On October 15, 2020 I had surgery on my right foot to correct three hammer toes. Recovery meant lying on my back with my foot elevated 7 x 24 for six weeks. Boring! And debilitating as I noticeably lost fitness week by week. When I finally could get out of bed just walking around the house was exhausting. By Tuesday February 9, 2021 I was skiing expert trails on my cross-country skis. I had skied or snowshoed 37 out of the 51 days.
As we get into our 50s, 60s and beyond body parts start to wear out and inevitably most of us will need surgery. Here’s my story and what you can learn from it.
My surgery was planned several months in advance and I used the time to get as fit as possible so I’d recovery as quickly as I could. I trained specifically to offset the inevitable loss of fitness:
- VO2 max. I hate intervals but I love mountain biking, which was a natural way to do very high intensity workouts.
- Endurance. I threw my leg over the top tube most days for at least an hour a day. Once a week I enjoyed a multi-hour ride with my buddy and at least once a week rode for hours on my own. Here’s a column on How to do Endurance Training Correctly.
- Power. In addition to my weekly MTB high intensity rides and multi-hour endurance rides I did several on-the-bike power workouts a week. Here’s a column I wrote on 6 Kinds of Intensity: Which One is Best for You?
- Leg strength. My right foot would be non-weight bearing for the six weeks so I could only use one leg to stand on to move about the house. In preparation I did single leg squats while brushing my teeth.
- Upper body strength. I would use a four-leg walker rather than crutches because there’s lower risk of falling. My right leg would be non-weight bearing. Using the walker would require upper body strength each time I stepped forward with my left foot. To get ready I did dips and other upper body exercises.
Here’s a column I wrote with more details on Preparing for Time Off the Bike.
Surgery and recovery.
In a three-hour operation the surgeon broke three toes and inserted pins to keep them straight. After the operation she made it very clear that I shouldn’t do anything to risk moving the pins. She told me to keep my foot elevated so the swelling would come down enough I could get on a shoe. And more importantly my ski boot! I asked about leg extensions. NO lowering and raising my foot! I asked about walks with the walker to maintain some cardio. NO keep the foot elevated except for going to meals and the bathroom.
I have a set of exercise cords and I devised a full body workout I could do lying in bed. I also did crunches and stretched. Four follow-up doctor’s appointments involved hobbling to the car, sitting in the back seat with my foot up while my wife drove us to the medical center, hobbling to the elevator and hobbling to the surgeon’s office. There I had to hop up several steps and then hop to different positions for x-rays. I sweated harder than when I sprint! Each appointment was more exhausting and by the time I finally got home I collapsed in bed for the rest of the day.
The day after Thanksgiving she removed the pins and liberated me from lying prone and from only using one leg. For the next week activities of daily living and a set or two of split squats without weights were about all I could do. On December 6, day nine of my recovery, I got on the trainer, pedaled for five minutes in my lowest gear and then took a nap. In addition to the trainer and leg exercises I slowly added back in upper body exercises. By December 11 I could ride the trainer for half an hour! I also started walking to get ready for skiing and shoveling snow and chopping firewood. December 21 we went snowshoeing with friends for 40 minutes. Too long – I barely made it back to the car.
The surgeon had originally said I shouldn’t ski for 12 weeks after the surgery but to listen to my body. I listened and after 10 weeks I felt ready to ski. Christmas Day we went for my first ski up and down a favorite gentle loop. Part way up the loop I was getting tired but stubbornly insisted on continuing. On the way back down my legs were wobbly and I kept stopping to rest. One of my coaching precepts is always to finish a ride or ski feeling like one could do more. Of course, I didn’t listen to my own advice. Fifty minutes was way too much.
The next day I skied at the dog park. One lap around took seven minutes and I was never more than 3-1/2 minutes from the car. I listened to Coach Hughes advice and only did three laps totaling 20 minutes. Over the next three days I increased the duration and added in some hills and then took a rest day. New Year’s Eve I skied 1:20 up and around one of my favorite loops.
Since then I skied 29 out of 40 days including expert trails this past Saturday, Sunday and Tuesday.
What can we learn?
- Athletic maturity. My athletic maturity is the biggest factor in how rapidly I recovered. Athletic maturity is a concept I developed to gauge overall fitness. The more years one has been exercising, the more riding per year and the greater total body fitness all contribute to athletic maturity. I’ve been cycling, hiking, skiing, swimming and strength training since the 1970s. The longer and more varied your fitness history the faster you’ll recover from time off the bike. Here are two columns on:
- History of surgery and recovery. I’ve had four serious accidents that required hospitalization and surgery. I knew from prior experience that I could recover fully and that it would take time. A friend broke his arm last summer – his first accident – and I keep reassuring him he will be able to resume all of his athletic activities.
