Once again, I have only good things to report. At times, I do not even think about my knee anymore. I am definitely starting to trust it more and more. Many thanks to Endurance Rehab for helping me regain my confidence.
Spring represents a new beginning. And nothing could be more true than this spring representing a new begining for me. In an effort to get to this new "beginning" I have continued to hike a ton. This time Max and I took Riley to the top of Camelback! We had another great time. It is so nice to be able to do active things again with my kids.
Rehab continues to progress very well. Each week, Andi adds more and more difficult efforts. I am now able to do repetitions of many single leg squats. Being able to do these has made it possible to truly run again.
Andi and I have worked on core and flexibility issues extensively. The top picture below was taken in February. The red lines represent my previous body position (original in lower frame) when I got back on the tri bike last Fall. This position is almost the exact position that I was able to get into prior to my injury.
I suppose the biggest news for me of the spring is that I actually put on a number again and did a running race. In February, I ran the Lost Dutchman 1/2 Marathon. My time (1:52) was not important - rather the only thing that matterred was whether I could make it 13.1 miles (yup) and whether such an effort would put me into the hurt box agaiin (inope).
Brad and I had a really good time running and chatting together. I really appreciate Brad jogging with me! I definitely forgot how far it is in a 1/2 marathon. What a treat to run in an event again.
By far my favorite part of the day was post race coffee with bff's Becky and Elizabeth. We hit the daily dose for pancakes - pumpkin - and some really good coffee. I also forgot how much I could eat following a good effort! - Ridiculous!
As I continue to up the training, I have continued to take advantage of more and more recovery techniques. Bel;ow I am hopping into the cold plunge at FASTER. This plunge is approximately 50 degrees. My legs always feel better after usiong this technique - although in the picture below one would not think so!
The ridinig this spring has been amazing. Below is a shot with Jeff, Kenny and Jerry. I have spent countess hours chasing these guys around town. This sport would not be nearly as much fun without these guys.
Speaking of having fun - this spring we helped PAC -WEST Athletics put on their spring training camp. 27 athletes from Northern California came to town for a week of training. It was great making new friends and getting some good efforts under my belt. Participating in these types of events again is so rewarding!
There is simply no better place to train than Arizona in the winter. The weather is great and there are so many places to discover. Even though I have lived here for years, I continue to find cool stuff!.
This winter I have been riding a lot with Jeff Bassett and Matt Russell .Below is a shot of the three of us at Needle Rock. This is just north of the turnoff to 9-mile hill. I cant believe I have been riding this area for five years and I have never been down this road. This summer I plan on jumping in this river before a climb up 9 mile hill.
Speaking of exploring, ona long ride, I discovered Wranglers Roos. Wranglers Roost is located in New River, Maricopa County, Arizona. It was once a stagecoach stop. Some of the original buildings that were used by the stagecoach drivers still stand, including a jail cell where prisoners were boarded while the stagecoach drivers rested.
The highlight thus far of the winter has been the Humbolt Mountain climb. This mountain just north of Seven Springs and Bartlett lake tops out at just over 5300 feet. Below is a shot of the radio tower at the top of the climb.
The views are just amazing from up there. Below is a view to the east. At 5200 feet we are several thousand feet above the valley.
And another view to the North. The final climb is one mile with a 650 foot elevation gain!
In addition to the cycling, I have been exploring the local hikes. Below is a shot of Brad Stocker, Nathan and Riley on top of Camelback Mountain.
And here is a shot of Nathan and Suzanne as we hike Tom's Thumb trail in North Scottsdale! Good times for sure.
I know one thing for certain - DE NOVO NT by Zimmer works. It is definitely a good solution for focal articular defect/lesions. Due to its success, I not only can run but now I am able to increase my overall running time each week. Last week, I ran 12 miles at 100 percent my body weight. In addition, I ran 1 1/2 hours on the Alter-G treadmill @ 85% my body weight. And I ran my first brick outside in over 20 months - a simple five minute effort.
I am building my volume very very slowly. In fact, last week, I increased my run time by a total of 8 minutes. To my dismay, I am able to run on back to back days now with no problems. If there is going to be any residual swelling/soreness I want to be able to address it before there is a BIG problem.
