Ankle OA at 26

H1985

Hi,

Apologies in advance for what will probably turn out to be quite a long post. I would really appreciate any advice anyone has to offer - not something the NHS appears to be very good at!

I had a nasty motorcycle accident when I was 21, im which I managed to shatter my tibia into several pieces and dislocate my ankle and hip. Ahh, youthful idiocy... :roll:

Seven months on crutches with an external fixator, a couple of years limping around everywhere with stabbing pain every time I took a step (kept swelling up). I recall it taking me an hour and a half to walk one and a half miles home after a night out...

I don't think it actually bothered me that much at the time, maybe because I wasn't interested in active pursuits, probably helped that it was a vast improvement over being housebound as well.

Only a few months after I got rid of the crutches I moved away from home, and due to bad lifestyle put on loads of weight (had always been a bit fat anyway). Ended up at 17+ stone at 5 foot 6. I've since had an epiphany and become a fitness freak, lost over 4 stone in the last 2 and a half years, got really into jiu jitsu, bodybuilding, airsoft (kind of like paintball, but better ) and fitness training generally. I eat very cleanly as well and drink a fraction of what I used to. And it's been the best years of my life so far by a long way. I had a sweet spot for perhaps a year, a little more, where my left leg was almost pain and weakness free from the old injury and I had believed I could train myself back to full health.

These last six months or so I've more frequently noticed my ankle bugging me, and I decided to make an appointment about it when I did a 12 mile hike on Exmoor earlier in the year (a new hobby I tried...) and the whole second half of the day was quite tiring and felt a lot of weakness and discomfort in my ankle. Was limping around for a week afterwards. The other week I ran a short distance into work when it started raining and I was just in a t-shirt and it was really painful - although I was wearing canvas shoes. When just at Christmas I ran a mile or so to catch my train lugging loads of stuff around and didn't feel any ill effects whatsoever.

I thought it was the screws that are still in my ankle causing pain and wanted to get them removed (was looking at joining the Royal Marines Reserves...haha, good one eh). Turns out I have the early stages of osteoarthritis. On the x-ray, you can barely see a few streaks of white in the joint.

That was a couple of months ago now. It hadn't really registered with me properly until recently, and then I had a few days of restless nights over the weekend and at one point felt extremely depressed and upset. Although, I feel better now. I tend to reach the "acceptance" stage of these things quite quickly...although it does seem very cruel considering my newfound love of fitness.

I still love bikes and have ridden bikes ever since I could hobble on to one again but am seriously contemplating getting rid now. No hobby is worth this.

I'm at a loss as to what to do exactly. The consultant just told me to replace my activities with swimming and cycling and discharged me. That was the end of his advice! Oh, he also said I could join the RMR if I wanted and at the moment I would probably be capable of it, but that I would destroy my ankle within a couple of years. Think I'll pass on that one.

From my own research I've since read about procedures that seem highly relevant to my situation and which weren't even mentioned to me. For example, I would seem like an ideal candidate for a tibial osteotomy since it is the misalignment of the tibia which is causing the problem in the first place. Why can't they re-fracture and re-align it and cure the problem? Then I've read things about stem cells treatment, distraction etc...SURELY it makes more sense to address the problem while it still doesn't impact my life in a huge way than wait until it's unbearable.

Then there is the question of whether the technology will advance significantly in the next couple of decades so they can restore the joint to a normal function. I've been trying to research progress in this area but not had a lot of luck finding out much.

What I really want to know is how fast it's likely to progress and whether it's possible, having caught it at an early stage, to prevent it from doing so but without giving up everything that I love.

As far as active hobbies go, I seem to have picked reasonably good ones for my situation. Fortunately I loathe running, and don't have any particular love for sports which involve constant running. Weightlifting should be fine you would hope - but I would like to know whether heavy squats and deadlifts are a good or a bad thing for my ankle?

Jiu jitsu is very intense but it's done on mats. Have noticed no ill effects from running on mats so far, unless my ankle was already playing up at that time anyway.

Airsoft is mostly walking/kneeling/standing/crawling around in heavy kit all day, with the odd bit of jogging or short sprint thrown in. Indoor sites on level ground are no real issue for me at the moment - I can feel it in my ankle by the end of the day but still seem to suffer a lot less overall than less fit people. It does affect me when playing at woodland sites (especially as the local one is basically built on the side of a hill, ridiculously steep climbs), but I think at least some of that is down to the fact that for some reason the tight fit of my hiking boots seems to make my ankle hurt in no time at all.

