Corticosteroid Injection Side Effects for Golfers Elbow

Corticosteroid Injection Side Effects for Golfers Elbow post image

I do try to keep up with what’s going on in the medical profession when it comes to golfer’s elbow treatment and recently came across this interesting article regarding a particular case of steroid injection for golfer’s elbow. If you don’t like all the technical speak, skip straight to the last sentence which is the most important one:

Examination revealed atrophy of the skin and subcutaneous fat over the medial epicondyle causing the epicondyle to become prominent like an osseous mass (). Marked tenderness was observed over the prominent medial epicondyle by palpation.

Intraoperatively, the atrophied skin and subcutaneous fat tissue were excised from an ellipsoid incision. Two chalky, whitish deposits of corticosteroid were observed over the flexor aponeurosis. The deposits were excised. The common flexorpronator origin was partially detached by sharp dissection and reflected without disturbing the medial collateral ligament. The underlying fibrous tissue was debrided. The medial epicondyle was drilled, creating multiple bleeding small holes, and then the flexorpronator origin was reattached. The adjacent subcutaneous tissue and skin were released and brought over the epicondyle, forming good soft tissue coverage. Three years postoperatively, the patient had unlimited range of elbow motion with no epicondylar pain, and no pathologic bony prominence of the epicondyle was observed.

Although steroid injection for the conservative treatment of medial epicondylitis is an alternative method, previously reported complications of periarticular injections and the case presented here demonstrate related adverse effects or complications. Injection into the medial site of the elbow may not be as innocent as expected if appropriate injection technique is disregarded.

Now I don’t want to be a doom munger here and if you read the 150+ comments on my golfer’s elbow cure page, you’ll notice that a few people have experienced good success with steroid injections, and I realise that this article is referring to poor injection technique. However my personal view is that injections of corticosteroid for medial epicondylitis is generally a bad idea. Not just because it can go wrong, in the case of the lady above, but also because it’s just masking the pain rather than treating the cause. If you like weightlifting like I do, I think there’s a real risk of making the injury worse. After all, the pain is there to make you aware that something is wrong and needs your attention. Pain is your friend!

As if getting over golfer’s or tennis elbow wasn’t wasn’t bad enough, you have to watch out for scammers too. Take a look at this blatant scammer on Amazon selling a single elbow pain product called TenDLite LED. Why do I say this is a scam? Here’s why (figures correct at the time of writing):

  • There are 7 reviews for the product, all suspiciously 5 star with 5 of them very suspiciously submitted on the same day (20th April) with a 6th the day after (21st April).
  • Between the 7 reviewers, they have only done 12 reviews in total, an amazing 10 of them are for the TenDLite LED (3 have reviewed it twice, including a previously withdrawn TenDLite LED listing).
  • Despite the 10 impressive 5 star reviews, TenDLite as a seller has only had 4 life time purchase ratings!
  • Checking the TenDLite website “FDA Approved” is all over it, except where, in their haste to shout this from the rafters, it was misspelled as “FAD Aprooved“, along with “Strenght and flexibility“. It may be being picky, but basic spelling mistakes are fairly dodgy.

Maybe I’m being harsh, but I don’t think I’m wrong. Watch out guys and gals, not all is as it seems out there, and at the end of the day, it’s your health that’s at stake, or at least your hard earned cash anyway.

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New Book: How Wheat Wrecks Your Health

New Book: How Wheat Wrecks Your Health post image

I have far too many books in diet. Actually that’s not true. I have a lot of books on diet and health and wellness and sleeping and fish oil and such things, but there’s always room for more books! And this new book by Dr William Davis, MD: Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health ticks all the right boxes.

First off, it’s by a life long cardiologist. Someone who has spent their career fixing people’s heart disease.

Dr Davis had many heart disease risk factors himself and followed the standard advice: eat low fat and whole grains, banish meat, increase vegetable oils and take up jogging. Imagine his surprise when he gained 14kg (30 lbs), his good HDL cholesterol when down, his bad triglycerides went up, and he became diabetic.

For many people this would have been a death sentence, but fortunately the good Doctor had the sense to recognise that what your Doctor’s tell you is wrong and throw out the bad advice. He cut out all grains (wheat, barley, oats, corn etc) and quickly reversed the above trend. Even curing his diabetes! This is what he had to say about it:

“Cutting wheat products in my diet, in particular, proved the dietary turning point that reduced my appetite, accelerated weight loss, and just helped me feel clearer, more energetic and happier than I’d felt in years,”

Will society wake up to this simple diabetes cure?

