I’m 21 and have had two knee surgeries, which shock most people when they see me, a young, apparently fit and healthy guy. In this blog, I’m going to be talking about my injuries and the rehab period/s which have come from them, my mistake, successes and tips. I have Osteochondritis Dissecans (OCD) which is a rare bone condition which is essentially where a piece of bone begins to die in the inside of the knee. This isn’t very common and typically occurs in active teenage boys (its thought I’ve had them since I was 14). In many people, you don’t notice them until they are 50-60 and need a knee replacement for other reasons, but unfortunately, if you play a lot of sport the lesion becomes apparent (for reasons unknown). One thing I want to stress is that the experts don’t believe its caused by being very sporty, which is the most the conclusion commonly jumped to. I’m almost finished a degree in Exercise Physiology so I was very well equipped to understand everything that’s going on, to the point where my surgeon said I knew more about this condition than he did. I was searching the internet to find other peoples experience with this because I hoped to return to a high level of sport and had been told I may never run again (NOT what you want to hear). I didn’t find a thing on it, except for the same condition in elbows of baseball players, so I documented my 2-year rehab journey so I can hopefully help at least one person who was in the same position as me. I’m not 100% ‘fixed’ yet, but I’ve begun running again and all is going relatively well so far, I’ll provide an update when I’m pretty confident I’m on the other side of it all.
A bit of background on my injury. I umpire AFL (Australian Football) in the state league (NEAFL), one level below the professional league and running is obviously a big part of this. Nearly 2 years ago we were doing a 3km time trial to assess everyone’s fitness before the start of the season, this was my first one after being promoted to the NEAFL that year. I had been doing a bit more running than before over the offseason and was hoping to run a fast time (<10mins). I did that and ran as hard as I’ve ever run and ran 9:55 which was awesome, but the next day my knee was in a lot of pain so I saw the group’s physio and he was perplexed, he couldn’t figure out the source of my pain so he sent me out for an MRI and after that, I was diagnosed with an OCD in my left knee.
Long story short, I ran the whole season without too much pain flaring up because the lesion was still stable and the week the season finished I had surgery to fix the dead bone in place (in Sept 2018), in theory fixing the problem.
After the surgery I had 6 weeks on crutches, I had in total 3 months off running and then began running a small amount (only 2-3km per week) and then because I had recently been asked to umpire in the AFLW (essentially a promotion) which started in February of 2019, so had to ramp up my running pretty quickly, where I went from 3km a week, to 13, then 20, then after a few weeks at 20 I went to 30, then all of a sudden I get a bit of pain in my left knee. I run out the AFLW season with pain hanging around each game and go on with reduced running after a few weeks off until halfway through the season of NEAFL both knees begin to hurt again. So I go back to the surgeon to have a look at how it’s going and I’ve developed a stress reaction in my left knee because of the rapidly increased load, as well as a near-identical OCD in my right knee, so we reduce my running to only games and a lot of strength work to make it through the season. In the process of this I consulted with 2 other surgeons on what to do with the right knee, and from both of them I got told i’d never run again, one recommended no more surgery but to stop running, and the other recommended a double high-tibial osteotomy (where they break both your legs to re-align them) which doesn’t have very favourable outcomes to running. After much deliberation, I also saw a sports-doctor (importantly not a surgeon) and he recommended I try rest first before having another surgery, so after the season I had 2 months off all weight-bearing exercise to reduce the stress reaction and hope that the OCD on my right knee spontaneously heals a little.
After more scans in November 2019, we notice the lesion hasn’t changed so I have the same surgery I had on the left, on the right knee, and this time we plan to double the rehab period to 6 months and take the whole next year off umpiring to give myself the best chance to have a positive long term recovery. I spent 2 months doing no weight-bearing exercise, so I had to get a bit creative, I spent a lot of time kayaking, swimming and doing upper body gym work, none of which I particularly enjoyed doing beforehand (or after for that matter). After the 2 months I was allowed to start cycling which I really enjoy, but a few weeks after increasing how much I was cycling I noticed my knees feeling a bit sore, and looked back on my load and sure enough, I’d increased too quickly again, but this time I caught it early and made a pact to myself to not be stupid and go slowly (something very against my nature). So I sat on a spin bike in the gym 3x a week starting off with basically no resistance and building up from there for a month, until I could do a 30min fartlek workout, proving to myself I had the capacity in my legs to ride outside with the hills and accelerations I’d be facing. After this, my knees felt great on the bike and the extra-diligence to manage load and slowly increase paid off and really drilled into me the importance of taking things slowly and reaping the rewards afterwards.
