I've put together a timeline of the injuries below. Some detail is bound to be inaccurate, as a lot of time has passed, but it should paint a pretty thorough picture of how I ended up in this place.
I did through my initial recovery from injury keep a photo diary of my recovery and the changes my body went through. Sadly I lost nearly all of the photos, but I found a few - they should give an idea of how things were, and how they are now.
Date
Knees / Shoulder
Everything else
2002 Q2
my right knee had always hurt a little when I bent it under tension . I remember going to the gym with a mate and not being able to squat because my right knee hurt. I assumed this was just me being out of shape. I could ride a bike OK though.
I was heavy, but life was pretty good - day-to-day stuff didn't hurt. Nothing 'bothered' me.
2002 Q3
Tore my ACL :
I injured my knee picking up a friend in a nightclub. It went pop. I was drunk. In hindsight this was probably the most stupid 30 seconds of my life. I went home and it was sore. Went to A&E the next day, was told go home and rest. For now the injury was undiagnosed, but my knee kept giving way. I don't find out for a few months that I tore my ACL. I didn't even know what an ACL was.
2002 Q4
ACL Tear Diagnosed :
Saw several specialists, a couple of different doctors, physiotherapists etc. Eventually a surgeon - Dr Rogers of Birmingham (Hagley Rd) - suggests I have torn my ACL. I get the MRI scan, and it's official - I tore my ACL, a complete rupture. He refers me for surgery - I am added to the NHS waiting list to be operated on by
Marcus Green
I haven't got many photos from the time but you should be able to tell from this I was carrying a lot of weight.
2003 Q1
Note at this point I took out private medical insurance. Since my left knee is an existing condition, it's not covered. But future treatments to my right knee and shoulder are both covered. Left knee is NHS, unfortunately.
2003 Q2
Rehab going very well :
Rehab is excellent. I am at the gym daily. Left knee gets stronger every week. Daily workouts involve up to 30 minutes cycling, various isometric and bodyweight exercises for the lower body, then resistance machines (leg press, hamstring curl).
2003 Q3
Fixed!!! :
I am discharged by the physiotherapist. My left knee feels amazing. I have changed my gym work to a bodybuilding-style split, with 1 day concentrating on quads, and the other on hamstrings / posterior chain. I am deadlifting and squatting - not particularly heavy poundages, but they feel great. Also doing a lot of cardio - running, cycling and swimming.
The pain my right knee mysteriously disappears!!!!!!!!! . I've never been able to figure out why and really, really, really, really wish I knew.
Saw a foot specialist who said I have
Overpronation and made me custom
Foot Orthotics . I'm not sure if they helped, since I already felt pretty good at this point, but they didn't make things worse.
Whilst this may not be amazing condition, 9 months prior I was around 35% bodyfat and very obese, so I was extremely happy!
2003 Q4
Everything feels great.
Gym training logs from the time say:
~100k squat for 10 reps
~120k deadlift for 6 reps
~80k bench for 5 reps
10 reps chinups with 15k added
8 Dips with 40k added
Military press - 50k barbell, or 26k dumbells
Bicep curls - 20k dumbells
Running - 6 minute mile
In hindsight this wasn't necessarily balanced training but I was in reasonable condition and a hell of a lot stronger, fitter and healthier than 12 months prior. More importantly, injuries were not bothering me at all.
In December 2003 I had a few pains in my left knee and was referred for an MRI scan by my surgeon. They found the following:
The screw from ACL repair had started to protrude very slightly
I was developing a tear of the medial meniscus
The surgeon (Marcus Green) said he wanted to wait it out and see what happened, since things weren't that bad, which was fair enough.
No problems with right knee or right shoulder.
My left arm, around 15.5 inches. I know I looked nothing like a bodybuilder, but I didn't want to - I was happy; I looked like I trained! No leg shots, unfortunately.
2004 Q1
2004 Q2
- this is the point at which things start to go wrong -
2004 Q3
After 10 days I was seen by the surgeon who investigated the knee and suggested it may be nerve pain. He blocked the nerve with a local injection and it immediately fixed the pain. Thus, I had a nerve irritated from surgery. Another surgery was immediately performed to investigate the nerve, which was found to be bruised. Some scar tissue was removed from around the nerve. When I woke up things felt better.
