After the halo was installed, Don was immobile and vomiting from painkillers at home. “Just try throwing up with one of those things screwed into your head,” he said. “I was telling my wife I was going into the garage and getting an Allen wrench to tear it out.”

For three weeks, he was upright in a chair in a corner of his living room, unable to sleep for more than 90 minutes at a time. His entire right side was black from bruising and swelling. Blood drained to his ankles, swelling them through their compression socks.

His wife, Kelly, became caretaker to her husband along with their two young children. “I think at first it was me that struggled more than Tim,” she said. “We as a family sacrificed so much to get him to the starting line at Kona. These opportunities don’t come often.”

But as he weaned himself off the painkillers, Don was determined to move beyond the confines of his metal halo to fight for a competitive comeback.

Photo

A physical therapy session. “It’s rare for people to break their neck and try to stay at an athletic level,” said a friend who has helped Don rehabilitate.

Credit
Nick Cote for The New York Times

Don rationalized his plan: “Most things we do regularly in endurance sports — training 25 hours a week, the sessions at altitude, high performance training — in general is not a healthy pursuit,” he said. “If I was 35, I might say, we can have a dark year. But I’ve only got one or two bites at the cherry.”

So he called his physical therapist.

John Dennis, an amateur triathlete who had treated Don as part of the British Olympic triathlon team and became a friend, flew over in November from Britain to supervise.

“It’s rare for people to break their neck and try to stay at an athletic level,” Dennis said. “If he was just a regular Joe, you wouldn’t need to worry about anything other than the neck, but we wanted to give him the best chance to come back quickly. So we had to think outside the box and focus not on his limitations but on what he could do.”

They improvised a plan. While Don was still in the halo, they worked on strengthening his lower body. Soon, he was painstakingly using an exercise bike, taking care not to lean forward and overload his neck. He wound up doing more overall core conditioning work than he’d ever done in his career.

Photo

Don broke the world record in the Ironman last year in Florianópolis, Brazil.

Credit
Wagner Araujo

Then Don began to push, in the gym every day, at one point in December fainting during a training session when the halo’s screws put too much pressure on his skull. He strained until his head swelled from friction. The halo’s screws needed frequent tightening. Technicians grew concerned that they were tightening them so much they might screw through the skull. Instead, they drilled a new hole in his head.

Don forged on, on his own terms.

“In the end, his work has probably paid off,” Dennis said. “I had some doubts about Boston. We thought maybe it was a little too soon. But nothing really surprises me now.”

A week before the marathon, Don was up to 20 hours of training, compared with his typical 30 before the injury. He is planning to compete in an Ironman in July.

Swimming remains a challenge. Unable to consistently twist his neck to breathe amid strokes, he has used a snorkel.

The injury came at a difficult time, not only costing Don a chance at the world championship, but also leaving him inactive during the window for renegotiating precious contracts. Most of his sponsors re-signed him despite the injury — his shoe sponsor, On, for three years — but a professional future without elite athletic performance remains uncertain.

Is his drive to compete again — the same drive that enabled him to record the world’s fastest time in one of the world’s most grueling races — fueling an incredible comeback? Or is he risking his health in pursuit of athletic feats that may no longer be attainable?

“I have no idea if this is going to work,” he said. “I just know I need to give it a go because we’re all trying to be faster than each other, and while I’m here, they’re trying to beat my world record. I just don’t want to be second in the world. I want to be the best-best, no matter what, and I’ll do whatever it takes.”

Then he reflected.

“That’s to say if I broke my neck another time, I really couldn’t do this again.”

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