Broken femur - anyone with experience?

[mimitabby]

you can pm Triskelion but this is what she told me in an email:

Please let here know she can PM me after Nov. 20, but that in the meantime she should know that I solved the problem with a custom crank set featuring a dropped pedal I got from Tom Slocum at High Sierra Cycling (mine is 3 cm). She can google him and phone him to discuss. Lennar Zinn's latest book also has good advice on this problem.

[Ogresse]

thanks for the butterflies, T. It was a relief to get the fitness back (though it took some time!). I really don't deserve any extra credit as I had no choice but to be on my bike for rehab - walking was out of the question - but it was so ironic to ride everywhere and then need my cane to walk the bike to the car! I have a long way to go before my legs have equal strength again.

I'm familiar with Andy's book and his approach. Basically I'm not sold (yet) on either approach but with regard to the arthritis, I wonder whether a shorter crank would mean less stress on the ball? My cleat-fitter friend thinks Andy's work is a sensory/proprioceptive approach, where shimming (and also moving shorter leg's cleat back and longer leg's cleat forward, I believe) should make you 'feel' even so you ride more comfortably (a bit oversimplified but that's the gist). Having ridden this way for my first year back I'm really curious to try another approach and see how that feels and, most importantly, whether it will slow down the arthritis. That part is a big bummer.

Eden, does your bike shoe fit comfortably with the insert? My orthotics don't work with all my non-bike shoes - not enough room in there. The shoes with stretchy laces (a la Keen) do well. I have similar thoughts about upper to lower leg length difference. With the big cleat stack (and the 170s) my left knee ends up pretty high on the top of the stroke and not as far forward as the right knee, and I think there's more dead space in the stroke than in the right. So it will be interesting to see if the different crank lengths do help or at least what they feel like. And - a thought - maybe it's not that your short leg is "too" short...maybe your longer leg is "too" long?! Maybe that short leg's length just works better for all the levers and pistons at work. My left (shorter) leg pedals very straight whereas my normal leg needs canting wedges to keep it from tipping in toward the top tube.

Deb, your ITB snapping friend and I should get together and play some tunes . He sounds like he's much more uncomfortable than I am and certainly had a more complex fracture. Anything in the femoral neck brings danger of avascular necrosis which (like Floyd), if it occurs, means eventual hip replacement, and all that. I'm sure they're monitoring him closely.

Does anyone know how common it is for (uninjured) cylists to get arthritis in their hip joints? I always thought we were better off than impact sports people who primarily run or ski (other than getting bad marks for osteoporosis). In my case the femoral head is probably out of alignment so that it's rubbing in a way it didn't pre-accident.

Oh well, so much to think about. Thanks, everyone, for your thoughts. I'll be checking back!
O.

[Eden]

My shoes are standard Sidis - two velcro straps and a rachet. The insole isn't an orthotic - just your standard insole material cut to fit my shoe and give that leg a tad more height, so I don't have any problems with my foot not fitting anymore (come to think of it, most people including me have feet that are slightly different sizes and it definitely looks like my left is smaller - hah! I can measure my feet and yup - the left one is about 8.5 inches long at its longest, the right almost 9)

I just had her do my winter shoes (they are "touring" style shoes, with recessed cleats so they are somewhat harder to adjust). The shoe with the insole felt a bit weird and tight when I first put it back on, but after a few minutes with it on I didn't even notice the insole any more.

It's pretty well impossible for me to measure my own legs accurately, but roughly giving it a try I'd say my left leg is definitely somewhat shorter than my right or perhaps you are entirely correct, my right leg is longer than my left I do have one wedge in my right shoe to tip my knee in a little - there are 6 plus the insole to prop up my left!

This is all quite interesting - it makes me think of other things too. I've been doing step-ups as part of my winter training/core strength routine and I've noticed that I have a tendency to swing my my right leg out when I do it if I'm not paying attention - could very well be an unconscious compensation for that one being a little longer and hitting the ground sooner than I expect????

