Loss of a Companion

Wohooo! 12 weeks have gone since I had my knee surgery! Today is the day I was allowed to ditch my knee brace. I wish I could have done it in Forrest Gump style, sprinting down the road with it disintegrating and falling off in pieces. Nah, I just woke up on Monday and went f*ck it, I'm not wearing it any more! Can't say I'm going to miss it, despite the fact it's given me so much support over that last few months.

It's been a while since my last update, life is getting busier again since I can do a bit more. Recently I have mainly been: partying, fishing, camping, working, physio-ing and court attending...

Camping it up at Loch Tummel

Knee Update

The last four weeks have been a little slow, unfortunately I feel a bit limited by the inflexible regime I'm on, but protecting the grafts is the #1 goal at this stage, so I can understand it. I've mainly been trying to improve my quad control with squats, 1-leg step-downs and leg extensions. The muscle is definitely getting stronger and more defined - not much increase in bulk, but that'll come once I'm allowed heavier weights.

Leg extensions have been with 1kg ankle weights - just stepped that up to 2kg and it feels great! Stairs are getting easier - up is a piece of piss, but going down still takes thought and effort.

Range of motion is progressing glacially! Still hovering around the 120° mark but I'm now allowed to use gentle pressure to increase the force; hopefully that'll get it moving.

Stability feels great - as long as all goes to plan, I think this knee op is going to be very successful! I've been on the static bike recently (my road bike on a turbo trainer) and it's nice to be able to do a little cardio! As off today I'm allowed to swim, front crawl only (which will be brutal as I've not done any in years) so that should at least let me get a bit of a work on!

It seems like now is the time when the amount of effort should correlate with the amount of improvement. Still not allowed to do much hamstring stuff, but it'll not be long.

Life Update

I can now talk about the undisclosed cause of my accident, wrecked knee and year of my life written-off...

Well, the bottom line is, I fell asleep at the wheel. I had been climbing up north on both the Saturday and Sunday I didn't quite make it to my parents house on the Sunday afternoon. 3 miles short.

It would be easy to think that with this year being such a shit-bag that I was pretty unlucky to be involved in such an accident. I'm not so sure. Yes, it's cost me a hell of a lot of money and I've missed out on a lot of things, but I consider that luck was firmly on my side!

No one else was hurt and I didn't die.

Two of my mates drove past the aftermath and commented "whoever was in that car must have come out in a body bag". It was only a matter of luck that I hit a bus and not a car, and that the bus was going very slowly and no-one was hurt. Luck stopped me hitting someone on the street. Luck. A roll of the dice. It makes me uncomfortable that I put so many unwitting people into a game of Russian Roulette.

I had to go and deal with the consequences a few weeks ago. Can't recommend court, it's not a nice experience, although, I doubt it's meant to be. Here's what the hacks had to say:

My fifteen minutes of infamy! Be careful out there folks...

Ice Ice Baby

Ice is my saviour. When I was staying at my parents and getting hyperbaric every day, I could noticably see the swelling reduce pretty much every day so I didn't really bother with ice much. Since moving back to my flat I hit a bit of a plateau in improvement - my flexion was getting better, but more slowly.

Obviously, starting back to work and generally being a lot more active will have contributed to this, so it's hard to pinpoint the exact cause but all I know is by the end of the day, my knee was pressurised with fluid and I was about 10 degrees less flexible than the morning. After a few hours of icing and lying on the couch, I could get back to the previous highpoint. I bought various icepacks and my boss (who tore his ACL last year) lent me a cryocuff. I've got a Vulkan gel ice pack, which is nearly useless, but came with a great velcro/mesh icepack holder, which my FirstIce icepack conveniently fits into. This stuff is AMAZING!

It's not cheap (£11) but it works really well. Compounds in the liquid make the water freeze like snow, so the ice pack is cold, but doesn't burn like solid ice and conforms well to your knee. It lasts a good hour and takes about 2 to freeze.

The cryo cuff is also good, but a lot more expensive. It's nice that you can pump it up to give you pressure and cold but it's a bit more fiddly.To be honest, you can't go wrong with a bag of Tesco Value peas, until you get a hole in the bag and melting pea-juice drips all over the place.

