Paul’s 2019 went well. He had moved up from Iron Distance triathlons to extreme racing – taking on Brutal Event’s Extreme Triathlon in North Wales in the over-50 age group, and loving it so much that he immediately entered to take on the Double Brutal for 2020! You can read more about the event here: https://www.brutalevents.co.uk/

However, the 2020 event was delayed by COVID-19. Paul kept positive and setting other training goals, with trail runs, taking on the local cycling club at their Time Trial course, and lake swimming with his partner and family.

Signs of a joint problem in the hip

Coming into Christmas usual runs started to become less comfortable and lead to pain later in the day. Then standing up from a seated position became rapidly more and more difficult. Such that by the start of 2021, it was clear that scans and a view from a consultant on the hip were needed.

This led to the recommendation that Total Hip Replacement (THR) was required – and that whilst the pain and discomfort may be manageable for a short time, it would always end up with THR.

This was very tough to swallow, as training had all been going so well and Paul’s goals were right in front of him.

Getting the right surgical plan

We started to do a lot of research on how fit people come through THR, and what they get back to in triathlon and how fast. The great news was that cycling and swimming (especially front-crawl) were clearly a part of the usual rehabilitation exercises. The questions were in the areas of hiking, running, and trail running. The good news was that we found a lot of useful reading and personal accounts from sportspeople, including a fireman who had captured on Twitter an almost daily account of all of his journey back to running after THR (@hippySpen) and we also had a member of the local Tri club who had come back to tri within a year.

All of this set up some excellent conversations with the physiotherapist (also a triathlete) and the surgeon on what it would take to get back afterwards, and what actions would help faster and better recovery.

Whilst neither of them could make any promises, there were a couple of key decisions with the surgeon about the components that he would use in the replacement in order to enable long-distance running. Plus the view from both the physio and the surgeon was that the stronger the whole hip and lumbopelvic region was prior to surgery, then the better the chance of faster and higher quality recovery.

Post-surgical recovery

Paul did a great job of a lot of strength work for the 6 weeks before the surgery – primarily bodyweight and simple dumbbell movements working on each of muscle groups around the hip, augmented with cycling and a little swimming to keep the endurance base.

The surgery went very well and Paul really did follow the guidelines for recovery – taking the time to relax and do sedentary things when that was the only option – and then consistently working through the exercises.

He was able to get back onto the turbo trainer very quickly. This was at light resistance and on the tops of the handlebars (for a more open hip position) to spin the hip, get the blood flowing and avoid getting constriction from scar tissue.

Paul was signed off by the physio after 6 weeks, and from there we built very gentle progressions on the bike – building time initially, then a little bit of intensity (both in terms of cadence and then power), then mixing in periods of a little more range of movement (moving to the hoods and starting to ride outside, then on trails on the mountain bike), then longer periods of the mid-level intensities. Getting the full range of cadences, positions (including being on the drops) and intensities was something that we went after one at a time, and then looking to mix bits in (eg higher cadences as well as higher resistances, then adding getting down on the drops at a later stage).

Then later we moved to the couch to 5K programme, building sequentially through the intervals to get to 5K graduation without any setbacks at all!

In parallel Paul had been doing unstructured lake swims and after the couch-to-5K moved up to a coached weekly swim set. He also supported all of this by ongoing body care and conditioning, with hip flexor stretching and releases around the torso to counteract where the muscles standardly tensed up to protect the injured area.

The golden skills

We are really conscious that major surgery is a very worrying time, and rehab can be uncertain. These golden approaches seem to have been key to getting Paul back to swim-bike-run on fast timings:

1. going into the surgery as strong as possible. Chatting with the physio, his personal experience is that strength and conditioning around that joint going into the surgery is the biggest predictor of rehab success. It makes sense – every system is working well for success: eg the muscles are well conditioned and stabilise the joint well, the blood flow is excellent and create an environment for faster healing, and the neuro-muscular movement confidence flows into the post-surgery exercise ensuring that the right movement habits are embedded quickly with the new joint.
2. doing what the surgeon and physio said! But also having very honest conversations with them about future sports goals in order to make the best decisions. Whilst it sounds obvious, we all sub-consciously think that we are better than that and can beat the odds, progress faster etc. The reality is that they do this surgery and rehab all of the time, so have great perspective. And they were very supportive of making the choices to enable a return to long-distance, extreme triathlons!
3. listening to what the body is saying – there were days when Paul was doing really well and could do some work on the car, and there were days where he really needed to rest. Following this was so important. Whilst the medics will give you approximate guidelines of what, and by when, everyone is different and healing is impacted by so many factors – some of which are difficult to even be aware of, let alone measure. So cueing in to the messages from the body and respecting them is really important.
4. we were pretty strict about only progressing one discipline on one dimension at any one time, and then moving to a much lighter maintenance approach when we moved to the next (eg adding in 3 runs per week for the couch to 5K programme)
5. whilst there were definitely days where Paul felt much stronger, we stuck to the plan and stopped even when there was more in the tank. The reason for this was the we prized consistency of the progression over fast jumps – and this worked. There was not a single set-back in all of the programme (even though we had planned and were ready for setbacks).

Back to sport

The great news is that Paul is coming back just as events are starting to open up again after COVID-19. He completed an adventure race with the family including kayaking, mountain biking, and cross country hiking, and running, and has also been getting out on the Stand-Up Paddleboard and back to all of his previous adventurous activities. So with a winter period to reactivate the years of endurance training, anything is possible in 2022 and beyond!

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