Why Recovery from Femur and Pelvis Fractures is Hard for Cyclists
By Chris Carmichael
CEO/Head Coach of CTS
I felt a twinge in my right leg this week when I read 4-time Tour de France Champion Chris Froome crashed and broke his femur. I broke my femur in the winter of 1986, and although every fracture, surgery, and recovery is unique, there’s no getting around the fact broken femurs and broken hips are hard injuries to come back from, particularly at the pro level.
My femur broke in a backcountry cross-country skiing accident and the bone split at the distal end between the condyles (see image above). Through the subsequent surgical repairs I lost an inch of leg length, developed scar tissue, and developed myositis ossificans (calcification within muscle tissue). I managed to return to professional cycling and raced until 1989, but I never fully regained the power and performance level I had before the injury.
A broken femur or pelvis can be a tipping point for a pro cyclist’s career. According to Procyclingstats.com, thus far in 2019 there have been a reported 123 injuries in the World Tour peloton, 9 of which were femur or pelvis fractures. A broken collarbone doesn’t typically foreshorten a career, but femur or pelvis fractures can bring a swift end to a cyclist’s best days. Besides my personal experience, the cases of Joseba Beloki and Craig Lewis come to mind. That’s not to say a full and powerful recovery is impossible; riders have returned to winning form after serious leg and hip injuries. I’m hopeful Chris Froome will be one of the fortunate athletes who makes a complete recovery and returns to full competitive strength.
Here are some specific reasons why coming back from a femur or pelvis fracture can be especially difficult:
You lose a lot of time
A professional cyclist’s career is not typically very long, and even for riders who spend 15+ years as a pro, they were most likely at their best for 5-6 years. Losing almost an entire season is a big setback because racing and training is cumulative. From days as a junior and U23 and into the pro peloton, each season builds on the previous, and that cumulative strength is invaluable. A major interruption and step backward in that process can cost a rider their most valuable commodity: time.
You lose a lot of fitness and muscle
When you break a collarbone or wrist you can often get back to training – indoors – within a matter of days or 1-2 weeks. As a result, you don’t lose a lot of fitness or muscle mass. In contrast, recovery from a broken femur or hip takes longer. You may be moving pretty quickly after the initial injury, but not training. Once you get clearance to train at full power again, it then takes a long time to rebuild the fitness you lost
Your biomechanics can be forever altered
This is one of the primary reasons my cycling career ended prematurely. With one leg an inch shorter than the other, my pedal stroke changed completely. Experienced cyclists have spent years and perhaps millions of pedal strokes creating the patterns and structures that allow for a smooth, powerful, and pain-free pedal stroke. When all of that changes as the result of an injury, you have to create new neuromuscular connections and patterns. The soft tissues that have adapted to your specific pedal stroke have to remodel themselves, too, which increases the risk of soft-tissue injuries during recovery.
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For most cyclists these changes in biomechanics can be managed with bike fit, physical therapy, or other modalities and riders can continue riding and racing. At the professional level, the margin between success and failure – being on the podium or off the back, or on the team or off the team – is so thin that losing a few percentage points off your best can be a career-changing injury.
Long recoveries are hard psychologically
Getting back on the trainer quickly following a collarbone or wrist injury helps athletes stay positive. You’re still training, and the injury feels temporary. With a broken femur or pelvis, there’s a long period – sometimes months – when you can do barely anything resembling cycling training. You can see the muscle and fitness you spent so long building withering away. You start to have doubts about whether you’ll ever make it back, and maybe you even start accepting that your best days are behind you.
When you do finally get back to training at full strength, those first rides are slow and you don’t feel like the same rider. This can lead to a lot of anxiety and stress. Addressing the psychological effect of serious injuries is one of the keys to returning to competition at a high level.
Chris Froome has a long road to recovery in front of him, and I sincerely hope his recovery goes better than mine did (technology and sports medicine have changed a lot since 1986…) and that he returns to the peloton at his absolute best. Best wishes, Chris!
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Comments 19
Thanks for sharing your comments. As Orthopaedic Surgeon I suffered a left pelvic fracture (LC1, B2.1) after a road bicycle crash 2 weeks ago, I am happy to see that I am not alone. I am 49 and I would like to share my own experience at this time. After 2 days of bed resting I began walking with crutches and no weight bearing for a couple of days, helped by NSAID and light opioids. Early isometrics, hip and quads exercises and EMS assisted were included aswell. After that I started floor touch as tolerance at the end of the first week. The second week reached 25 kg weight bearing and yesterday was able to get on/off from my static bike and rode almost one hour (150 watts) until groin and low back pain appeared. I do TENS after to decrease the muscle swelling and pain. The goal is a scheduled static bike exercises 3 days every week, EMS every 72 hours and progressive weight bearing (+20 kg) every week as long the pain allows it. I hope my experience be helpful.
