Lesser trochanter ostectomy July 2021

Revision femoral osteotomy March 2022

Bruising following the revision femoral osteotomy

2022 Update!

As you are likely aware, I have had a number of hip surgeries to manage my left hip dysplasia and femoral anteversion. At my last big hip update in 2021, I was recovering from a Femoral Osteotomy and was planning to have a combined Periacetabular Osteotomy and Femoral Osteotomy on my right hip.

Unfortunately, the left Femoral Osteotomy did not yield the results I was looking for and left me with a host of new issues- ischiofemoral impingement, knee valgus and increased biomechanical loading leading to a bone stress reaction, weak hip abduction, painful and weak quadriceps, reduced hip external rotation and hip extension. 

I ended up seeking a a second opinion from a different surgeon and this resulted in me having a arthroscopic surgery called a lesser trochanter ostectomy in July 2021. This was to remove an overgrowth of bone on my left femur, which was causing ischiofemoral impingement (pinching of the sciatic nerve where it runs between the femur and pelvis). This surgery was successful in rectifying the painful pinching of my psoas muscle (causing groin and abdominal pain), reducing the pain in my buttock and increasing my hip extension. However the other symptoms remained (as we suspected would be the case) and my new surgeon informed me that I needed a revision of the femoral osteotomy. I was, unsurpisingly, very upset and disappointed to have to go through such a big and painful surgery yet again. Any revision surgery holds extra risks and a major surgery to the femur is not to be taken lightly so I consulted with 4 different surgeons who perform this surgery and thoroughly discussed my options, the risks and exact surgical approach and techniques that they would use.

After much discussion with my Melbourne surgeon and physio I opted to have a revision femoral osteotomy (derotational and valgising) performed by a surgeon in Brisbane. This was performed in March 2022. I am currently recovering from this, but it seems to have been a lot more successful at this stage, much to my relief!

After the problems with my left hip, I was understandably cautious about having surgery to my right hip. I consulted with my new surgeon and we decided that as my hip dysplasia and femoral anteversion is mild on the right hand side I could manage with a simple capsular plication- this is tightening the soft tissue that surrounds the hip to give more stability. This was performed in December 2021 and the recovery has been uncomplicated.

At the end of this year I will need the hardware from my left hip removed again and hopefully that should mark my last hip surgery for a very long time! I am hoping to be able to fully resume sporting activities next year and very much looking forward to the potential of running again. In the meantime, lots more rehab!

Lesser trochanter ostectomy surgery

What is it?

Symptoms:

How is it diagnosed?

Treatment:

What is it: Low load blood flow restriction (LL-BFR) training entails applying a tourniquet-style cuff on the proximal aspect of a limb just prior to exercise eg. at the top of the thigh or at the top of the calf. The cuff is manually tightened or pneumatically inflated to a pressure that occludes venous flow yet allows arterial inflow. Muscular strength and hypertrophy can be improved with LL resistance training if combined with blood flow restriction (BFR) as opposed to resistance training without BFR, which requires loads of >70% of one rep max to induce gains in muscle strength or hypertrophy.

How does it work: Published studies hypothesize that blood flow restriction training induces skeletal muscle hypertrophy through a variety of mechanisms however, a definitive mechanism has yet to be elucidated. Proposed mechanisms include increased fiber type recruitment, metabolic accumulation, stimulation of muscle protein synthesis, and cell swelling, although it is likely that many of the aforementioned mechanisms work together.

Safety: A recent review looking at potential safety issues of this type of training concluded that it offered no greater risk of clot formation, muscle damage and increases in blood pressure than traditional exercise.

If you are post-operative you should consult with your surgeon before beginning this type of training.

If you have any medical conditions you should consult with your GP before beginning this type of training.

You should use a pneumatic cuff in your size for safest and most effective BFR training to ensure that the correct occlusion pressure is obtained. 

BFR training should be carried out under the guidance of a health care professional initially to ensure safe tourniquet application and pressure, exercise load and technique.

