Sunday, 16 February 2014

My 3 tips for losing excess body fat

I’ve wanted to do ‘nutrition’ ever since I started penning this blog but I’ve always got bogged down in the detail; it’s such a massive subject. Well with this post, I think I have it pretty much covered. Hopefully it will be viewed as easy reading and informative.
‘Before embarking on specific training you are advised to lose some excess body fat.’

How often have we read that in anyone of our fitness/ running books, only for the losing part to be completely left to ourselves, bereft of advice? I could’ve written over 20 tips but they all amount to the same thing so I’ve found a way to abbreviate them down to 3.
Here’s the real Brucie bonus though - if you’re not into exercise in any way shape or form, you can actually ignore the third tip; you do not need to exercise to lose excess body fat. I want to repeat that last part just so it’s crystal clear but I’ll leave it until later.

The added benefit of this post is that it has many correlations with a lifestyle change. Once you understand and practice these principles, you will come to realise that they have the potential to stay with you. Thus permanently improving your main control mechanism; your eating habits.
Here they are, my top three tips;
1.       Get used to the feeling of being hungry; Billy basics and should be considered before embarking on a plan to cut excess body fat. Nevertheless this gets overlooked by many.
2.       Understand your macros, their timing and the sacrifices associated; this is the lengthiest of the three tips so for those not interested in the finer details I’ll outline what I believe to be the most important aspects at the start of the explanation (below).
3.       Undertake weight training and High Intensity Interval (HII) training; endurance training is an ineffective way to burn body fat and as I’ve said, you don’t actually need to do any exercise to cut weight. However, I’ll provide a routine aimed at supplementing your nutrition plan and explain the science behind it.

Before I proceed, I think it is important to define ‘excess body fat’ because the truth is body fat gets a bit of a bad press. We need the stuff; it’s as simple as that. For example, did you know that our body fat has a blood supply and is linked to our central nervous system? It has many important functions to perform and is partially responsible for our moods and libido.
However, having excess body fat is unhealthy because it unbalances our hormones meaning we become susceptible to heart disease, high blood pressure, type 2 diabetes and certain types of cancer.

Not only that but all aspiring runners should know that losing excess body fat will not only lighten the load on their joints (of massive benefit to those with arthritis) but it will actually increase their speed; weight being a huge factor in ones VO2 max.
So what is meant by ‘excess’ then? Well we’re all unique and as such our best answer can be found by referring to guidelines which are been based upon the generic information of what threshold tends to bear witness the majority of associated health problems;
  • 21-34% is regarded healthy, therefore >34% is deemed excessive for women, and
  • 8-22% is regarded healthy, therefore >22% is deemed excessive for men.   
For those that don’t know, your body fat weight can be calculated by the body fat percentage given via weight scales that have such a measure. So if you weigh 200lbs at 25% body fat, you have 50lbs of body fat. An unscientific way of considering this is say you wanted to get to 15% body fat within 6 months prior to beginning base training; this would mean you would be aiming to lose just over 20lbs of body fat.

my body fat scales which cost about £45
Get used to the feeling of being hungry
I think this is the main reason that people who really need to lose excess body fat fail to do so before they’ve even got going. It’s barely even discussed by companies operating within the weight loss industry and I have my suspicions why. Sure there are tons of articles on what to eat and what exercise to do but none of them get down to the nitty gritty; the hard line; the real sacrifice – hence my inclusion here as to what should be a persons number one priority.

No one likes the feeling of hunger. After all, its one of our survival mechanisms as is the storage of excess body fat. But our bodies exist in a time when the food on our shelves tricks us into believing we need more – to be briefly touched upon in tip number 2.
Here’s the thing, if you want to lose excess body fat the only way to do it (aside from various types of operations) is to use it as energy. Sure, many people think of this as doing exercise but that’s actually way off point. Even if we lie in bed all day we’re expending energy; even if we have a desk job and do no form of recognised exercise at all, we’re still expending energy. It’s the reason we need food; to balance our energetic requirements.

Another unscientific example; if you expend/ burn 1800 calories a day at your desk job etc and consume 1800 calories a day, 5 days a week then chances are you will stay the same weight. So if you do have 25% body fat and your usual diet is 2000 calories a day then you cut to 1800 calories a day, you’re still not going to lose any of your excess body fat.
The simple equation is that we should eat less food than we need. By doing this we force our bodies into converting some of our body fat into energy thus making up the shortfall. How else would we (humans) have survived food shortages in generations gone by? The problem with this is that forcing our bodies is uncomfortable for us because it makes us feel hungry.