Hi,
I recently suffered fractured pelvis. Very tiny crack on one side, doctor said 6 weeks on crotches and no bike. After 2 weeks they moved me from non-weight bearing to partial weight bearing but still using the crotches for a total of 6 weeks.
One physio said indoor cycle if no pain and be very caution on getting on and off, other physio said only start indoor cycling at about 6 weeks after the crash.
I’m at 3.5 weeks now and have already done some easy rides 30min@80W and feel no pain.
I really want to follow the advice of professionals but i don’t see the harm of doing 30min of easy ride – any thoughts?
Thanks for the article and the comments! I’m 2 weeks into recovery from a left side pelvic fracture (pubic bone), after a relatively slow crash on my gravel bike (my front wheel washed out on a hairpin after hitting some wet gravel over asphalt, and my left hip took almost the entire impact). Fortunately, no misalignment and no surgery!
My ortho has me on a walker & crutches with no weight on the left leg for at least two more weeks, the we’re hoping to start light PT at that point… Is there anything I should really avoid or make sure to ask about to recover fully?
I’m 61 and currently average about 10k miles annually on the road/gravel bike…
Thanks Chris
With Covid-19 shutting down the Mt Bike racing season in Michigan I was able to put more fun miles in this year. On July 11 I hit the deck resulting in a fractured femoral neck. Although it was painful I was able to ride 20 miles to the hospital via the adrenaline train. Five hours and three screws later I began a six week journey in hopes of riding at the end of the recovery tunnel. My weight bearing walks began short ,slow and painful. Riding on the trainer I experimented with my different bikes settling on my cycle cross bike with it’s shorter frame and cranks. Getting in and out of the Road pedals was painful , however When the Mt bike pedals were turned down it wasn’t too bad.
Rolling the cranks over is also a lot easier than walking. After reading the many responses I feel pretty fortunate. At 61 this set back has presented many teachable moments.
Gracias
Brad Miller
Thanks for this article, it gives me hope. I’m 59 years old and broke my pelvis falling off my mountain bike at about 28 MPH. This resulted in 4 breaks to the pelvis and the hip trying to push through. Also resulted in a crawl to the road in the back country and 7 hours of surgery. My ortho had me on non weight bearing for 12 weeks. I’m now at week 7 and have moved to toe touch weight bearing and am on my second week of physical therapy. There’s lots of metal in my pelvis now and a pin through the hip joint. My PT guy (doctorate in PT) and the ortho folks at the level 1 trauma center in Colorado Springs assure me I”ll get to return to bike riding. I’ll be doing some upgrades to my bike in prep for this, a single drive on the front and probably a new saddle. I came across this article looking for guidance on the new saddle.
As the article states, the long period of inactivity looks to be one of my biggest hurdles, and I’m not a competitive athlete in any case, so I’m just hoping to get back to my sport. I’d include a pic or two, but don’t see how to do that. And I’ll mark and try to update in the hopes it will help someone else with the same specific injury.
I’d like to than everyone who has lifted my spirits by your comments on this article. My 75-year-old femur was nailed together beautifully 12 weeks ago today, after a crash on an icy road the day before. The slow rate of recovering strength and mobility would have been even more frustrating than it has been were it not from the advice of our local physiotherapist about the seriousness of the injury, and reports of others who have experienced it.
My timetable may be of some help to newly injured cyclists. The physiotherapist said I could go back to the gym 8.5 weeks after the operation. Right away, I could ride a static bike at low resistance comfortably for 20-30 minutes and have gradually increased the resistance back to my pre-accident level. It tires me, but I am glad to be back in a saddle again. (I know I could ride a real bike right now, but flicking out of the cleats might be painful, and my wife would be less than pleased.)
Eleven weeks on, I started strengthening the leg muscles using very low resistance on weights machines at the gym, and I also walk up and down the gym’s swimming pool. A few days before that, I was able to walk for about 10 metres with good quality steps and no support, but I’ll use an elbow crutch or stick for most longer walks for a while yet.
The tales of others who’ve been there, and support from family, friends and physiotherapist make it easier to keep persevering with the exercises.
Apologies for the typos (which I’m happy to be edited out): thank/than (line1); for/from (line 6).