Over coming weeks, the situation improved however I had constant pins and needles / intermitten pain in my left knee. Since this surgery, things just didn't feel right. Training ground to a halt as I pretty much had to 'start again' with physiotherapy. For 7 weeks after the nerve surgery I had normal post-menisectomy protocol (since the cartilidge was repaired, rather than removed) which meant crutches, limited weight bearing, etc.
2004 Q4
Intermittent anterior knee pain, both dull ache & stabbing pains. From what I remember, when it was bad, it was really bad - think 'not able to walk' bad.
Continued to regularly see surgeon, who was helpful but unable to offer an explanation. Sought a second opinion from an American surgeon - Dr Rogers - working in Birmingham. His team too, whilst being extremely capable, are unable to explain the reasons I'm having problems.
Very significant event: the pain when bending my right knee has come back, from when I was heavier, but it's a lot worse. Walking is OK, but when I squat it hurts. Cycling also hurts. I have no idea what the trigger was for this. This will continue to plague me for the next 4 years until the present day.
Possible triggers could have been:
Weight gain?
Workout out less
Overemphasis on right knee due to left being injured
I ask the physios I'm seeing about the right knee. We try a few things, but can't figure it out. It's hard though, because the left knee problems are more disabling at this time.
My knee[s] are my main concern at the moment, particularly the left, so I don't give too much attention to the shoulder.
2005 Q1
I continue to pursue the medical angle. No-one can offer any explanation. MRI and Ultrasound scans are done suggesting the possibility of Fat Pad Syndrome. It's also suggested there may be a small medial meniscus tear, and the ACL screw could be further impinging.
2005 Q2
Surgery is performed in June 2006. Two problems are found:
Small meniscal tear (removed)
The screw from the ACL repair is impinging (partially removed)
I'm hoping this is the end of it. The slow process of recovery begins...
Hurts a lot when bending. Things that hurt:
Stairs (on a bad day)
Squats of any kind
Lunges of any kind
Cycling
Cross trainer
The knee often subluxes and the pain is mostly medial in nature. When squatting I get pain at both the top and bottom of the kneecap. Physio can't explain why this is happening. It fits the profile of patella femoral pain syndrome but traditional strengthening of the VMO etc is not working.
Left knee problems are interfering more with day-to-day life so for now, nothing is done about this.
- and now they start getting better!!!!! -
2005 Q3
I undergo traditional knee physiotherapy - lots of leg raises, mini squats, etc.
After around 6-8 weeks I begin light gym work again. The pain in the right knee interferes.
- during the next 3 months I fix my right knee and don't know how I did it -
2005 Q4
Note: I only introduced squats once my right knee had 'fixed' itself (this is where it gets a bit complicated):
After 6 weeks of heavy good mornings (12 reps of 70k was my top set) and running to/from the gym, my right knee pain went away. This may have been coincidental.
This is the million dollar question. As is my understanding it could have been any of the following:
Not being in an office all day;
Lots of posterior chain work
A new pair of trainers and orthotics
... something else entirely??????
- and then... things go bad again. -
2006 Q1
The problems with my left knee make me feel absolutely drained. I've just moved to a new place with Zoe (my Fiance) and they really take the edge off things.
Marcus Green, my patient and long-suffering surgeon, suggests surgery. I agree. Due to a cancellation I get the surgery very quickly at short notice. The ACL screw is found to be impinging once more and is removed in it's entirity.
Post surgery, I make a quick recovery. Things feel good again.
- then they get worse! -
2006 Q1
In May, all of a sudden my left knee started hurting like crazy. It was so bad I could barely walk. Horrible stabbing pains. Sadly by this time I no longer was able to receive treatment from Birmingham due to the way the NHS works, and so had to go to a new doctor and effectively 'start from scratch'. My doctor offered painkillers. I explained I had a long, complex history of knee problems and needed to see a consultant. To cut a long story short, I didn't see that doctor again. I eventually managed to get a referral to a consultant but was told there would be a 3 month wait minimum.
The pain was so bad I was missing time off work and I'd used up all of my sick pay.
Subsequently took the decision to see a consultant privately (not cheap). I won't name them, since later in this long, complicated story I was offered absolutely awful advice, and I don't want to get sued. However, at the time, I didn't know this.