This is the reason most of us got fat in the first place; because we hate the feeling of being hungry. So we ate when we didn’t really need too and when we did we tended to eat in excess. This is what causes our bodies to create more fat cells (adipocytes) i.e. when we don’t expend what we consume.
People embarking on excess body fat loss (note, I’m not referring to ‘weight loss’ as technically, it’s not the same) need to grasp the nettle and understand that it will be uncomfortable for them and that it can be a long term battle. The upside to this is that the longer one stays the course the easier it gets.

To lose weight sustainably it is best to aim to reduce calorific intake by about 500 per day. Over the course of a week this equates to 3500 calories which is equal to 1lb in body fat weight. Thus aiming to lose about 3lbs a month can be regarded as sensible. The problem with this is two fold;
Many people can’t get used to the feeling of relying on their own body fat for their energy requirements (the feeling of hunger), and,

Not nearly enough people understand the basics of nutrition…………..
Understand your macros, their timing and the sacrifices associated

The long and short of all of this comes down to something very simple; eat real food i.e. the stuff that we’ve had around us for thousands of years, the stuff that our bodies have evolved with.
As promised here are the key bits for those that don’t like detail (the explanation follows);
1.       The carbs you eat should come from low to medium G.I. sources only.
2.       Understand that the only time you need (and can get away) with consuming high G.I. carbs is either;
       a.       at breakfast,
       b.      10-15minutes prior to endurance exercise,
       c.       during endurance exercise, or,
       d.      the 2 hours after hard endurance exercise.
3.       Keep hunger at bay and stimulate your fat loss hormones by making protein and fat more dominant in your macro nutrient count than they’ve probably ever been.
4.       With the above point firmly in mind, you must now tally it with limiting your calorie intake.
5.       Take the odd day off your calorie restricted diet.
6.       If you must eat something at night time, before bed, make sure it’s just protein.
7.       In terms of sacrifices, this process is all about changing your eating habits.

Here’s the great thing about what I’ve just written; once you reach your target weight all you need to do is amend bullet points No.3 & 4 to make it a maintenance diet i.e. you consume what you need as opposed to a deficit. This is then you, for the rest of your life, no matter what you’re doing. Done.
                The brief explanation for the above;

Ok so for those that haven’t worked it out yet, macros refer macro nutrients; micro nutrients are vitamins and minerals – not discussed here because if you eat a balanced diet they will naturally come - par for the course. 1 gram of carbohydrate (carbs) contains 4 calories; 1 gram of protein contains 4 calories and 1 gram of fat contains 8 or 9 calories, depending on what you read.

Broadly speaking we need carbs for energy, protein for repair and fat for efficient functioning of our hormones. There are different types of carbs, protein and fat each with their own effect on our bodies and there are good fats and bad fats. And you should also know that protein and fat can be used for energy too.
Something else you should know before I briefly touch on the bullet points is this; when you consume an unbalanced and unhealthy diet certain hormones are compromised. For example, everyone associates the production of testosterone with men and the production of estrogen with women. However, testosterone production in a man is inhibited when he eats rubbish. What happens instead is that he starts to produce much more estrogen.

Have you ever noted a lack of motivation, a general lull in performance, a missing desire to attack the training and your libido dropping off? Assuming you’re not clinically depressed or over-trained this is down to too much estrogen swimming about in your blood stream. The added side effect of this is that you will begin to gain excess body fat. The only way to halt this weight gain in its tracks and get back to your old self is by changing your eating habits, for the better.
I want to leave it at that for now as most people will surely know about macros and if not, well at least they’ve got the layman’s stuff now. If anyone wants to get into much finer detail than I do here then please refer to ‘Advanced Sports Nutrition, 2nd edn by Dan Benardot’.

some suggested reading
                 Bullet points 1 & 2;
1.       The carbs you eat should come from low to medium G.I. sources only.
2.       Understand that the only time you need (and can get away) with consuming high G.I. carbs is either;
       a.      at breakfast,
       b.      10-15minutes prior to endurance exercise,
       c.       during endurance exercise, or,
       d.      the 2 hours after hard endurance exercise.

You ought to be familiar with the type of carbs you can consume in order to limit fat gains; look into glycaemic index (G.I.) and aim for those low to mid on the scale. Only go near high G.I. by following the advice in point 2. This is due to their effect on your insulin (hormone) production – too much due to inappropriate (wrong type and ill timed) carbohydrate intake will lead to body fat increases.
You can get away with (and by that I mean not convert the carbs to fat) consuming high G.I. carbs at breakfast simply because the body is primed for carbs after a period of fasting; I’m obviously not referring to chomping down bars of chocolate here rather the likes of those who might like some marmalade on their toast, that sort of thing.

