Nonspherical femoral head shape

I went back to Wimbledon Clinic the other day to see the consultant physiotherapist who specialises in patella-femoral problems.

This was in fact the longest consultation I have had - 90 minutes. Went through quite a lot of the usual tests, but then she also started testing my hip strength. Apparently my left hip is super weak. I had to lie on my side and raise my leg, then she pushed down on my leg and I had to resist the movement. On my right side I could resist the push, on the left side - nothing.

So she thinks what might be causing my problem is my left femur is turning inwards due to the weakness, which then puts the kneecap under pressure. That, coupled with my dodgy gait, means sore knees.

She also put me forward for a hip X-ray as I also complain on hip pain. In the mobility tests I had extremely immobile hips, but it didn't seem to be due to muscle tightness - just the physical limitation of how far my legs could move.

I got a CD with the X-rays in the post the other day. What a lovely pelvis I have! I got a phone call from my consultant the other day to talk me through the results. So, apparently I have nonspherical femoral head shape, which explains why my hips are so inflexible.

That would explain the following:

• When everyone else was doing side-kicks at Ju-Jitsu aiming for the solar plexus, I could only aim for ankles.
• I can't really sit with my legs crossed.
• When rock climbing, I can't spread my legs with my feet facing in opposite directions when bridging. I had to adapt and have both feet pointing the same way.
• I have real trouble getting my leg over a motorbike.
• On some bikes, I get incredibly uncomfortable as the fuel tank spreads my legs too far. I can only ride skinny bikes!

It doesn't change anything and the consultant says it's nothing to worry about unless I start getting more hip pain, but it's nice to know what has made me so inflexible all these years.

So now I am a bit more of an intense physio programme to build up my left quad as well as my outer hip muscle. I will also be having more physio in Oxford to follow a new programme that my London physio has drawn up for me after seeing the X-rays.

Only problem is that I only have £88 of my BUPA out-patients money left, so hopefully I don't need much more done this year or it could get pricey!

Knee progress

I went to see a new surgeon today at the Wimbledon Clinic.

The surgeon I saw was very good and agreed my case was a very difficult one. He has referred me to a consultant physiotherapist who specialises in kneecap overload. I will apparently be getting a 1h session in a couple of weeks, through which I will be given a pretty intensive physio programme that I will have to follow.

He does think that that should help the pain in my knee and return strength to my left leg.

I also had a follow up for the orthotic inserts and had my foot force measured again, and they do appear to be helping my dodgy gait.

So, I have high hopes for the new physio regime. Positive mental attitude!

Biomechanical mess

I finally had my appointment on Friday with the podiatrist-type guy. Previous appointment was cancelled because he dislocated his shoulder! Turns out this had prevented him from emigrating to New Zealand. Bad for him, but, as it turns out, rather fortunate for me.

Anyway, the consultation lasted an hour. I had high hopes for this and had been looking forward to the assessment, not least because I am quite fed up of being unable to walk properly.

Well, the consultation was excellent! He really seemed to know exactly what was wrong with me. At first I had to stand there, then on one leg then the other. Some various static testing on the bed too. Then I did some walking over the force-measurement plate which feeds in to the computer. Then I went on the running machine (at walking pace!) and he watched my dodgy gait.

As predicted, I have a shockingly bad gait and my overall biomechanics are really messed up. In one of the tests to look at flexibility in my hips I got a score of -5. He was looking to see how much over 0 I scored and I was below! So, my dodgy hips turn my femur inwards and my dodgy gait turns my leg out the other way, so I have two opposing forces meeting at my knee. At least that is mu understanding of it. The problem in one leg is made worse my one leg being longer than the other.

I felt such relief hearing him explain it. Everything made sense to him, which made me feel really positive.

So he is making an orthotic shoe insert to hopefully sort some of this mess out. I should get it in about a week. I'm looking forward to trying it out!

The guy's practice is called Motion Lab. If you live in the South East of England and have any problems I highly recommend you see him before he leaves the country. I'm hoping I can get sorted before he goes.