Training and Rehab

I've been doing plenty chin-ups and some core work on the pull-up bar. Actually tried a 1-arm chin up the other day and was closer than I've ever been. Slight upward progress from a 90 degree lock! I'm going to put in some steady work into this and see if I can bust out some 1-arm action before I get back to climbing!

I've also been fingerboarding, but not as much as I'd like. Was round at a mates at a BBQ the other day and was mucking around on the bouldering wall in the garage - somehow I can still bear-down on some pretty small holds. All encouraging!

Rehab progress is good, but I'm still at a stage where I can't push too hard. My walking is getting much better. The brace is what causes most of my limp now - when it's on right I can walk almost normally!

After a 3 hour wait, I saw my surgeon for the 7 week check-up. He seemed surprised by my progress and especially the lack of swelling. Another nod towards the unsung wonders of hyperbaric oxygen treatment! Had an X-Ray which showed the crews to all be in place and nothing to worry about. Clean bill of health really!

Today my swelling seems great. I just added a new exercise - rather than doing static one-leg mini-squats on a step, I'm actually just walking up stairs! I still need support form the handrail on the way down but going up feels great! I hit 115° flexion today and it feels like the next 20 might come quite easily, but who knows.

Finally, Andy Murray is through to the Semi's!!! Can't wait for the match against Nadal.

A Breakthrough, or Breaking Point?

Lot's of things to write about since the last post. World Cup has started, Queens has started and finished and Murray went out...booo! Wimbledon next. I'm catching up on all the sports viewing that I've missed out on over the last 5 years. Back to work too, albeit from home until I'm walking again.

About ten days ago I was doing my range-of-motion stretches on my knee to get it bending more. I put my brace to checking the angle and there was a big release of pressure from the area around my PLC graft at the outside of my knee. The angle went from 75° to 85° and to be honest, I really crapped it. At the same time I started to feel a bit ill. I checked the area where the graft is and it felt much squidgier than before; I managed to convince myself that I'd torn the graft by pushing the ROM too far. Shit!!!

Next day I phoned the physio who thought I should come in to get it checked, depsite the fact I was probably being a total hypochondriac. I was, it was fine; all I'd done was push through some adhesion between the graft and something. So, it really was a breakthrough and not breaking point!

Over the next few days my ROM steadily increased at about the same rate as my muscle deacrease. I'm trying hard to do all the physio but my quads, calves and glutes are shrinking rapidly.


And some notes from the next few days:


Day 33. Hit 84*! More Weight bearing, no problems.

Day 36. First day back in the office. Knee bent too long and not propped up. Got home, bit swolen. Lot's of ice. not much improvement in bending, 85* ish but gets there pretty easily. Almost full weight bearing, hopefully off the crutches on wednesday.

Day 38. Physio. Allowed to progress to full weight bearing, brace unlocked to 90*. Bit of pain under kneecap doing quad mini-squats. Chuffed :-)

Some motorbike racers have been using hyperbaric oxygen therapy:

http://www.bikesportnews.com/news-detail.cfm?newstitle=ELLISONS%20START%20HEAL%20THE%20RIDER%20FOUNDATION&newsid=5827

The Crux (Day 13 to day 25)

I had my second Physio appointment yesterday and he was happy with the progress. Most of the swelling is now gone, as are my hamstring and calf muscles... It's quite amazing how quick muscles wither away when you're not allowed to use them.

Slighty puffy right knee and no calf muscle.

I've been working hard on my quad contractions, doing 4 sets or 10 contractions, 3 to 5 times a day and really gunning for it. My quads are shrinking, but much more slowly than the unused muscles. The physio was happy enough with my quad control than I'm now allowed partial weight bearing with the brace unlocked to 40°. So, all the hard work, squeezing the hell out of my quads has payed off :-)

I've also been working on my flexion, steadily going from 30°, through 35°, 40° up to 55° by the physio appointment. He felt my patella was a bit tight (it's got to be said, I've been slacking on the patella mobilisations) so he gave me about 10 minutes of massage and tissue stretching. After that I managed to get it to 75°, which is encouraging since my target for day 28 was only 60°. I'm not in any pain at all, any time of the day. Sometimes it stiffens up a little and the first few ROM exercises don't get very far, but it slowly returns. When I get to the end point it feels like pressure under the kneecap and around the posterolateral corner are preventing further flexion. I'm sure it'll all come in time.