At this point, I am still working on learning to run again.The hardest thing for me is learning to extend my left leg again as I land and landing on the ball of my foot. Below is a shot of me running from last week. Each week, I am becoming more and more comfortable with my actual running form - it is very weird having to learn to run again!
As for learning to run again, I am doing a series of drills. These videos are a month old but you can get the idea - the goal is to learn to trust to land on and push off the repaired left leg.
While the below is not yet perfect. It is so much better than it was a month ago. Sometimes the simplest things are the hardest. I think the mental part of recovering from this type of injury is the hardest - trusting that landing with full weight on my leg or using the leg will not cause excruciating pain and/or that the graft will hold.
Speaking of drills and trying to improve athletically, I love the picture below. I hope my kids will continue to enjoy athletics and that in so doing that they will care for their bodies better than I have thus far.
Here is a sport I never tried! Being from the desert, Nate started on some smaller waves. He had an awesome time.
Finally, when thinking of athletics, I would be remiss not to mention my buddy Erica. Erica recently qualified for the Ironman World Championships in Kona and is competing in Ironman Canada also. As part of her training, she supported her husband at the Leadville 104 mile mountain bike race (Chris crushed it) and while there she rode her bike up a little hill. WOW!
One of the hardest parts about being injured (having a focal defect) was that I was unable to move about freely. The smallest movements hurt BAD - thus I was virtually confined to the couch! It is so nice to have a good quality of life again. As you can see below, some movement was definitely necessary! Thanks to Dr. Glashow, Endurance Rehab, and De Novo NT I am able to do more than sit on the couch or as one doctor famously stated - I could take up canoeing!
The game was part of Joel's birthday celebration. If you haven't played, I strongly suggest that you try it. This was a blast. Above, Brad and I (woefully undermanned and low on ammo) successfully defended a charge from a pesky group of fourth graders!
Not much to say about the below other than I am still laughing!
I hope your summer was great. Keep working you can and will destroy your limitations.
Having missed the full force of last year's summer, I am definitely enjoying being able to play in it again. Out here temps rise very quickly thus we do a lot of riding before 6 a.m. Here is a shot of the sunrise that my friend Kenny took on our Saturday ride. The desert provides incredible beauty!
I had my one year MRI and I was thrilled to find that the focal defect that was repaired with De Novo NT has completely filled. There is a small area where the cartilage is still a little immature but that is to be expected. Thank you De Novo and Dr. Glashow for this second chance!
While the focal defect on the femoral chondyle has completely filled and the pain associated with it has disappeared, the defect in my trochlear groove still remains a bit open and I still have pain associated with this defect. This pain is different from the pain associated with the femoral chondyle. It is intermittent and sharp rather than dull and debilitating like the femoral chondyle tear. At this point, I am able to work through the pain and Dr. Glashow and I still believe that the stem cell injections in conjunction with the microfracture will fill this defect.
I owe the film below to the good folks at Endurance Rehab and Andi Felton whose tireless work has helped me achieve what so many doctors thought was highly unlikely. There is no doubt that the team that Nate Koch has put together at Endurance Rehab is one of the very best in the world. They are a big reason why the valley has become such a hotbed for training for Olympians and Professional Athletes.
I am so grateful for Dr. Glashow, Chris Prezzano, and the folks at DeNovo and Another Way who have invested so much in me. Without their dedication and belief in me the below would not have been possible. Most importanly, I am appreciative of my wife whose many sacrifices have provided me with the time necessary to achieve my goals!
I have watched an insane amount of baseball this summer. One of my sons began his season in early February and it ended with his All-Star Team's defeat in the Regional Finals. In all he played over 50 games and had at least that many practices -and he is only 9. It goes without saying that Arizona takes its baseball very seriously; hence, it is no wonder that ASU, UA and Grand Canyon represent this state very well year in and year out. The shot below was taken before a practice at ASU. Not a bad place for a practice!
The rest of the summer has been spent enjoying the good ole outdoors with my wife and kids. The kids have now discovered the BBQ. Accordingly, it seems we cook on it every chance that we can as they love being the chef!
This has been a terrrific summer. Everyday I am getting stronger and more hopeful that someday soon I will be able to race Ironman again!