A mention to vegetables; you’ll have read lots about the importance of getting ‘5-a-day’, don’t fret too much about this. The same goes for fruit, in fact, you can pretty much steer clear of fruit for a while when trying to cut fat (they tend to muck about with your insulin levels too much). Vegetables are good for two reasons; first of all they contain many of the vitamins, minerals, fibre and antioxidants that you need, and, secondly they fill you up when you eat lots of them.
                Bullet point 3;

3.       Keep hunger at bay and stimulate your fat loss hormones by making protein and fat more dominant in your macro nutrient count than they’ve probably ever been.

Essentially this comes down to an understanding of the words anabolic and catabolic. In an anabolic state your muscles are repairing and sometimes building, depending on the training stimulus. If you’re in a catabolic state, you’re literally devouring yourself, your muscles.

When you begin to examine your diet (bullet point 4) you will come to realise that it is difficult to eat too much protein such as its lasting and fulfilling effect. However, it is without doubt very easy to eat too little.
As an example, if you find yourself snacking at 10am and 3pm i.e. between your meals I bet you the dominant macro nutrient will be carbs and bad fats. Change this to protein (difficult I know, especially in western cultures due to commercialism of unhealthy food) and I guarantee a reduction in your hunger pangs as well as the beginning of your fat loss goals.

By making your diet more protein and fat based (remember we’re not doing any endurance training just yet) you will protect your lean muscle mass meaning that your calorie deficit will work to force you to burn excess body fat for energy, not muscle tissue.
Hydrogenated and Trans fats such as those found in all the things we’ve come to love (cakes, biscuits and other processed crap) are designed to make us want more. This is a huge trick that is being played on us by the food industry and it’s only for one purpose – to increase their profits. Put it this way, the amount of proven damage these fats are doing to us, I firmly believe they should be deemed as harmful as certain types of classified drugs. Sure, there’s nothing wrong with a treat now and then, so long as we follow the basic principles laid out above (bullet points 1&2).

"Approximately 20 percent of your calories should come from good fats. Any less than 20% and your hormonal production goes down."
As a rough guide when dieting for fat loss you should aim for 35-50% carbs, 25-35% protein and 20-30% fat within your daily intake. To be more specific, the lower your carbohydrate content the more anabolic your diet will be. The diets you see where the carb’ ratio is much higher is usually due to the person being an endurance athlete.

                Bullet point 4;
4.       With the above point firmly in mind, you must now tally it with limiting your calorie intake.

The fundamental problem with this point is that many of us don’t know what 200, 300 or even 1000 calories looks like; it comes in so many different guises. So unfortunately, for those that don’t like detail this is the main area in which you will come unstuck.
You simply have to invest some of your time educating yourself about the density of your food preferences. Once you start doing this, it will almost take over your life in a way, but the good thing is that once your food behaviour improves it will become like second nature to you.

You should start by working out your daily calorie requirements which is done on the basis of certain targets;
·         to maintain your current weight, or,
·         to add weight, or,
·         to lose weight.

I suggest you sit down with a pen and paper and calculate your current daily intake of your food preferences (very important) then tweak it to suit. If you’ve got a smart phone you can download an app which will do all of this for you; ‘myfitnesspal’ I think. I got the following calculation from the insanity workouts nutrition strategy;
                Factor 1

·         66 + (6.23xweight in pounds) + (12.7xheight in inches) – (6.8xage in years)

                Factor 2
·         Sedentary: little/no exercise = 1.2
·         Lightly active: 1 to 3days = 1.375
·         Moderately active: 3 to 5 days = 1.55
·         Very active: hard 6 to 7days = 1.7
·         Extremely active: all 7 days = 1.9

                Factor 3
·         Lose weight; minus 500cals per day
·         Maintain
·         Gain weight: add 250 to 300cals per day

72.5kg=160lbs, 69.25 inches, 37yrs old

66 + 996.8 + 879.475 – 251.6 = 1690.675
Weights 3 times per week and HII once a week;
·         Moderately active; x1.55 =                                          2620cal per day to maintain
·         Moderately active; x1.55 = 2620 + 250 =                 2870cal per day to bulk
·         Moderately active; x1.55 = 2620 – 500 =                 2120cal per day to lose weight

Now that you’ve worked out your calorie requirements it is crucial you divide into macro nutrient ratio’s as advised above.
                Here’s an example diet (to compliment bullet points 3&4);

(mon - fri)

7am Breakfast;
                                                 Medium bowl of porridge 150cal, 28C, 7P, 3F
                          2 slices toast with butter and 1 with peanutbutter, 310cal, 32C, 10P, 12F
2 boiled eggs, 185cal, 12P, 12F
A cup of tea, 10cal
655cal, 61C, 29P, 27F

 10am Mid-morning snack;
                                                    1 tin Mackerel (olive oil), 270cal, 18P, 23F
                                                               ½ broccoli, 25cal, 1C, 2P, 2fib
295cal, 1C, 20P, 23F