Dr Davis now refers to the “low fat, high carb” period thus: “We’ve lived through 40 years of a failed experiment” I’d go further than that and say that history will record the 20th century as the dark ages of dietary advice. Not only have millions died an early death because of it, the repercussions of eating a high grain, high carb diet could well bring down the National Health Service (NHS) in the UK, just by being overwhelmed by diabetes patients alone. The question is, will society wake up to the simple diabetes cure Dr Davis found before this happens?

It’s not just wheat that’s the culprit, although it’s probably it’s ubiquity that makes it the worst grain. Interestingly Dr Davis rounds on the plethora of gluten free products that are full of all sorts of other grains: corn starch, potato starch, rice starch etc, which are just as bad. The fact is, we’re just not designed to eat these foods.

Give up wheat for a 2 week experiment

I have personally persuaded several ill people to give up wheat for 2 weeks, to see if it would clear up their Irritable Bowel Syndrome (IBS) symptoms, and without exception the experience has utterly changed their lives for the better. If you ever feel lethargic, bloated, have bad wind, diarrhoea, craps, reflux etc, then you owe it to yourself to try a 2 week experiment that could change your life.

Getting back to the book, this is definitely going on my (ever growing!) book list, even though I already know most of what it’s going to say. Good information doesn’t displace good information. It looks like my other dietary books will have some company soon!

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Exercise from Day 1 may be best after SLAP Surgery

Exercise from Day 1 may be best after SLAP Surgery post image

Mikael Kornihkov, over at the CrossFit Message Boards has posted up a really interesting medical paper that details the results of an experiment on shoulder surgery patients, to determine whether it’s best to keep the shoulder immobilised for several weeks (as per current conventional thinking) or whether you should start exercising the day after shoulder repair surgery? For those without the patience to read a full medical report, here are the highlights:

The study was on 62 patients with a subtype of SLAP lesion: arthroscopic Bankart repair using suture anchors. Specifically addressing the following research questions:

  1. does early motion increase the recurrence rate of shoulder instability, and
  2. does an accelerated rehabilitation program promote functional return and decrease morbidity?

Exercise from the day after surgery

The accelerated rehabilitation program meant coming out of the sling during the day from the day after surgery and starting exercises e.g. day 1 was Pendulum with 10deg forward leaning. The patients were evaluated at 6 weeks and a final follow up evaluation at 2.5 years (on average).

The Results

Pain
At 6 weeks after surgery, patients who underwent the accelerated rehabilitation expressed significantly less pain than patients with conventional rehabilitation (P = .013) The pain scores at the final follow-up evaluation showed no significant difference between the 2 groups (P = .855).

Range of Motion
No significant difference was seen in range of motion at the final follow-up evaluation between the 2 groups. However, patients with the accelerated rehabilitation were faster in resuming 90% of the final range of external rotation (P = .001).

patients able to return faster to the previous activity

Return to Activity
No significant difference was seen in the status of activity return between the 2 groups at the final follow-up (P = .799). However, patients with accelerated rehabilitation were able to return faster to the previous activity (P = .001).

For reference, this is the protocol for the accelerated rehabilitation program:

Phase I: Protection phase (weeks 1-5)

Day 0: Rest with a sling, sleep in a sling for 2 weeks

Day 1: Pendulum with 10° forward leaning

Day 3:

  • Submaximal isometric exercises
  • Passive range-of-motion (PROM), Active assisted range-of-motion (AAROM) exercises to tolerance: Forward elevation and internal rotation (rope & pulley/bar)

Day 7: Forward elevation to 90°

Week 2:

  • PROM and AAROM forward elevation to 90°, external rotation at side to 20°
  • Isotonic internal rotation exercises: Arm at the side initiating at neutral rotation (light rubber band)

Week 3: PROM, AAROM forward elevation to tolerance, external rotation at 30° of abduction to 20°

Week 4:

  • Permit full range of motion to tolerance, except extreme abduction and external rotation
  • Isotonic strengthening exercises for external rotation at side and forward elevation

Week 5: External rotation at 90° of abduction to tolerance

Phase II: Dynamic strengthening phase (weeks 6-12)

Weeks 6-9:

  • Continue range-of-motion exercises
  • Isotonic dumbell exercises for internal and external rotator, deltoid, supraspinatus
  • Diagonal strengthening (rubber band)

Weeks 10-12

  • Tubing exercises in 90/90 position
  • Isotonics for trunk muscles

Obviously this does not constitute medical advice, but I certainly intend on bringing this study to the attention of my Consultant and/or physiotherapist, if and when the NHS ever get their act in gear and sort out what’s happening with my shoulder!

