CINCINNATI, Ohio (VN) — She rolled across the finish line and unclipped one shoe. However, Courtenay McFadden didn’t mingle with other riders, instead of freezing in place with one foot in the pedal and one foot on the ground. The cold, rainy weather that had come to the U.S. cyclocross scene was a shock to her system, especially her hips. They were stiff and the effort had been brutal, but she pushed through.
McFadden (Pivot Cycles-DNA Cycling) has struggled with a hip-impingement for the last year and a half, and yet she clocked her best season to date in 2016, capping the year with a 15th-place finish at the 2017 UCI Cyclocross World Championships in Biel, Luxembourg in February. A week later, she went under the knife to fix the impingement in her right hip. Against odds, she managed to get back into shape in time for the 2017 season, even winning two UCI races.
However, McFadden’s season has again been plagued by hip pain. She will have another surgery after national championships in January to fix hip-impingement that’s now in her left hip. Her next off-season will again be filled with rehab and recovery, instead of “fun things” — mountain biking and hiking.
McFadden’s desire to race and her love of cycling makes her push through this immense pain, even if it causes more damage.
“I think it’s just our desire, and I just didn’t really imagine myself sitting out a season when I was like, ‘I think I can do it,'” McFadden told VeloNews about putting off her initial right hip surgery for 10 months so she could race last season. “The hardest thing for me with my hip was I could ride and it wasn’t painful. Running was really hard and life was hard. I noticed I just started not doing things because it would irritate my hip and I was just like, ‘Well I’m not going to do that because I’m going to pay for it for five days.'”
Ironically, McFadden came to cycling because of her hip pain. She entered college as a runner but began to notice pain in her right hip in 2010. She was just getting into cyclocross at this point and found she had much less pain when she rode. So, she moved to full-time cycling as part of the Western Washington University cycling team.
Fast forward five years and McFadden is one of the top U.S. women in cyclocross. It was the spring of 2015 and McFadden’s hip was feeling OK. However, it began to flare up again, bothering her most when she had to run in cyclocross races. She opted to push through the pain and race the season. It was bad, but not unbearable. She experienced a burning sensation in her hips when she rode.
Athletes know their bodies extremely well, but McFadden is on another level. She earned a masters degree in exercise science from Western Washington. So, when she started physical therapy in February 2016, she hoped her right hip would begin to feel better. It didn’t.
McFadden got a few X-rays and MRIs and found she had a torn labrum in her right hip. Her doctor, Dr. Doug Nowak, explained to McFadden that the cause of the tear was most likely from Femoroacetabular Impingement (FAI).
“Basically, the way that her ball and sockets were forming in the hip joint, they’re not congruent, they don’t fully match up in certain positions, so the ball will pinch against the socket and the labrum will get caught in between there and through repetitive hitting of the ball against the socket, it leads to tearing of the labrum,” said Nowak. “That was her condition. So some of it was just the way her bone structure was and the way she developed, and the repetitive cycling on top of that is what led to it tearing.”
Nowak did his fellowship at the Steadman Clinic in Vail, Colorado under Dr. Marc J. Philippon, who many consider a hip arthroscopy guru.
McFadden was 31 at the time and was facing major hip surgery, as Nowak explained she needed surgery on her right hip immediately. FAI does have a genetic predilection and McFadden’s dad had FAI. Her dad got a hip replacement at the age of 50. Putting off surgery meant McFadden could be looking at a hip replacement even younger than that.
Despite this, McFadden went against what her doctor and education taught her and opted to race. On back-to-back weekends in October 2016 she was not able to finish her races, however, which made the case that it was time shut down the season and schedule the surgery. Her right hip was in pain and on top of that, the pain had begun to creep into her left hip. She brushed that off as mere compensation pain.
McFadden scheduled her surgery after that, but for the end of the season — in January after national championships. She was already doing physical therapy on her right hip, so after those DNFs, she began therapy on her left hip as well. McFadden’s education helped her guide the therapy with great specificity.
“I was able to help my physical therapist and be like, ‘this is where I’m feeling it’ and was able to describe the muscles I was feeling and just the range of motion and the actions that would bother me in my recovery and my rehab,” McFadden said. “Also, being able to know what to do and just the kinesiology and biomechanics of everything was just really beneficial to me.”
With the help of her physical therapist, McFadden developed a 30-minute routine for the morning of the race to temporarily ease the pain in her hips. The routine, which McFadden still does, involves having somebody pull her leg, which creates more space between the ball and socket in the joint. Thus, there is less friction in the joint, which translates to less pain.
Nonetheless, the pain had begun to affect McFadden’s everyday life, which set off alarm bells for her husband Chris Ellis. “It was a challenge and we had some serious talks about at what point would she need to stop racing and get the surgery sooner,” Ellis said. “It wasn’t just the biking thing, it was everyday life. Not going to trips or not going places because it would cause pain in the hip or hurt her. Just not being able to do things because of that.
“It’s really hard to see someone, and she’s my wife and I love her, and it’s just really hard to see her in that pain. It wasn’t always. She wasn’t always wincing in pain or not being able to walk, but still, it was hard to see her not feeling the best she can.”
McFadden would suffer through the rest of her season, but despite both her hips aching, the results still came. She powered to fifth at the national championships and rescheduled her right hip surgery for the first week in February. She was headed to her first world championships.
On the slippery and sloppy mud in Luxembourg, McFadden rode to 15th place. She would later find out she did so with a torn labrum in each hip.
McFadden’s surgery on her right hip went smoothly a week later, as she got lucky because Nowak found minimal to no additional damage from when he first saw her 10 months prior. But when she complained of severe left hip pain in July, Nowak ordered a few scans, which revealed a torn labrum.
Left hip surgery is scheduled for mid-January for McFadden — after the national championships. This sets the stage again for her to push it back a few weeks should she earn a spot at the world championships.
“The only way I can get through this process is by laughing,” McFadden joked after revealing the torn labrum in her left hip. She had kept it a secret until then, despite knowing since July that it was torn.
Ben Ollett is McFadden’s coach and has undergone hip-impingement surgery on both hips. That was one of the main reasons McFadden chose him as her coach because as she said, “Until you go through it, you don’t really know what it is like.”
Ollett also understood McFadden’s mindset — race at all costs.
“I think that traditional mindset of more is better and you kind of just push through things and that’s what an athlete does,” Ollett said. “I hope that’s starting to change, but it’s ingrained in our brain and sports and coaching. There’s a point where you can push through some things, but then you’re just making the problem worse.”
McFadden has fought through the pain and kept a positive attitude through it all, chronicling her struggles through multiple blogs and social media posts. The light at the end of the tunnel is still dim. Another offseason plowing through recovery from surgery is on tap, but she’s ready and knows what to expect this time and feels more resilient.
“I think it definitely made me a lot mentally stronger and almost a better athlete and just a lot more appreciation for being able to ride my bike and being active and for my body,” McFadden said. ” It just gave me a lot more appreciation for training and just activity in general because you kind of take it for granted when you are able to do whatever you want at any time.”