Why Recovery from Femur and Pelvis Fractures is Hard for Cyclists

Carmichael speaks from experience

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 last year. 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 back-country cross-country skiing accident and the bone split at the distal end between the condyles (see image below). 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.

Chris Carmichael’s x-ray

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 mo

ving 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.

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!

By Chris Carmichael
Head Coach of CTS


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