From hip fracture to Ardennes Classics contention: Ashleigh Moolman Pasio’s fight back from injury

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Every contender for the Ardennes Classics is a formidable athlete. Events such as the Amstel Gold Race, Flèche Wallonne and Liège-Bastogne-Liège see the world’s best riders go head to head on hilly courses, ensuring a hard-fought contest.

But for South African rider Ashleigh Moolman Pasio, her journey to those events has been harder than most.

Last October Moolman Pasio was scorching toward victory in the Chrono des Nations time trial in France. She was well ahead at the intermediate time checks, but then disaster struck.

“It would have been wonderful to win. It would have been a great way to end off the season,” she tells CyclingTips. “And I think that was what was most frustrating for me, that the crash could have been avoided.

“Another rider had crashed in the traffic circle and the police motorbike had parked to protect her.

“But no one was indicating what was happening in the circle to me beforehand. So I had absolutely no idea. And as I entered the circle suddenly I noticed all the commotion. I had entered it at sort of full speed that I practiced the day before. So I had to try and slow down. But the roads were wet. And when your wheels are at an angle already because I had entered the circle, you stand very little chance of staying upright…”

She couldn’t do anything more. Her wheels slid, she hit the deck and that was that.

“I felt on the left hand side and started sliding,” she explains. “I sat up on my bum and then unfortunately the motorbike was parked in the line of my slide. So I came to rest by hitting my right hip full impact on the bike.

“And that’s what fractured the hip. I suppose the only regret or frustration is if someone had only been able to have warned me before the circle, I had the time to spare to slow down. But it is what it is.”

Battling back into shape

Suffering a fractured hip was a very difficult end to a strong season for Moolman Pasio. She had ridden well before then, netting third overall in the Euskal Emakumeen XXIX Bira, fourth in the Festival Elsy Jacobs, fifth in the 36. SwissEver GP Cham-Hagendorn, first in the Auensteiner – Radsporttage and second overall in the Aviva Women’s Tour.

Tenth in the Olympic Games road race was another strong ride, although she had hoped to do better. Ditto for her 12th in the subsequent time trial.

She capped off the season with victory in the Giro Toscana, second in the Giro dell’Emilia and by helping Cervélo-Bigla to third in the world championship team time trial.

All in all it was a year of progression, showing that she was still improving as she approached her 31st birthday.

And then she had her hip fracture. The crash messed up her hopes to end the season on a high note, and also caused concern as she looked towards the 2017 season.

Moolman Pasio could have panicked, but instead did everything she could to ensure a fast recovery.

The doctors in the French hospital where she was treated after her crash told her that she would need to spend one month avoiding any weight-bearing activities on her leg, and a full three months off the bike. However, after being transported on a medically-assisted flight back to South Africa, she received different advice.

“I was immobilized for the first week, which I think was really great. But when I arrived back in South Africa I was lucky enough to be under the supervision of a less-conservative doctor,” she explains. “It was a doctor that had worked with athletes before and obviously understood the need or the urgency to get going as soon as possible.

“And so I think that definitely helped in terms of speeding up the rehab process. At two weeks already he started to encourage me to start moving a bit more and putting a little bit of weight on the leg, because he explained that the line of the weight bearing force actually didn’t interfere with the position of the fracture.

“I think that’s also the new sort of mindset nowadays in medicine…it is not necessarily to completely immobilize but to move as soon as possible, which obviously gets the blood going. It also just also reduces the other complications, because being off your leg for an entire month has its own complications. Muscle atrophy happens very quickly.

“So already having being immobilized for one week and being off the leg for two weeks, the muscle atrophy was very visible.”

However things weren’t quite plain sailing. Soon after increasing the use of her leg, Moolman Pasio felt pain in the hip joint area. This prompted concern about whether the doctors might have missed another fracture. However it turned out that the issue was bursitis, a fluid accumulation on the joint. It was caused by poor biomechanics after the crash due to being immobilized and then being on crutches.

Concern assuaged, she was encouraged by medical personnel to get into the swimming pool and gradually increase her activity.

“Everything that I did had to be done using pain as the guide,” she said. “So it was also important to wean myself off any pain meds as quickly as possible, because obviously you can’t use pain as your guide if you are masking it. So I was very motivated to do that.”

Moolman Pasio got into the swimming pool around two and a half weeks after her crash. “I first just started by getting the blood flowing by just using my arms. And then every time I got back in I would try and do a little bit more, and use the leg a little bit more.

“And, yeah, things went smoothly. I didn’t really have any huge complications in the rehab process. By week four I was already riding, but first on the indoor trainer, of course. And then I actually started training on the road a lot sooner than any of the doctors really would have recommended, because obviously the risk was that if I had crashed again that the complications would be huge.

“I just felt if I had spent too much time on the indoor trainer all the motivation that I had built up over from being off and being injured and really being keen to get going again…I didn’t want to kill that at all by just spending three months on an indoor trainer. So I pushed the limit a little bit and went a bit on the road, but tried to reduce my risk as much as possible by choosing quieter roads.”

