Broken Hip New Hip

When I fell and broke my hip I was riding a Raleigh bike.

It was Raleigh mountain bike, aluminum frame, large frame, hard tail—no rear suspension.  Rockshox (the brand) on the front fork, 1.75 inch knobby tires and caliper brakes.  I bought it new in 1995 and rode it maybe 200 miles in 10 years.

The bike came with platform pedals that I replaced with clipless pedals.  The term, clipless pedal, is misleading until one knows how the term came about.  Sheldon Brown, the bike guru, offers a good explanation. (http://sheldonbrown.com/).

Sheldon  Brown says that up until the late ’80s, the choice for pedals was between plain pedals or pedals with toe clips and straps. As the next generation of  pedals came along with a way to secure the bike shoe to the pedal without the clip, the “clipless” pedal name stuck, even though it is sometimes confusing to newcomers.

“Clipless pedals (think: no toe clip) use a cleat which is bolted to the bottom of the shoe. When the rider steps on the pedal with the cleat, the cleat locks into the pedal mechanism, and is held firmly in place (similar to ski boots and bindings.)

“With most clipless pedal systems, the foot is disengaged by twisting the heel outward.”

The clipless style I used was SPD, which stands for Shimano Pedaling Dynamics.  SPD pedals were introduced in 1993. Separate cleats mount to the bike shoes. Once clipped in, turning the foot outward releases the shoe.

With new clipless pedals and wearing shoes with cleats, I mounted the bike next to a concrete curb and practiced tilting the ball of the foot downward and forward and pushed the cleat on the ball of the shoe into the pedal mechanism and pushed forward to secure the cleat to the pedal.  Then I twisted my heel outward and pulled up with the ball of my foot to release the cleat from the pedal mechanism.  I figured a dozen or so reps would be enough to try releasing while riding the bike.

I rode around our neighborhood, rolling toward a stop sign.  I twisted my heel and pulled up and backward to release my foot from the pedal.   Then I tipped the bike and dropped my newly released foot to brace myself as I stopped.  It seemed to work just fine.  I rode around the block and came to a stop sign.   As the bike slowed I tipped the bike and began to move my foot to brace myself–forgetting my feet were clipped to the bike pedals.  The bike stopped, I paused and tipped over, banging my elbow and hip.  No permanent damage.

After moving to our present home a few years later I began riding again, both on paved roads in the country and on sandy dirt roads around our house set amongst the sage brush.  I talked with several seasoned bike riders who explained the added power from riding clipless so I installed SPD-style clipless pedals and bought me shoes to match the clips.  They explained that without the shoe being fastened to the pedal all the power to propel the bike comes from the down stroke using the quadriceps, the four prevailing muscles on the front of the thigh.  By fastening the shoe to the pedal power can be applied in the downward stroke and the upward stroke, that is pulling the pedal up with the hamstrings, the three muscles behind the thigh, and the gluteus maximus, or butt muscle.

So I traded my platform pedals for clipless pedals on my mountain bike.  I practiced clipping and unclipping dozens of times sitting on the bike leaning against the wall of our garage.  I rode around a local parking lot and practiced unclipping and stopping.  But the release action was not a habit and that’s why I fell when the bike slowed to a stop riding up the embankment of the new road.  Mentally I knew I was clipped in, but my reaction time was too slow and the release movement was too slow.

So, laying in the hospital with a broken hip, I told the doctor to go ahead and replace it.

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Broken Hip and Clipless Pedals

I was lying in the dirt, my head was downhill, my legs up the embankment.  It was August 28, 2010.  The intense pain in my hip was filling my body but I kept thinking that if I could just relax and rest for a few minutes the pain would ease and I would get up and walk my bike back home.

Rolling my head across the dirt I could see the edge of the roadway.  It was a new road crossing a wide open expanse of sage brush, chamisa brush and jack rabbits.  The new road began four miles away in a small subdivision, crossed a couple of arroyos and open desert, then connected to the road to the city dump three miles the other direction.  The new road was not yet open to the public so it was empty—no traffic.

I rolled my head the other way and looked uphill.  My bicycle was laying uphill from me, just beyond my feet.  I remember riding up the sandy incline of the new road, my bike shoes clipped to the bike pedals. The bike slowed to a stop.  I tried to twist my foot and unclip but I just tipped downhill, landing on my hip and shoulder.  Intense pain came instantly.

When I looked across the slope scattered with sage and chamisa I noticed movement in the brush.  The outline of a dog lopped along the horizon.  Except it wasn’t a dog.  It was a coyote.  I rested my head.  The pain was getting stronger.  I looked again.  A coyote appeared again on the hill, much closer to me this time.  He lopped across the hill and disappeared.  Do coyotes attack humans, I thought.  I felt uneasy as the coyote disappeared over the outline of the chamisa. Then I remembered what a local told me about coyotes.  They don’t hunt alone, they mate for life and they hunt in pairs.  Did I just see the same coyote circling me? Or was the second coyote the mate?

I felt the urge to move somewhere safer.

Raising my arms I pushed my hands against the soft sand and pushed–pulling my hips and legs up the hill toward the road. I raised again, pulling my body up the slope, motivated by visions of coyotes hunting me down.  Within 5 minutes I was at the edge of the asphalt.  The pain was excruciating.  I scanned to sage brush for coyotes but saw none.

A few minutes later I heard a car in the distance.  I raised my hand and listened as the engine slowed– a pickup stopped on the road near me.  An older guy in Levis and an old shirt got out and asked if I needed help.  He said he was out looking for his stray horse and he used the new road for a better view of the desert.  After a brief conversation, he grabbed me under the arms, lifted me onto the truck seat and put my bike in the truck bed.  With his cell phone, I called my wife and told her briefly what happened and that I was getting a ride home.

15 bumpy minutes later, we met my wife at our house, they got me into her car, put the bike in the garage and she drove me 20 minutes to the hospital.

Laying in the emergency room after x-rays were taken, the doctor told me the hip was broken at the neck—The head of the femur was separated from the femur itself and I had two choices:  Leave the joint alone, lay still for 6 months, let the bone heal then start intensive physical therapy to regain lost strength from no activity.   Or, he could insert a cap in the pelvic bone and a 4 inch pin with a new head into the femur.  He called it a total hip replacement, aka Total Hip.  I could be walking a week, physical therapy for 6 weeks and back to normal in 6 to 12 weeks.  I chose the new hip and rehab rather than 6 months of rest.

But it didn’t take that long—it took much longer.