I had an MRI scan revealing a meniscal tear. Surgery was proposed, which I agreed to (privately, since NHS wait was too long). Following the surgery it was explained that 2 problems had been addressed:
A small meniscal tear had been removed
A Plica had been located and removed from my left knee.
I asked about the integrity of the joint as by this stage I'm pretty worried about arthiritis etc. I was told everything looks OK and should be fine.
Following surgery, the 'oh-my-god-it-hurts' pain had gone away, but things didn't quite feel right. When I straightened my leg there was an inexplicable crunching. I was told this was probably scar tissue and would pass with time and an increase in activity.
Pretty much as soon as I woke up from the left knee surgery, the 'pain when bending' was back. It hasn't gone away since, despite my best efforts.
Jim refers me to Mohi El-Shazly, also of the Droitwich Knee Clinic. I have MRI scans, x-rays etc. Again, we can't figure out what's wrong. Mr El-Shazly suggests that I may need a lateral release but it's not a route he wants to go down unless he absolutely has to.
Physiotherapy with Jim is, at this point, ongoing.
2006 Q3
Continues to get worse. I mention to Jim that I had a plica in my left knee and removing it made things better. He suggests that maybe the same thing needs doing to my right knee. This is put to Mr El-Shazly (surgeon), who agrees to perform exploratory surgery with an aim to:
Remove a plica if one is present
Perform a lateral release only if absolutely necessary
Fix anything else 'simple' that is found to be wrong
Upon wakening I find a plica has been located and removed. A lateral release was not performed as whilst some 'patellafemoral tilt' was noted, it was not considered severe at all. I'm told the knee is pristine.
For the first day after surgery my knee felt *great*. Within a couple of days the pain was back. So basically, the surgery didn't do anything.
2006 Q4
No change. Still hurts when bending and subluxes often. Me and Jim (physio) try several different things. Theories that were tested (and debunked) include:
VMO weakness
Glutes not activating
Tight calves
Weak glutes
Weak hamstrings
etc...
The pain in my right knee means I can't do any cardio exercise, even walking is hurting (!). I can't train my lower body at all and day to day life is being affected. Sitting at a desk hurts.
Have an
MRI Arthrogram on my shoulder. This reveals that I have a
type 2 capsular insertion with a baggy anterior recess . The labrum and rotator cuff are OK.
It's explained to me that I may need surgery on this at some point, but for now I may be able to cope by just having physiotherapy to strengthen the rotator cuff and posterior delts. I decide to try the physio route first. The operation if required will be an anterior capsular shift
- things stayed consistently bad for 6 months -
2007 Q1
Phyiotherapy yields no benefit.
2007 Q2
See above - no change - things remain bad. At this point, I'm tearing my hair out fighting battles on 3 different fronts.
There is one interesting development however..
It's just wear & tear. Don't worry. . I ask the long term outlook and am told matter-of-factly You'll probably need a knee replacement in a few years. It's inevitable. . I go away feeling absolutely crushed.
In hindsight the physical examination was not thorough, he barely asked me any questions and I have a feeling he simply could not be arsed to think about the problems with which I was presenting him. If I'm prepared to travel 120 miles and pay £120 for 15 minutes of someone's time, to discuss a matter of huge importance to me, I'd hope they would at least give me their full attention. Apparently not.
Now comes the shoulder surgery..
2007 Q3
Surgery was a Bankhart Repair , with 'repair of the large Bankhart lesion using Arthrex Bio Anchor' (????). In layman's terms, I had a torn Labrum.
Surgery is deemed a success. Here's a video clip from my shoulder surgery:
I'm in a sling for the first 6 weeks.
Due to the shoulder being in a sling I have to take 7 weeks off work. I am freelance and if I don't work, I'm not paid; So this hurt financially. I also can't really use my right arm during these 7 weeks, so it's not a great deal of fun.
Then the shoulder fails
2007 Q4
In December I was reaching for a glass of water and felt an agonising sharp pain in my shoulder. I was crying in pain it was that bad. Following this, I could not move my arm at all, any time I did I had shooting pains all down the arm and bicep. I went to A&E and was told It's fine.. you've just strained it . Several hours later I felt like my arm was in the 'wrong' position so grabbed a doorway and forcably bent it back into what I felt was the 'right' position. There was a very loud 'clunk' noise followed by immediate belief.