I've stopped doing spinning classes because the standing climbs on high resistance really seemed to aggravate the ankle. I went through a phase just recently when I was doing 3x weightlifting and 2x spin classes a week where I started getting consistent low-level pain in my ankle even at rest, and it made me grouchy. Stopped the spin classes and it went away. The weird thing is the pain often goes away when I exercise and comes back later or the next day.

I'm not weak in that side by any means. I can leg press over 150kg with just the one leg, the range of motion is *almost* as good as in my healthy ankle and it doesn't really seize up. I am slightly concerned as to whether I'm also damaging my other joints through imbalance - I used to get pain in my right hip when walking as I was favouring that side significantly. Now sometimes I notice I get pain in my right hip through doing a heavy set of squats for example.

I really, really don't want to end up in a situation where I'm in constant pain and I don't want to do what I love to do anymore because the pain puts me off. It's THAT I find depressing. At the moment, it's an irritation but I can deal with it. Am I right to think that there are options for me at this stage other than waiting for the inevitable and then getting it fused?

The consultant seemed to think I would probably need an ankle fusion by the time I was 35-40. I would of course really rather avoid that if possible. To be fair, even mid-stage osteoarthritis sounds horrendous.

Thanks again for listening.

stickywicket

Hi H1985. I'm afraid this is going to be a very short reply to your very detailed post because it's past my bedtime. The short answer is that exercise is good for arthritis as it keeps the muscles strong, the strong muscles support the joints and so there is less pain. However, the ankle is a rather complicated joint which bears all our weight and I'm not sure about the activities you list. I need to think about this and I promise I'll do that and get back to you tomorrow. Meanwhile, a warm welcome to the forum.

H1985

Hi,

Thank you, that's very kind.

Bed for me as well I think. Sleep well.

stickywicket

Hi again!

First off, my commiserations for some rotten luck which has resulted in all this but hearty congratulations for the way you are dealing with it. The fact that losing so much weight, eating and drinking healthily and exercising has brought you the best years of your life is great.

Unfortunately, it seems fairly common for osteo to set in at the site of an old injury. (I know that from being on here. My own OA is the result of many years of RA.) Although you seem to be dealing with it very well, it must have come as a shock and a big blow given your lifestyle.

When you write about your ‘consultant’ I presume you mean an orthopaedic consultant. Unfortunately (because the swimming and cycling advice he has given isn’t really what you wanted to hear), he’s probably the best person to advise you. (However, non-weight beariung exercises are always the recommended ones) I know some thoughts always crop up after consultations. Would your GP be good for a chat? Or, a physiotherapist (one who specializes in orthopaedics)?

I know nothing about tibial osteotomy and, in any case, none of us here are medically qualified so we can only give our own opinions based on our own circumstances. (I can tell you a lot about THRs and TKRs ) My guess would be that as the original accident caused damage in more than one place, this might be a factor.

The stem cell therapy is, I think, what ‘sturge’ has tried in USA. If you look back and find one of his threads you can read up on it. However, I don’t think it has helped him to date.

Will ‘the technology … advance significantly in the next couple of decades so they can restore the joint to a normal function? ‘ Who knows? It’s a possibility but I wouldn’t pin any hopes on it.

‘how fast it's likely to progress’ – again, who knows? We’re all different. Presumably, if you continue to eat well, keep your weight down and exercise sensibly – that’s the tough word – it’s likely to stay in better nick for longer.

You really need some good, professional advice about the individual hobbies. From what I know of OA I’d be surprised if weightlifting didn’t put pressure on the ankle and ju jitsi (from what I remember of my son’s days with it) does involve twisting of the ankle under some pressure. The airsoft sounds better but possibly without the jogging and sprint :roll: and, if your hiking boots hurt the ankle, it might be good to invest in some that would treat it more kindly. (An orthotist could advise on that.)

As for the matter of being not weak in that side but are you causing stress on the other joints through imbalance - this is, I’m afraid, quite likely. We all do it subconsciously.