Application: LL- BFR training is great for people with an injury, post-surgery or with a medical condition where high-intensity training is contraindicated.

A metaanalysis of studies showed that 2-3 days per week for at least 10weeks had the best effect on strength and hypertrophy (more sessions per week actually decreased strength gains and strength improvements did not begin until 10 weeks). However, >4 session/week had a significant increase in muscle endurance. 30sec rest between exercises was found to be the most effective.

High volume is ideal; a standard structure for LL-BFR training is 75 repetitions over 4 sets (i.e., 30/15/15/15) with 30-second rest periods between sets.

Load as low as 20% of 1 rep max (RM) has been shown to be effective.

Cuff pressure around 150mmHg was effective, with higher pressures not having any increase in effect.

Low intensity (LI) BFR aerobic training results in significant improvements in cardiorespiratory endurance (i.e., VO2 peak). These changes have been observed with walk and cycle training at intensities as low as 30% of heart rate reserve, durations of 10-15 minutes at a frequency of 2-3 times a week for 6 weeks. 

Loenneke, J.P., Wilson, J.M., Marín, P.J. et al. Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol 112, 1849-1859 (2012). https://doi.org/10.1007/s00421-011-2167-x

Vanwye, W. R., Weatherholt, A. M., & Mikesky, A. E. (2017). Blood Flow Restriction Training: Implementation into Clinical Practice. International journal of exercise science, 10(5), 649-654.

I've been making these slices for a few years and they are a crowd favourite! We have affectionately named them buckini body slices due to the "buckinis" (buckwheat kernals) in them!

These are sweetened only with dates and are high in fibre, complex carbs and healthy fats. They're great as an energy boost for morning or afternoon tea and could also work well for snacks on a long hike or endurance activity.

First place 300g of pitted dates into a bowl or container and just about cover with boiling water. Leave to soak for at least 30mins until soft and gooey.

In a food processor combine:

Soaked dates (reserve soaking water)

100g melted coconut oil

100g almond meal

200g buckwheat or rice flour

2 tablespoons any nut butter or tahini 

5 tablespoons cacoa

pinch of salt

splash of date water to combine

Once processed into a smooth paste then add 150g buckwheat kernals and process until just combined.

Spread this out into a lined slice tray- mixture will be very sticky!

Cool in the fridge and then slice up

These are best kept in the fridge and consumed within 5 days 

After first hip surgery

After second hip surgery

Femoral retroversion, normal femur, femoral anteversion

Normal and dysplastic hip and mechanism of PAO surgery

Swelling after my second hip surgery

Continuous passive motion machine day 1 post PAO

Day 1 post PAO surgery- first steps

Hiking with one crutch four months post second hip surgery

Diagnosis:

At the age of 30 I was diagnosed with bilateral developmental hip dysplasia and femoral anteversion. This was something I was born with, however it took 30 years to receive an accurate diagnosis!

Hip dysplasia is a condition where the hip socket (acetabulam) is too small and often misaligned so the head of the femur is not fully encased. This is present at birth and can often be corrected through bracing as an infant if detected early.

Femoral anteversion is a developmental condition where the femur rotates inwards.

In my case both of my femurs were anteverted 30° (normal is 10°-15°) and my acetabulae were small and angled so that the front of my hip had very little support causing my femurs to sublux out of the front of my hip joint with any hip extension (part of the gait cycle and many normal movements).

Compounded with this I also had bilateral ischiofemoral impingement due to the shape of my pelvis and hip joints. This meant that the gap between my femurs and bottom of my pelvis was too narrow causing my sciatic nerves to get pinched.

Symptoms:

Normal symptoms of hip dysplasia are hip pain- including into the groin and front of the hip and into the glute- and often a feeling of instability in the hip. Sometimes lower back or knee pain are also present. Generally the range of motion of the hip joint is larger than normal (unless restricted by pain).