I believe that when this happened I had dislocated my shoulder.
I went to see my consultant immediately. I'll quote their surgical notes:
"I saw James today. He was making good progress until a few days ago when he strained his right shoulder. Since then, he has been getting pain in relation to the biceps tendon. Speed test was positive. Scarf test mildly positive. Impingement sign was mildly positive. Apprehension test negative. Shoulder was quite stable. After his verbal consent, I have gtiven him a local injection of steroid into the right shoulder around the biceps tendon sheath. IT helped his symptoms. (note: it didn't. I never said it did.) . I have referred him back to physiotherapy. I will see him in 8 weeks."
No explanation was ever offered as to what the hell happened when I got that sharp pain, but since then, things didn't feel right. I kept getting a similar (but less pronounced) pain during external rotation eg: reaching for car seatbelt, opening a door, etc. It was intermittent but, when it happened, extremely painful.
2008 Q1
Mr Green is apprehensive to perform surgery, but can't offer any explanation for the pain or sensation I'm getting in my knee. He offers to perform surgery with no guarantees - if he can see anything wrong, he'll fix it. I agree.
The choices given are to perform surgery on the NHS (free, but long wait) or privately. I opt for privately. I can't really afford it, but I don't care any more; I want my knee fixed.
Upon awakening from surgery, I'm told there was a small
Cyclops Lesion - a common complication from ACL surgery - which he removed. The knee feels instantly better. I can straighten it with no pain. Success!!!!!!!
Going back to 2007 Q2, when I was examined by a Consultant and told there's nothing wrong, it's just wear & tear and I will probably need a knee replacement. In hindsight I am absolutely furious at the advice I was given here. One surgery and things feel great straight away.
No change at all. To recap the following are painful:
Cycling
Sitting with knee bent for long periods of time (working, driving)
Squatting past 20-30 degrees
Pain is on the medial side of the knee. The knee often subluxes. Pain is consistant with patella femoral pain syndrome, but the common solutions aren't working.
"I reviewed James today. Over the last few weeks, following intensive physiotherapy, he developed sharp pain over the anterior aspect of the right shoulder. In view of this, I had arranged for MRI arthrogram. It shows that there has been some disruption of the surgicla stabilisation with some stripping of the capsular from the labrum anteriorly. There is also evidence of a partial rupture of the sub scapularis muscular tendinous junction. The rest of the rotator cuff appears satisfactory apart from mild cuff tendinopathy."
Plan: I have discussed treatment options with him. As the shoulder has never frankly subluxedf or dislocated (note: i would disagree with this ) it is important to treat him with muscle strengthening exercieses first. I have therefore referred him for a course of physiotherapy. If he developers any instability symptoms then it would be appropriate to proceed with anterior stabilisation. He is happy with this plan."
Note: I was actually having physiotherapy at the time, so discard the 'I have referred him for physiotherapy' comment )
Things were bad. Ever since the sharp pain in December 2007 my shoulder did not feel right at all. Physiotherapy failed to improve things. My shoulder was 'strong', but painful.
Some weeks later I was referred for another MRI Arthrogram which showed:
Some capsular tear
Some labral tear
Surgery was suggested - arthroscopic assessment with anterior stabilisation +/- capsular shift . I saw no option so agreed. Surgery was performed on 9 February 2008.
Here are the notes from surgery:
Diagnosis:
Operation:
Findings:
To be honest I have no idea what most of the above meant. I was told my shoulder had a problem, it had been fixed, and would be OK. Same routine as before - 6 weeks in a sling, physiotherapy.
2008 Q2
"James is making excellent progress following the surgery. His portal sites have healed well. No evidence of infection. Shoulder movements - flexion to 90, abduction to 45, external rotation to neutral. Rotator cuff strength is 5/5. No deficit."
I am hopeful my shoulder will be back to normal soon.
2008 Q3
The theory is, I've tried all the strengthening under the sun to fix the problem, so it's more likely to be a particlar muscle group being tight, a postural thing, or something else.