I don’t know what your options are. I do think you need a good old natter with a professional – or maybe two. The question of your options I think has to be put to an orthopaedic specialist. As for the sporting questions – in your situation I’d be looking for a good physiotherapist who specializes in orthopaedics. Your GP might be able to sort one out or you might want to go privately. Unfortunately, we here are only the experts in sympathy and empathy but you deserve plenty of both and I hope you can sort something out that works for you.

GraceB

Hi,

firstly well done on a fantastic weight loss. You should feel proud of yourself.

i've had cartilage stem cell treatment but to my knee. It didn't work for me but that's not to say it won't work for you. If you want more info, please 'pm' me and I'd be happy to help.

I swear by cod liver oil daily - others I know take evening primrose oil.

Listen to your ankle - if something upsets it don't do it again. Talk to your GP and ask all the questions you have; if s/he can't (or won't) answer a question just keep repeating it until s/he gets fed up with you.

It's your ankle at the end of the day so you are entitled to know what's happening.

Next sugestion is something you may not like the idea of. A stick. If this is your left ankle use the stick in your right hand and vice-versa. This'll take a third of the weight off your ankle on bad days. Just think about it before you go 'oh no, I'm too young for this'.

I'm 47 and have been battling with OA since my mid-30's. I know how you feel as I've been there myself.

Take care of yourself; listen to your body and keep asking questions. Keep posting here - there's a great crowd who've been wonderfully supportive to me.

Don't let the arthritis win - you need to control it, not the other way round.

Take care,
GraceB

barbara12

Hi H1985
You do sound the sort of person that will adapt well to whatever you have to do.
Losing the weight and taking control of your life goes to shows this, you will have down times, this is what pain can do.
But I find any distraction helpful, I am 62 now but like you I went to the gym to get my weight down, and I went for over 20 years before Arthur came to visit, but I do think that all those years at the gym have kept my muscles in good order ready for the surgery I face.
Sorry I cant help with the other things, you do say you dont want to go down the ankle fusion rd, we have a few 9on here that have never regretted it, one recently is even jogging... :shock: but I do understand you not wanting it.
Now you have joined us I do hope you stay, if anything its good to talk to people that understand some of what you are going through.
Take care.

sturge8

H1985, I'm in the same situation as you but probably a little worse off. I'm 31 and have OA in my right ankle and no doubt my left too. I'm in constant pain all the time. I too want to avoid fusion and will try everything at my disposal to do so. I've had surgery, tried all sorts of so called alternative therapy and a stem cell injection. Search for my posts, i've written plenty. Better still if you want to speak to me direct, PM me your number and let me know the best time to call you. I have loads of advice, but instead of repeating myself on here, either read my posts or we can have a chat on the phone.

H1985

stickywicket wrote:

Hi again!

First off, my commiserations for some rotten luck which has resulted in all this but hearty congratulations for the way you are dealing with it. The fact that losing so much weight, eating and drinking healthily and exercising has brought you the best years of your life is great.

Thanks. All feels like it's come to a rather abrupt end rather than the upwards spiral I was planning on mind!

stickywicket wrote:

Unfortunately, it seems fairly common for osteo to set in at the site of an old injury. (I know that from being on here. My own OA is the result of many years of RA.) Although you seem to be dealing with it very well, it must have come as a shock and a big blow given your lifestyle.

To be fair, I do recall being told at the time I had my leg fixed up originally that I would have arthritis by the time I was 30. But, at the time that didn't really mean anything to me and I didn't much care either. I forgot all about it.

I've had epilepsy since I was 13 (which was very severe and robbed me of my adolescence but has been controlled for 11 years now so no impact on my life anymore) and shoulders which are prone to dislocation due to that which I'm awaiting surgery on so these frustrations are unfortunately nothing new to me. Although this one would seem to be by far the worst. I'm not even sure there's any point me going through the pain of getting my shoulders fixed now, I'm only doing it for jiu jitsu and it's not a concern unless I'm doing some sort of contact sport.

What's really infuriating is that it's caused by the misalignment of the tibia. Why on earth didn't they fix that in the first place? I can't help but feel it could have been prevented.

stickywicket wrote:

When you write about your ‘consultant’ I presume you mean an orthopaedic consultant. Unfortunately (because the swimming and cycling advice he has given isn’t really what you wanted to hear), he’s probably the best person to advise you. (However, non-weight beariung exercises are always the recommended ones) I know some thoughts always crop up after consultations. Would your GP be good for a chat? Or, a physiotherapist (one who specializes in orthopaedics)?

