From Ex Fix to FKT Attempt, Part 1

Part 1 in a series reflecting on the journey of Kait Boyle, 2018 24-Hour Mountain Bike World Chamption, from ex fix, to FKT attempt
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For Christmas 2018, her gift was an ex fix holding her pelvis together.

This is Kait Boyle.

Kait Boyle, Professional Mountain Biker, riding her Mountain Bike down a small slope with American Flag draped over her shoulders.  Kait won the 2018 World Champtionships in 24-Hour Mountain Biking.
Kait Boyle winning 24-Hour Mountain Biking World Title in October 2018. 2 months later, she would be in a pelvic ex fix, following a car accident.

At the end of 2018, Kait was on top of the world. She had set two course records in ultra-endurance mountain bike races, establishing herself as one of the fastest ultra-racers in the country, male or female, and she had won the 24-hr Elite Solo World Championship.

Then, on Christmas Eve, just 2 months after winning the World Champion title, she was stuck in her crumpled truck without feeling in her legs and the deepest burning sensation in her pelvis.

She wondered if she would ever walk or bike again.

Image of a car after being involved in a motor vehicle accident.  The left quarter panel is destroyed, wheel collapsed into engine compartment, windshield shattered and driver
Kait’s Car, the evening of Dec 24. This accident resulted in Kait suffering a fractured pelvis, requiring an ex fix to stabilize; ruptured bladder; broken fibula and questions about her future as a pro athlete.

Kait had a quadruple fractured pelvis [that would require an ex fix (pieces of metal drilled into her pelvis from the outside) to stabilize], fractured sacrum, ruptured bladder, and a fractured fibula.

In laymans terms: She broke nearly every bone in her pelvis, had to have them screwed together from the inside and out, ruptured her bladder, and broke her fibula (outer lower leg bone).

Everyone ignored the fibula.

Kait woke up in the ICU, after emergency transportation from being extracted from her truck to the Driggs Hospital, then to Eastern Idaho Regional Medical Center (EIRMC) for an emergency trauma operation on her bladder in the earliest hours of Christmas morning.

During her 9-day stay in EIRMC, she had an emergency bladder surgery which resulted in an 8-inch vertical incision through her lower abdomen and insertion of a catheter.ย  Five days later she had surgery to stabilize her pelvis with an external fixator, and two long internal screws in her sacrum.


She spent 6 days completely immobilized in a hospital bed, and following her second surgery, had a “non-weight bearing” order for 5 weeks. After that, she would be allowed to bear weight only through her right leg for another 6 weeks.

Here’s Kait, in the hospital, with her shiny new ex fix

Kait Boyle, 2018 24 Hour Mountain Bike World Champion, in hospital bed, with dressings over abdominal incisions, many tubes, including oxygen monitor on finger, and metal pieces of her external fixator (ex fix) that is now holding her pelvis together, and will do so for the next 3 months to allow for proper healing.
The metal pieces you see held her pelvis together so it could heal. It had to be on the outside, because the infection risk of internal fixation was too great because of her ruptured bladder.

Kait starts outpatient PT…in a wheelchair…with a catheter and an ex-fix.

About a week after resting at home in bed and on the couch, Kait was connected with me at Streubel Physical Therapy.

I greeted Kait at her first appointment with a huge smile, didnโ€™t bat an eye at the catheter hanging from her wheelchair, or her ‘alien contraption’, the external fixator (she called it her ‘towel rack’), coming out of her pelvis. We talked about how Kait was feeling, what re-learning to pee would be like, how Kait would start to move her legs again. We even discussed what Kait’s journey back to riding her bike might look like.

Regarding the plan for return to biking:
It was not: This is now, and there is the finish line.
It was: This is now, and here is your next step.

We started with simple movements – laying on the couch and sliding her legs back and forth in each direction. First side to side, like a windshield wiper, then back and forth, dragging her heels up to have bent knees. For the healthy, able body, those movements are easy. For Kait, the exercises were as hard as any interval work she’d ever done.

I (Dr. Kelly), also did some fun and rather unique things, like dry needling, and having Kait do simple circulation exercises with Virtual Reality Goggles on, displaying a 1st person video of riding down a mountain bike trail. With athletes, I am big into visualization and ‘the whole picture’ of the athlete in eventual return to rehab, and not just the isolated, individual parts. There’s good articles about that, actually…I’ll do blogs on them, eventually ๐Ÿ˜‰

Kait Boyle, 2018 24-hour Mountain Bike World Chamption, in external fixator (ex fix) doing early physical therapy exercises.  Here she is sidelying, performing what is commonly called a 'clamshell', an exercise for your gluteus medius.
How do you exercise with a pelvic ex fix? Here’s one variant of a clamshell, to strengthen your gluteus medius. Just mind the metal and don’t tear the mat table or couch, please.

Like with anything that you practice with patience, and show up every day to try your best, life in the ex fix grew easier with each day.

As Kait improved, I progressed her onto more advanced movements like lifting her leg straight off the couch and doing a mini crunch. I taught Kait what movements were great to do within the confines of the ex fix, which were okay, and which should be avoided at all costs. Of course, we focused significantly on learning to isolate the diaphragm, apart from the abdomen, apart from the pelvic floor. We learned when it was okay to use them together, and when it wasn’t.

