Friday, 29 August 2014

Rafa and Me

There is much I don't share with Rafael Nadal: a great forehand, latin good looks, vast wealth... but there is one thing we have in common - Hoffa's Impingement. This is the very knee injury that Rafa had last year, which curtailed his season so painfully. But, after an extensive programme of treatment, he came back as strong as ever this year. I'm doing my best to emulate him.

My new physio doesn't believe in treatment machines, she prefers to get to grips with your flesh with her powerful fingers and arms. Earlier this week, I lay on the treatment table and she began to manipulate my knee. Then she pointed her elbow, placed it on my patella tendon, leant her weight onto it and started to rub very hard from side to side. I gasped and gritted my teeth, red-hot knives were shooting across my knee.

'Is that your pain?' she asked.

'Aooow,' I howled in assent, thinking she would stop.

'Good,' she said, digging her elbow in further.

'Really, really hurts,' I gasped, gripping the sides of the table as my body began to shake.

'Don't worry,' she said cheerily, 'it'll go numb in a minute or so.'

'Aooow,' I howled again, sweat coursing down my face. It felt like she was trying to saw my leg off. I kept wishing I had a piece of wood to bite on.

'Gone numb yet?' she asked

'Yes, yes,' I moaned, thankfully.

'Fine,' she said, moving her elbow to a fresh part of my tendon and the intense pain began again.

After what seemed an age, she stopped and left the cubicle to get something. I lay back on the treatment table, took some deep breaths and tried to relax. My patella tendon was throbbing, but numb. No ball-boy came to proffer barley-water, banana or towel. I sighed. My physio returned and strapped my knee. The treatment was over, until next week.

I may never reach SW19 or trouble Hawkeye. At this point, all I want to be able to do is to walk to the bottom of the lane outside my house without pain.

Friday, 22 August 2014

Hoffa's Impingement

I've been given the results of the scan on my knee. I'm very pleased and surprised to find that my cartilages and ligaments aren't damaged. I went for the scan because my local Physiotherapist thought I had torn a cartilage. Happily, I do not need an operation. But I am still in pain. At this point, the Osteopathic Surgeon seemed to lose interest and handed me over to another Physiotherapist for further treatment.

What the scan did show is that I have swelling inside the knee joint, inflammation of the tendons that attach to the kneecap and some misalignment of the kneecap itself. But my primary problem is Hoffa's Impingement. This is where the large pad that fits between the ends of the shin and thigh bones (and behind the kneecap) gets pinched and inflamed inside the joint. This pad is the most sensitive part of the knee, having more nerve endings than any other, and gives an excruciatingly painful injury. When my knee is bad, it feels like red-hot knives are being stuck into me.

After two months of pain, confusion and disappointment, I'm relieved to finally get to the bottom of the knee problem. The treatment for this injury is frequent icing (I have two large packs of frozen peas that do the job three or four times a day), stopping the activities that cause the pinching of the pad (for me this means most walking and standing) and taping the kneecap to restrict its range of movement.

The next step is a programme of special exercises to strengthen some leg muscles and to stretch others, in order to achieve healthy alignment of the knee. Some of these exercises are quite odd, like squeezing a football between your ankles and doing gentle squats with the ball between your knees. My current exercise programme takes over half an hour and I need to do this twice a day. All being well, my knee should recover in a couple more months.

Sunday, 10 August 2014

My Long Lost Pal

Out of the blue, I got a message from Patrick. We were the best of mates at primary school. Patrick lived along the canal from me at Bridgend, near the small town of Stonehouse in Gloucestershire. I lost touch with him aged nine, when we moved house to the other side of the county. 

We used to play together along the canal tow-path and across the fields and railway line that separated us from the town. Yes, we grew up (literally) on the other side of the tracks. Patrick's family had a TV (mine didn't) and I used to go home with him after school to watch cartoons. I recall us eating sarnies and shouting at the screen. The Lone Ranger was another favourite of ours.
We walked to primary school down a lane, across a main road, over a railway line and along a footpath to the iron railings that guarded the school. It was a journey of about a mile and a half each way and we did this every day without adult supervision. The school was Victorian in its construction: there was a bell in a turret above the main entrance, with separate doors for boys and girls. And in its ethos: you would be beaten regularly, on pretty much any pretext. I recall being caned one day for failing to eat my pudding. I still hate tapioca.
Patrick now lives in Orkney, so other than through Facebook, there was little chance of us encountering one another again. I must admit I can easily live without the pictures of cute animals and obscure homilies that seem to represent the majority of the traffic on the site. But putting you in touch with someone who you lost contact with fifty years ago, that's a real achievement.

Stonehouse Primary School, outside the main building at break.
Picture courtesy of Stonehouse History Group, date uncertain (late 1940's - early 1950's, I'm guessing).