Yeah. I made an appointment with the orthopaedics team about getting the screws taken out of my ankle and came out being diagnosed with osteoarthritis instead. I wasn't particularly prepared for that curveball.

There's a private foot and ankle clinic down here I'm trying to sort out an appointment with. I never know who to trust though. I recall prior to having my leg operated on there were 10 doctors around my hospital bed arguing about what procedure would be best for me. Doesn't exactly fill you with confidence. Although the opinion seemed to be that I got the best outcome I could have hoped for, and the consultant said it was the worst fracture that didn't break the skin he'd ever seen. I get the distinct feeling they don't really care what happens 5-10-15 years down the line though, as long as they fix it at the time...

stickywicket wrote:

I know nothing about tibial osteotomy and, in any case, none of us here are medically qualified so we can only give our own opinions based on our own circumstances. (I can tell you a lot about THRs and TKRs ) My guess would be that as the original accident caused damage in more than one place, this might be a factor.

It doesn't seem to be a particularly common practice, and there's very little information around on the treatment of ankle OA as compared to hips and knees that I can find - but studies I've read suggest that if caught in the early to early-mid stages and malalignment corrected with osteotomy, it can prevent the progression completely and even reverse/cure the arthritis. Which based on what I've been told about what's wrong with my ankle, also makes perfect sense to me. The thing is, who do you talk to about this and would I have to go privately and pay lots of money to have it done.

I would be more than willing to do that, but it would be really good to find an expert on these things to talk to about it. I have a feeling I won't find such a person in the local medical community, it's not exactly a procedure that seems to be in vogue.

stickywicket wrote:

You really need some good, professional advice about the individual hobbies. From what I know of OA I’d be surprised if weightlifting didn’t put pressure on the ankle and ju jitsi (from what I remember of my son’s days with it) does involve twisting of the ankle under some pressure. The airsoft sounds better but possibly without the jogging and sprint :roll: and, if your hiking boots hurt the ankle, it might be good to invest in some that would treat it more kindly. (An orthotist could advise on that.)

I don’t know what your options are. I do think you need a good old natter with a professional – or maybe two. The question of your options I think has to be put to an orthopaedic specialist. As for the sporting questions – in your situation I’d be looking for a good physiotherapist who specializes in orthopaedics. Your GP might be able to sort one out or you might want to go privately. Unfortunately, we here are only the experts in sympathy and empathy but you deserve plenty of both and I hope you can sort something out that works for you.

Thanks. I'm doing my best to seek that advice out. I really appreciate your time and help so thank you. It feels like no-one even remotely understands and therefore I can't really talk to anyone about it. I've pretty much had enough of being the martyr who conquers adversity by now. I thought I'd had my share of chronic health conditions but apparently not. Ridiculous how they can make a complicated, life-ruining and life-threatening neurological disorder into a complete non-issue but they still can't really do anything to fix a simple joint. At the moment I seem to be constantly switching between wanting to fight it away and feeling like I've just had enough of life now. Until just recently I've been pretty much permanently happy, content and optimistic for the last couple of years.

GraceB wrote:

Hi,

firstly well done on a fantastic weight loss. You should feel proud of yourself.

Thanks. It has certainly been life-changing.

i've had cartilage stem cell treatment but to my knee. It didn't work for me but that's not to say it won't work for you. If you want more info, please 'pm' me and I'd be happy to help.

I swear by cod liver oil daily - others I know take evening primrose oil.

Listen to your ankle - if something upsets it don't do it again. Talk to your GP and ask all the questions you have; if s/he can't (or won't) answer a question just keep repeating it until s/he gets fed up with you.

It's your ankle at the end of the day so you are entitled to know what's happening.

Next sugestion is something you may not like the idea of. A stick. If this is your left ankle use the stick in your right hand and vice-versa. This'll take a third of the weight off your ankle on bad days. Just think about it before you go 'oh no, I'm too young for this'.

I'm 47 and have been battling with OA since my mid-30's. I know how you feel as I've been there myself.

Take care of yourself; listen to your body and keep asking questions. Keep posting here - there's a great crowd who've been wonderfully supportive to me.

Don't let the arthritis win - you need to control it, not the other way round.

Take care,
GraceB

Thank you.