So what does she feel was key in helping her get back on track? One factor she credits was the use of the supplement Cissus quadrangularis. She – and others – believe that it helps bones to mend ahead of schedule, and this is also reflected in some scientific research.

The second factor is something quite different. “I definitely believe that what has helped speed up the recovery is mindset. And so my advice [to injured athletes] would be to embrace the situation,” she says. “There’s no point fighting it because if you do then generally your mind just is in the wrong place. It’s too many negative thoughts and that definitely slows down recovery. I definitely believe the mind plays a very big role in recovery.

“So I think just adopting a positive attitude. Going with the flow, accepting it, accepting the process and just taking it one step at a time is really important. And then I think just to celebrate all the little victories along the way, because there definitely are those.”

Early return to the winner’s step

Moolman Pasio had little victories, but also a significant one. On February 9, three and a half months after fracturing her hip, she won her fifth national time trial championship. She admits that when she was lying in hospital after her crash, neither she or anyone else believed she would be riding that race.

However come the early February event, she finished over three minutes clear of the next-best rider, Juanita Venter. It was a remarkable achievement, and one that reflected her natural drive.

She has continued to build since then. After netting third in the nationals road race, she travelled to Europe and had a training camp in Catalunya, Spain, with her Cervélo-Bigla pro team. At that camp she expressed optimism about where she was.

“I am way further ahead than what anyone would have had have expected and what the doctors initially thought,” she said then.

After the camp, she rode Strade Bianche and was 18th there. She then rode the four-day Setmana Ciclista Valenciana, netting third overall. Since then she took tenth in the Trofeo Alfredo Binda, fourteenth in the women’s Tour of Flanders and then ninth in last weekend’s Amstel Gold Race.

She is next due to line out in Flèche Wallonne on Wednesday and the first-ever women’s Liège-Bastogne-Liège on Sunday.

As a climber, these are the perfect races for her. She has been third, fourth, fifth and fifth in Flèche in the past and has long dreamed about winning the race.

If this was a Hollywood movie, her comeback from injury would see her prevail on the Mur de Huy and finally win an event she has been so strong in in the past.

However things have been complicated of late and she’s not sure what to expect.

“For me, I was very much aware coming into this year that I would have to take things step by step, race by race. To take things slowly and just see how I adjust and progress,” she says. “Of course I was starting on somewhat of a back foot, having had just taken a way longer break than anyone else would have, and with the injury.

“Obviously in terms of my injury things have gone more or less smooth, but of course I have also had complications. Nothing super-serious, but it just means it has taken time. I had to give the injury the respect that it deserves.”

The issue for Moolman Pasio was the location of the fracture. Her hip healed fine; the lingering issue was its role as an anchor for major muscle groups.

“All the glute muscles attach to it, and the deeper muscles like the psoas,” she says. “So I have had to be somewhat patient. With the increase in load and intensity of the racing, some of the muscles obviously took some strain to adjust again and to get firing up again.

“So I have had some complications. For example, Strade Bianche, I really had a problem where the whole right side of my body locked up. The race was a bit of a shock to the system, I suppose. As each race went on, things have improved.”

However, fortunately, she says that she feels she is approaching her normal self again. Even if her Amstel Gold Race wasn’t as good as she hoped, due in part to a chunk of bad luck for her team, she has taken encouragement by how she felt in certain races.

The Tour of Flanders was probably the biggest boost to her confidence. Her sensations were very good, she felt that she was back on track, and she also had a very good training block in the days after the race.

“That is when I really started to see huge progress again in the numbers,” she says.

Now she’s psyched to see how the Ardennes Classics go.

“It is just about looking forward and, again, taking again every race as it comes,” she says. “I don’t want to…coming from the kind of injury I came from, I can’t say, ‘ah, Flèche Wallonne is my target.’ Of course, every race I would like to see progress and every race I am pushing to improve and to get back to a position where I can be challenging for the podium.

“That is what I just keep trying to achieve. I have just got to see how each race progresses and how the body responds.”

Asked straight out if a podium is possible if everything goes to plan, she believes it is. But she also underlines that she doesn’t want to make any big declarations in the press.

She knows that her body is unpredictable at the moment due to the after-effects of her crash.

“Every day is a new day for me. Some days I can have really good days, with all my muscles feeling great. Then I am feeling back to my normal self,” she says.

“But then there are days when the glutes are not happy or something tightens up and my alignment is out. So it is still very much…not a lottery, but you know what I mean… I don’t want to put my head on the block and say I am going for the win. But of course that is what I am challenging for and obviously what I am hoping for.

“I suppose until I mange to get to the point where I am really challenging for the win or for the podium, then I can’t really say that I am fully recovered. But definitely I am closer and closer.”

Given where she has come from, she’s already well ahead of schedule and exceeding expectations.

Still, for an athlete as competitive and ambitious as she is, that’s not enough.

“Of course I will give my all in the next two races,” she vows. “I am hoping that everything clicks on the day and that I have a great day. Then of course everything is possible…”

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