Be well and never give up! You can destroy your limitations!
It has now been 50 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 26 weeks since my last arthroscopy. And it has been a year and sixteen weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
It has been four weeks since my last blog. During those weeks I have experience more improvement and growth than at any time during my recovery. I am going to break this blog into four segments. By doing so I will be better able to discuss changes as they relate to swimming, biking and running.
During the last several weeks, Brandon, Shani, Sophie, Nate, Ed and Wolfgang have spent so much time trying to get my knee to hinge correctly and without pain. Well, they have now succeeded in that effort. In so doing, what seems like the last of the adhesion and scar tissue has come loose. And it is indescribeable how good I feel.
You may notice in the shot above that my VMO is starting to come back now. If you look carefully you may actually see it protuding beneath the pad. This is huge as its return will minimize the patella femoral pain that I am experiencing.
In addition to the NMES, Nate now has me doing several additional exercises. These execises aare focused on the glute, the hammy, and the quad. We are doing a ton of short arc work on the extension and curl machine. in addition, I am doing bench squats, leg press stepdowns, monsters, side walks and TKE. I am also using a band as much as possible as I am trying to give myself feedback if and when my knee collapses.
I have also continued dry needling and needling with electro stimulation. By inserting needles directly into the muscle belly, the electrical circui in the muscle is in essence reset. In addition to the dry needling, I am also using electrical current to reeducate the VMO. Here is a good shot of that treatment.
Running - yes!!! for the first time in over 16 months I am writing a section on running. Why? Well because I am actually doing a little bit now. With the adhesions gone, my pain is so incredibly dimished. In fact, I feel great. Here are some video's that I have shot over the last couple of weeks that document these changes.
Below is a look at the first time that I ran in the past sixteen months. I am definitely favoring my good leg. However, that is out of habit and fear not out of pain as I am pain free.
Shortly after this video was shot we began to work on keeping me on my toes rather than my heels. Here is a shot of the very first agility work that I did. No commentary is necessary as I recognize that I am not quite ready for prime time.
Here is a shot from a day later. This time was a little better. I amd definitely starting to fear using the joint less and less.
Everyday was better than the day before. I was shocked when Brandon told me I was ready to do some jumping. I was certainly apprehensive at first but after doing one and realizing that the De Novo graft was doing a more than awesome job I became more and more comfortable. I am not sure these hops are quite ready for league play.
I would be lying if I did not share that during this process I doubted, at times, if I would ever run again. The learning from this is that no recovery from major surgery has a linear progression. My progress has always seemed like it was two steps forward and one back or three forward and four back, etc. And I anticipate that this will continue as I advance in my therapy. Last Friday, I ran for the first time in approximately sixteen months.
I ran on the Alter G Treadmill. The Alter G is an amazing device as it allows the user to change his effective body weight. These machines are used to help athletes increase their turnover and to allow an athlete to recover from injury quickly and safely. Here is a shot of my first run.
Above, I weighed 180 pounds. Depending on who is doing the calculation ervery step that I take results in approximatelty 180-250 pounds going through my foot and into my knee. At full weight that calculation yield a number in excess of 1400 pounds per foot strike. On the Alter G I was able to reduce my effective weight by 80%. So when I ran for the first time, I effectively wieghed 36 pounds. Thus every step during my run yielded between 250 and 300 pounds of pressure - an amount not appreciably greater than walking at full weight. This machine is amazing in that it allows you to retrain muscles without injury. Below i am running with an external rotation with my affected leg. Thus, I am rying to fix that flaw. Without this machine, I would likely have an injury to my foot as well.
Not bad as it allows me to work on form without hurting my self. I have increased my runs to 20 minutes. If I have no problems this week then we will increase my effective body weight by another 20%. Thats what I am talking about!!!!
I started riding again three weeks ago. Not surprisingly, as soon as I got on the bike I noticed huge improvements in my knee. The patella femoral pain had subsided and the popping and pain on the medial side was dimishing ride by ride. In three weeks I rode approximately 550 miles. I am super happy with where I am at on the bike. I seriously thought it would be much much worse.
