Louise Galvin: Cast builds character but emotional roadblocks hamper any recovery

Eight weeks post ankle break. One week out of cast. How am I getting on? That is the million dollar question. Physically and mentally it is time to take stock.

Modern medicine has evolved immeasurably, with the ultimate result being that men and women live for longer. Yet, for all its advancements, broken bones are still treated much the same way without much quickening in healing times. Fractures are immobilised for weeks on end to allow the fracture to heal and new bone to be laid down in its place.

What problem do I have with this? In a sense, it is robbing Peter to pay Paul. As this immobilisation is taking place and the new bone is being protected, the other structures around the area are being tightened and weakened. In my case, all the joints in my foot and ankle, each sinew supporting them, and my Achilles tendon and calf muscles, have been dormant for seven weeks. Once the cast was removed a week ago, as expected, the muscle wastage was cruel and unforgiving. If my emaciated calf was of the four-legged variety out in the farm at home, I’m not sure my dad would even waste the vet bills on it!

The time in cast itself was a challenge, physically and mentally. One thing I realised almost immediately is that even though it is your leg that is injured, when on crutches your arms are just as redundant. Advice to anyone new to the experience? Bring a backpack everywhere!

Intent on maintaining some sort of independence and not completely relying on my housemates and family, I tried to do as many daily living activities as possible, at times to my detriment, and laughter from those around me bemused by my stubbornness. The days, I found, didn’t go too long, as every task took twice the time! But the accumulated days and weeks passed slowly.

Most people in casts are off work, college or school during the period of immobility. Thankfully, I wasn’t. I attended our training base for daily gym sessions, targeting my upper-body strength and where I would also complete my rehab/prehab exercises which helped maintain some strength and flexibility in my non-affected joints and limbs. Though glad of this involvement, it also offered a daily headache trying to get across Dublin to training, especially when my housemates were away at World Series tournaments. Life on crutches negotiating public transport is far from enjoyable.

Psychologically, I coped adequately for the first few weeks post-injury. Although the novelty of being treated sympathetically and asked about the leg by everyone you encounter wore off pretty quickly.

When I end up in conversation with someone in a cast in future, I will refrain from asking them what happened, because I know from experience they are most likely sick of talking about it!

I started to make up outlandish Bear Grylls type stories involving wild animals for random taxi drivers near the end.

One particularly bad day I decided enough was enough and asked the taxi driver if he would mind not finding out what happened my leg and could we talk about anything else.

In hindsight, maybe a bright green cast wasn’t the best choice for discretion.

Four weeks in, I took a metaphorical tumble. At my fracture clinic appointment, I was told I required an extra week in cast. Seven weeks instead of six, not part of the plan. The consultant didn’t seem perturbed when I told him I had already written, highlighted, emboldened and underlined the original date of removal into my diary. An extra week immobilised was nowhere to be seen on my list of potential projected recovery plans.

I struggled massively with this information. In fact, even though I don’t like sharing this, I burst into tears there and then in the hospital. To put this in perspective, I was nowhere near crying when the bone actually broke, or when this was confirmed on initial x-ray. I was close to frustrated, angry tears the first time I tried to shower with a bin liner taped around my swollen casted leg, but this was different. To compound things, I was aware I was in a busy large acute hospital where patients were receiving infinitely worse information than having to spend a lousy extra seven days in cast, yet the sticky, salty, sweaty tears kept rolling. With each wipe of my face, I felt I was also wiping away some of my dignity. But maybe that pressure release had to come?

I couldn’t park this setback. Those around me were telling me ‘it’s only an extra week, you’ll still be back in no time’, but being completely honest I wasn’t convinced of the necessity, and that rankled with me. If this was conservatism, because of the future and imminent demands I would be putting my ankle under, I wasn’t buying. I wanted out of cast ASAP, not a few extra days just ‘to be sure’. I was never the most conservative. The nuisance of being non-weight bearing an extra week I could and would get over. But while that bone healing was consolidating, everything else would be suffering, stiffening, weakening, and my fitness dwindling. All meaning a longer time until I was back on the pitch.

I spent the last long three weeks pissed off, angry and anxious. I continued to do what I could exercise-wise, but mentally I let it consume me, to my detriment, and to the annoyance no doubt of those around me listening to my cantankerous complaints.

I said previously how rehab begins on day one of injury, and not when the cast comes off. But there is a real shift at this point. The fracture is completely stable, now it is time to tackle everything that has been suffering as a result of the bone-healing phase. Something, thankfully, which is much more within my control. Everything is stiff and sore, but my background as a physiotherapist has given me an added bonus in knowing what is safe to push, and what to hold back from.

Looking at the smaller picture, I need to get my ankle and foot moving again, build up the strength in the muscles supporting it and the endurance to keep them going. Once this is adequate, I need to work on my power and speed, before even thinking of returning to train and play. From a total body perspective, I am very much aware this period of immobility has unavoidably led to some deconditioning, and so I need to build up my general strength, fitness and endurance, which can be done in the gym, on the bike and in the pool. The endorphin release I got after my first proper sweat in seven weeks after a bike session last Friday was incredible, I floated out of the gym grinning from ear to ear! Of course I am training to be a rugby player, rather than just an athlete, and now I am able to incorporate ball handling drills.

The bigger picture? Although making daily small gains, I am still a considerable way off physically participating in a full rugby session. Although I have access to daily physio, strength and conditioning coaches, nutritionists and the facilities I need to support my return to play, the exercises I have to do to build up my calf and increase my flexibility are still mundane, boring and time-consuming when all added together, with limited immediate effect. It is up to me and me only to do them. Standing on the sidelines watching my teammates is more than enough motivation to make sure I don’t miss a single repetition.

The closer I get to the pitch, the more patient I will have to be. I will have been roughly ten weeks out in total when I hope to return, and I have to identify the potential risk to other muscles and structures that haven’t been exposed to the intensity of training in that time either, as well as my right ankle obviously.

Also, my handling, decision-making, and general skills won’t be as sharp as usual, which is something I need to accept to an extent and not let it overly frustrate me.

So how am I doing? Back on my feet, literally, I am a strong independent woman again! I can drive, I can do my own shopping, I can cycle and swim. No kind soul stops and asks me what happened my leg anymore! I can’t run yet, but I’m getting very close.

Mentally, the journey has been just as arduous. I’m not sure if I have developed some more patience, or just had it tested, a lot! I’m sure it won’t be all plain sailing from here on in either. But at least I feel I have more control of the situation now. Hopefully, I am better equipped now than before, to adapt and handle future bumps on the road.


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