In 2 weeks my brace will be unlocked to 60°  and I should be allowed to start walking without the crutches and I can sleep with the brace off, which will be amazing - these braces are damn uncomfortable in bed!!!

In addition to all the physio I'm already doing, I'm now allowed to do standing heel raises to work my calves a bit and to get more out of my knee flexion ROM I'm now doing them lying on my back with my

To try and minimize the effects of sitting on a couch most of the day, I've been out doing some upper-body work. I'm hoping to maintain some climbing fitness so that it's less of a mountain to climb when I'm allowed back on the rock. So far I've just been doing pull-ups, fingerboard hangs and core work on a bar my old man put up in the old stables. I'll ramp it up a bit once I'm back in the flat in Glasgow and am off the crutches.

Does the crutch count as aid?

I think that's the worst part of the rehab process done, the crux of it; now I can actually start working towards recovery and seeing the progress. It's still a long way to go, but I can feel the shift of momentum.

A nice shot of the main scar to finish:

Getting the Bends

Day 12

Don't fret, I haven't given myself the bends in the hyperbaric oxygen chamber (i.e  the torture tube) but I am working on getting my knee to bend a bit more...

After getting my staples out on Tuesday (Day 9), it was back to the Southern General to see the physio. This wasn't as bad as I was expecting, as we didn't do any forceful range-of-motion (ROM) exercises. I could only just get 30* of flexion, which was a bit worrying at first but after doing a bit of research on the very useful KneeGeeks website: http://www.kneeguru.co.uk/KNEEtalk/index.php it turns out that there is often quite a limited ROM for quite a while after getting the popliteofibular ligament reconstructed. They also don't like to do too much, too soon, to prevent too much stress on the new ligament graft.

I have been doing isometric (static) quadriceps contractions 4 times a day, 3 sets of 7 reps. I'm using a similar method that climbers use doing finger strength training called repeaters. This basically involves contracting the quad as hard as possible for 7 seconds, then relax for 3 seconds. This is repeated 7 times, then a couple of minutes rest, followed by a further 2 sets of 7 reps with rest in between. By the third set it's getting quite tiring, so must be doing some good. I'll up the reps as I get strength back.

On top of that, I'm doing hip abduction and adduction exercises (i.e. lateral leg raises lying on my side, then on my other side), plus normal leg raises lying on my back (although, I'm doing both legs at the same time time to give my abs a workout too, and finally, I'm doing patella mobilisation (i.e. wobbling my kneecap about).

So, plenty to keep my busy. I'm still going in the "torture tube" once a day. It seems that the swelling around my knee is reducing quickly, which is what the treatment is meant to do. Obviously it would be reducing without  the treatment so it's difficult to determine how much good it's doing.

Here is my knee:

Looking around the Internet, it seems that my knee is similar in size to people at about day 30! We all heal at different rates, but it seems like my swelling is going down fairly quickly.

On top of all the exercises, I'm doing passive range of motion exercises, using my left leg to support my right. At the physio I could only get 30* but today I managed to get between 35* and 40*, small progress, but it's going the right way!

I've been told not to push it too hard in the early days to make sure I don't over-stress the grafts.

That's all for today.

Day 8 & Hyberbaric Oxygen Treatment

Day 8

It has to be said, the last 8 days have drifted by much quicker than I was expecting. I've not even been particularly bored. I guess it's not so bad to be waited on hand and foot by the parents...

I've got through 3 books:

1. 9 out of 10 climbers make the same mistakes. Dve Macleod
2. Revelations. Jerry Moffatt & Niall Grimes
3. The Meaning of Sport. Simon Barnes.

I might even write some mini-reviews if I get bored.

Tomorrow I get my staples and stitches out, and get to see the physio to get my hinged knee brace fitted. I'm quite happy with the progress so far. The swelling on my calve and ankle have come down by 3.5cm and 2.5cm respectively. I'm off the painkillers and considering stopping the diclofenac tomorrow. I've been using some fairly experimental treatment: Hyperbaric Oxygen Therapy.

Hyperbaric Oxygen Treatment

Once a day, for about 60 minutes a session, I've been getting zipped into one of the only home hyperbaric oxygen treatment devices in the UK. Basically, the "tube" gets pressurised up to 1.5 bar (i.e. 1.5 x atmospheric pressure) and the inhabitant breathes ~95% oxygen through a mask.

