Microfracture Surgery cont.

Nutritionally I also had a strong programme and left no stone unturned. My first thought was calcium and making sure I had the right "stuff" to make new tissue. So my wife cooked beef bone broth for me every day for lunch, it was great for the waistline too.

My primary concern was to reduce the inflammation. I want to talk in later posts about chronic whole body inflammation, but this acute inflammation was my primary concern. So I started taking Arnica and Symphytum as homeopathic rememdies and symphytum cream topically. Now I know this will make many jump up and down, such as Prof. Brian Cox who describes homeopaths as distillation wizards. Well rather than just shout people down I looked to the literature and found some papers that suggest it might not be such a bizarre thing to be doing:

Symphytum Cream

Symphtum Cream 2

Arnica vs Voltarol for wound healing

Arnica gel in osteoarthritis

Arnica and symphytum treatments are not expensive and there appear to be no side effects so my professional opinion as a scientist is to give it a go!

I had also been taking glucosamine and hyaluronic acid chronically since well before my surgery and I would do the same again as there is enough positive evidence to suggest that for some people with certain conditions it could be helpful. Science could really be helpful here by increasing the amount of funding for these treatments and ensuring there is no observer bias such as funding from the biotech industry. This needs careful scrutiny.

More recently I have been focussing my efforts on getting rid of whole body inflammation. I have been reading a lot and a good text that I would recommend is the Gene Smart Diet. I will review this book in the future but I would definitely put it on your reading list. Basically I have been taking long chain omega-3's from fish oils, and omega-6's from borage seed oil. The potential benefits of this are long and varied so I won't include references. Secondly I have been increasing the polyphenol content of my diet including more veggies with the skin on, berries and other high polyphenol intake such as dark chocolate (control intake as high in calories), red wine (control intake because of alcohol) and supplements such as cherryactive. We have done work in our lab on cherryactive and I will cover this in a later post. Again these things are not expensive and will add to your health.

I can't be sure what had an effect and what didn't but I am sure that my refusal to fail helped me find the best possible strategy for recovery from microfracture surgery. An update on my progress, I am now double arm swinging 40Kg and double snatching 32Kg comfortably. This was more than I was doing before the surgery. I won't be jogging till at least January and I intend to investigate barefoot style running when I do. I am in a better place now than before my surgery.

Microfracture Surgery

So I had some long standing cartilage damage to my left knee. I went to the surgeon at the BMI Runneymede and had Xrays and MRI's taken which showed that I had medial cartilage damage from poor liftng technique, a small cyst and a lateral femoral tear that seemed to go down to the bone. The surgeon informed me that he could tidy up the torn cartilage and remove the cyst without any problems, but if the lateral tear did indeed go to the bone that he would like to do some microfracture surgery to repair.

I hadn't heard of microfracture before so I started reading around and although it has been around since the late 80's it is still a work in progress. It was actually developed by Richard Steadman, founder of the Steadman Clinic. The basic idea is that if you can make bone bleed the blood is rich in mesenchymal stem cells that can become a number of tissues. So special tools are inserted into the bone to create a rough, broken surface, deep enough to cause bone bleeding. A super clot or blastema then forms over the damaged bone, the bone heals and also new cartilage grows to cover the operated area.

Although new tissue will be formed in 6 weeks there is a long process of tissue remodelling that is required to cause the tissue to become what is required. Articular cartilage that covers the ends of bone is strong and elastic so it can last and absorb the impact forces it is subjected to. Unfortunately the new cartilage that formed during the early years of this technique was fibrocartilage, a much stiffer and less robust cartilage. It seems the great progress in the last 20 years has not been in surgical technique but in rehabilitation. Actually doing the right things to tell the tissue what it needs to become is the main focus of rehabilitation. Unfortunately the physio dept. at the Nuffield Woking seemed only to want me to be walking again and that was the limit of their care.

So post surgery I was non-weight bearing on the left leg for 6 weeks. Not a pleasant experience but it certainly grew my respect for those who use crutches on a daily basis. I was told by my consultant only to do mobilisation exercises for the 6 weeks. This didn't seem consistent with what I was reading so I decided to take control of my own rehab. For 2 weeks I only did mobilisation to get the full range of motion. After that I bought a cycle exerciser from ebay (an exercise bike is fine but place no resistance through the wheel) and started doing 5 mins of cycling twice per day as well as my mobilisation exercises. I very slowly and carefully and watched how my body responded to gauge what was too much. Any swelling or discomfort I took as my limit, when I could complete that without any symptoms I increased the duration. Eventually I built up to 40 mins of unloaded cycling per day.

Another technique I used was Revitive: Circulation Booster. This is a device I have worked on and I had one so I thought I know it improves circulation so it should speed my recovery. I used this 2x per day for 20 mins each time. Again building up the intensity as I got used to it. I would perform my mobilisation exercises after using Revitive: Circulation Booster as I found that I could get much larger ranges of motion after my leg was warmed up. Within a month I had full range of motion back in my leg. I did suffer from swelling in the leg and Revitive: Circulation Booster quickly removed this.

I also kept using my aerosure: youbreathe training device to keep my lung performance up to speed and this helped a lot especially whilst on crutches.

So 6 weeks came and went and when I went back to the surgeon he was very happy with the condition of my knee, full ROM and no pain or swelling. So he took my crutches away and sent me back to physio. I decided to move physio to a team I had used before, Balance Physiotherapy in Clapham North. I saw a knee specialist Paula Coates and she started me on a programme of knee strengthening and flexibility. I cannot jog till next year but I am back swinging my kettlebells which was the main aim for me. I am getting stronger and fitter by the day and knee feels great, very smooth and little discomfort. One important thing Paula added to my rehab is stretching as the quad had shortened from lack of use, getting the muscle back to normal length has been hugely helpful.

The links to some interesting research are here:

Pulsed ultrasound

Pulsed ultrasound observational study

LIPUS in rats

Microfracture rehab 1

Microfracture rehab 2

In my next entry I will describe my nutritional and supplement strategy.

Tune in!

Hi, I have been very busy for the last 2 years and have been doing many exciting things. Now again I have created the time and space for myself to start blogging about what I have been up to. I have being doing a lot of work in altitude simulation with the England Football Team, London Broncos academy team and we have more work coming up with Wasps academy. I have also been working at King's College Hospital with COPD patients and that has gone very well. I will be updating about all of these projects over the next few weeks. I am glad to be back, thanks for reading.