It’s about this time, 3.5months post-surgery, where I was able to begin doing deepwater runs, which are exactly as they sound, running in deep water with a floaty belt to ensure there’s no impact load going through the legs, I ran in the deep end of the pool for a month, then ever so slowly I began to run with my feet hitting the ground with just my shoulders out of the water, which is about 25% of body weight, then across the next 1.5months I worked my way down to running 3x per week with just up to my belly button submerged, for up to 50mins. During this time I was able to get back into the gym doing lower body exercises, building squats and deadlifts back into my program to get the knees used to heavy load and get the stabilisers working again. This period was frustrating because I was feeling great, back lifting heavy weights with my legs and ‘running’ even if it was in a pool in autumn/winter, but I knew I had to hold out until 6 months, which is when my physio and I had decided to return to running.
All was going well until around 4 months post in March 2020, COVID-19 hit and gyms got shut down, so I was without my heavy strength work, having to make do with a thick resistance band and gas bottle at home. Luckily we were at the point where I could begin doing plyometric work (ie. jumping and landing) so I began skipping and doing some drop jumps and then single leg hops for distance.
Finally, after what felt like an eternity the 6-month date came up (in May 2020) and since I’d been doing all my strength work and other impact loading exercises such as deep water running, skipping and plyometrics I was able to BEGIN running. This is one of the trickiest periods of the rehab journey because you always hear “the recovery is 6 months until you can run again” and think that’s when you’ll be back to normal, but unfortunately that’s not the case. At this point, I’d had 8 months off running completely, which is a long time for your joints and muscles to forget how to do it. So I had to start from rock bottom, my first run was 2km, in 100m’s on grass, I did this 2x per week, with the goal of increasing by around 500m each time, so 2km then 2.5, 3, 3.5 then 5km if all was going well, but as is always the case it didn’t, I had a few weeks where I was getting some pain (more than was expected) so had to stay around 2km for 3 weeks, then we get to closer to the present where I’ve been increasing by around 10-20% of total mileage per week, to a grand total of 10km last week! 7 weeks after I began running.
Now I’ve been running, that is definitely the priority, but I still need to fit in some strength work and cycling, which is all load, even if its not impact loading. This has been very tricky because I was to increase my running first and foremost, but I also want to get fitter on the bike and stronger in the gym. This means I’m constantly checking how my knees are feeling and trying to catch out large increases in load by measuring total internal load, a concept I discovered in a great research paper about training load (https://bjsm.bmj.com/content/50/5/273). I’ve been measuring internal load (IL) for running as RPE (rating of perceived exertion) ie. how hard it is, multiplied by the time I spent running. Eg. 20mins x RPE 6 = 120. For the gym I made my own equation up, I took the total load lifted (ie. 5,000kg) and divided it by 100, I did this based on how taxing the gym is on my knees. For cycling, I calculated IL by RPE x Time / 4, because cycling is 4x less taxing on the knees than running. And finally, I’m also doing some plyometrics, so with these, I’ve used each single leg contact (ie. each hop) as 1 unit of load and a double leg jump as 0.5 of a unit of load, so if I did say did a session with 20 hops on each leg, and then 10 box jumps, the IL comes to IL = 20 x 2 + 10 x 0.5 = 45. And using all these measures of internal load I add them and ensure I don’t exceed 10-20% more than the previous week. I’ve found using internal load incredibly useful when monitoring how much you’re doing across different disciplines (ie. running, gym, cycling), with there being no other option really. This takes a bit of time to set up, but I’ve done it all on google sheets and would be happy to share the template with anyone who is interested, just get in touch with me or leave a comment. I’ve found using internal load incredibly useful when monitoring how much you’re doing across different disciplines (ie. running, gym, cycling), with there being no other option really.
This has ended up being a very long blog post, but I hope that this gives a bit of an insight into the mind of someone who is going through a pretty hefty rehab period, as well as the importance of monitoring load, diligently listening to your body, not overdoing it and just being PATIENT! Its the hardest thing to do but it is the one thing that will get you back to doing what you love, whatever that may be.
I really suggest if you have an OCD and are feeling lost, you get in touch in the comments or directly on twitter @harrisonhansfo1 or instagram @hhansford98 and I’m happy to chat about more details of my own experience finding surgeons, physios and all other things related to the rehab.
Harrison Hansford 