We have owned 2 houses with ASHP’s. The first was a drafty barn conversion on bottled gas & a combi boiler (8.5kW), we built our current one to be all electric with Pv, an ASHP & a battery (4.5kW), it is designed to be super efficient – the EPC is 111.

The two key things to bear in mind are:

that a heat pumps peak power output is relatively low vs a conventional boiler so temperature changes occur more slowly.

the greater the temperature gradient you want to create the less efficient it becomes.

the knock on effects of these are that you will need larger emitters & hot water storage than with a conventional boiler & warming the house takes longer. AIUI every thing else comes down to designing/sizing the system well & cost.

Don’t ignore any additional heat sources you might have. In the barn we were at the upper limit of the heat loss calcs for the 8.5kW unit & installed a woodburner to compliment it for when the cold weather came in. We were fine when the ‘beast from the east’ hit.

If space for DHW storage is at a premium or you need quicker response times there are higher temperature ASHP’s which are reasonably efficient up to 70°C. We have a Vaillant aerotherm plus.

On the down side there is a real shortage of competent engineers to design, install & service them (at least in Cornwall) & parts can be hard to get hold of/ heinously expensive.

Steve at Audiocomm.co.uk (in Woking) is is great & reasonable. He specialises in Meridian, but sorted a Linn Classik for me (via post). 

Before getting my knee replaced reducing the shock load into the limb has a massive effect. Sorbothane worked for me, I used heel pads as they work in any shoes, you might find full length insoles more useful.
Maintaining flexibility also helped (particularly in the calves in my case).
Shoe soles with a rocker shape can make a big difference by reducing the range of movement in the foot/ankle joints while still allowing a fairly normal gait.

We are massively over-engineered so it is possible to compensate for a worn joint by ensuring good control over it – working on balance, strength (including optimal recruitment patterns) & flexibility.
Modifying the loads on the joint can also have a huge effect – weight, activity & foot-ware choice.
Eventually you run out of the ability to compensate, are in constant /regular pain, your sleep is affected & your world effectively becomes a lot smaller. It is at that point, in my opinion, that a joint replacement becomes a sensible choice.
I had a new knee at 59. The initial problem was a poorly treated meniscal tear in my 20’s, not helped by continuing to play squash, going windsurfing & snowboarding. Shock loading the joint was the major issue for a long time. Initially sorbothane insoles/ springy soled shoes were enough, then I gave up squash, then slalom sailing, then wave sailing & snowboarding. Instead I did more yoga, cycling, surfing & paddle boarding. When things started to deteriorate more rapidly I contacted the surgeon that had been monitoring my knee & agreed to have it replaced. There was a 6 month wait, during which things got rapidly worse.
The new joint is great, I have virtually no discomfort in normal activities & I sleep well. It is not however the same as the original when it was in good condition, just a lot better than the old one by the time it was replaced. I was diligent with my rehab & went for my first surf 3 1/2 months after the surgery. High impact sports are now off my agenda, not because they are impossible but because I believe that they will use up the life of the replacement faster & I get enough enjoyment from the lower impact activities I now do.

I believe that the same would be true for a hip in terms of managing the joint. There is one important difference: in order to get anywhere one leg has to be behind you. In a normal gait this is mainly hip extension. Extension is often lost relatively early on an OA hip, resulting in over use of the lumbar spine. If you have reduced hip extension & a degenerate low back I would be tempted to have the hip replaced sooner rather than later.

If you have the op & can afford it private specialist rehab will be money well spent. NHS physio is woefully underfunded &, largely as a result of this, the expected level of function is well below optimal.

Thermal camera?

Ricky Lee Jones, easy money.
Ry Cooder, down in Hollywood.
Pink Floyd, wish you were here.
(I’m old!)

I have had one at 58. My flexion is slightly better than it was pre op (130-140deg), I have slowly regained full extension, can kneel &, most importantly have no day to day pain.
As I understand it there are 2 opposing factors that determine the time to get it done – revisions are more difficult that the 1st replacement (they have a finite lifespan & the harder you push it the faster it will wear) and the worse your rom is pre-op the worse it is likely to be post op.
My symptoms didn’t have a linear progression, working on strength, flexibility and balance, together with modifying my activity & wearing shock absorbing footwear resulted in me feeling better than the images would have suggested – until I ran out of the ability to compensate, at which point they worsened fairly rapidly.
I chose a cautious surgeon who only did knees and paid for post op rehab.
At the point at which I decided to have it done it was affecting my sleep each night & I was reluctant to walk 200m.
Post op I was on crutches for 6 weeks to give it a chance to settle and the rehabbed pretty intensively. Rehab & your attitude are key.
I have been advised to avoid skiing, windsurfing, running & singles racquet sports. I still surf, paddle board, cycle & do yoga.
Hope this helps.