Pins in my knee

I had my third acupuncture session this weekend. Pic is my leg with the acupuncture needles in it. This time it was a different "doctor". Tellingly, he put the needles in different places from the other guy with none in my knee at all. He stuck one of them in teh top of my foot. You can't see it in the photo, but it didn't feel too nice getting stuck in. As usual I got the "I think my leg is going to start twitching" feeling towards the end, which is a bit scary.

After about 20min he came in and I though he was going to remove the pins, but no - he was just there to "tweak" them! Argh!

Anyway, once he was done I went out, drank some Chinese tea, let the girl tell me I needed another seven sessions, then smiled as I bolted out the door. I might try acupuncture again, but maybe elsewhere.

Acupuncture

Some people (including an orthopaedic surgeon) have suggested that acupuncture might be quite good to help reduce the swelling in my knee.

I was going to go somewhere that had been recommended to me, but I was feeling very impatient today as I couldn't find a decent knee support in Oxford, so I decided to go in to a Chinese health shop. You know the ones - slightly dodgy looking, often found in shopping centres, with questionable claims on the windows.

The only time I've seen inside them is when the likes of Watchdog have done stories about them conning people in to buying dodgy medicine after looking at their tongue.

First off, just like on Watchdog, I sat down with the "Doctor" and his translator. They then asked loads of questions about my knee, and I did my best to explain without using the words "synovial plica". They did ask how my bowels were - I reckon they ask everyone this - and I said they were fine. And of course I had to stick my tongue out and have my pulse taken.

It was then explained to me that I have three meridians flowing down my leg and that they were blocked which makes the chi monkey fall off my back. Or something like that. I was by that point just wishing they would get on with it and stick the bloomin' needles in my knee.

So they I was taken in to the treatment room and I lay down on the treatment bed with my trousers off. Once again I made a pants-related error, by not then covering myself up with the provided towel...

Then the doc comes in and brings out the needles. I think my eyes must have been as wide as dinner plates when he started sticking them in me. I think there were six in total. He stuck them in a little bit, then kinda tapped them in one movement with his whole hand. When he put the two in my knee, I was honestly crapping myself and I though he was going to go straight in to my patella ligament and I was going to then hit the roof. Actually it wasn't too bad. One of the needles in my calf felt quite uncomfortable - like he had put it in when the muscle was tense and when I tried to relax it felt weird.

So I lay there and looked at the acupuncture chart on the wall. Looking at the chart such as the eye and perineum. :S

After about 20min the needles were removed. The doc then gave me a massage with some menthol oil stuff. Although it felt like he was just randomly rubbing my knee, it did actually feel quite good... that is until he did some kind of slapping thing on my kneecap that I did not like much.

Of course, I knew that they would eventually "recommend" that I buy lots of Chinese medicine and sign up for loads more acupuncture sessions. They wanted me to sign up for 10 sessions for which I would get 3 free. Hmmm... perhaps they could not detect the Scottish accent. They also wanted me to buy the oil and two boxes of medicine stuff. I agreed to sign up for 3 more sessions - I do appreciate that if it is going to have any effect it will not happen in one go - and I bought the oil stuff. They did their best to get me to buy the medicine but I did refuse on that one. I willing to accept that Chinese medicine could have some efficacy in certain conditions, but for a gammy knee I'll stick to Glucosamine and cod liver oil for the time being.

So how does it feel now? Well it actually felt quite good afterwards. It's always a good sign when my right knee bothers me more than my left. However, it's impossible to tell if the improvement is because of the acupuncture or the random rubbing afterwards.

I now stink of menthol, but I go back on Tuesday for more...

Knee: Better then worse

Two days ago my knee felt great. Really strong and I could almost walk normally.

Then that evening I had to ride the motorbike up to Birmingham to get a new exhaust. I don't think the riding bothered my knee, but when I was up there I had to try and get on my knees to fit the new exhaust. I also kinda jarred it when I was sitting on the bike eating fish n' chips.

So now it is sore again like last week, which is especially annoying as the day before was the first time it had felt strong in ages. I have, however, managed to add about 2cm to the circumference of my thigh so I am managing to rebuild the atrophied muscle. Hopefully that should help!

Fraser - last week my knee was weaker than it was straight after the surgery - I couldn't do the exercises that I could do then. Now, my knee is definitely worse than before the surgery judging by its current state.

