Overcoming A Hip Fracture and Squat Fails

Most of us have goals. We set goals in order to give purpose to our actions. In strength training, for some of us the goal is overall strength to support our health and longevity in life. To allow us to do things better and longer than the average Joe. For others, our goals might be to squat, bench, or deadlift a particular weight, or achieve a particular total in powerlifting. Or, for someone like me, it may be to qualify for the Arnold Classic or for a spot on the National Team in order to go to the World Championship and be the best, or one of the best in the world.

Since 2014 I’ve had my eye on competing at a world championship. I’ve attended USAPL Raw Nationals every year since then and taken a podium position each time. Yet I’ve never quite been “good enough” to achieve that highest podium and snag a spot on the National Team as a full-power lifter.  

The game changed after Raw Nationals 2017. The two top contenders in the 72kg class were no longer competing at USAPL Raw Nationals for one reason or another. This opened the door for the rest of us to duke it out on the platform for that 1 shining spot on the podium that is your automatic invitation to the World Championship.

The playing field was changed.

For one full year I’ve had my heart set on claiming this spot but then at the Arnold Classic in March of 2018 I experienced and injury that would make it challenging for me to continue to build my total to win.

On March 3rd, 2018 on my 3rd bench press attempt in the Pro American I suffered and avulsion fracture of my right rectus femoris. At the time, I didn’t know what happened but I knew it was bad. I walked off the platform after hearing and feeling 4 pops in my right hip and missing 120kg due to the immediate loss of strength in my right leg.

My right knee buckled under me three times as I walked back to the warm up room. My husband told me to stop being dramatic. Insensitive? Seems so. But he knows me well and knew whatever was going on wasn’t going to stop me from finishing the meet so he was trying to remain calm and collected to help me get through it.

The pain was real. And it was bad.

I remember lying on the floor sweating thinking maybe I should just pull out now. But I didn’t. My husband encouraged me to start warming up my deadlift and see how I felt. I did. It was challenging. It was painful. I couldn’t set myself up normally for the lift. But fast forward and I was able to pull 200kg for a 5kg PR that day. I was shocked. I was beyond happy considering how much pain I was in. I was also happy because I had ended the 3-meet dry spell with my Squat and finally hit a small PR that morning before the injury.

We weren’t done that day. I had another meet to do so we weighed in, fueled up, and carried on. Despite the injury, I was able to come back in the afternoon bench-only meet and hit that 120kg bench that my hip avulsed on...because, well, it was already f*cked. Despite it hurting, I didn’t lose any strength like I had during my attempt earlier in the day when the fracture occurred.

It didn’t hurt any more or any less than it did in the morning meet but that night was a different story. That’s when I knew something was very wrong. I couldn’t sleep. Every position was painful.

I took a week off from squatting thinking that would help. After that week off I tried to squat even though my hip still hurt. The bar hurt. But thinking it was a muscle strain or tear, I hoped that as I warmed up it would start to feel better, as most muscle injuries do.

Nope. The pain crescendoed as I added weight and at a mere 50kg I was in tears realizing this was a more serious injury than I had lead myself to believe.

Still thinking this was a muscle tear I found an exercise that had an eccentric component to the area of pain. Since the pain was on the front of my hip, a squat does not really cause an eccentric contraction of the hip flexors, plus the squat increased my pain. That day I started with 3 sets of 15 reps on each leg with split squats. It hurt, but my pain did not increase with number of reps so I did 1 or 2 sets without weight and then 3 sets with the bar. That was enough for that day.

Every. Day. After. That. for 2 weeks I went into the gym and linearly progressed the split squat in 2.5kg increments according to the Starr Rehab Protocol.

On March 14th, 2018 I decided to see the orthopedist for a few reasons:

  1. My pain was not getting better.

  2. I had terrible trouble sleeping comfortably as my hip was waking me up every time I turned over and I couldn’t sleep in my usual positions.

  3. I was 9 weeks out from the IPF Classic Bench Press World Championship and I really needed my leg to be working for me.

Considering how much pain I was in and how seemingly slow my “hip strain” was healing, it was worth investigating further so we could change the intervention for faster healing.

I’m fortunate to have a good working relationship with my orthopedist and was able to be seen immediately. X-rays were actually negative 2 weeks after the injury but all symptoms and orthopedic tests pointed to something more severe than hip flexor tendonitis or strain so we got an MRI. The MRI revealed that I had, in fact, avulsed the rectus femoris.

An Avulsion is when there’s a fracture in the portion of the bone that a muscle and tendon connect to. Instead of the muscle tearing, the muscle pulled off the bone and took some bone with it.

No-freakin’-wonder I was in so much pain and healing slowly! Bone pain is intense pain and bone healing is slow. We wavered with the idea of doing a PRP injection to promote faster healing but in order for the injection to work optimally, I wouldn’t be able to “use my legs” in training for about 2 weeks. Well, training for Bench Worlds would be halted if that was the case so I decided to wait until after the world championship to make a decision about the injection.

On March 19th, 16 days after the injury, I added in squats at 45kg for 3 sets of 5 reps. It hurt, but the pain didn’t increase much above baseline from rep 1 to rep 15, so that became my starting point.

I was heartbroken.