Monday, 28 July 2014

Pauls Knee (ii)

My bad knee continues to be a problem. It's been five weeks since my fall and I've been getting treatment every week. The swelling has now gone down to leave a large lump on the top of my tibia. The lump is egg shaped and gives a little if you press it. I'm told this is a haematoma, a blood blister that formed on top of the bone when it was bruised in my fall. The lump is no longer very painful and I'm told it will go away in time.
The knee joint itself is the most painful: it still feels weak and I get stabbing pains with certain movements, especially when walking. I've been wearing a support bandage a lot of the time. The physiotherapist now believes that I have torn a cartilage. I'm booked to have a scan on my knee which will tell for sure.
You have two pieces of cartilage in each knee. They are crescent shaped and look a little like the segments of an orange, thicker on the outside of the knee and thinner on the inside. The cartilages fit between your tibia and femur, working as shock absorbers. A sudden impact on your knee, particularly with a twisting movement, can damage them.
The outer edge of the cartilage has a blood supply and thus can repair a small tear. So I've been doing plenty of hot compresses on my knee to help stimulate this. The inner surface of the cartilage doesn't repair. It's possible to have surgery to repair large tears of the cartilage and for damaged pieces to be removed. But, especially given my recent experience, I don't want to go down that road.
As driving is a little painful, I'm leading a fairly enclosed life. At home with my injury I surf the internet and watch plenty of TV, which has driven me to fix the drip on the kitchen tap and other minor tasks around the house that I had been putting off. I don't seem to be in the mood for writing very often. It's pretty frustrating, this is the longest interruption to the active life that I've been enjoying over the past three years. And of course I'm very worried about what the scan will show.

Tuesday, 15 July 2014

Americano and Caramel Square

I've become a connoisseur of independent coffee shops. My usual is an americano and a caramel square. I've tried plenty of different places.

You sit and wait with anticipation: the coffee machine growls and hisses, a teaspoon clatters onto the saucer and a plate is loaded with your pastry. But so often the outcome is disappointment: coffee insipid or brackish, caramel square thin and tasting like sugary cardboard.
I end up returning again and again to the few places that provide consistent high quality: strong flavourful coffee and a delicious caramel square (smooth shortbread, caramel and chocolate in good proportion). My favourite independent coffee shops are:
Grounded Café, Monaghan St, Newry. On the corner near the Canal Court Hotel. A café with a youthful vibe, always busy but the quality never lapses. Great coffee and the best caramel squares I've tasted.

Green Bean Café, Townsend St, Banbridge. Just off the main street, behind Supervalue. A peaceful place, rarely full but always high quality. Fantastic bespoke coffee (they ask you how strong you want your americano) and great caramel squares.

I've tried independent coffee shops across much of Co Down and South Belfast. These two stand out as the best. Are there any others of note that I've missed?

Monday, 7 July 2014

Paul's Knee

Home sweet home is a dangerous place. Three million of us visit A & E every year because of an accident in the home. I'm afraid to say I've joined this unhappy band.

I don't recall exactly what happened. One moment I was stepping out from my front door to collect something from the car, the next I was lying on the gravel outside with a terrible pain in my knee. I guess I must have tripped on the steps down to the driveway.

Many accidents must happen just like this. You are in a well known place doing something routine, and your attention lapses momentarily. It's the sort of thing you find yourself doing pretty often, thankfully without unpleasant consequences most of the time.

On this occasion the top of my shin bone (tibia) took most of the impact of my fall, pushing it upwards and across into my knee joint. I've been told that I've sprained two knee ligaments (patellar tendon, lateral collateral ligament) and bruised the cartilage. It could all have been a lot worse, had the impact been an inch or so higher it would have hit the side of the kneecap itself.

I've had a couple of ultrasound treatments and one of electrical stimulation, where a pad is placed either side of the knee and electric current passed through. It's a very odd feeling, intense pins and needles, like you're attached to a farmer's electric fence for a couple of minutes.

During the good weather it's been tough having to sit quietly at home and give my knee hot and cold compresses. Thankfully I've also had the distractions of Wimbledon, the World Cup and the Tour de France. All being well, in another couple of weeks my knee could be back to normal.

Friday, 27 June 2014

From Kabul to Moss Side

This journey took place a few days ago in Dublin. I was talking with Concern's new head of operations for Afghanistan and asked him if he was worried about being kidnapped or murdered by insurgents in the course of his work.

He assured me that he took security very seriously, but personally he didn't feel under threat. Why, I wondered, because he had armed bodyguards? There were guards on all Concern workplaces, he told me, but these guards weren't armed. After all the footage I'd seen on TV, I was surprised by his response. But isn't it really dangerous in Afghanistan, I asked, especially for foreigners? It depends who you are and what you are doing, he replied.

He went on to explain that Concern's operations in Afghanistan depended on the support of the local communities in which they worked. If what you were doing was perceived as being beneficial to the community then you received support from that community. He told me that this support included Concern staff being warned when it would be dangerous to travel to and be in any of the places in which they worked.

Afghanistan is one of the poorest countries in the world: it is ranked 175th (out of 187) on the UN index of development, calculated from a range of indicators such as under five mortality rate, life expectancy, years of schooling and so on. Concern's operations take place in Kabul and two rural districts and are focused on maternal and child health, water and sanitation, agricultural development and the empowerment of women. Despite the threat of the insurgency, these developments are wanted by the communities in which Concern works.

It was a fascinating conversation, over lunch at a Concern away-day (I am in my tenth year as a member of the Board), and reminded me of an experience I had thirty years previously. Whilst studying for a PhD at Manchester University, I was supporting myself by working on an experimental community project in in Moss Side, Manchester. The team ran a drop-in advice and education project from an empty unit in the Moss Side Shopping Centre. I worked there for two years.

At that time Moss Side was a notorious district synonymous with very high unemployment, enormous social deprivation, drug gangs, drive-by shootings and riots. My friends and acquaintances were shocked at where I worked, they would never have ventured anywhere near the place. Yet the project team were told again and again how valuable our work was for the community and all of us felt safe working there.

There is a further link between Afghanistan and the inner-cities of developed countries. Afghanistan is the source of 90% of the worlds heroin and the production of this cash crop is largely in the hands of the Taliban: this is how the insurgency is financed, how small farmers in remote districts are kept under control and how some people choose to try and escape from the disadvantage that shapes their lives.