Knee progress - getting worse

I had another physio appointment tonight. My physio is quite amazed about how much muscle I have lost in my thigh. She thinks I may be stuck in a vicious circle where my knee is so swollen it is causing the muscle to atrophy and because my thigh muscle is weak my knee cap is out of position, which causes more knee swelling.

My knee feels so odd. I have no feedback - it feels like it could snap backwards at any time. When I do squats, I can feel the muscle in my right leg tensing, but in my left leg in the same place it just feels like jelly.

So I now have to start from scratch and treat my knee as if I have just had the surgery (it was about 3 months ago now). My main aim is to try and build up the thigh muscle again (inner thigh muscle - can't remember the name). I have to do exercises every hour and try to ice it three times a day.

I was unable to do exercises tonight that I was able to do in my first physio appointment after the surgery - so I am weaker than I was after the surgery.

I have been to the gym a couple of times this week, but I am going to start going every day (if I can get a lift!).

So I did actually broach the question of my physio - "do you think I will walk properly again?" Answer - "I hope so!"

I do feel a bit guilty moaning about this once I have spent a few minutes on KneeGuru and you hear about the terrible knee injuries some people have.

Must work on my positive mental attitude!

Pandora's box of knee problems

I had some knee surgery a couple of months ago to try and sort some pain I had when I stressed the joint after a long walk or if jogging.

Unfortunately the recovery has not been smooth.

A few weeks ago I went to see my Consultant for my post-operative follow-up consultation. By that point I had had some physiotherapy, had a full range of motion in my knee again, and had done some light walking in South-West England. The knee was still a bit swollen though, and I did still get some twinges in it. Overall it didn't feel too bad, but I also didn't feel like anything had been "sorted".

I had thought the surgeon had found something in my knee in the operation, but in my conversation with him it became apparent that although he had done some stuff in there he hadn't really found anything that made him think, "Ah - there's the problem!"

He suggested I needed to try and stress the knee again to see if it was improved. However, I never got that far.

Almost the next day my knee started to hurt more. I was getting twinges in different parts of the knee and I started to limp again. It got pretty bad, so that it was sore to walk almost anywhere, so I made an appointment with the physio again.

While I was at the physio I mentioned that I had never had my leg length measured or my hips checked. All these things are linked so that should have been checked early on. Well, it would seem that my left (injured) leg is 2cm longer than my right. How have I managed to walk normally for 28 years? Not sure...

So here are the things that are apparently wrong with me. I'll start at the bottom and work my way up. Like the song says - it's all connected!

My feet - well I have a bit of a dodgy gait. That alone can cause a whole manner of knee problems, not to mention problems with the hips and back.

Knees - well first off I've had what I now think was unnecessary surgery, so my knee is still swollen. This means I don't have very good feedback and it feels weak and unstable. Something in there is more inflamed that before so I am getting shooting pains all over the place when I walk and the original problem with the patella ligament is almost certainly still there.

Also, I have a mal-tracking patella, which means my kneecap moves kind of funny, which can stress the knee too. Combined with the bad gait, this means lots of stress on the knees. Although my left knee is the big problem at the moment, before the operation I actually had more consistent pain in my right knee.

Thighs - well nothing permanent, but my left thigh muscle has atrophied quite badly. It's circumference near my knee is about 2-3cm less than the right leg.

Hips - not necessarily related to the knee problems - but I have very tight hips. Where this does cause problems is when I ride the motorbike - I can get some really bad pains in my right hip in particular, and I can't comfortably ride a bike with a wide tank. I'm thinking Moto Guzzi...

So if that makes me sound like an old arthritic 88 year old man, well, that is exactly how I feel. I can barely walk once around my business park at work without getting in pain, and I will tell you it is not just a little scary.

So what am I doing? I am still seeing the physio and I have exercises to try and build up my thigh muscle as well as stretch my hips. I have taping to adjust my patella when I am doing exercise. Next week I will go back to the gym and try to build up my legs.

I am applying ice to my knee once or twice a day and also taking the diclofenac (NSAID) that I was given after the op. I also went to Holland & Barret and bought Glucosamine, Chondroitin and Cod Liver Oil. I am also open to the idea of acupuncture and anything else that might remotely have a chance of helping.

