Member Case Study: Triathlon with Disk Replacement

author : AMSSM

comments : 0

Have I bitten more off than I should? What do you recommend for progress?

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Member Question from JMMauldwin

I underwent nine major surgeries over the past year and a half prior to retiring from Special Forces after 26 years. The "biggest" ones being the replacement of C5/C6 disc, a complete rebuild of my right shoulder, and facial reconstruction due to a severe head trauma back in 1997. I've favored my left arm for many years prior to the surgery and I am able to only work with 25lbs dumbells in the gym with it right now, although I can handle up to 80 when utilizing both arms.

I still have a way to go for complete recovery and will be completing my first Oly in Oct. Is it advisable to max myself out during workouts or should I baby all the repairs and not try to push the envelope if I feel that I can? I don't like doing things halfway. It's usually all or nothing but I do know when to stop and regroup if I'm going to tear something up... I think... Have I bitten more off than I should? What do you recommend for progress? I'm on a 6/7 schedule with a mixture of weights, running, cycling. Swimming soon to begin.

Answer from Grant Morrison MD
Member AMSSM

Your story, even briefly presented here, is remarkable and would be an amazing achievement alone.  To attempt an Olympic length triathlon after that is beyond words! I appreciate being able to comment on your inspirational journey. There are a number of things to consider in reply to your questions, roughly falling into categories on training, medical issues, and philosphy.

Before even getting to the nature of your injuries, I am curious about your level of training before this attempt.  Seems like it would be tough to get much of a base in with this many surgeries.  Are you truly prepared for the length of your race? Does your training level, regardless of your injuries, meet the demands of a race of this
length?

With regard to the specifics of your treatments there are a number of things to consider. Many people with cervical disc problems have weakness in one of their arms due to compression of nerves that arise from the neck and travel to the arm.  Perhaps that is the reason for your left sided weakness.  The longer this compression exists, the more difficult it is to return to normal strength. The work that you are doing with just your left arm is exactly what you say it is; using both arms means that the other arm is doing ALL the rest of the work.

Which arm is at greater risk, the weaker one trying to do more than it can, or the normal one overworking to make up for the weaker one? Consider your facial surgeries.  To what degree are your vision and your sinuses involved?  Any vision loss could be a dangerous liability while riding at high speeds.  Sinuses can be at risk for infection from lake water organisms.  How stable is the reconstruction after the surgery?  The last time I did a triathlon I got my goggles kicked off by the swimmer ahead of me repeatedly; a heel to the face could undo all the work you have had done.

There are many more medical issue that bear consideration, but in my opinion this is less a medical question than a discussion on the philosophy of risk.  Could you finish the race?  No one can possibly know.  Is it possible? Sure, but how likely is it that you will finish?  A lengthy debate could follow, with the doubters likely being a source of inspiration to you!  Given the vast number of injuries and extensive nature of the repairs involved, it would be very difficult to say with confidence that you will do just fine. Pushing to the limit during workouts before the race certainly puts you at significant risk for leaving your best race behind you before you even get to the starting line.

Bottom line: I think you have answered your own question if you feel that you are truly honest with yourself in knowing "when to stop and regroup if I am going to tear something up".  Start slowly, build up your endurance, push the envelope only if you can deal with the increased risk of injury that any athlete - well-bodied or not - would have to bear at the upper limits of their physical abilities.  With the increased risk of injury also comes the increased risk of being unable to toe the starting line.  What level of achievement can you live with?

Grant Morrison MD
Staff physician, University of Minnesota Athletics,
Department of Family Medicine, Division of Sports Medicine, University
of Minnesota
763-898-1000

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date: September 9, 2010