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Burpees with a Torn Rotator Cuff, Yay Burpees!

Since I’ve returned to exercising and prehabilitating my shoulder’s torn rotator cuff by doing rotator cuff tear friendly exercises, I’ve noticed a marked improvement in my shoulder pain. No it’s not fixed, nor close to it but to be honest, if it wasn’t for wanting to exercises fully again, I reckon I could live a normal life how it is now. Most of the pain has gone and the dull aching has disappeared completely.

Whilst doing a CrossFit / SPEAR System type workout to fellow PDR Coach Chris Worrall at CrossFit Tameside, that involved Combat Squats, Half Spears, and Burpees with a medicine ball(!) I realised that it didn’t hurt as I had expected. Previously I was unable to even get into the plank position, so any form of push up was out, which meant Burpees were out too. So this week I felt confident enough to try out a slightly modified burpee in a workout to see how it went.

What I discovered is that I could do narrow stance push ups without any significant pain, so narrow stance burpees are also in then, providing I don’t do them to excess I think. So the workout I did was this:

Torn Rotator Cuff Workout 6

In x minutes, do As Many Rounds As Possible (AMRAP) of:

  • 1 Box Jump
  • 1 Burpee
  • 1 sit up
  • Each round, increase the number of each movement by 1, so on round 3, you do 3 Box Jumps then 3 Burpees etc

You can pick any time over which to do this. I’d already done heavy sets of 5x deadlifts and didn’t want to push the first time trying burpees on my shoulder, so I just did AMRAP in 6 minutes of the above.

2k row with Death By Burpees built in

Rowing doesn’t aggrevate my shoulder injury so I think I’ll be able to do a workout suggested by Tom Bold of CrossFit Bold which is a 2k row, with Death By Burpees built in, so it works like this:

  • Start the first minute by doing 1 burpee then hop on the rower and row as far as you can
  • When the minute rolls around jump off and knock out 2 burpees
  • Get back on the rower and continue from where you left off…
  • Continue in this fashion adding one burpee per minute until you’ve completed 2km or you can’t finish the burpees within the allocated minute.

It looks rough! 🙂

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Your Chance to Influence the ‘Squatters Rights’ Laws

Squatters Rights

I came across a consultation by the British government yesterday asking for people’s opinions on squatters and that current situation where the police don’t get involved because Trespass is a civil (not criminal) matter. But when your house is possessed and trashed by squatters, like Julia High’s (right) was when she went away for the weekend, it seems pretty criminal I’m sure!

The full consultation document is here, but here’s the short version. The options are:

  1. Create a new offence of squatting in buildings
  2. Expand existing offence in section 7 of the Criminal Law Act 1977
  3. Repeal or amend section 6 of the Criminal Law Act 1977
  4. Leave the criminal law unchanged but work with the enforcement authorities to improve enforcement of existing offences
  5. Do nothing: continue with existing sanctions and enforcement activity

To get involved in the decision making process and respond to the consultation with your thoughts and feelings, you just have to email this address: squatting.consultation@justice.gsi.gov.uk My personal preference is for Option 4. My reasons are explained in the response I sent yesterday:

Dear Sir / Madam,

I would like to respond to the consultation request regarding squatting. I have no particular prior experience of this and am not affiliated to any associated group or organisation. As such I perhaps represent the silent majority, from whom responses to consultations are probably rarely heard.

I’d like to start by saying that this review and consultation is long overdue. Only a very tiny minority of society condone the behaviour of squatters and their “squatters rights”, whilst an overwhelming majority consider it unbelievable that in our civilised society, you can go out for a family meal and come home to discover you’re homeless for the next few months as some squatters have decided to move in while you were gone. This is clearly not right and something that the police should feel they are empowered to resolve immediately.

As a member of the silent majority, I don’t have enough iron in the fire to answer all the questions you have asked or give answers to each proposal in turn, so will jump straight to the point and say that I prefer Option 4. Creating a new offence is overkill and is one of the things the last Labour administration was infamous for. I believe Labour created over 4000 new offences since 1997. Let’s not continue that trend.

