The Awesome Things Helping Me Regenerate Knee Cartilage, Avoid Surgery and Snowboard a Whole Lot

Branko Kral

Mammoth Lakes, California, United States

I love mountain sports. They energize, inspire, and motivate me—highly so. But sadly, I’ve become a regular patient at the orthopedic clinic. A renowned surgeon told me I need surgery on my right knee. As well as the left knee. And I trust the guy—yet, joint surgery is profoundly terrible. I know first-hand, I’ve been through it five times. Instead, I decided to see what I can do to stay active and put my back into knee cartilage regeneration through holistic and modern procedures and habits.

 

It’s worked very well. I’ve recently been doing 40-60 days of snowboarding a winter, learned new rotations, skinned up big mountains, entered amateur downhill bike races, and picked up biking down big mountain lines. I can trampoline again, and run as fast as ever. I’ve carried a friend’s 30lb backpack (put on top of my own 45lb backpack) for most of a 13-mile trek, two days after a 19-mile trek, in the Eastern Sierra.

 

 

Thrilled about where I’m at, I’d like to share what I’ve learned. I want to help you avoid the mistakes I made and take advantage of holistic and modern knowledge I’ve gained so you can sustain your athletic activity for years on years.

 

The Fall From Mountain Sports Bliss

Mountains and mountain sports have always been where I find my flow state and build my drive. In my teen years, I’d be gone biking for hours at a time, finding shortcuts in the woods around our Eastern Slovakia home. In the same green, forested, rolling hills, I learned snowboarding in knee deep powder. During college, I passed two snowboard instructor certificates, a CPR class, an avalanche safety class. I’ve lived in the mountain sports hubs of British Columbia, Scotland, Norway, French Alps, Colorado, and now California.

 

In terms of measurable achievements, I’ve had the honor to be a downhill bike instructor in Mammoth, one of the best bike parks in the US. That experience gave me the blissful opportunity to report back to my dad that people will pay me to do this. I’ve won a pull-up contest on my day five at Burning Man.

 

I also came second in a plank contest at the Pohoda Festival in Slovakia. I’m more flexible than most and very comfortable upside down. I’ve been in finals and on podiums in amateur snowboard and bike contests. I’ve guided people in the backcountry, trained corks on trampolines. I can comfortably walk on a slackline, backward. I am ambidextrous with both hands and feet.

 

The Awesome Things Helping Me Regenerate Knee Cartilage, Avoid Surgery and Snowboard a Whole Lot - Fitness, knee injuries, injury, skiing, snowboarding, rehabilitation, physical therapy, surgery, knee surgery, cartilage

 

Now I live in the breathtaking Mammoth Lakes, CA, and work on my marketing analytics company. The major part of the motivation to work online was to be able to have a great professional life in a mountain town where I can continue my pursuits.

 

Life is great when you get to a fair level in mountain sports. They fulfill you, provide hours in the meditative state of flow, give you lessons about fear and growth you get to apply in everyday life, bring you to unique friends and places. Yet, it’s not just high-five’s and Instagram likes every day. Almost everybody I know who does this long term has been through sports injuries and surgeries.

 

I was not always very coordinated, definitely not in my teens and early twenties. Neither did I always know enough to make my own educated decisions about health. As a result, I have a horizontal tear in the medial meniscus of my left knee. The big problem, though, is the right knee. It doesn’t have an ACL or the medial meniscus, it does have a hole in condyle cartilage.

 

In the fall of 2017, the surgeon told me I need surgery 1 to try and stitch together the meniscus in the left knee. They also want to do surgery 2 (ACL reconstruction, meniscus transplant from a cadaver, condyle cartilage transplant from a cadaver). Surgery 1 is mellow. Surgery 2 has of some 10 intensive months of recovery, then a risk of reinjury for up to 2 years. More than that, the procedure can’t be planned for a specific date and the process is fairly morbid.

 

 

Frozen menisci are held in stock and can wait for your day of transplant. For condyle cartilage, it’s harder than that. Typically, a teenager needs to pass in a car accident. So, once you put your name on the list, you may get a phone call in a few days. Or in several months.

 

When they finally call, they’ll ask you if you’re ready to go under next week. When you say yes, life changes drastically for a while. Knowing that a deep focus on rehabilitation routines is a major factor of successful recovery, this is not ideal. It is equally not ideal to introduce myself with “Hi, I’m Branko. And a little bit of Johny.”