One thing he's noticed is that I have a tilted pelvis meaning a functional leg length difference. Consider the following drawing (I did this in paintbrush so apologies in advance):
Basically I am dropping on my left hand side. This effectively makes my right leg functionally longer than my left. This may not be the cause of the problem but it's definately not helping. We've yet to figure out why I'm doing this, but for now we have inserted a raise in my left orthotic to try to bring things back to neutral:
It's too early to tell whether this has had an effect. We are also working on stretching of the calves, hamstrings and entire posterior chain. So far, the knee pain persists. I'm still doing strengthening exercises at home - mostly concentrating on the glutes, hamstrings then quads (in that order), but not convinced they help.
Then the shoulder gets even worse.
2008 Q4
In October I reached for a phone and felt a really sharp stabbing pain in my right shoulder towards the front. This radiated down my arm into the bicep. It was really, really painful. I contacted my surgeon and was referred for another MRI arthrogram.
Between referral and scan, I regularly experienced an extremely sharp pain in the front of my shoulder when raising my arm. In addition, my arm would tire very quickly after doing household chores such as hanging laundry, doing the cashing up, mopping etc. Driving was painful (holding arm in front).
In summary: My shoulder feels crappy most of the time, and sometimes has very very sharp localised pain when raising the arm in front of me.
I have also discovered that Scapular retraction , even with no resistance, brings on pain in the front of my shoulder if my arms are perpendicular to my body (if not, it's fine).. For those of you that don't know what it is, it's basically pulling the shoulder blades together. The following is an example of something that would currently really, really hurt:
I had the scan and received the following diagnosis. Please take note of the underlined, bold bits:
"I reviewed James today with the results of his MRI arthrogram. It confirms that the glenoid labrum rotator cuff and biceps tendom are satisfactory with no tear. There is no evidence of cuff impingement. He does have changes of degeneration in the gleno humeral joint mainly involving the superior aspects of the gleno humeral head where there is a cystic lesion as well as degenerative change in the AC joint.
Plan: I have explained to James that the intermittent pain he gets with his arm in an overhead position as well as sometimes at rest appears to be arising from the degenerative changes in the gleno humeral joint
During the face-to-face meeting with the consultant I asked the question: If it's degeneration, will my arm always feel like this? . I was told: It's not that bad. I've seen worse. . I even even told to 'take some paracetomal'.
In all honesty, the condition of my shoulder at the moment is ruining my life. While I type this, it's hurting. The vast majority of things I do with my right shoulder, even as simple as driving or using a mouse, are painful. When I was told it might not get better I was practically in tears.
I have since spoken to my physiotherapist who agrees with me that it seems absolutely crazy that my shoulder is a write-off at age 27. I feel like my consultant hasn't explained anything to me properly (the quotes in this article are from a copy of my medical notes - in our meetings half of what's written either wasn't explained, or was lost on me) and I don't really understand the situation I'm in at the moment.
I've decided to see Marcus Green, the chap who fixed my left knee, to discuss my shoulder. He is a shoulder specialist too. I'm taking along copies of MRI scans and all of my surgical notes. I refuse to accept my shoulder is beyond repair, and I'm not happy with the advice of 'wait 3-6 months and take some paracetomal'. The appointment is in a couple of days; I'll update this article once I've seen him. I feel a little that my life is effectively 'on hold' until I've had this meeting; Currently I have no idea if I'm going to make a full recovery, or if I'm condemned to a life of being effectively disabled in my right arm.
One thing is clear - things can't go on as they are. So.. here's my plan.
I have a hunch the answer lies with a combination of overuse, lack of proper gluteal function and posture.
My right knee has had the current problem twice before, and on both occasions has recovered. So, I believe it has the capacity to recover again, once I've figured out what's wrong with it.
I actually suspect losing this much weight may help 'kick-start' my right knee to recovery.
I plan to add a facility to BodyDaemon in the near future to upload videos. As soon as this is done I'll start uploading videos of my rehab workouts.
Whilst all of this is happening normal life is going to have to go on. I have a busy job, the recession is definitely a cause for concern - so money is tight - and there are lots of people in my life that I need to make time for.
If I go quiet, it's because I'm busy with the rehab, but I will endevour to keep my journal up to date. I also have this site to run, and lots of new features I want to develop, which takes up a little of my time :-)
If any of you are having similar problems, or able to share words of motivation or hope, I would love to hear from you.
I have a feeling bouncing back from this is going to be really, really hard. Wish me luck!!!!