What ordinary people want is the squatters removed by the police. Enforcing current laws should accomplish this. Even if the squatters are not charged, at least arresting and removing them accomplishes what the property owner wishes. Then it’s a matter for the CPS to press charges as appropriate, but from the moment they are in police custody, the main problem is solved. It is common sense that a squatter has committed one or more of the following criminal acts:

1) Criminal damage. Until the property owner has regained access to their property, what is broken may not be obvious. Arrest the squatters and allow the property owner to determine the extent of the criminal damage. If none is subsequently found (unlikely), so be it. The problem is still solved as the squatters have been removed. Bear in mind that criminal damage could be something as simple as a bit of dirt on the carpet or a broken blade of grass. Where someone’s property is concerned and the police are trying to find the legal hook with which to do the right thing, then the letter of the law should be used in the extreme, in order to aid the property owner and bring about a just conclusion.

2) Theft of electricity. As soon as a light is switched on, or mobile phone charged, or fridge used, electricity is being stolen. Arrest the squatters for theft, how much can be determined later.

3) Theft of gas. Using the heating or cooker is theft. Arrest the squatters for theft, how much can be determined later.

4) Theft of water. It can be safely assumed that the squatters will at least flush the toilet or get a glass of water. Arrest the squatters for theft, how much can be determined later.

5) Even if none of the above apply, how about theft of air. I own everything in my property, including the air that’s in it (I believe). If a squatter is breathing, he’s using my oxygen!

I know the last point sounds silly, but the point is that there are already lots of criminal offences that a squatter has / could have committed, certainly enough to justify an arrest, which is the aim of the property owner. Common sense should be applied and the police should enforce what 99%+ of the population would consider the “right thing to do” in the spirit of the law and natural justice. Even if there is just the allegation of theft by the property owner, then in this circumstance the police should arrest the squatters, so that they can be interviewed properly about the allegation down at the station. Again, problem solved.

Just to pick up on one last point, your consultant document paragraph 34 says: “the people inside might claim the damage occurred before they arrived at the property.” in which case benefit of the doubt should always be given to the property owner, not the squatters.

I hope that you have found my reply to be constructive.

Beat regards,

Colin McNulty

If you have any opinion on this matter, I would urge you not to leave all the responses to a vocal minority, and let the law makers know directly what you think. This is Democracy in action, what our (and others’) troops are dying for right now in foreign countries.

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My Rotator Cuff Tear Exercises & Workouts

I’ve been holding off posting an update on my torn rotator cuff (specifically the supraspinatus) as I went for an MRI and Arthrogram (MRA) 3 weeks ago and was hoping to post the result up. The National Health Service (NHS) in the UK may offer free quality care, but it’s certainly not fast! 3 weeks on and I’ve not even got the appointment through to see the Consultant for the results. 🙁

Whenever I tell people I’ve torn my rotator cuff, the first question is invariably: “What is the rotator cuff?” The rotator cuff is 4 small muscles / tendons, which form a sleeve around the shoulder joint, comprises the supraspinatus, infraspinatus, teres minor and subscapularis. A picture speaks a thousand words:

Where is the rotator cuff

Whilst I wait on the NHS however, things are improving. After I stopped sulking, started going back down the gym again and doing some focused rotator cuff exercises, my shoulder has ironically improved quite a bit. So I thought I’d post up what I’ve been doing in terms of exercises and workouts.

In terms of workouts, there are 5 CrossFit style WODs (Workouts Of the Day) that I’ve devised for which, I let pain be my guide. Basically I spent several hours down the gym and tried every exercise I could think of to see what hurt. When I had the list of shoulder painless exercises, I mixed them up and put them together. As I come up with more, I’ll post them up here too. If not otherwise stated, all workouts are timed and done as fast as safely possible.

Torn Rotator Cuff Warm Up

Glute Ham Device (GHD) Back Extension3 rounds of:

  • 200m Run
  • 10 Kettle Bell Swings (Russian style / head height only) increasing in weight through 16kg, 20kg and 24kg
  • 10 GHD (Glute Ham Device) situps
  • 10 Back Extensions (also on the Glute Ham Device)

Torn Rotator Cuff Workout 1

Lance Armstrong doing a head height Russian KettleBell Swing21-15-9 of:

  • Box Jumps
  • Sit Ups
  • Kettle Bell Swings (Russian style / head height only)

The Russian style kettle bell swing (thanks Lance!) puts hardly any load on the shoulders, as all the momentum is generated from the hips, the straight arms just guide the weight up and don’t pull it.  The American over head kettlebell swing is fine, but it’s a different swing with different goals (like the dead hang pullup vs the kipping pullup) and loads the shoulder to the point of pain with a rotator cuff tear.