 If this all sounds a bit strange, well, it is!

The aim of the treatment is to reduce inflammation and stimulate the regrowth of the damaged tissue in my knee. The second process is the promotion of growth of new bone, collagen and blood supply to the ligament grafts and bone tunnels.

The reason we have one in our house is because my dad has serious rheumatoid arthritis and has tried every damn treatment under the sun, none of which worked and some of which made his health significantly worse! Rheumatoid arthritis can cause debilitating lung damage (whether or not it's the illness or the drugs that are the cause is debatable, anyway, I digress...) and his lungs currently function at about 42% and he is on supplemental oxygen 24 hours a day.

At the rheumatology clinic he attends, he is the only patient who has not got significantly worse year on year since the start of the hyperbaric treatment. In some tests he has actually improved, which is practically unheard off. Oh, and he's not using any of the usual anti-inflammatories or immuno-suppressants that are normally prescribed and has cut down to a near homeopathic dose of 5mg/day of steroids. (He was previously on 30mg/day).

So, the upshot of all this is, I have access to the treatment at home. Unfortunately there has not been a great deal of research on the use, partly due to the fact "Big Pharma" (the massively wealthy and influential drug companies) pay for most of the UK's fundamental research and they have no intention of financing it.

Anyway, one recent piece of research, Effects of hyperbaric oxygen treatment on tendon graft and tendon-bone integration in bone tunnel: Biochemical and histological analysis in rabbits, concluded:

Experimental results demonstrated that a higher number of Sharpey's fibers bridged the newly formed fibrocartilage and graft in the HBO group than in the control group. In addition, HBO treatment increased neovascularization and enhanced the incorporation of the progressive interface between tendon graft and bone. Biomechanical analysis showed that the HBO group achieved higher maximal pullout strength than the control group. Examination by EM showed that HBO treatment resulted in regenerated collagen fibers with increased compaction and regularity. Based on experimental results, HBO treatment is a treatment modality that potentially improves outcome following ACL reconstruction.

I really hope more research is done in this area, as it seems very promising, is very safe and, if implemented properly around the UK could help lots of people, and save the NHS a whack of money on drugs.

Here's the link to the paper:

http://www3.interscience.wiley.com/journal/114110845/abstract?CRETRY=1&SRETRY=0

Andy, if that doesn't work...  http://lmgtfy.com/?q=effects+of+hyperbaric+oxygen+treatment+on+rabbits+acl+wiley&l=1

Day 2 to 4

Day 4

Four days since the surgery and all seems to be going well. Yesterday I only took painkillers in the morning and before bed - slept from 11 till 6 then dozed till 8. Today I'm avoiding them altogether but I'll put some by my bed in case I can't sleep. Swelling doesn't seem too bad, but it's under about 4 layers of bandage, so hard to tell! I really hope BBC Radio 6 doesn' get axed as it's definitely helping to keep me sane! Cutting 10% of the wages of the top DJs would pay for it...

Posterolateral Corner

As I've said before, I tore both my Posterior Cruciate Ligament (PCL) and my one of the ligaments in the Posterolateral Corner (I tore the often missed Popliteofibular Ligament - PFL).

Surprisingly, the tiny, insignificant looking PFL is anatomically more important than the PCL. The PCL stops the shin bone translating rearwards under the knee and anyone with reasonably strong Quadriceps can live a normal life without one. Many sports can be played with a knee that has no PCL.

The PFL on the other hand stops the lower leg moving outwards (varus translation, or more commonly "bowlegged") and it stops the lower leg rotating in a toe-out direction. For me, the most important aspect of this repair is the varus translation, as I was finding that my knee was giving way in this manner, especially when outside edging in my climbing shoes.

For anyone who's interested, and not squeamish, here's a video of the procedure of reconstructing the PFL:

http://www.youtube.com/watch?v=Zz_U2CWES3s

My PFL was replaced with a tendon graft harvested form my hamstring and my PCL was replaced with a ligament from a donor, called an Allograft. The allografts are usually taken from the Achilles. I recently read a decent article on the various aspects to think about if you are considering a PCL Allograft:

http://www.kneeguru.co.uk/KNEEnotes/node/2125

Four more days till I get my staples and stitches out. Then I can get into my locked, but releasable, knee brace and out of this monstrosity: 

Happy days!