Normal symptoms of femoral anteversion are visually that the knees turn inwards. The person will have a large range of hip internal rotation and often feel comfortable sitting in the W position and they may walk or run with a flaring out of their legs behind. They often will have increased quadriceps bulk and strength compared to the glutes and hamstrings.

Hip dysplasia and femoral anteversion are commonly missed and often take many years to be diagnosed.

My symptoms were less obvious. I was always very quad dominant and had several episodes of anterior knee pain through my teens and twenties. My left leg in particular always flared out when I ran. In my mid twenties I started to get sciatic tension in my legs during and after running. This progressed to the point where my calves "seized up" after a mountain race and I had a long break from running and a back procedure performed (due to a misdiagnosis- we logically attributed my symptoms to the prolapsed discs in my lumbar spine). Afterwards the sciatic tension still would come and go, particularly with uphill running, and I started to get a deep ache through my legs at times. I then also began to get feelings of weakness, where I struggled to lift my legs up properly, particularly uphill. Then my left quad started getting incredibly tense and tight whenever I ran too. My times started getting slower and my athletics club coach noticed that I was limping at the end of races and workouts. I then started getting classic hip pain symptoms in my left hip and my left leg started to give way when I was running downhill. As my symptoms progressed I would be affected in walking as well as running.

Throughout this time I saw countless different health practitioners and specialists (as well as doing a lot of my own assessment and rehab and speaking to colleagues), had numerous scans and tests and did daily rehab and glute activation exercises! My condition was somewhat of a mystery and I was advised to continue running- my sports doctor even thought it was psychological, which I did question myself for quite some time. Eventually when I started getting true hip pain and my leg giving way in the left I requested a left hip MRI, which showed the dysplasia. Frustratingly I'd had a right hip MRI over a year previous and the dysplasia had been missed.

Tests:

Clinical tests for hip dysplasia are hip range of motion and strength tests checking for pain, clicking and excessive range or movement of the femur within the hip. Gait and posture will also be analysed. Clinical tests for femoral anteversion are similar and will also include the Craig's test- where the patient lies face down, the femoral head is found and then tracked with the hand whilst the hip is internally and externally rotated by the practitioner to determine the bony limits of range.

A plain xray of the hips and pelvis in standing and in an angled stance are needed to diagnose hip dysplasia. After this, many other tests may be taken- I had bilateral hip CT scans to determine the angles of my acetabulae and my femurs. I also had D-Gemeric MRI's of both my hips where you consume a radioactive solution prior to the MRI and the integrity of the joint cartilage is assessed.

Next steps:

My sports doctor took my scans to a meeting of hip surgeons and presented my case and was advised that I should first seek rehab from a highly regarded specialist hip dysplasia physio in Melbourne. I saw this physio for 3 months and did all the rehab he prescribed. Whilst this did help slightly, it was not enough and it was determined that I would need surgery.

I met with two good hip surgeons and decided to go with a surgeon who specialises in hip dysplasia. Unfortunately though, as he is so well regarded, he is also very busy and I had to wait for four months after my appointment until I could have surgery!

Surgery and recovery 1 (Jan 2020):

My first surgery was a left Peri Acetabular Osteotomy, whereby several cuts are made around the left side of the pelvis so that the acetabulum can be rotated and screwed into a position that covers the femur better and gives more hip stability.

As expected this procedure is quite painful! However, luckily I only had pain with movement and certain positions and if I was at rest on my back I was ok. I spent 6 weeks on two crutches and two weeks on one crutch. Throughout this time I was doing progressive daily rehab under the direction of my hip physio. I recovered very quickly and felt very strong initially, however I started to encounter problems from about 10 weeks post op. I started to get seat bone pain, pain and impingement in my anterior hip and then weakness through my left leg, pain to weight bear or put pressure through my left leg and an inwards giving way of the leg. We determined that by correcting the hip dysplasia, my hip was now fixed into an impinging position due to the femoral anteversion and my bony anatomy also causing ischiofemoral impingement. My surgeon had initially thought that I would get away with just the PAO and not need my femoral anteversion corrected, but unfortunately more surgery was now required.