If you’re not familiar with the terminology, 21-15-9 means do 3 rounds going through each exercise in turn.  In the first round do 21 of each exercise, in the second round to 15 of each exercise and in the last round just do 9 of each, so written out long hand, it looks like this:

  • 21 Box Jumps
  • 21 Sit Ups
  • 21 Kettle Bell Swings
  • 15 Box Jumps
  • 15 Sit Ups
  • 15 Kettle Bell Swings
  • 9 Box Jumps
  • 9 Sit Ups
  • 9 Kettle Bell Swings

In terms of box jump height and kettle bell weight, as with all CrossFit style workouts (and particularly if you’re rehabilitating an injury) they should be scaled to your capabilities.  For me I did 24″ box jumps, and started at 16kg kettle bell swings, but worked up to 24kg.

Torn Rotator Cuff Workout 2

5 rounds of:

  • 200m Run
  • 15 Kettle Bell Swings (Russian style / head height only)
  • 15 sit ups

Torn Rotator Cuff Workout 3

Dumb Bell Dead Lift AnimationAMRAP (As Many Rounds As Possible) in 10 minutes of:

  • 5 Dumb Bell Deadlifts
  • 5 Dumb Bell Hang Squat Cleans
  • 5 Front Squats

You could change the time here to whatever suits you best, from 5 – 20 minutes would be good.  For me, I wanted to make sure I was always able to control the dumb bells so they didn’t crash onto my shoulder during the cleans, so I went with a pair of 10kg dumbbells.  The AMRAP nature of this workout doesn’t mean that going light is any easier, it just means you do more rounds.

Those used to CrossFit will probably recognise that this is a modified Dumb Bell Bear complex, but without the Push Presses.

Torn Rotator Cuff Workout 4

21-15-9 of:

  • Kettle Bell Swings (Russian style / head height only)
  • Sit Ups
  • Lunge Walk (1 rep is one single lunge

Torn Rotator Cuff Workout 5

CrossFit Air Squat3 x Tabata of:

  • Squats
  • Sit ups
  • Kettle Bell Swings

“Tabata” means that for 20 seconds do as many reps of the assigned exercise as you can, then rest for 10 seconds. Repeat this 7 more times for a total of 8 intervals, 4 minutes total exercise (including the last 10 seconds of rest). I like to score this as a total of all the reps achieved in all 8 rounds, but officially you’re meant to score only your worst round.  For example, if you did:

  • 13 squats (in 20 seconds) then rested 10 seconds then:
  • 12 squats
  • 11 squats
  • 10 squats
  • 10 squats
  • 9 squats
  • 8 squats
  • 7 squats

Your official tabata score would be 7.  But I like to record total work, which would be 80 in this case. Watch out for swinging the air of your sore shoulder too much!

So for this workout, you do 8 intervals of squats as I’ve just described, then straight into 8 intervals of situps (with only 10 seconds rest between the last squat and the first sit up), and then 8 intervals of kettle bell swings, for a total of 12 minutes.

Again CrossFitters will recognise this as an adaptation of “Tabata This” which is the same formula but 4 Tabata rounds of squats, pushups, situps, and pullups.  For my rotator cuff tear, even push ups give me shoulder pain, and pullups are how I tore it in the first place, so they’re out.

DB Hang Squat Clean in the squat positionTorn Rotator Cuff Workout 6

Round 1:

  • 400m run
  • Then 5 rounds of the dumb bell bear complex (see Workout 3 above):
    • 5 Dumb Bell Deadlifts
    • 5 Dumb Bell Hang Squat Cleans
    • 5 Front Squats

Round 2:

  • 400m run
  • Then 4 rounds of the dumb bell bear complex (see Workout 3 above):
    • 5 Dumb Bell Deadlifts
    • 5 Dumb Bell Hang Squat Cleans
    • 5 Front Squats

Round 3:

  • 400m run
  • Then 3 rounds of the dumb bell bear complex (see Workout 3 above):
    • 5 Dumb Bell Deadlifts
    • 5 Dumb Bell Hang Squat Cleans
    • 5 Front Squats

To be clear then, you go through the bear complex a total of 12 times, so 60 Dumb Bell Deadlifts in total for example.  3 rounds is hard enough (I suggest again, that you go light on the Dumb Bells) but you could always do rounds 4 and 5, with 2 and 1 times through the bear complex respectively.

As you can see, a torn rotator cuff is a right pain (pun intended!) in terms of reducing the types of individual exercises you can do, and there’s a lot of box jumps, sit ups and kettle bell swings in there.  At some point I’ll move up to doing GHD sit ups for some of these workouts.  What’s important to me though is keeping up some strength through some range of motion, without exacerbating my injury.