 1230 - Lunch;
Chicken salad and a baked potato, 400cal, 32C, 26P, 6F
½ snickers, 135cal, 17C, 2P, 7F
A cup of tea, 10cal
410cal, 50C, 27P, 13F

3 - 3.30pm - Mid-afternoon;
A small tin of kidney beans, 125cal, 21C, 10P
A small tin of tuna (in water), 55cal, 13P
2 boiled egg whites, 50cal, 12P
10ml flaxseed oil, 85cal, 10F
½ broccoli, 25cal, 1C, 2P, 2fib
315cal, 22C, 31P, 10F

 Post training;
1 scoop whey protein in water 110cal, 2C, 20P, 1F
200ml apple juice in 200ml water 90cal, 20C
200cal, 22C, 20P, 1F 

Post training meal;
1 scoop casein protein in water 110cal, 2C, 20P,
Scrambled eggs (2 whites, 1 yolk) with sprinkle of garlic powder, 100cal, 12P, 6F
                                                                         210cal, 2C, 32P, 7F

8pm-ish; melatonin supplement (if required)

(remember I need 2120 calories per day to lose 1lb body fat per week) I consume approx 2085cal of which 159g is P/30%, and 81g is F/35%; this means that 35% of my food does not come from protein or fat sources; the two fundamental macronutrients for fat loss.

I’m sure you’ll agree that by sticking with the above diet, I don’t tend to get too hungry, yet I still manage to lose excess body fat weight! Granted, it’s not setting my world alight but once I’ve reached my target I can reintroduce some more carbs in lieu of proteins and fats, especially as I’ll be needing them due to commencing endurance training.
                Bullet point 5;

5.       Take the odd day off your calorie restricted diet.

Leptin is the hormone that helps us burn excess body fat. Think of it as a battery and the more it’s used the more its power is depleted. It is put into use by way of the calorie deficit and appropriated macro ratio diet; this is how we force our bodies to use body fat for energy.
However, if you think starving yourself is a good idea, as opposed to eating a healthy balanced diet through a prolonged period think again as you will actually knock your hormones out of sync and ironically, force your body to start storing body fat!

So what happens here is like all batteries, they either need to be replaced or recharged. We can recharge leptin to normal levels, primed for more fat loss, by eating a calorie surplus diet when we need it most.
The written guidance is that you should aim for 6 days deficit and 1 day surplus but this assumes we’re all identical. I personally go for about 3 or 4 days on diet and then have a day off, which is decided by how I feel.

If you follow the principles above you will know when the right time is to revert to a surplus. It’ll be the day when no matter how strict you’re being you’re simply too hungry to think of anything but the food you crave. Give in; don’t beat yourself into the ground. It’s what you actually need to do. Any weight gained from that one day will quickly fall off in the following few days.
Some people call this a cheat day, others call it a reward day. I’m probably a bit more pragmatic than that. It’s just a day like any other; only on this day your body is telling you it needs something else.

                Bullet point 6;
6.       If you must eat something at night time, before bed, make sure it’s just protein.

When we’re sleeping our main function is repair and recovery. Any carbs floating around in our body are unlikely to be used and thus will be converted to body fat. Even though you might feel like you need carbs or something filling, you really don’t need carbs prior to sleeping.
However, you might need protein. Casein protein is a supplement which is filling and slow release meaning it will work with you right through the night, especially important if you’re trying to recovery from a long endurance session or trying to add lean muscle mass.

                Bullet point 7;
7.       In terms of sacrifices, this process is all about changing your eating habits.

After all, the inescapable truth is this; your eating habits are the only reason you now have more body fat than you desire.
If you can handle your hunger pangs and get to grips with this main tip, I guarantee you will begin to lose excess body fat and will continue to do so until such time as you reach your target. It really is as simple as that. There are no supplements required, no cheats involved. It’s just you, the food you choose to eat and your mental strength; how determined you are to make it happen?

That’s it in a nutshell. Trust me, I know you might be looking for the magic potion or recipe but they don’t exist. The fundamental truth is this, you have to change the way you eat and you have to stick with it.
For example, there is a certain ‘magic’ weight loss pill that can be bought in our pharmacies which guarantees to cut 25% from all of the fat you consume before it is absorbed by the body. This is an absolute crock of shit; if you change your eating habits i.e. do this properly then why would you want to pay £60 for a batch of tablets to remove 25% of the good fats your body needs. Look at it another way, you don’t change your eating habits and you take these pills to help you lose weight. What happens? Your body still absorbs 75% of the bad fats you really don’t need; you still gain weight and you’re out of pocket! Supplements hit your pocket; the most effective way to get rid of excess body fat is by changing your eating habits via consumption of a controlled and balanced diet.

                Conclusion to tip No.2;
I acknowledge that I’ve perhaps led some into a false sense of security with ‘my 3 tips’ but I remain content that the basics of fat loss can be taken from the abbreviated translation.

