[Fiend]

"Go see a physio"

- booked for next Monday, ta 

I think I have strained my gracilis adductor muscle, likely at the muscle-tendon join, on the inside of my left knee. I was in a heel-hook, hauling a fair amount of weight around a roof, and heard a "clunk" which was worrying, but it didn't feel immediately terrible and I completed the move and the route, but soon realised something was a bit injured. After a bit of mild "after nearly 3 years of continuous injury, aging, weight gain, depression and my climbing going dogshit, I cannot cope with recovering from another knee injury and that's it, it's all fucking over" panic, I realised that although tender in the rear-inside of the knee (specifically just over/inside the hamstring tendon), it was mostly functional.

Further tentative climbing with supporting taping (restricting the ability to fully extend the leg - see below) confirmed this functionality (thankfully, definitely including rockovers without any pain at all, as well as most walking), and process of elimination (with help from a very geeky and injury-aware friend) suggests it's the gracilis. As far as I can tell it's not: the MCL (not the right place, plus little inwards instability), the calf (no issues with calf raises / stretches), the hamstring (no direct issues with pulling back the leg in a hamstring curl), the popletus (initially suspected but just doesn't seem right), anything inside the knee / meniscus (it's just not there).

What I suspect happened was the gracilis "twanged" over the taut hamstring as I moved through the heelhook, and this strained / stretched / abraded / partially tore it (the "clunk" didn't sound like a "pop", "snap" or "crunch" - obviously this is guesswork but I suspect a serious / full tear would be a lot more painful / debilitating). This fits with both the causal movement, but also the restrictions I have: Firstly, trying to touch my toes is definitely not feasible / too painful - I suspect this is the gracilis injury site being pulled taut over an equally taut hamstring tendon. Secondly bridging or scumming my foot out left without fully weighting it - I suspect this is the gracilis trying to do it's job of adducting the lower leg in and getting aggravated. Also a combination of both i.e. moving off the leg when fully extended.

My current plan is to wear a useless bollox knee support in general to remind me it's injured, tape up if needed for climbing (but avoid doing so in general as the taping is pretty uncomfortable), keep moving and keep using it but avoid the specific motions / stretches that aggravate it, and pretty soon start doing gentle adduction movements with my foot (just liked I'd do for the MCL tear). In time I will be looking into strengthening the knee / area around the knee in general as this is the 3rd injury to the same knee and that's quite e-fucking-nough.

Any other thoughts welcome especially "go see a physio" after I wrote that I've booked a physio for next Monday in the first damn line of this waffling post

[petejh]

Sorry about your knee. Currently 8 weeks post meniscus tear and strain of tendon insertion after twisting my foot a bit too much in a crack at Pembroke, so can relate. Same meniscus I tore in Rodellar about 13 years ago so maybe some susceptibility to re-injury in there.
‘See physio’ and ‘follow physio’s plan for rest, then mobilisation, then progressively strengthening tissues surrounding knee’. That’s about it isn’t it? 

Going in cold water made mine feel much better long after the initial ‘rest/ice’ stage. But I live next to a lake and can go in whenever, dunno if I’d have bothered otherwise. Cold bath?

[slab_happy]

My one tip is to grab some comfrey oil to massage in -- in my experience, it actually seems to speed up healing of strains, sprains and miscellaneous tweaks, as long as they're near the surface.

May sound like woo-woo but it performs on a par with diclofenac gel in studies on ankle sprains: https://pubmed.ncbi.nlm.nih.gov/16323288/

[mrjonathanr]

Have you considered buying a Performance Lettuce Plan and confining yourself to board climbing ?

Given you can climb front on now, I  expect with some assiduous rehab and patience (the tricky bit, admittedly) it’ll settle in a while.

[Nike Air]

My one tip is to grab some comfrey oil to massage in -- in my experience, it actually seems to speed up healing of strains, sprains and miscellaneous tweaks, as long as they're near the surface.

May sound like woo-woo but it performs on a par with diclofenac gel in studies on ankle sprains: https://pubmed.ncbi.nlm.nih.gov/16323288/

Totally agree with this. Worked a treat over the years for me

[slab_happy]

Going in cold water made mine feel much better long after the initial ‘rest/ice’ stage.

Fancy some more cold water therapy, Fiend? 