I have been to see a physiotherapist about my shoulder, but for some reason I always come away underwhelmed by them.  They charge a fortune and I’m never convinced by the efficacy of what they do.  But perhaps that’s just the one’s near me!  I’m all for self learning and educating myself as to the problems, issues and treatments, as it makes me better able to understand and manage my own recovery, and I thank the stars for the internet, which enables this to happen so effortlessly in this day and age, particularly when it comes to accessing the best information from around the world.

As such I’ve spent some time researching rotator cuff injury exercises and treatments and am currently following a program put together by a specialist injury physiotherapist from Ohio.  When I’m sure I’m happy with it, I’ll post the details up here, but at the moment, things are looking good.  Combined with the workouts above, as I said at the start, my shoulder pain has diminished considerably for 90% of day to day activities.

I’d love to hear your own shoulder pain experiences or if you have any questions, please post a comment below.

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Rotator Cuff MRI Shoulder Scan & Arthrogram (MRA)

A little while ago I posted about my torn rotator cuff (PASTA lesion), well this week I went to hospital for a shoulder scan, looking for a SLAP Lesion Tear. Just to be clear about the differences here, the terms mean:

  • PASTA Tear – Partial Articular Sided Tendon Avulsions, which in terms you and I can understand, means that you’ve partially torn one of the 4 rotator cuff muscles. In my case I’ve partially torn my supraspinatus.
  • SLAP Tear – Superior Labral tear from Anterior to Posterior, which means that you’ve torn the labrum away from the bone, which is the cartilage lining on the inside of your shoulder socket.

shoulder-arthrogram-mra-slap-tearNeither of these is a good thing to have! Diagnosing the PASTA tear was relatively easily and completely painlessly done via an ultrasound. The SLAP diagnosis was done with an MRA though, which is not so pleasant. MRA stands for Magnetic Resonance Arthrogram (sometimes Magnetic Resonance Angiogram) or more succinctly can be described as MRI + contrast dye.

shoulder-arthrogram-mra-slap-tear-injection-x-rayThe basic process is, before you get the MRI scan (Magnetic Resonance Imaging) you first have a contrast die injected into your shoulder. Unlike an Angiogram where die is injected into your blood stream, for a SLAP scan the die is injected directly into your shoulder. This is NOT NICE! The procedure was done whilst under an x-ray machine and takes several minutes during which the needle is constantly in your shoulder. The dye is injected directly into the labral area as shown on the x-ray.

shoulder-arthrogram-mra-slap-tear-mri-scan-contrast-dyeThe reason for this is the doctor needs to make sure the needle is exactly in the right place in your shoulder joint so that the labrum shows up properly in the MRI scan. So after an initial local anaesthetic, he sticks the big needle and, takes an x-ray, adjusts it, takes an x-ray etc etc until it’s right. Then he injects the contrast dye, which is another unpleasant experience I could do without repeating. But it’s worth it in the end, as the MRI scan shows up the labrum very clearly.  Note that this isn’t my picture, it’s just one I found on the net, I have yet to see my own scan images.

mri-scanner-cutawayI was also a bit nervous of the MRI scan itself, as you never know really how you’re going to react to the claustrophobic environment that an MRI machine puts you in, especially as I’d never been head first into an MRI scanner before. Apparently they reckon that 10% of the population is so claustrophobic that they can’t have a tradition MRI scan (there are new walk in MRI scanners now that aim to solve this problem).

photo-of-mri-machine-cutawayThe other fear factor often cited is the noise, but personally I think it’s just the whole unknown thing, so I did some research into how MRI machines work and found it quite hard to find pictures of their innards. This one on the right shows the inside of an MRI scanner face on. Click to enlarge it to get a better view.

In the end though I was fine with the MRI scan. Sure I can see how people would get upset by it, but it’s completely safe and ultimately it was simply loud and boring. It’s amazing how many itches and twitches you find the moment someone says to you: “Please lie as still as possible!”.

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No Charges Against Man who Stabbed Burglar to Death

No Charges Against Man who Stabbed Burglar to Death post image

It’s the classic nightmare scenario: it’s nearly midnight and you’re asleep in bed at home and hear noises downstairs. You go down to investigate and are confronted by 4 masked men in your house, one armed with a machete. In the struggle that ensues one of the burglars is stabbed in the chest. His 3 accomplices drag him outside but leave him in the road as they flee. The burglar (John Bennell was his name) dies. But when the police come, they arrest you for murder!