Surgery and recovery 2 (Sep 2020):

I had to wait until August for my second left hip surgery so that I would be covered by my private health insurance (I had paid for the first surgery out of pocket). My initial surgery date then got postponed due to Covid- being dependent on the health system and requiring major surgeries during a pandemic is not ideal!

This surgery was a derotational femoral osteotomy (to correct the femoral anteversion), varus osteotomy (to correct the ischiofemoral impingement), femur shortening (my left leg was 16mm longer than the right), labral tear repair (labral tears are very common in hip dysplasia due to the extra load put on the labrum to stabilise the hip) and PAO screw removal. My femur was cut and the head rotated into a normal alignment in the hip joint and pulled outwards (varus) and 5mm of bone was removed to shorten the femur. A plate was put on the outside of my femur and six screws were drilled through my femur to hold it in place. The labrum was stitched where it was torn and a PRP (platelet rich plasma) was injected into the labrum to encourage healing. The 5 screws through my pelvis from the first surgery were removed as it had now healed.

This surgery took longer to perform and was a lot lengthier and more painful recovery than the first. I was in a lot of pain, even at rest for the first month and was exhausted. I had considerable pain with moving and sitting for about three months and the plate and screws caused a lot of irritation to my surrounding soft tissues making it hard for me to do my rehab and come off the crutches. I was supposed to use 2 crutches for 6 weeks and then 1 crutch for 2 weeks. But, despite my bone healing very fast, I was in too much pain from the plate and remained on two crutches for about 10 weeks and on one crutch until the hardware removal.

Surgery 3 (Feb 2021):

The plate and screws in my left femur are being removed tomorrow (23rd Feb)! I cannot wait! They have been causing me a lot of pain and irritation and I can't wait to ditch the crutch and get on with my rehab and start getting strong. There will be a bit of downtime after this surgery as I will be inflamed through the soft tissue disruption to get to the plate and screws and the holes left in my bone that will need to heal.

Right hip:

My right hip has deteriorated a lot in the last nine months whilst it has been compensating for my left hip. I need the same surgeries done on my right hip as my left, although I am hoping that they can be done all at once. I meet with my surgeon in March to discuss this and have surgery later this year.

Looking forward:

Both my surgeon and my physio are confident that I will be able to get back to running and a full and active life. I am hoping to begin my return to running in 2022.

My hip cartilage is in very good condition, however my surgeon warned that I have a much higher chance of needing hip replacements later in life than the general population.

Hypermobility is when joints move past the normal range of motion. This can be due to ligament laxity (genetic or from trauma), lots of stretching/training of a joint into increased range of motion eg. gymnasts, abnormalities of the bony structures of a joint eg. hip dysplasia.

Hypermobility can occur in one joint, several joints or throughout the body. Generally when it is throughout the body it is due to a genetic weakness of the ligaments.

Hypermobility is a spectrum in terms of degree of mobility and in the effect it has on the individual. Some individuals with hypermobility may be asymptomatic, whilst others can have chronic pain and disability from it. Most people will fall somewhere in between those two extremes.

The standard tool for assessing if a person has generalised joint hypermobility, eg. it affects multiple joints in the body, is the Beighton score. The Beighton score assesses finger hyperextension, thumb opposition, elbow and knee hyperextension and lumbar spine mobility. The total possible score is 9 and a score of 4 or above is defined as hypermobile. Generalized joint hypermobility is distinct from flexibility, which is due to increased stretch/or length of muscles and tendons.

When a joint or joints are hypermobile pain can result. This can be due to damage to surrounding structures including irritation of local nerves due to the joint moving further than it should, degeneration of the joint cartilage due to abnormal wear on the joint, muscular spasm due to working harder to control movement of the joint.