[chillax]

Well isn't this serendipitous! I did exactly the same thing to my right knee last week. Adductor gracilis, hurts just below the kmnee where it attaches to the tibia. Confirmed by a visit to my physio yesterday (I initially thought it was the MCL). Pulling hard on a right heel hook then a 'pop'/'clunk' happened and everything started tightening up. Have been limping ever since, but its gradually improving. 

General thoughts from physio are that its possibly going to be a bit awkward to rehab, but should be fine in 8 to 12 weeks. This winters bouldering might be fucked, but can probably start doing some indoor routes in about a month. Exercises include some light strengthening by standing on the injured leg and challenging the balance, and some upstream core stuff to rectify some imbalances/compensations happening where my core is covering for weak hip muscles.

Fingers crossed we both get out of this relatively unscathed

[Fiend]

Fancy some more cold water therapy, Fiend? 

Chillax - tweaked gracilis bros unite  I think mine sounds a fair bit milder. Good luck with yours. If I get any extra info from the physio I will post it here. Good reminder for me to dig out the wobbleboard too.

[Fiend]

Saw the physio, didn't reveal my guesstimate until I'd explained the symptoms, he suspected an adductor amongst other things, did lots of extra tests, and said gracilis too (incidentally I was doing some gentle hamstring curls at the gym and could feel tissues rubbing over the hamstring - without too much aggravation as I was taking it gently - which reinforces what could have happened in the heelhook).

He didn't give much extra / unusual information - keep using it, take it steady, drop the intensity, mix in some rehab exercises (including one legged weightless Romanian deadlifts, as well as my own suggestion of adductor machine just using my foot). The one thing he did say was keep stretching the hamstring, but since touching toes is one of the most aggravating things, do lying down hamstring stretches holding the back of my thigh and carefully extending the leg.

I've done two light indoor bouldering sessions, with it taped and without jumping off the top of the wall, and it's felt fine, maybe a bit stiff after / the next day but almost no aggravation whilst climbing apart from very occasionally pushing out on an extended leg - which I'm avoiding.

[crzylgs]

My one tip is to grab some comfrey oil to massage in -- in my experience, it actually seems to speed up healing of strains, sprains and miscellaneous tweaks, as long as they're near the surface.

May sound like woo-woo but it performs on a par with diclofenac gel in studies on ankle sprains: https://pubmed.ncbi.nlm.nih.gov/16323288/

Totally agree with this. Worked a treat over the years for me

You guys who vouched for the Comfrey Oil/Ointment any particular brands you'd suggest? I'm down for giving it a try but after some brief Googling there doesn't seem to be much precise information regarding the amount of Comfrey in many of the products. For example listing ingredients as: Sunflower Oil, Comfrey leaf. With no percentages or quantities involved. This makes buying with confidence quite tricky...

[Fiend]

I just got a bog standard one from Holland & Barrett, as I figured it was fairly supplementary compared reducing intensity, keeping moving, avoiding aggravation, doing re-strengthening exercises etc.

Oh, one more thing, the physio recommended unilateral / asymmetric leg exercises as part of better knee strengthening.

[Nike Air]

We actually grow our own and harvest it year round to make a comfrey poultice when we need it. A pal just bought the oil  off of the Amazon and seem to find whatever he got super helpful for his cankle injury.

[slab_happy]

My one tip is to grab some comfrey oil to massage in -- in my experience, it actually seems to speed up healing of strains, sprains and miscellaneous tweaks, as long as they're near the surface.

May sound like woo-woo but it performs on a par with diclofenac gel in studies on ankle sprains: https://pubmed.ncbi.nlm.nih.gov/16323288/

Totally agree with this. Worked a treat over the years for me

You guys who vouched for the Comfrey Oil/Ointment any particular brands you'd suggest? I'm down for giving it a try but after some brief Googling there doesn't seem to be much precise information regarding the amount of Comfrey in many of the products. For example listing ingredients as: Sunflower Oil, Comfrey leaf. With no percentages or quantities involved. This makes buying with confidence quite tricky...

Neal's Yard used to do a good one but they don't seem to any more. But yeah, wouldn't stress too much, they're all likely to be much of a muchness. Bog standard Holland & Barrett one's likely to be as good as any.

[petejh]

Thought I'd mention this here as it's the most recent 'help my xyz soft tissue injury' thread.