The above story happened to Salford/Manchester man Peter Flanagan who along with his son Neil and girlfriend were all arrested, this week learned that the police would not be pressing any charges against him despite the fact that he admitted stabbing and killing 27 year old John Bennell. We’ve all heard stories of people doing what Peter Flanagan did; remember Tony Martin, the Norfolk farmer who shot and killed 16 year old Fred Barras with a shotgun when Fred and his accomplice broke into his house? Martin was originally sentenced to 10 years in prison for murder, eventually serving 3 years inside after the conviction was reduced to manslaughter on appeal.

So why did Peter Flanagan get away with killing a burglar whilst Tony Martin was charged, convicted and served time for doing the same thing (albeit with a shotgun)? It all comes down to that elusive concept of “reasonable force”. These are the words of Nazir Afzal, Chief Crown Prosecutor for the North West:

“I have today told the police of my decision that Peter Flanagan should not face any charges in connection with the death of John Bennell, an intruder who broke into his home in Salford on 22 June. John Bennell was stabbed in the chest by Mr Flanagan, and died from his injuries shortly afterwards.

“I am satisfied that Peter Flanagan acted in self-defence after being woken by noises downstairs in his house shortly before midnight. On investigating the disturbance he was confronted by intruders, one of whom was armed with a machete.

“… In a case such as this I have to ask myself whether the use of force was necessary and whether it was reasonable in the circumstances.

“People are entitled to use reasonable force in self-defence to defend themselves, their family and their property. All the evidence indicates that in the frightening circumstances that he faced, Mr Flanagan did what he honestly and instinctively believed was necessary to protect himself and his home from intruders.”

You’d be hard pressed to find many people who wouldn’t agree that Peter used reasonable force in this situation, but interestingly UK law does not actually say that you must use reasonable force, and this is where many people get confused. Here are the (paraphrased) principles that the Criminal Justice and Immigration Act 2008 says must be the case for you to successfully claim you acted in self defence, you must have:

1. Acted instinctively.
2. Feared for your safety or the safety of those around you.
3. Or be enacting a lawful arrest.
4. Used a level of force used was not excessive, in the circumstances as you believed them to be at the time.

Note point (4), somewhat counter-intuitively it’s actually ok to use excessive force, as long as you didn’t realise it was excessive at the time. Or put another way, if you genuinely believe you were using reasonable force, even if in hindsight you were mistaken and actually used excessive force, you can still successfully claim you acted in self defence. Think back to the shooting of Charles de Menezes, an innocent man who was shot 7 times in the head because the firearms officer believed he was a suicide bomber, a mistake that was only discovered later.

As it happens I think the force Peter used *was* reasonable, given that John Bennell (or one of his accomplices) was armed with a machete, and clearly the Chief Crown Prosecutor agrees. I would suggest that it was Tony Martin’s illegal shotgun, the traps he’d set in his house against burglars and the fact that he shot Fred Barras in the back as he was fleeing out the window, that probably sank his self defence claim! He clearly fails all of the above tests.

We have essentially been talking about what Tony Blauer’s Personal Defence Readiness (PDR) self defence system calls “the 3rd fight”. In any confrontation there are usually 3 fights which all affect each other:

1. You vs your own mind (are you psychologically & emotionally ready to defend yourself).
2. You vs the bad guy (the actual physical encounter).
3. You vs the legal system (often these days as caught on CCTV).

If you are worried that you can’t do this or that in a fight, because it might be seen by a court as unreasonable, that affects your ability to fight effectively. Whilst talking to my daughter just this week about how to protect herself if someone’s trying to grab her, I discussed eye gouges. “But that might blind someone!” she said. That’s a component of the 3rd fight, but if you believe you’re in a fight for your very life, there can be no limits and you must give yourself permission to do anything and everything necessary to survive.

That’s the key to a successful claim of acting in self defence; if you “believe you’re in a fight for your very life” then extreme, even fatal violence can be reasonable, as in the case of Peter Flanagan. So yes, in the UK it’s perfectly legal to pick up a knife, stabbing someone in self defence, even killing them, provided you meet the tests of acting in self defence and using reasonable force.

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>1,000 Visitors to my Blog Yesterday!

>1,000 Visitors to my Blog Yesterday! post image

It’s been tantalisingly close for some weeks now, but for the first time since starting my blog 4 years ago, I tipped over the magic 1,000 visitors mark yesterday.

The actual number was 1,103 visitors, and that doesn’t include me (I filter out my own ip address from the stats). It’s interesting that Mondays or Tuesdays are always the busiest days, then it drops off throughout the week with just over half the normal traffic at the weekend. I’m guessing it’s people bored at work who mostly visit my site then, lol!