Swimming - swimming continues to improve. Like in any other pursuit, if one puts in the time generally the reward is improvement. Well, I have definitely put in the time. My total swimming yards for the l;ast four weeks total 109,800 yards. My biggest week during that time was just over 40,000 yards. The return - my monthly test set has improved dramatically. At the end of every month, I swimm 4000 meters and then do an all out 8X100 @ 2:00. Last week, the group of 8 was on average 7 seconds better than where I was prior to getting hurt. Over the course on an Ironman 7 seconds per hundred is huge!! My fastest Ironman swim was just under an hour. Thus, I feel comfortable that my Ironman swim is now somewhere around 56-57 minutes.
There is nothing as rewarding to me as being a parent. I love my boys and I enjoy being a boy with them. During their recent break we did some guy stuff.
Above is a shot at the Skeet shooting range. I know very little about shooting but we ran into a gent that did. This guy was awesome and gave the boys and me some excellent pointers. The good news is that I think my boys may be able to survive in the wild. Me - not so much.
Thanks for checking in! every week is getting better. I will continue to strengthen the muscles surrounding my knee again and I will continue to work on the Alter G,. Next week I will travel to Las Vegas for another round of shots. And the following week I will travel to New York for anoher checkup. If all goes well, which I anticipate will haooen, I will be running outside by July 1. Never give up folks. You can and will destroy your limitations!
The numbers below represent four weeks of work. I have not blogged in a little while and I wanted my numbers to remain accurate.
It has now been 46 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 22 weeks since my last arthroscopy. And it has been a year and twelve weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
It has been another two weeks since my last blog. During the last two weeks, I traveled to Denver to begin what I hope will be the final answer to my knee puzzle. BTW - I thoroughly enjoyed seeing the snow on top of the mountains again!
However, when I woke up and found snow everywhere I was somewhat shocked. This desert boy is just not used to the amount of snow that I have seen this winter.
And I was even more shocked to find my car under snow also!
In an effort to ensure a complete recovery, I am still augmenting my De Novo transplant procedure with stem cells. . DeNovo has been a blessing - the addition of the stem cells is just icing on the cake! In addition to Dr. Harshfield's technique I have also introduced the Regenexx procedure.
The Regenexx™ procedure is a breakthrough, non-surgical treatment option for people suffering from moderate to severe joint or bone pain due to injury and other conditions. Regenexx is only performed in one place and that is at the Centeno Shultz Clinic just outside of Boulder, Co.
The Procedure Explained
Stem cells live in all of us – they are the repairmen of the body. The problem is that as we age or get injuries, we sometimes can’t get enough of these repair cells to the injured area. The Regenexx™ procedure takes care of that problem by amplifying your body’s natural repair process.
The Regenexx™ procedure begins when the doctor thoroughly numbs the back of the hip (PSIS) and takes a small bone marrow sample through a needle. In addition, some blood is also taken from a vein in your arm. These samples are sent to the Regenerative Sciences lab.
This picture was actually taken last April when I had my cells harvested the first time. Unfortunately, due to new FDA regulations, I had to undergo this procedure again. It actually looks a lot worse than it actually was.
Their trained staff isolates the mesenchymal stem cells. These cells are then grown using natural growth factors found in your blood. The goal is to achieve much greater numbers of stem cells than you could muster to the injured area. It has been shown that the Regenexx same day method yields approximately 3X as many MSC cells as a traditional bedside unit.
After the harvest, reinsertion begins with the aid of Fluoroscopy. Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope..
The next piece of the puzzle is the reinsertion of the needles. These are carefully guided via fluoroscope into correct position. Again, it is way cool to see these instruments being placed in real time via the fluoroscopy.
This reinjection focused on a couple of areas : (1) the medial femoral condyle, (2) the trochlear groove, and (3) the ACL and MCL ligaments which Dr. Schultz wanted to tighten up!
After the needles are placed in the correct place via fluoroscopy - see the monitor below. The growth factors are reinjected into the appropriate locations!
The goal in all of this is to close any remaining fissures in my articular surfaces. Below, it is possible, but not certain that I have a small fissure, less than 1mm, that remains on my medial femoral condyle.
Thanks for checking in! I feel like I am so very close now. In five weeks, I will try and strengthen the muscles surrounding my knee again and with some luck these interventions will be over. Never give up folks. You can and will destroy your limitations!