 

Stacked Up Problems

The story of getting to this point is one of progressive degeneration and a series of poor decisions. It started during a night-skiing session in December 2009. Last-minute, I changed my mind and decided to dodge a rail. Launching to the side, I flew onto flat ice.

 

My landing posture was solid, but the impact was too much. It felt like the knee was going to come out, and as I later found out, I made myself a partial ACL tear. Getting drunk for New Year’s that night and carrying a buddy up and down stairs didn’t help.

 

A partial ACL tear is a minor injury, but I didn’t know enough at the time. Worse yet, the ER doctor misdiagnosed it as a knee sprain and said I should just give it a break for a month. Knee sprain, oh no. Beware that it is a vague diagnosis that doesn’t determine anything. The partial tear that I actually had requires doing mild exercise for strength, stability, and blood flow, as well as avoiding twisting under pressure.

 

You do not just want to give a partial ACL tear a rest. So when I resumed activity, I kept tearing the ACL further. It would snap during controlled moves such as pushing off the chairlift or dancing. I would collapse to the ground every time; it was like snapping a guitar string that’s keeping you upright.

 

The Awesome Things Helping Me Regenerate Knee Cartilage, Avoid Surgery and Snowboard a Whole Lot - Fitness, knee injuries, injury, skiing, snowboarding, rehabilitation, physical therapy, surgery, knee surgery, cartilage

 

One year after the first crash, December 2010, we went snowboarding on a powder day and I hit a pillow of fresh snow. It brought me to halt instantly. The weak, misdiagnosed, and mistreated knee gave out. The ACL finally tore completely and took the medial meniscus with it, too.

 

The ER doctor I saw once they drove me off the hill probably had a fake MD. He told me it was only a torn ACL. It should’ve been clear to her that when I can’t either bend or straighten my knee, something is very wrong with the meniscus. By the time I saw another doctor three days later, the meniscus had died off and couldn’t be stitched together anymore.

 

As they were going to operate on me for the first time in my life, they told me they wouldn’t do ACL reconstruction because the recovery time for that is too long. Overwhelmed and on pain killers, I thought to trust a surgeon is always a good idea, so I said OK. They removed the ACL as well as the meniscus. This was the last time I went to a doctor thinking that showing up at the clinic is all I need to do to get good care.

 

The missing parts in my right knee cause instability. That leads to higher than normal wear. For me, it’s resulted in a deficiency in condyle cartilage. Through compensation during strenuous activity, the left knee joined my laundry list of conditions and developed a horizontal meniscus tear.

 

Please don’t get me wrong. If I’m mad at anyone for the knee issues, it’s with myself and nobody else. I have high respect for orthopedic surgeons. I’m now very familiar with their work and it is indeed some of the hardest vocations one can choose.

 

Beyond that, their work sometimes solves problems that no other procedures can solve. The lesson is not to avoid surgery at all times. It is to make your own decisions about how to use surgery as one of the ways to solve or help a problem, instead of viewing it as a magic wand.

 

There’s also the fact that if I engaged in lower risk activities, I would not have to deal with sports injuries as much to start with. That’s valid. The point I’m making is rather that no matter what you do to yourself, you’ll have a more successful and faster recovery if you seek out a variety of diagnostics if you take ownership over your healthcare decisions.

 

1. Variety in Diagnostics

Healthcare professionals have great opinions—qualified opinions based on rigorous education and hands-on experience. But it’s still just that, opinions. No less, no more. Further, a diagnosis is just an estimate of what’s going on.

 

An experienced surgeon will tell you that they only know for sure what’s going on once they’re under the skin. I once had a rear and front labrum tear of the shoulder, but the MRI only helped discover the front one. My mom once had torn wrist tendons, but the imaging only helped discover the fracture.

 

Getting a variety of diagnoses is the best way to get the full picture. For a busted hand, I got opinions from a GP, a hand surgeon, an acupuncturist, two chiropractors, two occupational therapists, and one physical therapist. Two of them misdiagnosed me; each of them helped inform one of the stages of my healing process.

 

This leads to a lesson I’ve learned in my marketing analytics work—knowing the finding is less important than knowing how the finding was drawn. With that approach, even if you get a misdiagnosis, you dig into the factors that lead to it and end up learning a lot about the condition.