Next stop, 10,000! 😉

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Jaycee Dugard

The astonishing story of 11 year old Jaycee Dugard’s abduction, 18 year captivity and eventual escape is so rare and so horrific that it’s been headline news throughout the world. It’s coincidental timing then that the same weekend that sees me assisting on another 2.5 day PDR self defence course with Tony Blauer, Jaycee launches her book: A Stolen Life.

I say it’s coincidental because Jaycee Dugard’s story can be instructive from a self defence perspective. Before I go into this though, it’s important to bear in mind that Jaycee’s story is extremely rare. Child abduction is typically done by a family member and it’s quite normal for the abducted child to be found unharmed. Total abduction by a complete stranger is rare, which is exactly why we get to hear about it; it’s only extreme events that make the news. It does happen though. This time last year in my own town of Stockport, there were 4 attempted abductions of young children off the street in a week! Below is a snippet of Jaycee’s interview by ABC News and there are 3 points I want you to pay particular attention to:

1) @ 3:55 Jaycee tells how the car pulled up with her abductors in (the married couple Phillip and Nancy Garrido) whilst she was walking to school. When Phillip Garrido wound down the window, Jaycee approached the car as she assumed he was looking for directions and was close enough for Phillip to stun her with a stun gun.

2) @ 5:39 It’s actually the interviewer that gives us an important fact when she says: “120 miles later the car stops in front of this house on a neighbourhood street, Garrido tells her to be quiet.”

3) Jaycee picks up the story and goes on to say: “Kidnap is ransom right? Yeah. No! Not always.”

Watch the extremely brave interview and then I’ll come back to the points I want to make:

So point (1) is fairly obvious: It should be a no brainer to teach kids not to approach too close to a car that stops by them in a street and a man (or woman) calls them over. Note I’m not saying “don’t talk to strangers”, I actually believe kids should be encouraged to talk to strangers. I know this sounds crazy but let me qualify it. Children should be allowed to talk to strangers in a safe and controlled environment, for example whilst in the company of a parent or responsible adult, and to learn from the experience.

The encounter should then be discussed afterwards with questions along the lines of: “How did that person make you feel? Were you comfortable or wary of him? Why is that? Does it follow that a nice person is also a good person?” In this way, children can be encouraged to tune into and listen to their instincts about someone, so if they ever do find themselves in a situation where they have to interact with a stranger, they are better armed and prepared to deal with the situation. In the Personal Defense Readiness (PDR) system, we teach our students the 3 I’s:

“Trust your Intuition, follow your Instincts, and you’ll make an Intelligent decision.” – Tony Blauer

Point (2) however is more profound: at the point of transitioning from the car to the house, Garrido told Jaycee to be quiet. That was his mistake and should have been a clarion call to Jaycee to potentially do the exact opposite. To be honest, knowing what I do about human psychology, sadly the chances of intervention by a passing neighbour would have been remote, but maybe shouting her name would have prompted someone to remember her struggle when the story broke on the news, who knows?

There’s no point second guessing, but there’s a very important principle here. When a bad guy tells you to do something, they are really telling you what they are afraid of and you need to hear that as an opening to do the exact opposite! If you’ve been grabbed and your attacker says: “Come quietly and you won’t get hurt.” that could be your cue to make as much noise as you can. One of the 3 things a bad guy doesn’t want is they don’t want to get caught. If you can increase the chances of that, you increase your chance of escape.

This leads nicely onto my third point, Jaycee assumed she was being kidnapped for ransom; I wonder how long it was before she realised her mistake? There are only ever 3 things a bad guy wants: your body, your property or your life. Knowing this can help you make a good decision on how to act. Jaycee guessed it was property (ransom) but sadly got it wrong, it was her body Garrido wanted. If she had realised that from the start, perhaps that would have been more ready to act on any opportunities that presented themselves.

It’s all very well me sitting here with 20:20 hindsight however and saying what Jaycee perhaps should and shouldn’t have done, but that’s not what I’m trying to do. When faced with an assault, only you know all the facts, only you know your own emotional and psychological state and so only you can decide what is possible and what is the right thing to do in a particular situation. No self defence instructor should tell you “When the bad guy does A, you do B.” because the scenario dictates everything, and that scenario includes your own mental state.

At the end of the day, as harrowing an ordeal as it was, Jaycee Dugard is alive and physically well and here to tell her story and her abductors are languishing behind bars. From a certain perspective, that can be considered as happy an ending as was possible in the circumstances. I can only admire Jaycee’s resilience and bravery in the face of what she endured and from a professional perspective, I look forward to reading her book in full.

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