With that said, we are all different/ unique therefore a further piece of advice I have is that for those wanting even more specific information please look into;
·         somatotypes,
·         biomechanical individuality, and,
·         metabolic typing.  

Oh yeah, one last thing; alcohol. This is converted in acetate which is used in place of our body fat supplies for energy. When trying to cut fat, cut back on your alcohol intake, better still ditch it altogether.
That’s it then, if you don’t like exercise, feel free to stop reading now…………….

Undertake weight training and High Intensity Interval (HII) training;

Ok, very briefly, the science bit first;
·         weight training increases the resting metabolic rate meaning that combined with a clean diet, you are more efficient at burning excess body fat whilst resting,
·         Long moderately intense cardio eats away at both fat and muscle (think running for anything longer than 30mins), whereas
·         Short high intensity eats away at more fat than it does muscle.

Points to note on HI workouts;
If you’re aiming to retain any lean muscle mass (or even make some gains) do not even think about doing insanity workouts. These will have you shrinking all over. Sure, Shaun T looks ripped but that guy was huge as a pro footballer; ordinary folk with ordinary 9 ‘till 5 jobs simply don’t have that foundation to rip back to. In simple terms, insanity workouts will help you lose weight but it won’t exclusively be body fat weight you’ll be losing.

Exercise to the uninitiated should be thought of as alcohol to the pubescent teenager. It will act as a toxin meaning that unless you build your tolerance to it gradually and carefully, you will get ill and/ or injured. This is the main reason that highly driven people get ill too soon when taking up exercise. With this in mind, surely now you will see why some people would be absolutely crazy to be taking up insanity workouts – just because they heard it was good for losing fat!
OK caveats dealt with, here’s a quick example of what to do;

In terms of weight training, you want to do something that creates a state of hypoxia within the muscles; being in an oxygen deficiency. By doing so, your muscles will be stoking the ‘fat burning furnace’ for the next 24-48hrs. Note; this isn’t about building new muscle fibres; it’s about losing excess body fat. This workout might make you’re muscles appear bigger but that’s only a short term process. This technique will assist with your fat burning goals.
A state of hypoxia can be found by doing what are known as drop sets. Alternatively you can do giant sets or tri-sets. Essentially get a muscle group working consistently (time under tension) for between 40-70seconds. Rest for 90 seconds and repeat 2 or 3 more times, then change to a different body part. Do no more than 4 body parts in on sitting.

For example (I workout in my garage at home – so not the purest of drop sets, but you should get the jist);
All body workout (all 4 sets)

Barbell rows
Drop set
Inverted dumbbell rows

Flat bench press
Drop set
Dumbbell bench press

Back squats

Shoulder snow angel
Tri set
EZ bar upright row
Tri set
Trap hold
Standing calf raises

I do something similar on a Wednesday and a Friday and on a Saturday or Sunday I perform a High Intensity Interval (HII) session on my turbo trainer (stationary bike).
This usually takes the structure of something like a 5min warm up followed by 3 lots of all-out-sprinting for 20secs, each with a rest period of 2 or 3 minutes between, and a final cool down. All in, no more than 20 minutes work. That’s all the cardio I need to be doing when my specific goal is cutting excess body fat.

Like I said near the end of my previous post, my main goal - post hip arthroscopy - is to lose some excess body fat and rehabilitate prior to commencing base training in preparation for next years Highland Fling.

Since Xmas 2013 I’ve so far lost 9lbs. I was 18.3% body fat before my operation (16 days ago) and I’ve not checked since. However, my goal is to get to 15% body fat, anything below that will be a bonus, before I start running again which will hopefully begin in June of this year.
I’ve lost this weight, and believe I will continue to do so by employing the principles mentioned above. It’s taken me a long time to finally understand nutrition with confidence and hope that by penning this post, it will take others much less time than it did me. Best of luck.

Sunday, 2 February 2014

Hip arthroscopy; the lead up, the procedure and the immediate aftermath

I have been influenced to write this by John Kynaston, who thanked me via facebook for my previous post. The intention is that;

1.      It will encourage others with similar hip related problems to pester their doctor incessantly until they are taken seriously,
2.      It provides a perspective on the operation and likely recovery process, and
3.      I provide a platform for fellow bloggers etc to answer a couple of (my own) questions which conclude the post.

The first section (the lead up) lists the events leading up to the operation. Several conclusions will be brought together to close this rather lengthy episode before proceeding onto the next; the procedure. Here I will go through the rather uncomplicated operation I had, before finishing this post with where I am now and what I think the future holds for me, as a runner.

The lead up

11 Nov 2012; I fell awkwardly coming downhill during a run. I didn’t actually land on the deck; I managed to keep myself upright but at the same time heard and felt a crack coming from somewhere inside my hips. From this day forth I had been unable to run or even powerwalk without severe pain materialising within my hips.