The numbers below represent two weeks of work. I have not blogged in a little while and I wanted my numbers to remain accurate. I did, however, have a huge swim week two weeks ago when I logged 36,000 yards!
It has now been 44 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 20 weeks since my last arthroscopy. And it has been a year and ten weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
It has been three weeks since my last blog. Sorry about the lack of updates but once again this time I did not get lazy - this time I got real busy! I am back to riding and swimming and I feel great! Thank you once again Endurance Rehab, Denovo, Dr. Glashow and Chris Prezzano!
A week ago my son and traveled to the Big Apple for another checkup! Even though it is a five hour flight, I absolutely love going there. This by far was my best visit to date! And the news continues to get better!
I have provided a brief pictorial to demonstrate the changes that have occurred since last March. As you know, in December 2009, I fractured the articular cartilage in my left knee.
In an effort to rehabilitate that knee I tore a gaping hole in the articular cartilage covering my medial femoral condyle. The bright white line illustrates the injury, This image is dated March 21, 2010.
Below is an image from this trip - roughly one year after the last tear! . I'd say there is a huge difference! The new cartilage may be a little thin but it looks darn good!
This image clearly illustrates that other than the focal defect, my knee is extremely healthy! My menisccus loioks good and so does the articular surfaces!
Hence, in no way was my injury a product of my pushing beyond appropriate limits. Simply stated - accidents happen and this was one of them! Nice!
Not all the images look as good as the one above. A slightly different cut from the study pictured below suggests that there may still be a very small fissure that remains!
We cannot be certain but if it is one it is less than 1mm. The bright line represents fluid within the knee. It does not go to the subchondral bone. Accordingly, if a tear remains it is very very small indeed.
In an effort to ensure a complete recovery, I am still augmenting my De Novo transplant procedure with stem cells. Below is a shot of the ports just before the cells were reintroduced. DeNovo has been a blessing - the addition of the stem cells is just icing on the cake!
One of the things that we noticed is that while my knee extends to 0 degrees extension that is not full extension for me. Full extension for me is likely -2 or so degrees. Accordingly, we have added prone hangs to help facilitate the hyper-extension! My little guy loves his new job holding me down!
My return to riding is hit and miss. Three weeks ago, I rode just over 165 miles. However, due to my trip back east and the additional injection of cells, I have been off the bike for a couple of weeks again. When I did ride a couple of weeks ago, I rode to the towers. I had not been there in a long long time! Great times.
It is amazing how quickly one abandons the notion that cold must be better than hot. Every summer us Phoenicians complain about the heat. We continually boast that a winter in the east must be easier than a summer in the desert. WRONG!!!!
As soon as we hopped off the plane, we realized that we did not have proper attire. We promptly addressed that problem. I love the North Face Store.
COLD COLD COLD! My little guy had never seen it snow. So, we spent a ton of time in Central Park! What a treat. I loved people watching. I even saw a middle aged man running barefoot through this stuff! Now that is hardcore!
New York New York! The big tall buildings are remarkable. And the views from the park at Sunset are just awesome!
Culture Culture Culture. When in Rome right? I took my son skating at the Rock! What a treat - he had an absolute blast! In fact, a day or so later he asked to go back!
Everyday was exciting and unique. The Metropolitan Museum of Art exceeded my high expectations. One could literally spend months inside its walls and still not see everything! Bellow is one of our favorite exhibits -Medieval Armour!
Seriously the place has everything. The Met has taken an Egyptian temple apart piece by piece and put it back together in New York! To say it was amazing is such a gross understatement. They even have one of the surviving Sphinx inside it!
Not all culture is just for observing. New York has plenty for tasting and touching. Ess-A-Bagel is widely considered the Best Bagel House in New York! We ventured there and we were definitely not disappointed!
PIZZA PIZZA PIZZA - There is no better! And I assure you this slice did not last long! Nor did it suffer!
Neighborhoods! One of the coolest things about New York is the uniqueness of the various Neighborhoods. One day we ventured to Astoria just to walk the streets where we happened upon a very cool Greek neighborhood! Accordingly, it was GYRO time!
