by Ruth Heidrich, Ph.D. (63) (Six times age group winner of the Hawaii Triathlon) One of the most devastating injuries the body can sustain is that of fractures affecting two or more limbs, or multi-focal fractures. The human body is so dependent on movement that total immobility results in a steep decline in function. The bones lose density (just as in outer space), the muscles atrophy, the tendons and ligaments contract, the cardio-vascu-lar and pulmonary systems lose their aerobic capacities, the gastro-intesti-nal tract slows, and even the cerebral functions reflect the lower oxygen levels from lack of vigorous exercise. Immobilisation is the beginning of the end. This is the situation I found myself in after being struck by a truck while doing the cycling portion of my triathlon training. The impact resulted in comminuted fractures of the left tibia and the right acetabulum (pelvis). Because I was extremely fit and the greatest threat was the loss of my fitness level, I had to devise ways to maintain as much of my fitness levels as possible. The treatment of the fractures would have required six to eight weeks of bedrest. Besides the above declines in bone, muscle, etc., I was also facing increased risk of pneumonia, forming and throwing blood clots, and bed sores. Without the ability to do any weight-bearing on either side, the prognosis was grim. The alternative I was offered was to have a rod put in the tibia to allow weight-bearing on at least the left side and get me out of bed. This was a difficult decision because I did not want the surgery to recover from in addition to the fractures. [...] I did not realise how much pain there would be and how long it would last. Although pain medication helped, I tried to keep it to a minimum and yet still function. Orthopaedic beds have bars suspended above the bed for patients to pull themselves up. It seemed to me that their primary purpose was to lift up for the bedpan. I saw it as a means to do pullups. At first, the pain was so great that I could not pull up at all. As the days went by, I found some strength returning and was able to pull up higher and higher. By the time of my discharge two and a half weeks later, I could pull myself up as far as the bar would allow. I started from just one repetition 3-4 times a day (this was required in order to use the bedpan) and ended with 15 reps ten times a day. That helped with the upper body. The lower body was another matter. I could see the quadriceps on the left leg literally shrinking away. Physiotherapy consisted of trying to contract the muscles, using an electrical muscle stimulator, then raising the leg, and then finally, strapping weights on. It took two months to finally reverse the atrophy and start seeing the quadriceps rebuilding. The same process was occurring with other muscles but it was not as visible. There was also the long, slow process of regaining the range of movement of my joints, primarily the knee, hip, and ankle. Twice a day sessions of 15 exercises has been my routine for three months now. When I was discharged from the hospital, I was still using a walker and moving was extremely painful. Knowing that exercise was crucial to reversing the loss of fitness, I had someone lift me onto my stationary bicycle until I could get on myself. The same with getting into a swimming pool. With the bike and the pool, I was able to do my own version of the triathlon very soon. Although the biking started with only two minutes, I'm now up to one to one and a half hours. Swimming started with barely one lap and now up to 80 laps. Water-running started with barely two minutes with feet not touching the bottom and I'm now doing 45 minutes in water up to my waist, so there's more impact on my legs. I'm using a heart rate monitor so I know when I'm slacking off. This helps keep me motivated to push myself. While I'm not yet back to doing triathlons out in the real world, doing my own version every morning has helped me regain much of the fitness I lost. I recommend this exercise routine for everyone, multi-focal fractures or not! Ruth Heidrich 1415 Victoria St. 1106 Honolulu, Hi 96822 e-mail: Ironlady@compuserve.com