I am trying to get an appointment with the podiatrist and will probably end up getting an orthotic.

It has only been like this for a few weeks, but at the moment it feels like a life time. I should never have had that surgery. I really thought the problem was some specific damage to the tendon, but it is now clear it is all biomechanical. The problem is working out what caused what...

I'm hoping the orthotics will be the biggest benefit. I really do feel like one leg is really long at the moment. Presuming one of my legs hasn't suddenly got longer or one of my hip joints collapsed, I'm not sure how I can have walked like this normally for so long. It's not that an unusual problem - David Beckham has it - Patrick Vieira has one leg 3cm longer than the other. I am not yet walking in circles!

At the moment I am just hoping I will be able to walk properly again. I also wonder if ski-ing will ever happen again. I'm kind of assuming that eventually I will get proper arthritis in that knee.

Meh - this sucks!

New hospital policy

So as I mentioned in the previous post, my consultant decided I needed surgery on my knee. The procedure is called arthroscopy.

So I got the bus down to the hospital for the surgery. It is minor day surgery, albeit with a general anaesthetic.

I had a private room, and was just relaxing waiting for the nurses to prep me. The nurse came in and gave me the surgical gown and a few other bits and bobs, then left to let me get ready. I put on my surgical gown fine (no - I didn't put it on back to front!) and put on a hairnet and a single TED stocking.

I then lay there watching TV for a while, waiting for the consultant. While I was waiting, the nurse popped in once or twice to see I was ok.

After a short while, my consultant came in with the senior physiotherapist. The consultant kind of gave me an odd look when he came in and said something about "new hospital policy". I wasn't sure what he meant, but then lay there listening as he and the physio described some of the aspects of the surgery and recovery.

Towards the end I asked him if I really needed to wear the hairnet for the operation.

"That's not a hairnet," he replied, "that's your pants!"

OH SH*T!

Yes - I was sitting there in front of my consultant and the senior physiotherapist... with my surgery pants on my head!

So I then burst out laughing, as did the consultant and physio. I was laughing so hard that I strained a muscle in my neck. They had quite impressively managed to be completely serious with me till that point. The consultant had thought someone was playing a joke on him ("new policy"), then when I didn't take them off, figured he would let the physio explain to me once he had left.

As I said to them - I had wondered why it had a hole in the top, but thought it maybe doubled as a beard net too. I didn't notice that it had two holes (for me legs!).

To say I was embarrassed would be a slight understatement.

Even once they left I kept bursting into spontaneous laughter every time I thought of it.

I have since told this story to anyone who will listen, and pretty much everyone is reduced near to tears!

So anyway, I've now had the surgery. The consultant thinks he found the problem and has sorted it. I am now off my feet for a couple of days, and hopefully in a few weeks my knee will be back to 100% normality!

Sailing and surgery

Ok, It's been a while since my last post.

To summarise the more significant events of the past few weeks:

1) I went to Chicago for a conference and visited Kev. Greg and Cara came down from Toronto and we had a very good time. Conference was pretty good too. I had a speaking slot which went quite well.

2) My consultant decided that I needed surgery on my knee for the problem I've been having.

3) I went to another conference in San Diego last week. That was a very cool conference with around 30,000 people there are around 6,000 exhibitors. What was even cooler was that my company chartered a yacht, which I got to go out sailing on a couple of times.

So that's the last couple of months summarised. See next post for something more... amusing!

Gammy knee

As I mentioned at the start of the year my gammy knee has been flaring up.

I decided to take advantage of my work's private healthcare insurance and see if I could get it sorted out.

It's actually slightly more involved to get an MRI scan privately than through the NHS as they insurers want you to be referred by a consultant rather than the GP. From those I've spoken to, the main difference is that getting that first scan appointment is much faster once you go private.

Anyway, I've now had the scan, and the consultant has taken a look and can't see a thing wrong with any of the structures in my knee.

The next step was to try a cortisone injection in my knee to see if that would stop whatever was getting inflamed in my knee.