In an effort to improve healing of my torn meniscus, which is taking an age to improve ( 9 weeks, and re-twanged it last week), I'm seeing if boosting HGH using intermittent fasting 2 days per week, with compound weights exercises in a fasted state, may help along the healing process. Weights unrelated to knee specific strengthening - just normal compound stuff like chest/back. n=1 and I've only just started.

Wondered if anyone else on here has used this method to potentially aid healing?

[sidewinder]

I haven't, but I have some minor torn meniscus (historical) and my understanding is that some parts of meniscus don't have any blood supply so 'cant' fully heal. As such can either be surgery or (as in my case) live with it/try not to aggravate it/try and make sure surround musculature is strong to assist. Thought I would mention in case you weren't aware of this (depressing) option.

[cheque]

intermittent fasting 2 days per week, with compound weights exercises in a fasted state

I’ve never done it deliberately but my experience of exercising in a fasted state is that it’s a handy shortcut to getting ill.

[petejh]

It's a well-known method to get a significant boost of HGH, which is well-known to aid healing. Loads of studies.

You're right that it's possible to over-exercise in a fasted state for too many days, weeks, months to a point that it harms not helps. But this isn't that.  You break the fast immediately following exercise and don't do it more than 2 times per week - even once a week provides a good boost.

[Fiend]

Thought I'd mention this here as it's the most recent 'help my xyz soft tissue injury' thread.

I can start another one if you need??

I did a small "evening meal skipping / late breakfast" fast last Wednesday night / Thu morning. I ended up feeling a bit queasy, had no energy, my manflu came back, and I had a spike of depression for a couple of days.

[petejh]

That's the spirit - what could possibly go right? 

[duncan]

I haven't, but I have some minor torn meniscus (historical) and my understanding is that some parts of meniscus don't have any blood supply so 'cant' fully heal. As such can either be surgery or (as in my case) live with it/try not to aggravate it/try and make sure surround musculature is strong to assist. Thought I would mention in case you weren't aware of this (depressing) option.

You do hear a lot of people say this but unable to heal is putting it a bit negatively but it will be slow. Meniscus has a poor blood supply (as do other forms of cartilage). It receives nutrition via imbibition: compressing and relaxing the tissue pumps synovial fluid through it, like squeezing and letting go a sponge in the bath. Exercise, particularly weight-bearing, probably encourages this process.

I have no idea whether increasing HGH speeds up this process or whether increase in HGH (if any) through diet manipulation is in a clinically important range. I'd be interested in what the original research says as, often, this is not always what the gurus say it says (not aimed at you Pete).

I get variable results from brief fasts: sometimes I feel good and have lots of energy, other times I feel tired, hungry and grumpy.   

[slab_happy]

Thought I'd mention this here as it's the most recent 'help my xyz soft tissue injury' thread.

I can start another one if you need??

I did a small "evening meal skipping / late breakfast" fast last Wednesday night / Thu morning. I ended up feeling a bit queasy, had no energy, my manflu came back, and I had a spike of depression for a couple of days.

Yeah, fasting's a physiological stressor, so the idea is that the right dose you get a hormetic effect.

But from what I've read it's often recommended that you only play with fasting if you're currently in a good (unstressed, well-rested, broadly healthy) state. If you're already experiencing a lot of physiological stress, then adding more on top will not have a beneficial effect.

[petejh]

I have no idea whether increasing HGH speeds up this process or whether increase in HGH (if any) through diet manipulation is in a clinically important range. I'd be interested in what the original research says as, often, this is not always what the gurus say it says (not aimed at you Pete).

I get variable results from brief fasts: sometimes I feel good and have lots of energy, other times I feel tired, hungry and grumpy.

These are some of the studies I've been reading:
Fasting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC329619/pdf/jcinvest00482-0014.pdf

Weights: https://pubmed.ncbi.nlm.nih.gov/8550252/

Exercise (not weights) & Fasting: https://academic.oup.com/jcem/article/95/9/E64/2835165


Basic premise: a 24hr fast produces an increase in HGH secretion compared to fed state. Weight training or resistance exercise shows an increase in HGH secretion compared to base state.
Combined weight training and short fast (I'm using 16hr, twice per week) may show increased HGH again, but this is isn't clear. I've not seen evidence of harm to healthy people of combining shorts fasts with weight training. But I haven't looked very hard.