Thanks for checking in! I will try to get back to weekly blogging. Never give up folks. You can and will destroy your limitations!
Clearly the numbers below represent three weeks worth of efforts. I have not blogged in a little while and I wanted my numbers to remain accurate.
It has now been 41 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 17 weeks since my last arthroscopy. And it has been a year and seven weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
It has been two weeks since my last blog. No, I did not get lazy - I got busy! I am back to riding and I feel great! Thank you Endurance Rehab, Denovo, Dr. Glashow and Chris Prezzano! Below is a shot just before Elizabeth, Brad and I had a spin! Great times!
Over the last two weeks, I rode just over 175 miles and the pain that I have been experiencing medially continues to dissipate. Why? I believe it is because the good folks at Endurance Rehab now have my VMO firing. We have integrated a mobile TENS NMES unit into my rehabilitation. Whenever I use the quad I depress the button in my left hand and a nice jolt of electricity flows to my VMO. The impulse is teaching the VMO to fire again. And it is working!
It is amazing how much better one can feel from such minute changes to the body. My patella is still not quite centered within the trochlear groove. But it is approximately 50 percent better than it was a few weeks ago. Now as my quad contracts, my patella is still pulled laterally but because the tracking has improved there is less irritation of the patella and surrounding structures.
I learned something new at the pool last week. What? I learned that swimming is a full contact sport. HA! One of my lane mates, on an all out set, FORGOT that we were circling and came right back into me! That felt good!
I absolutely love my swim group. The folks at Sun Devil Masters awww.sundevilmasters.org are friendly, focused and fun! We work hard and we have a darn good time while doing it! Laura Winslow and Jonny Tunstall are amazing coaches and this is masters! Below is a shot of Steve Pohle aka ORCA having a laugh at practice!. This has to be one of the funniest things I have ever seen a human doing!
I love watching my kids compete. Below is a shot of one of my little guy working on his passing skills! Not bad form me thinks!
The highlight of the efforts to date by Dr. Glashow, Chris Prezzano, and the great work from Endurance has to be that I got to throw a ball with two of my sons last week. I had not had that opportunity in over a year! Talk about a great experience - it is definitely one I will always remember and one that I never thought I would have again just eight months ago!
When your rehab gets tough or emotionally things get difficult just focus on the things that you look forward to doing. Don't fjust ocus on what you cannot do at this time!
Another one of my little guys has taken up Lacrosse, a game of which I know nothing about. He is a scrappy little dude and I love watching him mix it up! Fun stuff for sure. Its always exciting to learn a new sport. I actually got to throw the ball with him this week also. Make no mistake my tosses and catches were very interesting!
Everyday seems to get better and better. Thank you Endurance Rehab! for making so much of this possible.
Never give up folks. You can and will destroy your limitations!
Clearly the numbers below represent two weeks worth of efforts. I did not blog last week but I wanted my numbers to remain accurate.
It has now been 39 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 15 weeks since my last arthroscopy. And it has been a year and five weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
Generally, I feel really great now. I am getting around so much better. As far as normal life is concerned, I have very few complaints! The graft has integrated very well and I feel no pain whatsoever at the graft site. Below is a shot of the knee. I think it looks great! Thank you Denovo, Dr. Glashow and Chris Prezzano!
Unfortunately, when it comes to training or any exercise involving my legs, I still experience medial knee pain associated with patella femoral syndrome. This pain is intermittent but extremely sharp! The fact that it is transient combined with the fact that it reacts to stress inconsistently makes it very difficult to overcome.
The great folks at Endurance Rehab have been all over it. However, Patella Femoral Syndrome is a very complex condition, often with several different contributing factors. Boiled down to the basics, it centers around the patella, and the way that it tracks within the femoral groove.
The patella is a small bone that sits on the end of the femur. The femur has a shallow groove in which the patella moves up and down during knee flexion and extension (bending and straightening). The quadriceps muscles are the large muscles on the front of your upper leg, and all four connect to the patella, and then the patellar tendon connects them to the lower leg. Everytime the quadriceps contract, the patella moves along the femoral groove. It is within this groove, and as a result of Patella Femoral Syndrome, that i tore a .5 X.5 CM hole in the Articular Cartilage surrounding the Femoral Notch doing rehab for my Denovo NT.