I hit a PR of 370lb 19 days ago and now I was starting over with 99lb that left me sweaty and tired? Demoralizing. But, if being a physical therapist who specializes in working with barbell athletes has taught me anything, it’s that there is light at the end of the tunnel. The tunnel may be long. You may not know how long or what’s there waiting for you at the end, but it’s there. So I put on my doctor hat and reminded myself to put one foot in front of the other, keep my morale high, and keep working towards my goal.

My goal was multifold. My ultimate goal was to get better.

Better meant the following...I wanted to:

  1. Squat heavy loads pain free.

  2. Hiit a bench PR at the IPF Classic Bench Press World Championship 11 weeks after the injury.

  3. At least squat 160kg by the time Nationals 2018 rolled around 32 weeks (8 months) after the injury.

  4. Squat enough weight to win the 72kg class at USAPL Raw Nationals in order to qualify for the 2019 Raw World Championship.

5 x per week I went into the gym and added 5kg to my squat for 3 sets of 5 reps. Light weights were hurting but not increasing across sets. I found I needed to wear my belt and squat flat-foot to not have as much pain, so that’s what I did. By April 20th, 2018 (7 weeks after the initial injury) I was back up to 100kg squat for 3 sets of 5 and now squatting 3 x per week instead of 5. I wasn’t out of the woods yet.

It was painful, but not debilitating.

As the weights grew heavier I had to lessen the incremental jumps and change from 5s to 3s to avoid lingering pain. Eventually the loads got heavy enough that I had to switch to twice a week with a volume and a light day to avoid deep bone pain and promote recovery. We incorporated single leg work because my right leg was showing significant signs of weakness with single leg activities that challenged it (like stepping up onto the bench to reach the pull up bar).

PSA: What I want you all to realize from this is the following…Pain should not lead to quitting. It should not lead to immobility. It should not lead to movement avoidance. Movement does not have to be pain free when we are recovering from an injury. If we waited for movement to be pain free we’d lose a lot of ground, a lot of motivation, and we wouldn’t heal as well.

The KEY is finding the precise amount of movement and load that doesn’t increase symptoms. Once we establish that, we build from there. This will all vary based on your injury and what causes you pain.

I had manageable pain for a while with training.

My pain rules were as follows: if symptoms increased more than +2 out of 10 on a pain scale or got worse with every rep then I’d back off.

I didn’t have to back off frequently because of managing the programming progression well without being too fearful or too ambitious. I wasn’t a hero and didn’t try to slap 300lb on my back every time I felt “ok.” I stuck to my plan and chipped away with 2.5kg increases every session.

By July I finally had that session that was completely pain free.

On August 3rd I participated in a Strength Lifting meet for fun. In that meet I squatted 147kg (325lb) which was 12kg (26.5lb) more than I had handled in training since the initial injury. This gave me tremendous hope that by Nationals in October I’d be within walking distance of my best squat ever (167.5kg).

This might have been where the anxiety began without me even knowing it. I felt extremely hopeful that I could contend for first place if my squat rehab continued as it was. I started to believe I would win. I started to tell myself I would win.

I knew that after Bench Worlds in 2019 that I’d be taking a break from competing to start a family so I added on this idea that I could do both Bench and Raw Worlds and then take a break. So I put an exceedingly high degree of pressure on myself to win this year.

Couple that with a history of little-to-no progress on my squat and I worked myself into a major squat fail on my opener at USAPL Raw Nationals. I created so much internal anxiety with the pressure I was putting on myself plus the fears I had about progress and injury that I literally toppled over on my first squat attempt like the Leaning Tower of Pisa.

It’s fine, no big deal. I brushed it off. Got over myself. Retook 150kg and crushed it and the meet was smooth sailing from there. Unfortunately though, this miss cost me at the end of a very tight meet. The winner took 1st by body weight. She and the second place lifter tied with a 495kg total. The 3rd place lifter had such a tremendous squat that she was able to chip her squat to break an American record and because of that she beat me by 1, ONE kilo!!! With a total of 486 versus 485.

While I didn’t win, I did achieve many goals at USAPL Raw Nationals.

  1. I am better. My hip no longer hurts and I’m training as if nothing ever happened.

  2. I squatted 160kg at Nationals 32 weeks after fracturing my hip.

  3. I hit a full-power bench press PR of 120kg.

  4. I hit a huge deadlift PR of 205kg.

  5. I matched my best total which was achieved on the day I fractured my hip.

So, regardless of not winning, I’m still really pleased with my performance, my ability to come back long term after a major injury, and my ability to come back short term after a major squat fail and let neither affect the rest of my performance.

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The biggest thing I’ll need to work on between now and my next meet is decreasing my pre-meet anxiety to reduce the chance of something like this happening in the future. This is the 3rd meet in a row where I’ve screwed up or choked on my squat. At Nationals in 2017 I had the wrong belt on and missed my second attempt. At the Arnold in 2017 (when I fractured my hip) I was so nervous on squats I was vomiting in my mouth and thus under performed.

I have to thank my Coach, Chris Aydin, my training partner and colleague, Will Brenseke, and most importantly, my husband for never ever giving up on me during the ups and downs of my rehab and for always encouraging, supporting and helping me brainstorm the process.

I’ve created a situation of squat PTSD and I need to break this cycle! So that’s what I’ll be working on before the Arnold Classic in March of 2019.

In the words of the Man himself, I’ll be back! See you on the platform :)