One of the discussions mentions that measuring base levels of HGH secretion in the fed state may not be measuring a 'true' 24hr bodily rhythm of HGH secretion, because a 'fed state' isn't typical of the state in which the human body evolved to perform. Being in a perpetual 'fed state' is very a recent phenomena and its possible this blunts a body's natural HGH 24hr cycle.
Similar to how being physically inactive for prolonged periods isn't the environment in which the body is designed to operate. Lots of conjecture.

Interested to hear other's experience/opinions.

My knee's feeling better since I started weight workouts in a fasted state a week ago, but that's probably just doctor time

[Johnny Brown]

Struggling to follow this. Is HGH human growth hormone? What is GHG? Not greenhouse gas?

[petejh]

You could have scrolled back to the earlier posts? HGH not GHG, my typo's.

[Johnny Brown]

I did, and just have done again. Can't find it longhand. Then I googled it. Your typo's what?

[User deactivated.]

From my reading, natural interventions to boost HGH (testosterone is also a common one) seem to be short lived; an initial spike followed by the body trying to achieve homeostasis. If you want high GH levels that are more likely to be clinically effective, have you considered injecting it? (if it can be acquired legally) I'm not recommending it as I have no idea what the risks are but it will obviously be a more effective way to raise HGH if that is your objective.

No idea if it will be helpful for your particular knee issue, but if you can ignore the silly name, 'knees over toes guy' on YouTube seems to be the place to go for advice on working towards healthy knees. Many people have allegedly avoided surgery by doing the things he recommends.

[petejh]

Thanks for the link I'll look him up. I'm defo not considering injecting HGH! I'm more interested in understanding if this is something that can be improved through lifestyle.

[petejh]

From my reading, natural interventions to boost HGH (testosterone is also a common one) seem to be short lived; an initial spike followed by the body trying to achieve homeostasis.

Just to go back to this. This was my understanding too - a short-lived spike in hormone following stressor (exercise, fasting, physical attack etc.).

However this study suggests that fasting might change the duration of an increase in HGH levels (and associated signalers). Look at fig 1 B, for comparison between exercise and fasting on HGH levels. Discussion in the study reports increased area under the curve for HGH in the fasting state, in other words a more prolonged low-level release of HGH, leading to cumulatively higher levels of HGH versus 'just exercise'.
https://academic.oup.com/jcem/article/95/9/E64/2835165

''We found that exercise induces distinct GH bursts after 30 min followed by increased STAT5b phosphorylation after 90 min and increased IGF-I mRNA expression after 270 min. This sequence is in full accordance with studies showing that exogenous GH administration leads to rapid initial STAT5 activation followed by IGF mRNA after some hours (9, 10, 15). Recently one study (14) has shown increased STAT5 phosphorylation 30 min after exercise in humans. The study, however, did not include a control situation without exercise, and it is uncertain whether a needle biopsy per se may increase stress hormone levels (16).

Fasting is characterized by complex enhancement of GH pulse frequency and amplitude and decreased blood concentrations of IGF-I (11). Our design did not capture distinct synchronous GH bursts in the eight individuals studied, so it is not surprising that we only observed a tendency toward increased STAT5 phosphorylation. In addition to the ups and downs of disorderly GH secretion, increased levels of FFAs may inhibit STAT5 phosphorylation (17). It is all the more striking that IGF-I mRNA expression in muscle remained elevated in both biopsies after 72 h of fasting, and the expression may be addressed to the overall elevated GH level. Data on GH signal transduction during fasting are sparse. One study has shown decreased STAT5 phosphorylation after a GH bolus during fasting (13), but the study did not include direct assessment of the effects of fasting, and the finding of decreased GH activation of STAT5 could relate to FFA inhibition of phosphorylation (17).''

[Fiend]

''We found that exercise induces distinct GH bursts after 30 min followed by increased STAT5b phosphorylation after 90 min and increased IGF-I mRNA expression after 270 min. This sequence is in full accordance with studies showing that exogenous GH administration leads to rapid initial STAT5 activation followed by IGF mRNA after some hours (9, 10, 15). Recently one study (14) has shown increased STAT5 phosphorylation 30 min after exercise in humans. The study, however, did not include a control situation without exercise, and it is uncertain whether a needle biopsy per se may increase stress hormone levels (16).