Due to hypermobile joints having excess wear on the joints, there is often premature degeneration and/or arthritis. Affected joints and limbs may also be weaker through inefficient transfer of power and often coordination is affected.

When a person has pain in or around a hypermobile joint the exact cause of the pain should be determined. Which structure is damaged or irritated? Why is the joint hypermobile? This will then guide the treatment.

The main goal of treatment for hypermobility is to stabilise the joint(s) to reduce pain and further damage. This will often involve rehab exercises aimed at strengthening the surrounding musculature, learning control of the joint movement, retraining biomechanics if appropriate, training joint proprioception. If there is a bony abnormality this may need to be surgically corrected.

There is emerging evidence that ligamentous laxity can be treated with prolotherapy injections with good results. Prolotherapy is an injection of dextrose solution into a lax ligament, this causes an inflammatory response and subsequent deposition of more collagen- strengthening and tightening the ligament.

Generally hypermobile joints should not be stretched and pushed to their end of range. Yoga is often not advised in hypermobility unless guided by an experienced instructor with knowledge of the client's condition, with a strong focus on technique and control of movement.

https://www.amjmed.com/article/S0002-9343(17)30220-6/fulltext

I was gifted the Run Fast, Eat Slow cookbook for christmas this year and it is full of nutritious recipes. This is the first one I've tried and it's delicious! I was attracted to it because I love ginger and it is sweetened with blackstrap molasses, which means this loaf is high in vitamins and minerals, including iron, and low in sugar.

Ingredients:

1.5 cups rye flour

1 inch piece of fresh ginger grated

1/2 tsp ground cinnamon

1/2 tsp salt

2 tsp baking powder

1 tsp bicarb 

1 egg

1 cup plain yoghurt

1/2 cup blackstrap molasses

4 Tbsp butter melted

1 tsp grated orange zest

1/4 cup raisins or sultanas

Method: 

Mix together the dry ingredients in a mixing bowl. In a separate bowl mix together the wet ingredients. Combine the wet and dry and stir to combine.

Pour batter into a lined loaf tin and bake at 180C for 45minutes.

Iron is a mineral in food that binds to the haemoglobin in our red blood cells. It is also involved in synthesis of haemoglobin. Iron is essential as without it the haemoglobin can not properly transport oxygen from the lungs to our cells.

When we get a blood test for iron there are several different values measured:

• Serum iron is the amount of iron in your blood

• Serum ferritin is your store of iron. Ferritin is stored in the liver, spleen and bone marrow.

• Transferrin is a protein that transports iron

• Transferrin saturation is the percentage of transferrin that has iron bound to it

• Haemoglobin is the amount of haemoglobin in your red blood cells

Normal values:

• Iron 7-27umol/L

• Ferritin 30-300ug/L

• Transferrin 2-3.6g/L

• Transferrin saturation 13-47%

• Haemoglobin 115-165g/L

If ferritin, iron and haemoglobin are low then you are classed as having iron deficiency anaemia and will be instructed to increase iron intake through food and supplements or potentially through an iron infusion.

Sometimes iron and haemoglobin can be within normal limits, but ferritin low. This is a sign that you are becoming low in iron and you may have symptoms of fatigue and decreased performance.

Ferritin levels will rise with acute inflammation or illness, so sometimes you can get a 'false positive'. Doctors will also look at levels of Transferrin to get an accurate picture.

If your iron or ferritin levels are too low you will likely feel fatigued and weak, your physical performance will decrease, you may be dizzy or have headaches, you may have shortness of breath or increased heart rate, you may look pale.

It is recommended that adults consume 10-15mg of iron per day to maintain healthy levels- with women advised to consume closer to 15mg/day. Of this 10-15mg of iron, only 1-2mg gets absorbed and 1-2mg is lost per day through bleeding, menstruation, mucosal sloughing (shedding dead cells), skin peeling and sweating. Athletes may have higher losses than this due to increased sweating and "footstrike haemolysis" where heavy repetitive foot strikes on hard surfaces can destroy red blood cells.