Thanks for the article, Chris. I’m no pro, but recovered quite nicely from a pelvis break as the result of a crash on a wet descent last November (2018). Although not able to walk, I did get on a trainer after about 4 weeks. That was good for my physical as well as mental fitness. I rode the trainer everyday for about 40-50 minutes for about 6 weeks. I took my first real ride at the 11 week mark after surgery. I’m currently 63 years old and I’m back to riding about 200 miles/week (pain-free). After 10 weeks of riding, I did two back to back bike tours. One was 4 days down the California coast (350 miles) and the other was in the hilly mountains of northern Spain for 8 days (about 370 miles). I can’t say I’m back to full speed, but I was never that fast anyway. I can hike problem free. But I used to run a bit, and that isn’t happening yet. But as my surgeon said, running is for people who can’t ride a bike. (I like that!) I’m just here to say that with a good surgeon, it is possible to get back to pain free riding after a pelvis break.
Hi Chris, thanks for the article. Is there more advice you can give about diet, supplements, medications like Biphosphonates, training one can do for a fracture like femur, Tib fib?
glad you are recovering
Chris, interesting read. I’m 71 raced at Master Nationals in Augusta last year, went out to early in road race and sucked, but came back back and took 9th I the crit race. So I decided to hire a coach to help me get on the podium this year at nationals in August. After reviewing several coach’s, arrowed it down to two and selected Renee Eastman from CTS. Started Feb first this year and on the 10th broke my femur and since it was a high break, I now have a rod down my leg and a new hip. Crashed on a casual gravel ride. It’s been a bitch, after 2k in PT work and injections finally road 20 miles today outside, nice to be off the trainer. It’s going to be a long climb back but with the help of Renee, I’ll be racing next year at the Masters National and will be on the podium! Renee has be a wonderful coach and I can’t thank her enough for the mental support. Her communication skills are outstanding and a I look to start training again late summer…
That’s allot of hardware Chris. As previously stated impressive you were able to return to the pro circuit.
Question, so are experiences similar as stated above with having a THP, total hip replacement?
Ben Rocco
NJ USA
You should distinguish between a hip fracture and a pelvic fracture. Your hip is not your pelvis. It’s the top of your femur.
Chris, thank you for sharing your X-ray. As an orthopedic surgeon it’s always enlightening to see how internal fixation has progressed. The intramedulary nail was in its infancy in the 80’s. It’s superhuman that you were able to resume competition on this leg.
I will never forget riding behind you at a camp and asking what is wrong with your Right leg. You responded how do you know or see what is wrong? It is what I do for a living was my response! You are so right saying how it alters the very finite biomechanics of the pedal stroke. Thanks for writing such a great article.
Chris, how do you compensate for having one leg an inch shorter than the other? I too have this affliction due to a skiing accident. However, I didn’t start cycling seriously until my mid-50’s. I’m now 72 and continue to compete in Gran Fondo’s, etc. Since my injury pre-dated my start into cycling, my pedal stroke didn’t change, so I left it alone. I experimented briefly with shoe lifts under my cleats but didn’t like the feel. I also thought about different crank arm lengths. I don’t feel it would be that beneficial to do something at this point. Thanks,
Ah John Walker, you make it sound like you’re not going to do anything in any event, but in case you want to try anyway, I’ve heard that folks *have* had success compensating for different leg lengths by using a different length crank. You could talk to Tony Tom at A Bicycle Odyssey in Marin. He was skeptical until he saw some have success. At this point he may even be able to make a crank for you if you don’t have someone close to you.
John, my right femur is an inch shorter than it once was as a result of a motorbike accident and, more specifically, the treatment I received after it. I use one set of extra cleat washers (the thick ones) under the right cleat but that only assists at the bottom of the stroke. I also nudge the nose of my saddle slightly to the left which pushes my right hip forwards slightly. So, in conclusion, you can’t fully compensate for a femur length reduction on a bike but you can give yourself the best chance of keeping going by getting a good bike fit. Good luck.
I’ll vouch. In April 2013, I was brought down hard by an inattentive motorist resulting in a broken left pelvis (among other injuries), specifically two non-displaced (so no surgery) fractures, one of which was non-weight bearing. Two months on crutches. I wasn’t allowed to drive, let alone ride. Once cleared to get back on a bike, my orthopedist and I had a little misunderstanding on what “go easy” meant, resulting in setback after setback all summer into autumn. Though the bone had long-since healed, there are a LOT of nerves and blood vessels which run through that region which were easily inflamed. Going into winter (such as it is in San Antonio, Texas), I just stopped riding at all for a few months. I later had to give up driving stick-shifts (goodbye WRX!). And I am just a recreational/fitness rider, not a racer. It took me a couple of years to get back to where I had been. I sure wish Chris Froome well.