 

For my knees, I went overboard, and I’m happy I’ve done so. I got opinions from the same list as for my hand, plus two more surgeons, one stem cell doctor, and two pro athletes who’ve had similar injuries. All of the opinions were very useful. The result is not one 100% clear recommendation for how to take care of my knees. Better yet, the result is a list of things I can try and a comprehensive set of options with their respective probable outcomes.

 

2. Know Success Factors

Whatever procedure you’re recommended, become closely familiar with the success factors. Then compare those with what the doctors are telling you and consider how well you’re able to control them.

 

For a knee, for instance, you need stability. If I had an ACL reconstruction, but no meniscus and deficient cartilage, the ligament would likely tear again.

 

3. Research Autologous Stem Cell Therapy

Stem cells are what repairs our body. When you have a cut, stem cells are what comes to the rescue to repair the wound. But they have a hard time accessing joints. Modern medicine has figured out a way to do a 3-hour procedure where a doctor harvests stem cells from your own bone marrow and fat, adds growth factors from your blood, and injects the stem cell formula into your knee (or other joint).

 

You then need to take a month of a break from activity that involves impact or twisting, i.e. compression. Anesthesia is local and you can return to work the next day. You can keep up your non-impact exercises.

 

I’ve had this done at a stem cell clinic in Colorado that I’ve known about for years. I went in January 2018 and took 6 weeks off snowboarding. Then I went again in April 2018 and took three weeks off snowboarding. I continued with yoga, swimming, bike commuting, and weightlifting throughout the breaks. Contrary to surgery, I thus returned to snowboarding stronger and more confident. That’s an amazing process.

 

Patients have avoided knee replacements this way, so yes, you can expect a lot. But don’t expect miracles or another solve-all. I went in for a new MRI nine months after the first stem cell procedure, in October 2018. All the deficiencies still looked the same. But my symptoms, my pain and discomfort and decreased range of motion, diminished rapidly right after the procedures and remained that way until now.

 

4. Meditation and Visualization

Meditation has helped me slow down, focus better during both sports and work, be more present, and understand the body’s energy flow better. I now do quick sessions to wake up or to put myself to bed. I also do occasional long sessions—those were highly effective for me in pain relief during surgery recovery. Then, I try to focus on the flow and meditate by clearing my head completely during yoga and swimming. Audible and Calm have been very helpful in guided content.

 

Visualization, to me, is a form of meditation. I won’t be telling you that you’ll experience major improvements from this alone—instances of that may have been anecdotal and definitely require a high level of meditation skills. But, visualization via visual and healing imagery is very effective in making you believe in getting there. It also helps you learn to work with your energy flow and to send healing sensations into your injured body part.

 

I find it easiest to visualize healing when I’m actually doing something physical that’s healing, too. I visualize during acupuncture sessions and when applying ointments and creams. Of the latter, the most effective ones have been those with THC or comfrey, as well as the phenomenal pain relief cream by The Feel Good Lab.

 

5. Acupuncture

I swear by this one. Maybe it’s the blood flow it supports, maybe the depth of relaxation it fosters. Acupuncture can be very effective at helping your body heal itself. I do it every other week if I’m hurting and once a month if I just want to maintain a healthy status of a deficient joint.

 

6. Chiropractic and Massage

Body alignment is key. If you have knots, misplaced little bones, uneven gait, or misaligned spine, your knees and the tissue that surrounds them may heal in ways that promote harmful compensation or that make problems resurface later. It is important to remember that your body is one machine, and every part of it that’s off will throw off the rest, too.

 

I get a chiro adjustment or a long massage session once a month. My favorite chiropractor is a skilled climber and backcountry skier. My favorite massage therapists know a combination of massage techniques, along with cupping. They’re both great at evaluating my body and picking the right technique to establish balance.

 

7. Kinesiology Taping

The tape is magical. Its texture stimulates muscle fiber and blood flow, and its tension works like scaffolding that fosters stability without causing atrophy. I’ve used a complex pattern instead of my custom carbon knee brace and it was actually better than the brace. On a regular basis, I use simple taping patterns for taking pressure off the knees during impact.

 

8. Mindset Shift

First of all, I realized I used to jump through unreasonable hoops. Now, inspired by Mark Manson’s articles and book about what to (not) care about, I’m much pickier about the challenges I pursue. I want long seasons instead of intense seasons.

 

I want to be active year round instead of going through frequent downtime after or during winters that wear out my body. I am very conscious about what I want, I even write it down. In snowboarding, I clearly set my priorities on jumps and backcountry lines, so snowboarding where I rarely ever get beat up.