27 Nov 2012; I visited a sports injury clinic at Castle Douglas to find out what my injury was and to get some treatment – yes it took me 2 weeks to admit there was something wrong. I was given some Physiotherapy (PT) exercises and told to refrain from running for 2-3weeks.

21 Dec 2012; I waited longer than 3 weeks to give the injury every chance to clear before I embarked on a run on this day. The pain was actually worse - within the joint between my hip and the top of my right leg. I decided to stop running for as long as it took to clear the injury and assumed on the basis of previous advice that this would be no more than another week or two. I continued with the PT exercises suggested – again almost refusing to believe I was really injured.

10 Jan 2013 (2months post injury); I phoned my GP,  because the hip injury was not clearing despite very low levels of activity and to enquire about being put forward for a referral. When he informed me that the process could take as many as 18 weeks I agreed that it might be of use if I simply re-visited the sports injury clinic. This is the date I first enquired about a referral.

12 Jan 2013; I was unable to get an appointment at Castle Douglas for a couple of weeks but I did manage to get in at FASIC in Edinburgh that Saturday morning. I was given a thorough examination and thereafter, a number of PT exercises and told to refrain from running for another week or two. The specialist did not seem concerned about the pain I described which was referring into my groin.

16 Jan 2013; I had been emailing the physiotherapist at Castle Douglas to update on my progress and was invited to attend again on this day. He ran some checks and confirmed the diagnosis made in FASIC; femoral anterior glide syndrome with medial rotation. He concluded by giving me a variation of some of the PT exercises I had already been doing for nearly 7 weeks. He also said I could continue with my running and that it should be done up to the point of pain and when the pain kicked in I was to stop and carry out my PT exercises. He added that the injury should clear up soon and the clicking noise within my hip would soon dissipate. He did not appear overly concerned about the pain that I described which was referring into my groin.

22 Jan 2013; I wrote to my GP to explain the events above and to request that I be put forward for a referral with a specialist. I did this because despite being told by a number of specialists that my injury would soon clear up (since the end of November) it had shown no signs of abating. I wanted to start the ball rolling with the referral process then rather than wait months for someone to acknowledge that it wasn’t clearing and then begin the lengthy process.

23 Jan 2013; sub note to add that both by regular osteopath and physio disagreed with the diagnosis of the specialists thus far.

27 Jan 2013; I went for a 4 mile powerwalk to investigate the condition of my injury. This was my first attempt at rigorous forward movement since my visit with the PT at Castle Douglas (2 weeks earlier). Within 10minutes the pain re-emerged within my groin and gradually got worse for the duration of the walk. Afterwards I decided to pull out of the entire years competitive commitments on the basis that I would not be physically ready for any of them. THIS WAS WHEN I STOPPED RUNNING.

01 Feb 2013; my GP replied via letter and made reference to the issue that I wanted to return to running as soon as possible but requested that I be patient with the process of rehabilitation, therefore turning down my request for an MRI. I took up Yoga this week.

20 Feb 2013; (more than 3months since the injury) I visited the physio in Lockerbie and was with her for almost 90mins. I explained the following;

·         My pelvis appears to be pulled backwards during the night when I’m sleeping.
·         When I wake in the morning I am aware of an isolated area of acute pain in one spot of my lower right back.
·         The two large muscles either side of my spine feel fatigued most evenings.
·         I often roll backwards and forwards on my back (with my knees tucked in to my chest) to get rid of the perceived build up of fatigue.
·         I experience a very strange creaking sensation within my upper right groin whenever I do a backwards lunge; almost like the stretching of a rubber glove.
·         The clicking noise in my upper right groin shows no signs of abating.
·         I’m in constant daily pain and this is despite being almost completely immobile lately.

She was very thorough and explained that the core has four parts to it and all need to be working in unison to help prevent injuries. She also corrected a slight imbalance in my lower back. I’ve been told to continue with the PT exercises and also try to engage the entire core and to focus on doing the exercises properly i.e. keeping the pelvis aligned properly. There was no time limit given for when I should expect to resume full fitness from injury though she did say that it could take as much as 12-18months!

19 Mar 2013; there were still no changes in any of my pain symptoms. I was concerned that almost 4 months of conservative treatment had not helped in any way. Therefore, I wrote to my GP again.

22 Mar 2013; my GP replied to inform me that he had forwarded my letter to the MRI dept at DGRI for further assessment. This is the date my referral process eventually begun.

15 Apr 2013; my wife (works in Radiography etc dept) told me that Dr Haque had spoken with her re my condition. He says that he would prefer that I get properly diagnosed. That way I will either have an arthrogram or a plain MR. Apparently, my GP should have referred me to a specialist in the first instance.