As a result of swelling and VMO atrophy I have a rather serious case of Patella Femoral issues. With patella femoral compression syndrome, the patella is not quite centered within the groove. As the quads contract, the patella moves along the groove, but if it is not aligned correctly, there are areas of greater pressure, and areas of lesser pressure. Repetitive activities often cause irritation of the patella and surrounding structures, because of this mal-alignment and abnormal pressures.
As irritation increases, you begin to have pain around the kneecap, and eventually have a continual ache throughout the knee with all activities. The good news is that by increasing flexibility and strength of certain muscle groups, your alignment issues can be overcome. Weak muscles can contribute to patella femoral compression syndrome as well. This is true for the quadriceps, as they are the primary muscles that move the patella along the groove.
In the past week, my VMO has actually started to fire again. Literally, for the first time in over a year I am pain free again in one area of my knee! My VMO had not fired in over one year! It is not firing great but it is firing again which is way cool. So long as the Microfracture works and my VMO starts to fire consistently and with vigor then the issues associated with the patella femoral syndrome should be overcome.
I owe this change to Electro Acupuncture which I introduced last week,. With Electro-Acupuncture, small electrical leads are connected to already-inserted acupuncture needles and an electrical current is sent through the needles and into the acupuncture point.
Below is a shot of my VMO as I underwent Electro Acupuncture.
There is no end in sight to my winter swimfest as it continues and continues and continues! This week, I swam 32,000 more yards. The highlight of the past week was another set of 100 X 100's. This was another great experience. Sun Devil Masters offered it so Jeff Basset, Kevin Taddonio, George Gage, Elizabeth Rich and I all did it! It was also great to see Simon and Jonny! They are both Pac-10 legends and all around great guys!
My riding has continued to improve and I have been able to get out a little more. I was able to get out four times last week. In total, I rode just over one hundred sixty miles on the week - and again I had a great time. Per Wolf's instructions I held right around 150 watts average. I did go over at times but in general I sat at 150 the whole time. In addition to getting outside again, the good news is that I experienced no pain during the ride but I did have some transient pain after riding. I am so excited.
The highlight of the week was a little fifty miler, my longest ride since Kona '09, with Steve Rink and Elite Runner and Rock and Roll Marathon Champion Sally Meyerhoff! A close runner up was a loop of the IMAZ course with Basset and Taddonio following our 100 X 100 smashfest - Great times!!!!
I am really excited about all the changes that I am experiencing now. The folks at Endurance Rehab have made so much of this possible. And for all of these gifts I am so grateful.
Never give up folks. You can and will destroy your limitations!
It has now been 38 weeks since Dr. Glashow and his assistant Chris Prezzano transplanted a De Novo NT Allograft into my left knee. It has been 14 weeks since my last arthroscopy. And it has been a year and four weeks since I tore a pothole (1.5 cm X 2.1 cm) in the articular cartilage of the femoral condyle of my left knee.
I am very close to discontinuing this chronological approach to blogging. I feel great and it is almost time to move on. I am, however, still suffering medial knee pain associated with patella femoral syndrome. Thus, it is somewhat helpful to still provide a chronologic timeline.
Trauma to the knee in the form of impact, twist, or surgery can leave the VMO defenseless. 20 cc's of swelling in the knee basically shuts down the VMO. It takes 80 cc's to shut down the vastus lateralis. Because of this difference, the vastus lateralis muscle pulls the kneecap to the outside, dragging the kneecap along the lateral femoral ridge. Unless VMO weakness is addressed, this will continue to happen until pain and degeneration of the kneecap makes it too painful to walk.
This is exactly what has now happened to me. Thus, rehabilitation from this injury continues to focus on rebuilding and reeducating my VMO. Because I am limited in the exercises that I an do this little project requires some more thinking outside of the box. Next on my list of outside the box thinking is "dry needling."
Dry needling is the use of a solid needle for therapy of muscle pain, sometimes also known as intramuscular stimulation. Dry needling contrasts with the use of a hollow hypodermic needle to inject substances such as saline solution, botox or corticosteroids to the same point. Such use of a solid needle has been found to be as effective as injection of substances in such cases as relief of pain in muscles and connective tissue. Analgesia produced by needling a pain spot has been called the needle effect. Acupuncture and dry needling techniques may be similar, but their rationale and use in treatment are quite different.