Some people may not absorb iron very well, particularly if they have a gastrointestinal disorder or are taking anti-inflammatory medications. The hormone hepicidin also reduces the amount of iron in circulation and decreases the absorption of dietary iron. Hepicidin is upregulated in states of iron excess and inflammation (eg, after intense exercise). Other factors that influence iron absorption are vitamin C and animal protein, which increase absorption, whilst polyphenols and phytates (found in legumes and whole grains, tea and coffee) and calcium reduce absorption.

Dietary iron is classified as Haem iron or non haem iron. Haem iron comes from animal sources (liver, red meat, poultry, fish and eggs) and it's absorption is less affected by polyphenols, phytates and calcium. Non- haem iron comes from vegetable sources (dark leafy greens, fermented soy products, iron fortified foods) and it's absorption is generally quite low. Non- haem iron absorption can be increased by eating with vitamin C and/or haem iron sources and avoiding polyphenols, phytates and calcium around meal time.

To maximise iron absorption it is also a good idea to try to consume iron when hepicidin levels are low eg. not directly after a hard workout.

In cases of low iron it may be recommended to take oral supplementation of iron. Low doses of iron (40-80mg) on alternate days are most effective as high doses increase hepicidin and block absorption. Iron supplements are best consumed with a source of vitamin C to maximise absorption.

In some cases an IV iron infusion may be recommended, here the iron is absorbed directly into the blood.

Iron supplementation should always be taken under guidance of a medical practitioner as excess levels of iron can have serious health consequences.

It is a good idea to have your blood checked annually to monitor your iron levels. If you tend to be chronically low in iron, despite consuming adequate amounts through diet and/or supplementation, then further investigation should be undertaken to determine if there is malabsorption or other factors at play.

References:

https://journals.physiology.org/doi/full/10.1152/japplphysiol.00631.2001

https://www.qml.com.au/Portals/0/PDF/Newsletters/052_Q_May19.pdf

https://pubmed.ncbi.nlm.nih.gov/11029010/#:~:text=Absorption%20enhancing%20factors%20are%20ascorbic,on%20iron%20absorption%20is%20described.

https://ashpublications.org/blood/article/126/17/1981/34441/Oral-iron-supplements-increase-hepcidin-and

What is tendinopathy?

Tendon injury can occur from "overuse" whereby the chronic load placed on the tendon is greater than the tendon's capacity to regenerate. An overuse tendon injury is called tendinopathy and results in pain, decreased exercise tolerance and reduced function.

Tendinopathy can occur in the mid-tendon or at the end of the tendon where it inserts into the bone.

In 2009 Cook and Purdham proposed a continuum of tendon pathology (see image).

Reactive tendinopathy is an acute response to overload eg. increased volume/speed/weight/force or unaccustomed activity or a direct blow to the tendon eg. a knock or fall. The large tendon protein cells proliferate rapidly (hours to days) to thicken the tendon to reduce stress. Normally tendons adapt to load via the small protein cells proliferating causing stiffening of the tendon, which takes about 20 days.

The reactive tendon can revert back to a normal tendon if enough reduction of load and/or recovery is allowed.

Tendon dysrepair is an attempt at tendon healing with large amounts of cell breakdown. Due to the greater amount of cell activity there is increased vascularity (blood vessels to the area). This occurs in response to chronic overload. It is possible to return to a normal tendon from this state with load management and appropriate exercise to stimulate the cells to repair and reorganise.

Degenerative tendinopathy is a result of chronic overload and repeated bouts of reactive tendinopathy. The degenerative tendon has areas of cell death and loss of collagen and infiltration of vessels, there is little capacity to reverse these changes. Degenerative tendons are often weaker and can rupture if placed under high load.

Unfortunately pain is not a reliable predictor of tendon health as pain can occur at any point along the spectrum from normal to degenerative tendon and often severely degenerated tendons are pain free. Increasing load on a tendon will usually induce pain. A skilled practitioner will assess pain in conjunction with other signs of tendon health to accurately prescribe rehab exercises and loading tolerance.