So on Wednesday I went in to the hospital and got a mixture of anaesthetic and cortisone injected in my knee.

Soon as I got home from the hospital I thought I would go for a run to test my new steroid enhanced knee...

YOU DID WHAT?!

...is what everyone has said to me when I tell them that.

However, the idea is that the anaesthetic acts immediately where it is injected, therefore I needed to go for a run to test whether the injection had been in the correct place. If I felt no pain then the anaesthetic was in the correct place, therefore the steroid would also be in the correct place.

Well, it's fair to say everything expect my knee hurt during the run. Mainly my lungs. I was missing my little W pace-setter!

As the anaetheic wore off in the afternoon I could feel my knee a little bit, but nothing bad (remember last time I went for a run I couldn't walk in the afternoon).

on Thursday, however, I was in a fair bit of pain and was limping about in the office.

This meant one of two things: the steroid probably was in the right place but had made no difference, or this was the initial reaction to the steroid injection (which, I was warned, meant my knee might hurt for 24h).

So now my knee feels fine. I will probably try another run next weekend to test it again. Fingers crossed... then my international rugby career can recommence.

On Monday I go off to India for work for a week. Should be interesting!


(pic above is not my knee!)

Not Running Man

One of my New Year's resolutions was to get some decent running shoes and go running with Wendy. My aerobic fitness has always been rubbish, and I though that maybe if I tried running I might be able to get back in to rugby eventually.

So yesterday we went to a running shop in Oxford and I bought a pair of Mizuno running shoes for £75. This morning Wendy and I went running for about 45min.

Now I can barely walk. My knees, in particular my left one, are killing me. I've always had dodgy knees (since a fall at Kev's - kitchen/water pistol combination) and then I hit my left knee pretty hard when I fell in Spain whilst climbing.

So apparently I can go back to the shop and get a free consultation from the physio there. I reckon I have two choices - no more running ever again, or some kind of surgery. The sort of surgery where the NHS will try to fob you off with "rest" and painkillers for a few months first. Meh.

Dodgy knees

I got a guy at work who is a former consultant orthapaedic surgeon to have a look at my knee, which I hurt while climbing earlier this year.

He gave my knee a pretty good exam, then told me he thinks the reason I have grown an "extra knee" is due to scar tissue. When I fell I must have had a slight haemorage in the soft tissue below the patella tendon, and after the swelling some scar tissue has formed. Because my tendon is now pushed in a funny position by the scar tissue, I now get pain in my knee when I walk. Apparently the scar tissue will go eventually, but until then there's nothing I can really do about it. It's not really serious and mean smy knee isn't really that buggered up so I can still ski next year. Yah!

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Went to an Oxjam gig tonight at the Zodiac. Was all in aid of Oxfam. The acts were quite decent but it probably could have done with more people in the crowd. Still, well done to Clare for organising it!

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The pumpkin crop is quite bad this year, but I will still endeavor to carve a nice pumpkin for tuesday's ghost walk. Pic is of my attempt two years ago.

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Lastly, we have a new shower! After a year of using one of those useless "stick it on the taps" things, we have had a proper shower fitted. Water pressure very high hmmmmmm.

Two Weeks in Andalucia, Spain

Just got back from a two week holiday in Andalucia, Spain. The first two week holiday I have had in a long, long time and it was very welcome!


We were staying in a villa called Casa Rosina, which is in a fairly remote part of Andalucia in the South of Spain. The nearest village was a place called Periana (map)

This is the first time I had been to Spain. Unfortunately, I barely speak any Spanish. On the other hand, this made me feel like a real British tourist as I could walk around in ignorance just asking things in English, in that annoying, LOUD and SLOW was we do. However, I did find much use for the phrase 'no entiendo'. I think I will try to make more effort to learn some of the lingo before I go next time.

The holiday party was Me, Wendy, my Mum and Dad, my brother Fraser and his girlfriend Lauren.

The villa was really nice and over 200 years old. Mum and Dad took the large double room upstairs, while Fraser and I wrestled (winner - me! Yeah!) then tossed a coin (winner - Fraser. Boo!) to see who would get the other big double room with en suite, or the small double room. We agreed to swap rooms halfway through the holiday, although, amusingly, somone had a little temper tantrum when we actually got round to the big swap! Staying in the small room was the first time I can remember being in pitch dark for a long time. I woke up in the middle of the night and for a second thught I had gone blind as I had no night vision and could not see a single thing - not even my hand in front of my face!