Fasting is characterized by complex enhancement of GH pulse frequency and amplitude and decreased blood concentrations of IGF-I (11). Our design did not capture distinct synchronous GH bursts in the eight individuals studied, so it is not surprising that we only observed a tendency toward increased STAT5 phosphorylation. In addition to the ups and downs of disorderly GH secretion, increased levels of FFAs may inhibit STAT5 phosphorylation (17). It is all the more striking that IGF-I mRNA expression in muscle remained elevated in both biopsies after 72 h of fasting, and the expression may be addressed to the overall elevated GH level. Data on GH signal transduction during fasting are sparse. One study has shown decreased STAT5 phosphorylation after a GH bolus during fasting (13), but the study did not include direct assessment of the effects of fasting, and the finding of decreased GH activation of STAT5 could relate to FFA inhibition of phosphorylation (17).''

Yup, I still have to avoid heelhooks.

[chillax]

Yup, I still have to avoid heelhooks.

Me too. Mines eased off loads though. Can walk/climb/boulder fine as long as I don't do right heel hooks, and can't quite run yet. I'm sure some of the physio stuff went towards recovery, but reckon the majority was just time/rest. Feels like I took ages off, but was only about a month. Time perception is weird. Hope yours is feeling good Fiend

[mrjonathanr]

It is all the more striking that IGF-I mRNA expression in muscle remained elevated in both biopsies after 72h if fasting, may be addressed to the overall elevated GH level.

Are you planning to eat nothing for 3 days at a time to fix your knee? Seems quite an unorthodox strategy for tissue repair tbh

[petejh]

Is that a serious question? I'm assuming not but you never know.

[mrjonathanr]

Well not exactly, but reading your quote (I didn't dive into the linked article) the measurable improvement after a 3 day fast seemed a bit irrelevant to likely real world scenarios. Maybe I missed something?

I totally get why anything that might shift the dial is worth considering when you're injured btw, injuries utterly suck.

[petejh]

You missed that it's something I'm doing 1 - 2 times per week (for 16hrs)*.


* I didn't mention the 16hrs bit, although I didn't think I needed to.

[mrjonathanr]

Well if impact correlates with time 
Good luck with it, let us know if you think it helps.

[Duma]

Not sure most people would think of missing breakfast once or twice a week as fasting, I do that by accident most weeks!

[Fultonius]

Not sure most people would think of missing breakfast once or twice a week as fasting, I do that by accident most weeks!

I guess terminology has changed. There seems to be mounting evidence that giving your digestive system a long break can have various benefits, and a longer break can just be from 7pm to 10am, but extending to midday might be even better.

I mean, we all fast every night and break that fast in the morning. Breakfast, the most I important meal of the day, but only partaken by 1/3* of the world's population.

*or some other low percentage that I can't be bothered to look up. And it's actually incorrect since by the definition of "breakfast", EVERYONE eats breakfast, just at different times.

[petejh]

Not sure most people would think of missing breakfast once or twice a week as fasting, I do that by accident most weeks!

Very droll. Yeah it doesn't sound like much does it.

However that isn't exactly how it goes - the idea is you have a feeding window of 8hrs, then a 'fast' for 16hrs, followed by workout, followed by a day of 800 calories, then back to normal.

edit: and what Fultonius said. There's plenty of research out there on the various benefits of giving your digestive system a longer break (either with or without occasionally lower calories) than is nowadays typical in a western lifestyle. 

[petejh]

No idea if it will be helpful for your particular knee issue, but if you can ignore the silly name, 'knees over toes guy' on YouTube seems to be the place to go for advice on working towards healthy knees. Many people have allegedly avoided surgery by doing the things he recommends.

Just to follow-up on this.. Have been following the 'rehab your fucked knee' protocol from 'kneesovertoesguy' for 3 weeks. Good shout! I've been trying to get out every other day walking backwards up the steep hill by my house (steep enough that I guess it's not too far off the effort of the weighted sled pull), tib raises and lunge squats. The exercises feel like they really work the right structures in the knee and hopefully get the fluids in and out of the areas. My knee is defo feeling better whether due to Dr time or Dr walking uphill backwards.