Treatment:

A reactive tendon (or in early dysrepair) should be relatively unloaded to allow adaptation and return to normal health. This involves having two-three days between high load activities and avoiding eccentric or elastic loading eg. jumping and power activities. At this stage biomechanics should also be assessed to check if high loads are being put through the tendon with relatively low load activities.

Anti-inflammatories can also be used at this point (if there are no other contra-indications) as they reduce cell response. Corticosteroid injection has been shown to be of benefit in reducing tendon thickening, but it is unknown if it may cause long term changes to the tendon.

For a tendon in late stage dysrepair, or a degenerative tendon, treatment should focus on stimulating cell activity to increase protein production and reorganise the tendon structure.

Eccentric exercise is highly effective in increasing collagen structure in abnormal tendons, decreasing vascularity, improving tendon structure and decreasing pain. This process takes four-six weeks and it is acceptable to feel pain during this stage without adversely affecting the outcome.

Friction massage, extracorporeal shockwave therapy, ultrasound and surgery have all been shown to have some degree of beneficial effect. Prolotherapy- injection of blood or glucose- has been shown to stimulate cell activity in degenerated tendons. Sclerosing therapy and glyceryl trinitrate have also both been shown to be beneficial.

References:

https://bjsm.bmj.com/content/43/6/409

These tasty little treats provide a good source or protein, healthy fats, carbohydrate and fibre so they are a perfect small snack on the go or post workout. 

Recipe:

Combine all ingredients together with a spoon then shape into balls with your hands and refrigerate- easy!

1/2 cup natural peanut butter

1/4 cup honey/rice malt syrup/maple syrup

1/3 cup vanilla protein powder (I use a vegan protein powder, but whey would work too)

1/3 cup coconut flour

1/2 cup rolled oats

1 Tbsp chia seeds

1/2 tsp cinnamon

It has recently been discovered that gelatine has a protective effect to bone and connective tissue by increasing collagen synthesis in the body. In fact, studies have shown that if you consume 15g of gelatine 1 hour before a short burst of exercise that you more than double the rate of collagen synthesis and encourage tendon, ligament and bone repair.

Gelatine comes from collagen and is almost 100% protein. It has benefits on joint health, skin moisture, hair growth and nail strength, brain function and mental health, strengthens the gut wall and protects the liver.

I wanted to access the many benefits of gelatine, but I wasn't keen on the idea of buying packet jelly or gummies which are both loaded with sugar. So I decided to have a play and see if I could make my own with just fruit, water and gelatine.

These are now a staple in my fridge and I have had success with all different types of berries and with mango.

Recipe and Method:

Pour about 750g of frozen berries or mango (or experiment with other fruit) into a medium saucepan.

Cover fruit with water and bring to the boil.

Boil until fruit is soft then remove from heat.

Mash fruit into water with a fork or stick blender- it doesn't have to be fully pureed

In a separate jug/bowl/mug place 3 heaped Tbsp of good quality gelatine and mix into it 4-5 Tbsp of your fruity water mixture. Mix into a paste.

Pour the gelatine paste into your saucepan of fruity water and stir until smooth.

Pour the jelly mixture into a large pyrex dish and leave to cool on bench and then in the fridge

Once set (approx 2-3hours) cut into squares and enjoy.

This should keep for about one week in the fridge.

18th November 2020

In the couple of years before I was diagnosed with hip dysplasia I was in my peak physical condition. I was the fastest I have ever been and also had the most lean muscle that I have ever had, whilst having low (yet healthy) body fat.

I worked very hard for that with my training and diet plan to optimise my performance and body composition. 

(In my teens and early twenties I had an eating disorder and at times was very underweight, but that was an unhealthy leanness with low body fat and low muscle.)