18 Apr 2013; I have a Hemorroidectomy (operation) and am fairly immobile from this point onwards for a number of weeks. I volunteered for this on the basis of having to cancel my running commitments this year.

19 May 2013; I’m recording this date to demonstrate the ongoing nature of this problem. Whilst walking the dog this morning I felt a number of sharp twinge’s within my upper right groin i.e. the same area that I have been having pain in for the last 6 months. This is despite the fact that I stopped running in January and have been practically immobile the last 5 weeks due to having had a Hemorroidectomy.

03 Jun 2013; first activity since my Hemorroidectomy operation – a 4 mile walk. I had a niggling pain in my lower right back and across my right side trochanter. I’m still getting the popping/snapping sensation coming from my right hip at the front.

04 Jun 2013; my right greater trochanter felt as though it wanted to pop out this morning whilst walking the dog – the day after my 4 mile walk.

07 June 2013; 30wks since injury, 11 weeks since official referral, I have received an appointment for the orthopaedic specialist – 11th June.

11 June 2013; appointment with orthopaedic specialist. He says that I have a bony prominence on my right hip ball joint and that this may be causing a labral tear which is referring into the area at the front of the hip. He says that the greater trochanter pain may be simply due to a bursa which is not pertinent at the moment due to my level of inactivity. He also added that the psoas may be degenerated and that the scan may or may not confirm this. Either way, if it is, there is no repair that can be done. I am to have an arthrogram MR at Glasgow Nuffield soon. I hope to find out what condition my psoas is in so that I can make a decision one way or the other.

16 July 2013; 35wks since injury, almost 17 weeks since referral, I returned to find out the results of my scan. The specialist confirmed that I have a labral tear and that he is going to refer me to Glasgow General for the next stage of my treatment. My appt was 0900hrs and I was not seen until 0940hrs; just to be told this very quickly. Why could I not have been consulted with over the phone? This would have saved my time (I took the morning off work) and the time of time of the consultant.

29 July 2013; constant hip pain. The pain is now referring deep into my ball and socket joint and is a constant burning sensation. At least the pain into my groin has dissipated. I’m wondering if my ongoing ITB strain can be addressed at the same time as any potential operation to my hip?

01 Aug 2013; I phoned Glasgow today (Mr Patel’s secretary – the consultant that was supposed to see me) to be told that I had to wait up to 12 weeks if I was to be seen and that she couldn’t even confirm if I would be seen at all as it would be up to the consultant. Almost 9 months since my injury and I’m being told I need to wait another three just for another consultant meeting.

30 Aug 2013; 41 ½ wks since injury, 23 weeks since referral, I phoned to ask what the progress was only to be informed that Mr Patel (above) had declined my referral requesting that Dumfries stop sending him referrals because he is too busy! I’ve now, as of the 23rd, been re-referred to a different specialist in Glasgow; Mr Campton at the Gartnaval. I phoned the Gartnaval to be told they had no record of my referral and that when they received it I would be looking at 12 weeks to be seen again unless it was marked as urgent. I phoned Dumfries and asked them to fax the referral through today and mark it as urgent.

23 Sept 2013; 44 ½ wks since injury, 26wks since referral, I phoned the Gartnaval to find out when my appt is due. I was told that my referral was marked as ‘routine’ and that I would not be seen until November at the earliest; a year since my injury.

26 Sept 2013; I write a complaint to the NHS

12 Oct 2013; I visit a play area called ‘crocky trail’ with my kids and run about playing with them. The day after and for another couple of days the top of my right leg and down into my groin is in incredible pain i.e. I definitely cannot run anymore.

11 Nov 2013; a year to the day since I was injured, 34wks since referral, I have my consultation with Mr Campton. He says he will help me.

30 Jan 2014; 14 ½ months since injury, 10months since referral, I have my operation and it turns out that I was more in need of this than had been previously thought!

So what can be taken from this period of time?

Up until my Xray (which was 7 months to the day after my injury) I had four separate professionals all telling me that I had the same injury; each of these individuals had no means of collaborating with one another and none of them was informed of any previous diagnosis.

Under normal circumstances a person would have been considered deluded to question four individuals each with considerably more medical knowledge than his own. However and with this clearly in my thoughts, I remained totally convinced that they were wrong. Here’s why;

1.      When you are injured and unable to train at your chosen sport for any more than 5 weeks then you have a real problem that needs addressed. This simply doesn’t equate to 12-18months of physiotherapy as one of the individuals suggested,
2.      I had pain referring into my groin which was consistently overlooked by every professional,
3.      My osteopath and personal physio both told me that the diagnosis’ of my injury didn’t make any sense to them,
4.      Some people have a higher tolerance to pain than others; I suggest highly driven individuals such as ultra runners fit within this bracket. Therefore, to be fair to the four who got this injury wrong, diagnosing can be complicated by this factor,  
5.      Two of the physios suggested that I should be able to run after just a few weeks of the PT exercises but had no suggestions for when that proved incorrect, and,
6.      Quite simply, I didn’t believe anyone was taking me seriously and got the general impression that I was being fobbed off.