[Triskeliongirl]

No time for a lengthy response, but my LLD is 3 cm following a serious bicycle accident. You need to ring up Tom Slocum at High Sierra Cycling. While the custom 'systems' he builds are not cheap (he calls them systems not crank sets), it was the only way I could ride again without pain. My crank arms are 165mm (sized for my short leg), but then the crank arm on my longer leg side has a dropped pedal that rotates throughout the pedal stroke. The chain rings are also elliptical and off set, to balance the leverage and be gentler on my knees. His work isn't cheap, but its right on. I did have to fly to california for a personal fitting, but it was worth every penny.

[Wahine]

Clinically, I would say that early onset OAS is more frequently seen in weight bearing sports and occupations. But I have seen it in people at a relatively young age that do not participate in high impact sport. For eg, last year I saw a 56 yr old male post bilateral hip resurfacing surgery (this is a technique to deal with hip OAS that is less invasive than a total hip and has a very good success rate in the younger population). He was a professional kayaker, still runs a guiding and instruction company. He was also a cyclist, both road and mtn. So no high impact sports, no major trauma. No clue as to why he had such severe arthritis at such a relatively young age.

I did find this excerpt from an abstract on The American Journal of Sports Medicine:

Men with high exposure to sports of all kinds com bined (in hours) had a relative risk to develop osteoar throsis of the hip of 4.5 compared to those with low exposure. Track and field sports and racket sports seemed to be the most hazardous to the hip joint. Men who had been exposed to high physical loads both from their occupation and sports had a relative risk of 8.5 to develop osteoarthrosis of the hip compared to those with low physical load in both activities. Potential confounding factors, such as age, body mass index, and smoking, were considered.

Long-term exposure to sports among men seems to be a risk factor for developing severe osteoarthrosis of the hip; this is increased when combined with heavy load from occupation.


In your particular case I would say that any alignment changes will result in faster degeneration of the joint. To the extent that you can decrease the forces going through the joint, you will decrease the pain and slow progression. A shorter crank arm would help significantly with this as it decreases the amount of torque required to turn the crank. In addition to this, staying in a gear that allows you the highest possible efficient spin would also help.

[Ogresse]

Hi Eden,

I bet it would be useful to have a PT or someone in the know spot you as you do your step-ups to make sure your knees are aligned properly. I have no training in this area - just a ton of rehab experience! - so it's a layperson's $.02. But if you're already wedged and canted as much as you are in the bike that might be a good thing to do (and consider orthotics which correct for varus/valgus and all that). As part of my rehab I treated myself to a superdy-duper (as my 7-yr old says) pair of trail running shoes. I tried to find the most stabilizing shoes possible and found an (expensive!) pair of Salomons that have helped me do lateral lunges and stuff like that without feeling like I'm going to fall into the refrigerator. Of course, I could always do them some place other than the kitchen...

Trisk - thanks for that note. I'd already seen that High Sierra site and eyed the one-piece wedges with great interest. I'll see how it goes with this next approach (I bet I'll end up with 165 on the right and 160 on the left/shorter leg - if it's even possible to find a single left 160mm Shimano crank!) and will definitely keep Tom in mind for a consult.

Wahine - thanks, also, for that info. I'll see if I can find the article you quote from. I've also heard about a surgery (osteotomy?) where they cut a deeper or different angle in the socket so the ball can rotate correctly once again. Lots of invasive things to do. Hoping to find something non-invasive (like maybe some kind of torture stretching device that can reposition my leg out and up!). The "funniest" ( ) comment I've heard so far is that if I do have to have a hip replacement, they can also lengthen my leg...

Hope everyone can get in a ride today! It's 40s and very sunny out here in New England and my legs are itching for it. Thanks for your help.
O.

[Triskeliongirl]

You don't need the wedges. Those are for folks with smaller LLDs. For small LLDs, approaches like blocks, shims, and creative cleat placement can work, but for large ones like ours, I believe that a dropped pedal is the best approach.

http://www.hscycle.com/Pages/cantsandwedges.html

While I had him build me an entire crank set, it may be possible for him to build you a single crank arm with a dropped pedal for your long leg size that would be comptable with any crank set.