To be fair, it's not really that bad at the moment that I would need to use a stick or any other form of aid. Nobody would know I had any health problems except for the fact that I moan about it! A lot of the time, I can walk around on it and it feels just as good as my other ankle. But, I'm sure it's got quite rapidly worse these last few months...every day I feel it at some point or other. Generally when I move around after being inactive for a period it feels a bit weak for a little while but goes away as I continue to walk. If I think back to a year ago, it would flare up but only if I'd really done something quite strenuous and it never occured to me at the time that it might be arthritis.

I've just started to wear trainers to walk into work and change into my work shoes when I get there because I feel them aggravating my ankle a bit to walk in them. That's something I never would have had to be concerned about a few months ago. I really don't like this trend. But I don't know how much of it is psychological either because now I know what it is.

I suppose it's ALL psychological really, I had the exact same symptoms before the diagnosis and didn't much care because I thought they were the remnants of a healing injury and not the beginning of a degenerative disease.

Can I ask what caused your OA and how rapidly it's progressed?

barbara12 wrote:

Hi H1985
You do sound the sort of person that will adapt well to whatever you have to do.
Losing the weight and taking control of your life goes to shows this, you will have down times, this is what pain can do.

Thanks for saying so. I've never had a problem shrugging off disappointments (probably how I ended up with a career in sales!), what I'm really struggling with this time is the finality of it. No cure. No escape. No trying again next time.

I find inspiration in some people. David Prowse was of course a very successful bodybuilder and he had arthritis since he was 13. I met a guy at airsoft the other day who so happened to have been in the Marines for 12 years and played squash for hours every day of the week and as a result developed OA in both knees and both hips which has been around in some form or another for the last 15 years. He can't be much older than 40, maybe younger. Apparently his doctor is on about him to get knee replacements but he's just not interested, experiences constant pain but just does what he wants to do anyway. He was running around with the best of us and you would never know he had a thing wrong with him. Still, I don't want to be in constant pain!

barbara12 wrote:

But I find any distraction helpful, I am 62 now but like you I went to the gym to get my weight down, and I went for over 20 years before Arthur came to visit, but I do think that all those years at the gym have kept my muscles in good order ready for the surgery I face.

I find being active helps my mood immeasurably. Seems to be at least a temporary solution to pretty much any problem. Hopefully you have found the same.

Sorry I cant help with the other things, you do say you dont want to go down the ankle fusion rd, we have a few 9on here that have never regretted it, one recently is even jogging... but I do understand you not wanting it.
Now you have joined us I do hope you stay, if anything its good to talk to people that understand some of what you are going through.
Take care.

I suppose logically I'm not averse to it, I just can't really believe that's what awaits me in my future - and as far as I can gather, we're not exactly talking in my old age either. See, I'm still suffering from the delusion I can stop it from reaching that stage.

It's a big shock to be suddenly battling with feelings of despair and hopelessness the likes of which I haven't felt for many years. In fact what really angers me is how so many people my age have had it so easy in life and have no problems whatsoever and they do nothing with their lives.

Thank you for your time.

sturge8 wrote:

H1985, I'm in the same situation as you but probably a little worse off. I'm 31 and have OA in my right ankle and no doubt my left too. I'm in constant pain all the time. I too want to avoid fusion and will try everything at my disposal to do so. I've had surgery, tried all sorts of so called alternative therapy and a stem cell injection. Search for my posts, i've written plenty. Better still if you want to speak to me direct, PM me your number and let me know the best time to call you. I have loads of advice, but instead of repeating myself on here, either read my posts or we can have a chat on the phone.

That sounds horrible. At the moment at least, a lot worse off I would say.

I will drop you a line at some point soon. I'm feeling slightly in recluse mode at the moment but certainly it would be good to talk. Thanks for getting in touch.

elnafinn

Hi there

I am sorry to read your story and that you have oa in your ankle as a result of the accident. OA often does start after trauma to a joint.

Before joining this forum I was under the misapprehension that oa takes a long time before it is of any great nuisance but have since learned some people have been diagnosed with oa in one joint for it to quickly deteriorate and spread to others joints which of course comes as a great shock.

I was wondering if ankle supports would help you in any way, either off the shelf or to be "made to measure" for you.

Elna x

H1985

elnafinn wrote:

Hi there

I am sorry to read your story and that you have oa in your ankle as a result of the accident. OA often does start after trauma to a joint.