There was also a bit of wound care to manage, which I outsourced, but in general, learned that ‘granulation tissue’ (fancy word for healing skin), if it can’t close together (like if there’s a piece of metal blocking it from sealing a hole in the skin), it will start to climb the metal to try to close the hole. COOL! (& and a little gross…but mostly cool). If this happens to you, don’t freak out, just talk to your doctor, and they’ll clean up the extra tissue (numb it and cut it away). It will heal fine when the metal is removed.

Within a couple weeks, Kait had the catheter removed and began re-training her bladder. Then she was ready to sit on a stationary bike and spin her legs with zero resistance on the pedals.

Her first ride was 5 minutes, and she said it was one of the best rides of her life!

Kait Boyle, 2019 24-hour Mountain Bike World Champion, on an indoor stationary bicycle, while still having a pelvic ex fix in place.  She is smiling, and the metal ex fix is visible in front of her lower pelvis.
When some weightbearing was allowed for pivot transfers, Kait was instructed in how to mount an indoor stationary bike, while sitll in my ex fix! FREEDOM!

Kait could see her future of riding a bike outside again someday.

For the last three weeks in her wheelchair, Kait got on her indoor stationary bike nearly every day to spin her legs. The exercise, while it never raised her heart rate notably, got blood moving through her legs, gave her mind the meditative movement she craved, and fueled her inspiration for continuing the simple, but challenging, physical therapy exercises.

Still in the ex fix, Kait progresses from wheelchair to crutches

Kait was cleared to transition from the wheelchair to crutches with as much mobility and strength as she could attain within the wheelchair restrictions.

While crutches are generally viewed as limiting, for Kait, they felt like freedom sticks!

She could finally stand upright. With her new capabilities from standing on one leg, she could more easily get in and out of bed, more easily to the bathroom, get in and out of the car, reach cabinets, climb stairs, cook, shower standing, go into stores, etc. These, often taken for granted human capabilities, were liberating and greatly helped Kait’s outlook during this time.

When Kait was finally able to begin weight-bearing as tolerated on one leg, I (Dr. Kelly) was able to prescribe balancing, & strengthening exercises to keep her challenged and engaged. Remember those VR goggles? Now we’re standing on the one leg we’re allowed to, practicing on maintaining balance while watching a Roller Coaster Video. NOT EASY.

Meanwhile, Kait was making slow but steady progress in increasing her time and resistance pedaling on the bike.

Truth: She was also getting tired of physical therapy and healing. 

All goals take focus, but motivation is a muscle and it can get tired.

As the weeks turned to months, Kait started to fatigue mentally from the focus and daily dedication to physical therapy and healing. Kait used journaling of her intentions, setting mini daily goals, and allocating days off to just rest and be unmotivated to keep her going.

“You get to…” was inscribed on her ex fix, and was a regular mantra to focus on the positives.

Kait Boyle, 2018 24-Hour Mountain Bike World Chamption, stretches her hips, as much as able, while in a pelvic ex fix.  She is performing a variant on pigeon pose, seated with one leg long in front of her, and the other leg bent so that her ankle is over the straight knee.  She opens the bent leg to stretch her hip outward.
Smiles on the outside, ex fix on the outside, but getting tired on the inside.

Finally, three months after her surgery, her external fixator was removed and she was cleared to bear weight on her other leg. She quickly transitioned from crutches to a cane, added strength and balancing exercises, now with both legs, and marched into Kellyโ€™s office ready to ditch the cane.

I tested Kait’s functional strength, balance and mobility and then tossed her cane aside! Kait walked out of my office without any support, and was ready to get on her bike outside.

All of Kait’s hard work, patience, vision and the support from her medical team, family and partner had paid off. She was healthy and functional again. Her next chapter would be rebuilding from healthy and functional to elite mountain bike athlete. Tell you about it soon. In the meanwhile, visit her sponsors, Pivot, Industry Nine, and Ride With GPS. They have all been amazing and supported her through this journey.

All her hard work paid off! Ex fix free!

Kait Boyle, 2018 24-hour Mountain Bike World Chamption, tossing her cane to her PT, Dr. Kelly Sadauckas, founder of Pelvic Floored, as Kait was cleared to progress to full weight bearing with no assistive device.
The Infamous Cane Toss. Ex Fix is now removed, and Kait is cleared for walking without a cane by Dr. Kelly! Woot-Woot!

And yes, that is a WORS shirt that I have on. I was a runner up in my age division in Citizen Class a few years ago…bet you didn’t know I was also a ‘big time’ cycling star, did you ๐Ÿ˜‰ Kait & I in one room?!? Now you’re impressed ๐Ÿ™‚

Thanks for Reading!

Stay tuned for what happened in the next steps of Kait’s journey! And if you want to know what exercises I started Kait on, check out this post, one that she wrote on beginner core awareness activities! Word on the street is that Kait is even a guest star in my Signature Series!

Thanks for reading!

xoxo, Dr. Kelly ๐Ÿ™‚

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