Rebuilding the man with the halo

Physiotherapist John Dennis has worked with Tim Don for over a decade. In that time, he’s seen Tim bounce back from several setbacks. But nothing could prepare him for hearing the news that the Ironman had broken his neck. Tim's friend as well as his physio, UK-based John was among the first to fly out to visit Tim at his home in Boulder, Colorado, US, after the accident. And when the time came, it was John that Tim called on to help him begin the painful process of regaining race fitness. Here, he gives his perspective on the Man with the Halo's remarkable recovery.

"I remember being excited ahead of the Ironman World Championships in Kona last year. I’d followed Tim’s progress and he was having possibly his best year ever. He was getting older, but he was not getting slower. 

So waking up to the news of Tim’s accident just days before the race, was an anxious time. At first I was just trying to find out how serious it was. With a neck injury you worry about complications that could impact everyday life. It was a relief to hear this wasn’t the case for Tim. After that, it was about working out how I might be able to help. 

I think Tim’s decision to mount a comeback was almost instant. That’s why he chose to go with the medical halo rather than fusing the vertebrae, which might have been easier short-term but would have restricted mobility in future. 

I first saw Tim about a month after the accident. That initial period wearing the halo was extremely painful. He nearly tried to take it off himself at one point. 

I had never treated an athlete with a halo before – as you might expect it’s not a common sports injury and brings added considerations and limitations. So we had to adapt. 

Building a strong foundation

Tim was back in the gym as soon as possible, still wearing the halo. He got a few funny looks, but I think it was good for him psychologically to be back training again, even if the sessions were very light at first. In the beginning, the focus was just on getting him moving again. In co-ordination with the strength and conditioning coach, we could start retaining and building his base fitness at an early stage.   

With his upper body restricted in the halo, training initially focused on bringing mobility and stability back to his lower body.  He spent time on the exercise bike to retain muscle memory. We used the cross trainer sometimes to mix things up. There were a couple of setbacks along the way, but nothing Tim couldn’t handle. When he started pushing more, the screws in his skull came loose and had to be tightened, which as you can imagine is not a pleasant process.  

When the halo came off and was replaced with a collar there was more potential to vary the exercises, but of course we had to be very careful to keep Tim’s neck stable. Soft tissue massage helped as Tim began more upper body work and increased the complexity of the movements. To further build lower body strength there were a lot of step ups and lunges, with resistance bands used for added rotational work. We worked on machines like the leg press, but the approach was always functional, with running and cycling in mind. 

Core exercises were also an important component of the program. Tim was doing a lot of planks and side planks, with added movement and weights thrown in. This served to build a strong foundation for when Tim would return to more intense cardio work later. In fact, Tim now probably has a stronger core than before the accident. Much of the work we did in those first days will hopefully help prevent injuries further down the line as the intensity of Tim’s training increases again. 

Tim was focused and positive throughout the recovery process, which I think was helped by having goals like the Boston Marathon and, ultimately, a return to Kona. He also wanted to get back to being able to support the family more – just simple things like helping around the house and being able to drive himself again. I think this side of things was actually harder for Tim than pushing through the athletic elements of the recovery.

The work continues

Can Tim get back to his best? It will take time, but the neck shouldn't restrict him long term, provided there are no complications. In terms of expected recovery times he’s already ahead of the game. The doctors were certainly surprised by how quickly he could run outside again.  

Of course, there are risks on the comeback trail. Together with the other members of his team we’d always be asking how quick the acceleration should be, but it was more a question of how, not if, he would get back to competitive fitness again. Getting active again as early as possible, building the strength in the right areas, will help in the long term, but of course there’s no substitute for the time in the pool, on the bike and on his feet running again.  

Tim’s performance at the Boston marathon was impressive, but it didn’t surprise me. I messaged him before to say I had money on him running quicker than 2:50, which he did by running 2:49. He told me he backed off a bit after 25–30 kilometers, which is good – I didn’t want him to overreach in his first competitive event in several months.  

Tim has always been appreciative of where he is and what he has achieved. If he can get back to racing at elite level at all, he’ll be pleased. I think he’ll now appreciate the last few years of his career even more. And, like always, he’ll do everything he can to be the best he can be."   

John Dennis appears in The Man with the Halo, the short film documenting Tim Don’s remarkable comeback from a broken neck. See it now at manwiththehalo.com.