In the last 18 months since I was diagnosed with hip dysplasia, and particularly in the last year since my first surgery, I have slowly but surely gained body fat and lost muscle mass. I no longer have an eating disorder, but I still have struggles with my body image, especially when it feels like I don't have control over my body. Naturally, it has been quite depressing to see my physical fitness and what I consider my peak body composition slip away.

Throughout most of my hip injury journey I have been very restricted with what exercise I can do and to what intensity and duration. This has not only affected my mental health, but also my calorie expenditure. Theoretically to maintain my weight, then most of the time I should have been consuming less calories than when I was in peak training. I have not been counting calories, but I am 99% sure that my energy intake has not decreased much. For me the motivation to eat a pretty strict diet has been pretty low when there has been nothing to be "in shape" for. Plus, what with not having my usual training outlets and being in lockdown for most of 2020, I have been at home a lot more than usual. I am notoriously bad for being a "picker" particularly when bored. So, although my meals have been smaller and less calorie dense than when I'm in full training, my snacks and treats have been a lot more abundant!

The positive I have taken from this is proving to myself that I am recovered from my eating disorder, as previously I did not need motivation to avoid treats or restrict my intake as I had a huge fear of calorie dense foods and a compulsion to stick to all the food rules I had made myself.

So, with that in mind, I have gone down the route of learning to accept and appreciate my changing body and it's "softer" appearance. I am choosing to acknowledge that I am going through a tough time currently- physically, mentally and emotionally- and give myself grace for relaxing some areas of my lifestyle to reduce strain. Sometimes a piece of chocolate gives me that little burst of endorphins that I miss so much and can't currently get from exercise!

I am choosing to appreciate my body for all the amazing healing and adaptation it is doing and for allowing me to lead a very physically demanding lifestyle for 30 years with a sub-optimal anatomy. I know that in order for my body to build bone and muscle I need a protein and nutrient rich diet, so I ensure I am eating plenty in the recovery period after surgeries (at least 3 months). I realise that if I were to reduce my intake at this time, I would actually be selling myself short as my body could have delayed healing and therefore delay my return to activity.

I am choosing to embrace this time as a step away from my usual strict routine and enjoy some of the indulgences that I wouldn't usually. I am accepting that I am currently in a phase of rest, recovery and adaptation and now is not the appropriate time for me to have my leanest and most muscular body composition. I have faith that that time will come again though, and I will have so much energy and motivation to do the work to get back to my peak because I have not exhausted myself now trying to chase something that is currently unattainable.

I am choosing to love myself for who I am as a person and not for what my body looks like. There is so much more to me and I have so much more to give than just a physically fit body!

This shift in my mindset has not come overnight and I have to remind myself of these things each day. Every time I look in the mirror or put on my clothes I am reminded that my body is different to how it was 18 months ago. My mind often will automatically jump to its default condescending and berating self talk and I have to consciously pull it away from that and remind myself of all the points above.

We can't always change our circumstances, but we can change our mindset.

Food has always been something I've been very interested in and as I've grown older and learnt more about optimal nutrition I have discovered how important protein is for repairing and building tissues. Whether I'm in training or recovering from an injury or illness protein plays a vital role.

I love to bake and experiment in the kitchen and I came up with this nutritious recipe to satisfy my sweet tooth and get in a good dose of protein.

In a food processor combine until smooth:

1 medium beetroot

1/2 a zucchini

1 banana

3 scoops vanilla or chocolate vegan protein powder (whey powder will not work)

1/2 cup cacao powder

1/3-1/2 cup of brown rice or buckwheat flour (to get a thick consistency)

1 egg (or 1Tbsp chia seeds plus 2Tbsp water if vegan)

pinch of salt

optional: teaspoon of chilli flakes for a kick, sprinkle of raisins for extra little bursts of sweetness and/or cacoa nibs for some crunch

Spread into a lined slice tray and cook at 180C for 20-30minutes until a skewer comes out clean.

Cool on a wire rack and then cut.