- Confidence. Because of my prior experience I was confident I could recovery fully. If this is your first come-back trust me: if you do the following you’ll recovery fully, too.
- Take the long view. Rather than bemoaning the loss of my pre-surgery fitness and obsessing over slow improvement I thought about goals, confident that with patience I could reach them. My goals were to be cross-country skiing by Christmas, road biking by spring and mountain biking and hiking in the summer.
- Listen to the doctor. Focusing of my long-term goals allowed me to discipline myself to do what the doctor said in the short term. Even though it was frustrating I kept my foot elevated so I could fit into my ski boots and cycling shoes.
- Patience. Two of my accidents were very serious and each required a year of recovery. From them I had learned to be (mostly) patient. Rather than jumping on the bike and going for walks right after the pins were removed, I just did activities of daily living (ADL) trying to do a little more each day. ADL may not sound like much but I was sufficiently de-conditioned that my ADL taxed both my cardio and strength. I waited to get on the trainer until I my ADL weren’t an issue.
- Moderate intensity. By exercising moderately I progressed more rapidly. I always exercised at a conversational pace. For example, I climbed stairs slowly. Strength training never felt hard. I knew that once I’d rebuilt my endurance base I could work harder, e.g., skiing expert trails.
- No training plan. I didn’t create a plan with weekly or even daily activities. What I could do on Wednesday depended on what I’d done on Monday and Tuesday and how I’d recovered.
- Build slowly and recover fully. Each day I pushed my body a little bit more. When I gauged how much I did correctly the next day I was ready for more. But if I got up in the morning feeling tired I kicked back.
- Consistency. The more days I exercised the more rapidly I got fitter.
- Non-linear progress. I didn’t improve every day. I had off days. I knew from prior experience this would happen. I didn’t worry about an off day as long as the next day I started improving again. However, if I had a couple of poor days I knew I needed more recovery. Instead of pushing ahead I took another recovery day.
- Quality recovery. As we get older we generally need more recovery; however, this can be offset by the quality of our recovery. Human growth hormone (HGH) is a small protein that is made by the pituitary gland and secreted into the bloodstream. Exercise and trauma increase the output of HGH, which stimulates physiological recovery. Under normal conditions, more GH is produced at night than during the day. In addition to a full night’s sleep I took a naps, one of the advantages of being self-employed. I ate smaller meals six times a day so I’d have constant energy. I massaged my legs. Here are Nine Recovery Tips for Older Riders. I’ve written an eBook on Optimal Recovery for Improved Performance.
- Double workouts. I got more exercise per day by exercising twice a day. Once I was riding the trainer instead of one 15-minute ride I rode for 10 minutes in the morning and ten minutes in the afternoon.
- Full body conditioning. Because of the six weeks of idleness I’d lost cardio, muscle strength and even balance. For cardio I both rode the trainer and walked. For muscle strength I did squats with light dumbbells. Instead of step-ups I made trips up and down the stairs. For balance I practiced dry-land skiing. I stepped forward with my right leg, shifted all my weight to the right leg, lifted my left leg and slowly moved it forward while maintaining my balance. Riding the trainer, walking, squats and dry-land skiing all worked my muscles in different ways and provided greater overall fitness.
Ask the coach. RBR reader Art V. asked, “Due to an injury, I’ve been off the bike for almost a year. All medical issues are history. How do I get back into riding and make sure I don’t over-stress tendons etc.?” Here’s my response How to Come Back after a Long Time off the Bike.
The biggest factor in the speed and quality of my recovery was my many years of different kinds of activities that provided full body fitness. My eBook Anti-Aging: 12 Ways You Can Slow the Aging Processincludes chapters on cardio, high intensity cardio, strength training, weight-bearing exercises, balance and flexibility. I discuss the importance of recovery and how to gauge if you are getting enough recovery. I combine the different kinds of training into programs balancing training and recovery. The 106-pageAnti-Aging: 12 Ways You Can Slow the Aging Processis $14.99.
Coach John Hughes earned coaching certifications from USA Cycling and the National Strength and Conditioning Association. John’s cycling career includes course records in the Boston-Montreal-Boston 1200-km randonnée and the Furnace Creek 508, a Race Across AMerica (RAAM) qualifier. He has ridden solo RAAM twice and is a 5-time finisher of the 1200-km Paris-Brest-Paris. He has written over 40 eBooks and eArticles on cycling training and nutrition, available in RBR’s eBookstore at Coach John Hughes. Click to read John’s full bio.