Physical Therapy Reinvigorates Endurance Athlete’s Career
February 12, 2021
As a devoted endurance athlete, Don Ramon of Acworth, GA has seen his fair share of bumps and bruises during rides and races. Several years ago, he took his biggest hit, literally, when he was struck by a car while cycling.
The incident left him with several fractured vertebrae in his neck. Not the kind of diagnosis anyone wants to hear, let alone a competitive athlete. Fortunately for Don, no damage to his spinal cord occurred, and his road to recovery started.
Within just weeks of the accident, Don began training again and even ran a marathon six months later. But other problems started to occur: tendinitis in his elbow, shoulder pain, and even a heart condition. Not sure of where to turn, he began physical therapy and has made incredible improvements.
Here’s Don’s story in his own words.
“It was a beautiful sunny Saturday in May 2016, so I decided to go out for a 70-mile bike ride. I was an avid endurance athlete, but I had taken a couple of years off from doing Ironman triathlons, and I was going to use this ride as a test to see if I was ready to sign up for another one. The ride ended after about 10 miles when a pick-up truck turned in front of me, and I hit it in the passenger door. My GPS showed I was going approximately 25 MPH when I made impact.
After the impact, I found myself lying on the road dazed and confused. I felt pain all over but mostly in my chest. I remember saying out loud, “I have to get up”, and I heard a someone say “don’t get up”. I protested and said, “No, I have to get up!” He protested with “I’m a doctor…don’t get up!” Not being in the right state of mind, I got up off the ground and started looking at the damage around me. I took off my helmet which had crushed in on the back.
Apparently, I hit the passenger window and shattered it with my head upon impact. Per the police report, an ambulance arrived in three minutes from the call. I was talking to my wife on the phone when the EMT said, “Come on sir, we’re going to take you to a hospital”.
I walked to the ambulance, laid down and as some of the adrenaline started to decline, the real pain began to come through. It was a short ride to the rural hospital where they did a quick but thorough assessment. This included giving me a CT scan to look for any issues. I remember four people coming in to place a collar round my neck for what they said was a precautionary measure. I remember thinking that four people don’t rush into a room to put a collar on your neck for precautionary reasons. A few minutes later, the doctor rushed in and told me not to move as I had severely broken my neck.
The diagnosis was multiple fractures of the C4, C5 and C6 vertebrae. Two of my spinous process, those bones that stick out on the back of your neck, had shattered. After several hours in the ER, I was transported to a larger hospital and had an MRI; I received the best of news. There was no spinal cord injury. To my surprise, they put me in a large brace from my neck to my chest and sent me home. The recovery time was six weeks, and then the orthopedist told me the bones had healed, and I could take off the brace.
My daughter, Amanda, was in her last year at Emory University working on her Doctorate of Physical Therapy when all this took place. With all I had been hearing about physical therapy while she was in school, imagine my surprise when the orthopedist said I didn’t need PT. He said I was very strong, and all I needed to do was return to my normal routine, and I would be fine. Not knowing any better, I returned to sport with a vengeance.
While in the neck brace, I signed up to run the New York City Marathon as a fundraiser for the Christopher and Dana Reeves Foundation. I felt so lucky not to have a spinal cord injury, I wanted to do something for those that were not as fortunate. Besides, it would be a great way to get back in shape. I returned to my training, and six months from the accident, I completed the marathon!
The next year, my body seemed to recover, and I went on to compete in two more triathlons, including Escape from Alcatraz. Then, I developed a heart condition, where my heart rate increased far above normal and was not in proper rhythm especially when I exercised. The diagnosis was atrial fibrillation (A-Fib) combined with atrial flutter, which my cardiologist said was common with endurance athletes. The solution was a procedure called cryoablation which lead to another long recovery period.
In 2018, I started having problems with my right elbow. An orthopedist diagnosed it as tendinitis and gave me a cortisone shot. This made the pain go away, but in six months, it returned worse than before and now my left shoulder hurt. I couldn’t lift anything over my head with my left arm and couldn’t pick up anything with my right. I was a mess! Amanda had graduated from Emory, passed her boards, and was a practicing clinician at PT Solutions. I needed help, and she arranged for another physical therapist, Tye Marr, to see me and assess my injury.
PT Solutions preaches a philosophy that to treat the pain, you have to find the source, which may not be where the pain is being felt. In my case, Tye determined that the muscles in my neck were not healthy and resulted in the ulnar nerve being blocked. Basically, my body had been trying to protect the injured neck, absorb the bone fragments, etc. and, as a result, developed multiple layers of unhealthy muscle fibers. He told me, nerves need to flow freely through the muscle fibers to be healthy, and in my case, the nerve was not flowing freely and that was causing my elbow and shoulder pain.
As part of the assessment, I also told Tye that my running pace had really dropped. Prior to the accident and the A-Fib surgery, I could easily run a sub 8-minute mile and hold it for a long time. Now, I was struggling with a 10-minute pace, and it was hard to go longer than 3 – 4 miles. I thought all of this was a result of the A-Fib surgery, so I just tried to fight through it and accept my new normal. Tye thought there was a possibility that the problems with my neck may also be causing the challenges in my running.
My treatment plan started with multiple exercises to strengthen my neck. This included manipulation, dry needling, and various exercise routines with weights. Even at 56, I’m still very strong as I have done a lot of weight lifting over the years prior to and while doing my endurance sports. The biggest thing I had to learn was to not over do my workouts and give the muscles time to rest and heal before pushing them again.
After a few months, I started showing signs of progress. The ulnar nerve was coming back, and the first thing I noticed is that my left shoulder pain went away. Then as the pain on the inside of my elbow went away, I developed pain in both elbow on the outside. This, Tye tells me, was the radial nerve. He explained how there are four layers of muscle fibers in the neck, and to get the muscles healthy, he has to work down through each of those layers. Once we got through the layer that was impacting the ulnar nerve, the radial nerve got inflamed. Progress was happening, but it was slow.
Interestingly, as the elbow pain started going away, I started to notice my running improving. Where I was struggling with 3 – 4 miles, I was back up to easily doing 6 – 7 again. Also, while my overall pace was still below where it used to be, I began seeing progress when doing speed work. I was able to run quarter mile sprints down in the 6:15 per mile pace. Could the improvement in my neck through physical therapy impact my cardiovascular system? Fascinating!
While I’m still not cured, I’m making great progress. My grip strength has improved, the radial nerve pain is almost gone, and I’m seeing improvement in my running.”