocated and to understand more about the damage sustained. Being pulled around by the radiography team for the second time in a few days was no less painful but needs must! It's a pretty open book when the Consultant says 'it's a very nasty injury... it's far too early to know how or whether the shattered section will heal...' Even in my still dazed/traumatised, sleep-deprived state I realised that I perhaps wasn't going to heal overnight.

Friends with flowers to the rescue!
So, it seems like there is a long road to recovery ahead. As is more often than not the case with any injury, but definitely such traumatic incidents, it's so much more than the sum of the physical ailments; arguably they are the easiest part. Given time bones will regenerate and muscles and tendons will heal. It is certainly not as cut and dry as 'just' a smashed shoulder, it's an ongoing battle of a multitude of things, especially with an entire left side that took quite a battering as well as significant abdominal swelling. Think of taking up martial arts, not being very adept at it and landing on the floor more times than you remained upright and you might be somewhere near! At least I will mend given time, which is more than can be said for Hetty (the bike), who unfortunately broke a little more than me on the impact and will need retiring, along with the majority of her parts - some of which were in a fairly abstract shape!

Until you can't do them you don't appreciate just how many incidental, small activities of daily living you do without them even registering. Getting dressed; not being able to move an arm in any direction makes getting into most clothes almost impossible! Washing and drying your hair, especially when it's long, is definitely some sort of feat of balance, endurance and patience. The latter of which is starting to run pretty thin, especially when getting anywhere near comfortable at night to attempt to sleep has proved nearer impossible than difficult. My memory has been far worse than normal, I know, you wouldn't think that's possible would you?! I'll be unable to drive for quite a while, so the total reliance on others for assistance is pretty heavy. Thankfully Paul has been more than patient and accommodating in being a taxi service to and fro the hospital and Physio and my parents did some 'daughter sitting' in the early days!! Thankfully my left hip settled after ten days or so and I can at least walk around, although my knee is still keen to point out that it didn't go unscathed in all of this and is currently a tender shade of purple and green!

Appreciating the small things

Despite the well meaning assurance of many that 'I'll bounce back in no time' we are all on a different personal journey and 2018 has started to feel like somewhat of an extended nightmare to date. Albeit a nightmare that I've been lucky enough to still be working my way through and that I'm certain can only get better!

Thanks to everyone for the support, many of you have gone the extra mile or fifty to help and it's very much appreciated x

To be cont'd in Part II...

Blood, sweat and fears Part VI...

Not everything that can be counted counts, and not everything that counts can be counted. Albert Einstein Continuing the theme of discussi...