These tactics may deter less determined individuals from pursuing further action through the NHS and this is where I believe the crux of this matter lies. Please, someone/ anyone correct me if I’m wrong because this entire affair has blighted my view of the NHS. In fact, if it was up to me I would like to opt out of paying my NHS contributions with the aim of taking out health insurance instead.

I know they are chronically under resourced but they should not be making promises such as ’18 weeks from referral to procedure’ when they clearly can’t keep to them.

The procedure

At my pre-operative assessment, I was told that I was going to have a hip arthroscopy with the potential for a labral repair and/ or osteoplasty (bone shaving). I was also informed that I would be in crutches for between 4-6weeks, and that the more I had done, the longer I would be in rehab for afterwards. The time to resume full activities was placed at roughly 6 months.

During my own research, prior to the operation, I uncovered some wild stories of people being in severe pain post operation for anything up to 18months! I admit that I was very anxious especially given the complications I suffered from my haemorrhoidectomy last year where I could barely walk for 8 weeks afterwards and have been left with a prescription of laxatives for the rest of my life.

However, for me this operation was a final throw of the dice; without it I would never run again. I might never run again with it but at least there was a chance that I would. And despite the potential for monumental pain in the aftermath I considered it a chance worth taking.

Hip arthroscopy is a procedure that allows surgeons to treat many hip problems that previously required large incisions, muscle splits, and dislocating the hip. The surgery generally takes about 2 hours, and is performed through two or three small incisions in the upper part of the thigh/groin. A small telescope (the arthroscope) is placed into one of these incisions and the entire hip joint can be visualized. The arthroscope is connected to a tiny camera, allowing the entire surgery to be visualized on a TV monitor. The other incision(s) are used to place various instruments into the hip to perform the surgery. A special operating room table is used to perform hip arthroscopy to gently distract the joint and allow for safe movement of instruments inside the hip.

Now, it was the consultants’ intention to repair a labral tear. However, it turns out that my tear was larger than expected, so much so that it was beyond repair. Instead (I was informed afterwards) he removed much of the debris and smoothed out the labral joint.

In addition, he had to reshape the neck of my femur as a bone deformity was causing an impingement (femoroacetabular impingement to be exact). It was this that caused the labral tear and regardless of whether or not I had taken a tumble on that fateful day, at some point in time this was always going to happen.   

During my research I have come to realise that many people have labral tears to some degree and that many of them do not require surgery. I think it’s important to state this as these things should be taken on an individual basis. The same goes for the recovery process.

The immediate aftermath

So I had the operation exactly 3 days ago from now. Within hours of the procedure I was up walking to the toilet without the aid of crutches and have to say that I was pleased to feel only minor pain.

The consultant visited me the following morning to tell me what he did and answered the first question on my lips; did he find any signs of arthritis? The answer was that yes, yes he did.

So here it is folks, what do I do now?

I told the surgeon that I had my sights set on one last hurrah before putting the running shoes away for good and asked his opinion. He was non committal as I suppose any true professional would be.

He said that I should be able to resume a normal level of activity but that I would always experience some minor niggles within the hip region. Thankfully though, none to the extent I had felt within the last 14 months. Instead, he said I would probably not notice it too much but just to be aware that things would never be perfect.

At 37yrs old I now know that the head of my femur is ‘scruffy’ i.e. that I have the onset of mild arthritis. Being realistic, and assuming I live to about 80, this means that I can expect a hip replacement at some point in my life.

So the burning question is this, can I resume running once I have rehabilitated from this operation or should I just give up once and for all?

Truthfully? I have already prepared a training programme based on me arriving at the start of the 2015 fling. This has been based on the principles of injury prevention and running/ training the absolute minimum that is required.

I aim to reduce my bodyfat significantly prior to starting running base training; over the last 4 months I have went from 13.4% to 18.3% due to strength training with the aim of bulking my upper half up – to bring some balance to my overdeveloped lower half. The problem is, I made a huge balls up with my nutrition – despite witnessing some lifetime best strength gains.

Thereafter, I have 3 block of 12 weeks running training each with a two week active recovery period between. All of this has been specifically tailored to match my own abilities and is based on everything I have learnt within the last 5 years.

My only concern is that I may have missed something. For example, I know that I keep getting niggles on my right side. Therefore, does anyone know of a specialist I can visit who can assess me and help me with my running gait or alternatively, even tell me straight that running is not good for me?

Until then, I really hope I at least get the chance to fulfil my dream.