Marca, the major spanish sport newspaper has published an interview with Nadal's doctor. My (poor) translation
Is increcibleble that Nadal play with the knees in that state
Results in crisis and doubts caused by the pain in the knees. Rafa Nadal came into medical clinic of Dr. Mikel Sánchez (Vitoria. 1955), a 'wizard' of the trauma that has improved the natural regeneration of tissues with a treatment based on plasma enriched with growth factors. After infiltration of the tendons of each knee avoided the pain to the current world number with whom he lived for many years.
QUESTION: How and when you contacted Nadal?
ANSWER. The truth is that contacted last year, but then did not come at the time because other treatment began with a physical therapist who calmed down the Nadal pain. But then the pain came again and that was when they called me. That was after the Australia Open.
Q: What state of mind you found him?
A: He was a superchampion and the boy was coming from a year without winning anything. One reason was that he had very sore knees and that prevented him from playing the game he wanted. He had made numerous treatments, but returned to relapse. It's a kid who has extraordinary willpower, and only for that reason he still playing. It's amazing that I could continue playing with the knees as he had.
Have you already completed the treatment?
At this point I'm not doing anything, but he probably just need come back. His tendons will continue breaking down and he must regenerate them.
What is the treatment with ‘growth factors’?
The mainstay of treatment is simple to understand. In our body we all have proteins that are plying to the cells to heal injuries. If someone breaks a bone, the bone cells know they need to build bone and when to stop because he is cured. Its no coincidence, there are proteins that stimulate the cells.
What we do with this treatment is to concentrate many of these stimulus to put on a particular area, which increases the cells that works in the regeneration and therefore the healing speed is much higher and the quality of the scar is better. But there is nothing new. Is the same that nature does, but in a intensive manner. What you do is draw a little blood to the patient and treat it to concentrate on many of these growth factors and then put in the right place.
So Nadal is definitely cured or may lie in the future?
When there is a chronic injury due to overload, as is the case, we can heal, but he will continue stressing his tendons. He will not change his game, and will not lose games on purpose to avoid injuries. He will continue at the same rate and there is a risk that his tendons degenerate again. Therefore we can not say that it is a treatment forever. And this problem can occur in other tendons, such as the Achilles tendon.
then the way he play is the origin of his injury?
All tissues are destroyed and regenerate constantly. When this balance is broken and you spend more than you can replace degenerative lesions appear.
For Nadal, his tendons suffer violent stress it trains a lot. He has congenital qualities, but to be number one he has been working very hard. Working many hours, many matches and always playing a hundred percent. He don’t play thinking: "This game doesn’t interest me win it." Neither is a team sport in which for a moment you can skives off work. Playing each point one hundred percent and the stress you put on your hamstrings is tremendous. If your body is not able to regenerate what he damaged, the injury arises. The more violent play, the more jumping stick, the more powerful musculature, there will be more injuries.
The World Anti-Doping Agency (WADA) showed some misgivings about the use of plasma rich in growth factors. Why?
There has been a meeting of 20 experts from the IOC in Lausanne, organized by WADA about the growth factors. Their unanimous opinion is that there isn’t doping. It can infiltrate a tendon with cortisone if you do show up. The plasma has been placed on this category. The only requirement is to notify it. But after that meeting we know that WADA is not going back, because it has nothing to do with the increase of performance. The plasma purpose is to heal the injury, like a plaque and screws in a fracture. And never this can improve athletic performance.
the Rafa improvement should not be due to this treatment then?
Rafa has improved because he has been training. Before there was balls he couldn’t catch because of pain. And he had to practice at a slower pace. If I infiltrate him a tendon he will not improve his serve, which its seems more improved right now, but his jump elevation is what has made him improving
Are you following his career?
Yes and this is stress me. Every game he had played I was devoted he won and didn’t feel pain. Because even now the plasma is accepted by the medical community, has been a very tortuous path. Research has gone ahead despite many people, much opposition and many envy.
many doctors in Spain use this treatment?
Now this is applied by many people in Spain and around the world, but this began in the maxillofacial field. Eduardo Anitua was who managed it with small volumes of autologous blood and all without putting anything external to the patient, in the late 90's. In late 2000 were when we began to apply it to musculoskeletal injuries. There was controversy over whether it was true or false. Now there are a technical scientific recognition.
Would it have been better than Nadal had underwent this treatment earlier?
What has happened now would have happened before, probably, but maybe if he had come earlier we would not know as much as now. All we have done now has been the best.
How many years Nadal will endure?
Rafa has accomplished so many achievements because he is a physical marvel, besides playing very good tennis. Moreover, the plasma has worked so well because his body is very good. It does not work the same to everyone. So it is not a miracle treatment, it is not a magic wand. The issue is that Rafa started very young and when you're young is very difficult to dosage.
What he need to know is the situation may become increasingly dangerous if he wasn’t dosed himself. He can’t expect to win every tournament he plays over the next 10 years. He must learn to care himself to endure many years. He has done that this year. We convinced him to stop playing in Barcelona because he put at risk his healing.
Can he have some kind of consequences?
No. He has the tendon healed, wider, with a different physical appearance, but cured. We stimulate his tendon and is ok. If return to degenerate it because he is playing a brutal pace, we will help him again.
What is Rafa Nadal as a patient?
The doctor-patient relationship with Rafa has been very easy. It is a charm. Maybe because of his age or his personality, but once he has committed and has not put any sticks to anything. It's far from worship. There are other athletes who are much more demanding asking for results.
How much responsibility do you have in Nadal's victories?
Many people ask me and I always tell them that I serve a little worse than him. My merit isn't he win, but his knees hurt less him and so can practice and play hard.
In Spanish (page 36):