The villa had a small pool, which when we arrived seemed to be the favourite hang out of the local wasps. Fraser and I soon put an end to that, aided by the pool net and a couple of wooden bats. I think between us we must have killed a fair few dozen of the useless insects. In fact the locals were so impressed that they held a party in the street for us a named me 'águila de la sierra de la cadena', which in Spanish means 'the great warrior who came and saved us from the evil insects using his quite impressive ninja skills'. Fraser, for his part, received the name 'tablero que plancha', which means 'the slightly less impressive warrior who helped the better warrior'. They promised to hold a street festival in our honour each year.

We found a strange insect around the pool. I thought it might be some kind of Rhino beetle, perhaps Dynastidae, but Dad is an expert in insects and assured me that it was a spider.*

In the first week, Wendy and I made a long drive to Cordoba to visit the Mezquita Cordoba Mosque. It's quite impressive - a huge mosque, with a Christian cathedral built within it. How's that for harmony?! ;)

We visited Malaga thinking it would be a bit of a dump, but it was actually quite nice. It has a huge Moorish fort which we didn't bother visiting. (I intend making those photos into a panoramic)

Of course you can't visit Andalucia without visiting the Alhambra. It was incredibly hot there though, which made the day a bit of a struggle.

We took some climbing stuff with us (thanks Rina and N*****K!) as we were reasonably near El Chorro gorge (photo by Wendy), which is one of the world's most famous rock climbing spots. Unfortunately most of the climbs were too difficult for us *insert usual excuses here* so we decided to climb down in Valle de Abdalajís. After an age looking aorund, we eventually found some bolted climbs, including Wish you were here, Spocky, which looked like a reasonable climb. Unfortunately it didn't go so well. As usual I was rubbish and got stuck. I eventually went for the move and managed to get the quickdraw in, but then I fell... I was just about to clip in so was about 2m above the previous bolt, so I guess I fell about 4-5m. I haven't actually ever fallen before when leading and I would have been okay, but my left leg went into a crack so my left knee made contact with the wall first. That hurt. It's about a week since thne as I type and it still hurts a fair bit (I had a bit of trouble walking around for the rest of the holiday!). Poor Wendy had a bit of a weight disadvantage and got pulled up a meter or so through a spiky bush! Nevertheless, she held on well and saved me! So if you're ever looking for a belayer when you are about to lead climb, don't overlook Wendy just because she is 'not experienced' enough. A) She's got to learn somehow and B) she has just proved that she is more than capable of holding a falling climber.

Anyway, I hurt too much so I had to lower off the quickdraw and leave the other one in too, meaning I left two quickdraws for some lucky climbers (who are not as useless as me). Can you spot them?


No trip to Spain is complete without some motorbiking, so Fraser and I got a hold of a couple of bikes and took some action shots.

Here is the full public picture gallery of my holiday pics. (N.B. That's not all the photos. Most of the pics with people in them are not on the website, because one of our number is a little shy - I will put them up in a password spot later)



*For the sake of Dad's sanity, I must point out that I am only joking. Dad knew what type of beetle it was. He really likes his beetles does our Dad. In fact, as soon as that picture was taken, he picked it up, bit its head off and sucked out the insides! We didn't show Dad any more beetles that holiday.

Pills, pills, pills

I went along to Holland and Barrett as they've got a 'better than half price' sale on at the moment.

So I've bought:

Ginkgo Biloba, to try and improve my pathetic memory...

Glucosamine, to help my aching knees...

Cod Liver Oil, also for joints and general the 'it tastes 'orrible so it must be good for me' effect

and lastly, Ginkgo Biloba, to try and improve my pathetic memory.

When I went to pay I was originally told it was £66! Apparently I'd picked up non-sale Ginkgo Biloba which was £47! The total still came to nearly £30. I'll let you know if it's worth it when I start remembering things and my knees stop hurting.

I also joined the gym at my work...