Before joining this forum I was under the misapprehension that oa takes a long time before it is of any great nuisance but have since learned some people have been diagnosed with oa in one joint for it to quickly deteriorate and spread to others joints which of course comes as a great shock.

I was wondering if ankle supports would help you in any way, either off the shelf or to be "made to measure" for you.

Elna x

Hey,

That's actually something I intend to ask the foot & ankle clinic about when I finally get an appointment with them (why would a private clinic require a GP referral? Don't they want my money?!). I've used plenty of off-the-shelf neoprene supports for my shoulders and a persistent wrist sprain that just refused to heal and I've never found them to do a whole lot. Taping my wrist up was of great benefit though. I'm thinking some sort of proper brace may well help.

Thanks for your message.

stickywicket

H1985 wrote:

[
That's actually something I intend to ask the foot & ankle clinic about when I finally get an appointment with them (why would a private clinic require a GP referral? Don't they want my money?!).

It might be that they are a responsible clinic and, being aware that you have serious problems (Not just an athlete with a tweaked muscle) they want to ensure they can actually help rather than make things worse. I hope so.

elnafinn

http://www.nhs.uk/chq/Pages/892.aspx?CategoryID=68&SubCategoryID=158

Interesting .....

Elna x

H1985

Hey,

Fortunately I've got it all sorted now.

Do wish I had private healthcare mind - £165 for the consultation! I will be sure to get his expert advice on everything possible. But, in PARTICULAR, this:

http://www.healio.com/orthopedics/foot-ankle/news/online/%7B7D6A59B9-530D-450C-A7A3-535C6B0088A0%7D/Low-tibial-osteotomy-alone-proves-successful-for-ankles-with-specific-varus-type-OA

I'm at an early level of stage 2 according to the definition there (medial joint space narrowing). In my case, specifically, it's anterior medial joint space narrowing (to the front and inside). Hopefully that doesn't make any difference.

So, according to that study, I would appear to be the ideal candidate for that procedure and it looks like it could well even provide a cure. I don't know why information is so thin on the ground on this, with all my Googling I've managed to find one surgeon/clinic who actually performs this operation in Singapore, so I've dropped him an email outlining my circumstances.

We shall see...

racergirl

Hi H1985,

Sorry to hear about your woes. I broke both ankles quite badly 6 years ago in a racing car so I know how you feel. After all the metalwork was removed, I was then told I would have OA, which I now have.

After my ankles got worse earlier in the year, it was suggested that I have my ankles fused, which I would rather not do. It was suggested that I try physiotherapy first, I did put my name down for it but appointments have not been forthcoming. However I did increase the exercises I do, and on the advice of my osteopath (who I see once a month) got a wobble board. They do seem to have improved over the last few months. I also swim twice a week and do Yoga once a week. It seems to be that if I can do a small amounts of exercise regularly, even short walks & gardening keeps them from stiffening up. I also take glucoslamine, rosehip, hydralonic acid, cod liver oil and devil's claw, which hopefully help as well. I did have to start using a stick a couple of years ago, which does help and gives me confidence as my balance is not great.

I saw the consultant again last week after an MRI Scan, I was told that I am unsuitable for stem cell therapy since the OA is too advanced and i'm too young for an ankle replacement (I'm 50). So at the moment my only option is ankle fusion, but i'm going to leave it until I absolutely have to. At the moment the movement I have (which is very little) is enough to outweigh the pain I have.

Thanks for the link to a different treatment, I try keep looking for other options so it would be nice to know how you get on. Hope what I said helps.

pegleg

Hi there , I too had a motorbike crash at 23 , had a fixator fitted for 6 months and then plaster for 6 months , had skin and bone grafts to name but a few of my ops ! , I smashed my Tib and Fib plus my pelvis so was imobile for the first 6 weeks . Over the years (I'm 48 now) my ankle started to trouble me to a point (and you WILL know when you get there!) that a consultant appointment was needed , she recommended an ankle fusion and explained how good they are , so , in 2009 I had it done , and , honestly its the best thing EVER ! , no pain and I walk perfectly normally , took about 3 months from start to finish and I would, hand on heart, recommend it to anyone . Ive just had a knee replacement done now (as a result of the crash) and am recovering well . I would say walking , cycling and swimming are the best things to do , nothing high impact . Hope you find some answers from us all but thought I would add my thoughts in too xx