 

Second, I’ve understood Lincoln’s quote “folks are usually about as happy as they make up their minds to be” (unless it was said by another wise person). You tend to be as healthy and strong as you decide. I have friends who’ve had identical injuries, yet vastly different recovery results from each other. If you make it an important goal to be back to your favorite sport, you’ll most likely be there. This doesn’t imply it’ll be easy, but it’ll indeed be simple.

 

Third, a lesson from a rafting guide friend. Healing yourself can get intense. It grows into somewhat of a hobby and it’s rewarding when it goes well. Therefore, it’s important to set my mind on wanting to be done with the process.

 

For me that meant making a plan for when I’ll be done working on my knees. I now treat my knees well by default, but I also want to treat them as normal knees eventually. Not as deficient knees forever. I have a clear idea in my head for what is enough to call this project done, along with tentative dates based on experience.

 

9. Regenerative Sports

The Awesome Things Helping Me Regenerate Knee Cartilage, Avoid Surgery and Snowboard a Whole Lot - Fitness, knee injuries, injury, skiing, snowboarding, rehabilitation, physical therapy, surgery, knee surgery, cartilage

 

Lift-based snowboarding is super fun. So is lift-based downhill biking. The amount of lines and the progress one can make in a day is tremendous. You couldn’t learn this much downhill technique if you were to hike it all yourself. But the potential energy you build by taking lifts, the energy your body then has to absorb, is ludicrous. It’s far too much for you body to handle long term.

 

For every three to four days of snowboarding or downhill biking, I’ll do one swimming and one yoga session. Both provide the stretching and core strength you need for protecting your joints. Then, for every one day of lift-based snowboarding or downhill biking, I do one day of hiking or pedaling my own lines. This strengthens the same muscle groups and ligaments as those you need for the downhill part. It also creates balance and pumps synovial fluid through the knees like there’s no tomorrow.

 

Straight-up balance sports deserve their own shout-out. Put an Indo Board in your living room and you’ll have a blast when your friends come over. Put inflatable discs or an easy balance board in front of your standing desk at work. Stand on one foot when brushing your teeth. Take your date slacklining in the park or paddleboarding on a lake—besides a mad amount of points, you’ll gain strength, dexterity, and confidence.

 

10. Wholesome Supplements

For what you can take in pill form, I’ve read great things about MSM and chondroitin. But I prefer natural, whole alternatives. My rule of thumb is that our grandma knew it all already. Biohacking via Kion by Ben Greenfield’s Kion is a great resource, too. I make my morning mixes with ingredients such as molasses, ground flax seed, turmeric with pepper, collagen, ashwagandha, or fish oil. Pick your favorite(s), stick with it for a few months at a time, switch it up, keep going.

 

Much of the above, as well as the fasting and cold-hot routines described below, targets inflammation. On the contrary, sugar and alcohol support inflammation. Don’t do that to yourself. As hard as it may be to cut out the two completely, reducing them significantly is easy. Change your drinking from casual to purely occasional, it’s one of the worst drugs out there, anyway.

 

11. Fasting and Time Restricted Eating

Intermittent fasting has been great. My routine is to give my body 14 hours to fully process everything, four times a week. This is best done on work days when you’re less social and your schedule more predictable. In practice, I only eat 10 am to 8 pm Monday through Thursday. It’s super easy to get used to—you’ll love it very soon.

 

This has also been called the warrior diet. The benefits include reduced inflammation, building lean muscle mass, higher nutrient absorption, and being more in tune with how your body reacts to what you feed it.

 

I’ve also adopted 12-hour intake windows and now I firmly believe that it’s unnatural for our bodies to be able to eat whatever we want, whenever we want. I believe that your metabolism shouldn’t run 7 am to 10 pm, not even if it’s just tea you drank to wake up. Per Rhonda Patrick, limiting your intake of everything but water to twelve hours a day keeps your body cleaner, lighter, and much healthier. This, too, is very easy to get used to, and it’s completely OK to break the routine once or twice a week.

 

Finally, I do a 36-hour fast once a month. Typically, I eat a lot on Sunday. Take seconds with every meal. Then I stop eating at 8 pm and take in water only through Tuesday 8 am. I sit down to break the fast that Tuesday morning, eat slowly, and choose light foods that re-line my stomach, such as bone broth. This helps clean the intestines further, and it also resets me.