In addition to the dry needling, I have begun a series of sports medicine acupuncture. Sports Medicine Acupuncture is a series of needling techniques specifically geared towards the treatment of orthopedic disorders and painful musculoskeletal conditions. The scientific approach behind this style of acupuncture is fairly modern, however the points utilized remain largely traditional and historical in nature.
This style of acupuncture follows the theory that most painful orthopedic conditions are due to an imbalance of the muscle systems of a particular area. By treating these conditions through a re-alignment and balancing of the pathological muscles involved, range of motion is restored, pain is reduced, and the speed of recovery time is increased – often with exceptionally fast results.
This is achieved is through the use of Motor Points. Motor points are areas on each muscle that possess the least resistance to electrical conductivity. Extensive research and practice has found that, by stimulating stainless steel needles in these particular points, a nerve response occurs which essentially ‘re-sets’ the communication between that particular muscle and the central nervous system. This ‘re-setting’ of the muscle helps to release spasms in chronically tight muscles, and conversely, helps to ‘turn-on’ muscles that have become weak through over-stretching, atrophy, or fatigue.
This style of acupuncture is exceptionally popular with athletes who are actively training for events or needing a quick recovery from an injury. It also serves as an excellent therapy for those individuals struggling with injuries due to chronic overuse and repetitive stress.
In addition to the Sports Medicine Acupuncture therapy I have also introduced Electro-Acupuncture. Electro Acupuncture is most often used in conjunction with Sports Medicine style acupuncture, though it can be used with nearly any type of acupuncture. With Electro-Acupuncture, small electrical leads are connected to already-inserted acupuncture needles and an electrical current is sent through the needles and into the acupuncture point. This process has exceptional health benefits.
Below is a video of Electro Acupuncture on a healthy VMO - clearly not mine!!!
Below is a shot of my VMO as I underwent Electro Acupuncture. When compared with the above video it is clear that my VMO is not functioning correctly yet. However, I have no doubt that it will get there.
A couple of months ago I suggested that a time would come when I needed to start focusing again on my weight. Well that time has come. Below is a shot of me when I made that statement. A little puffy and heavy me thinks!
Since then I have continued to work on core and related strengthening with Andi Felton at Endurance Rehab. We have focused on a program where I do a series of core exercises while keeping my heart rate elevated. After two months of this program, I am beginning to feel rather good again. Below is a shot just before I rode yesterday. In addition to Andi's program I am writing down absolutely everything that goes into my mouth and this seems to keep me on task. One good site that I have found that facilitates this nicely is www.livestrong.com.
Well, I did not get dressed for a picture. Nope I got dressed to ride. I was able to get out twice last week. I rode just over seventy miles on the week - and I had a great time. First, it was awesome to get out and ride again. But more importantly, I had absolutely no pain while riding or the morning after I rode. I have not had that experience since my crash in Germany in July '09. To say that I was stoked would be a huge understatement.
My winter swimfest continues and continues and continues! This week, I swam 33,000 more yards. I also spoke with Ironman legend Hillary Biscay, www.hillarybiscay.com and she wrote me a couple of quality smashfest workouts. I promptly hopped on these and definitely smashed myself! I certainly miss Hillary and her smashfest approach to Ironman Training!
This weekend several of my mates and I are going to try to expedite the getting into swim shape process by knocking out another set 100 X 100 long course meters. Why? I don't know other than Sun Devil Masters is offering it! After that I have my first brick - a 37 mile ride out to the Ironman Ariona turn around with Jeff Basset. He has promised not to drop me as he will be riding his single speed. I am holding him to this.
This week's things that I like is a double edged sword. I guess I like weather. Living in Arizona we have weather - hot and hotter. Thus, we don't have four seasons. Below is a shot of my friend Allie Lind as she prepared for her long run this week. I gotta say that this looks like a good time!
Thanks for stopping by folks. I have no doubt that I am going to overcome this darn knee injury. Just know that you can and will destroy your limitations.