 

It goes without saying that drinking a lot of water supports all of the above. If you’re fasting, you’re burning fat. Fat is where a lot of your toxins are stored. If you then don’t drink enough water, the fat can’t be flushed out of your body well.

 

12. Cold Therapy

I have a sauna at our condo complex and a steam room at the athletic club I’m with. I’ll do a long session a few times a week and end with a cold plunge one to five minutes long. This is another great opportunity for deep meditation, especially if you’re trying to brave the cold longer.

 

I also end all my showers on cold-hot-cold, thirty seconds on each. This pumps your blood, burns fat, trains your body to create its own heat, and relieves inflammation. Wim Hof cold therapy for the win.

 

13. Inversion

There’s something special about hanging or standing upside down. Running that much blood through your head wakes you up, raising your legs helps them regenerate. I’ll do a 10-minute inversion table session or savasana most days, as a part of my morning routine.

 

The inversion table is my favorite. Gravity boots are a great alternative. They decompress and create room in your spine and joints, which I feel is key to overall flexibility and alignment.

 

14. Listening to the Body

Last but not least, just listening to what’s going on with your body can often be neglected. When pushing our skills at sports, we tend to lean toward ignoring pain. Even more importantly, we often ignore signals that come before pain, and those are the ones you can do a lot about. Get better at it via meditation for energy flows, body scan, learning about alignment via chiro or yoga, resting enough, or applying the biofeedback method.

 

What’s Ahead

The Awesome Things Helping Me Regenerate Knee Cartilage, Avoid Surgery and Snowboard a Whole Lot - Fitness, knee injuries, injury, skiing, snowboarding, rehabilitation, physical therapy, surgery, knee surgery, cartilage

 

I’ve been at it for about a year and a half. My latest MRI shows no further degeneration from the previous one made a year prior. It doesn’t show a better condition of the cartilage either, but I do feel great. I’m fully functional, thirty years old and stronger than ever, more coordinated than ever, and almost pain-free.

 

I’ve been sent home by a surgeon who told me he wouldn’t work with me if I can engage in my level and frequency of sports without feeling significant pain. I have to say I do feel like a hypochondriac when I go for an ortho follow-up. Then we look at my imaging and I’m reminded the war is not won yet.

 

The process has been highly rewarding and I don’t need to try and remember to keep up my good habits and mindset anymore. It’s my standard now and it’s all highly enjoyable. The plan is to simplify my current routines, not to drop them when I’m done working on the knees.

 

The hard part is that I will indeed need to go for knee surgery on each knee eventually. I’ve bought myself time, all of the body works. I can keep going like this for a handful more years, which is huge. I may eventually need to go under to avoid further knee cartilage degeneration. A persisting problem, even when dealt with, is still a problem. I have an opportunity to undergo both surgeries this year, and I’m considering doing so in the fall. If I do, the awesome list above will help me recover much, much faster.

 

Please leave a comment and let me know what you think. Should I keep postponing the surgery as much as possible, now that I got the knees to great shape? Should I get it over with as soon as possible?

 

It’s Your Call, Not Your Doctor’s

Yes, healthcare professionals are thoroughly trained and well paid to take care of us. But they are not perfect and especially surgeons tend to have a hard time admitting there’s something they don’t know. In their role of high expectations and responsibility, that’s understandable. So, do not try to delegate your health. You can merely get help with it. You, yourself are the project director.

 

Know When to Stop

Most of my injuries happened on days when I felt off. They happened on small features, when I had my guard down, but mainly when I was tired or distracted. Now I strive to understand and respect that feeling.

 

Yes, I do not want to just leave the hill when I’m a little tired. But it is indeed OK to keep it easy or go home early. That is not a failure. Pro athletes often say they pick their battles carefully; they don’t push it every day.

 

My Main Takeaways

When you need help, get at least a few qualified opinions. Complement those with your own research, observations, and goals.

 

Remember:

 

  • Your body is yours and your health decisions are for yourself to make.
  • Find balance between being proactive and patient.
  • Adapt routines you enjoy so you can sustain them.
  • There’s always an alternative.
  • Tailor-make your own unique list of routines and procedures.
  • Mind is over matter, indeed.
  • Small changes in how you do your sport can have a big impact on your health.

 

I hope this detailed elaboration serves you well and helps you be strong and healthy. Please let me know how you were able to apply it. Reach me on my Instagram account. It’ll be rewarding to read about your own thoughts and experiences.

 

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