People are getting aerated about this aren’t they!
A few points:
Risk – my annual professional indemnity insurance is circa £270, this means that the chance of me needing it is low. There are risks associated with all interventions, ask a surgeon or anaesthetist what there premiums are.
Treatment – when I trained the definition of osteopathic treatment was ‘treatment provided by an osteopath’. You need to be competent in using your chosen technique, but it is not limited to HVLA manipulation. I use various techniques, including (occasionally) HVLA thrusts, probably the most useful element of what I do in the longer term is offer advice about how to help recovery and reduce the chance of recurrence in the future. Different patients get different treatment, dependent on the nature of their problem and what is appropriate and safe for that individual.
Manipulation – there were pictures in the library where I trained of a chap called Cyriax (a physio IIRC) doing the kind of manipulation described by tj, it was universally felt to be unacceptable then. We were taught that the correct way to manipulate was to create tension using a variety of levers and apply pressure within the physiological range of the joint. Not just ‘take it as far as it can go & then force it further’.
@Kryton53 you are asking the symptomatic area to do more than it can manage, you need to alter what you are asking it to do &/or make it more able to cope with the demands placed on it. Looking at a combination of your strength, flexibility and movement patterns should help.

I am an Osteopath.
Nedrapier is right, there are wide variations in the knowledge and technical ability of osteopaths, chiropractors & physios. Some individuals in each profession are money-grabbing charlatans, most are just trying to help.
Outcomes of treatment are affected by the diagnosis, the treatment itself, the interaction between the patient and therapist and the circumstances of the patent – hence the rise of the biopsychosocial model of healthcare.

My suggestion to the op is that he goes to see someone recommended by his peers who he feels he can get on with & trusts. He should be given a plausible explanation of his symptoms and their cause, a treatment plan, including the risks of treatment and no treatment, treated (if he agrees), given manageable exercises to do at home and advised how to change the use of his body. If the problem is curable and things do not change in a reasonable time (2-4 appointments) either he should be reassessed or go elsewhere. It may be that the previous spinal injuries mean that the best outcome is managing the symptoms, but that should be discussed.

Shoulder stabilisation exercises & hip mobility sound like areas worth looking at.

Please bear in mind that by virtue of disagreeing with tj I am, by definition, almost certainly biased, ignorant & wrong…..

We have bought a granite ‘barn’ (ex cowshed) in west Cornwall and are in the process of trying to sort it out. On the basis that it is impossible to stop all moisture getting in we have started by making it as difficult as possible for it to get in & as easy as possible for it to get out. This has involved repointing in lime which is then painted with Beeks BS+ – a clear vapour-permeable coating ($$$/l!) & replacing the windows/doors & window cills. It appears to have made a big difference to the damp. When funds allow a MVHR system & internal insulation (woodwool) together with lime internal plaster are planned – it may be a while……

There are many potential causes of back pain. In the situation you describe I would check the flexibility of your hip extensors (mainly glutes) and the strength of your abs (transversus & obliques), also check saddle height.
Try to keep a neutral position pedalling & don’t rock.
Short hip flexors are more likely to cause pain on standing upright.

I love Cornwall, But the simultaneous colosures of the A35 & A303 yesterday took the shine off the return journey to Sussex…….

Aeron & Swiss ball here. Both great, but you can sit badly on anything & get back pain. Try to keep your pelvis in the same plane as your spine, whatever you sit on.

Cheshirecat speaks the truth – the same is true of osteopaths (I am one).
IME anterior knee pain generally involves poor control of femoral rotation at the hip. This can only be improved by the patient (exercises). Effort free recovery from muskuloskeletally based problems is a myth IMHO.
Gluteal strength, ankle mobility, cleat & saddle position would be good places to start.
PS the quads stretch above is very easy to do ineffectually. It is much better done on the floor wih the front of the pelvis down & the body supported on the opposite elbow.

Try some shoes with a rockered sole – I used to sell MBT’s & a couple of people with fused ankles literally came in on crutches & walked out. It’s not a great look, but should help your knee/hip/low back considerably.

John Lewis +1.
We got an extra discount for a ‘special offer’ mattress by taking the display one – but had to wait until the end of the sale.

Get someone to check her wrists are working properly – the actual wrist is only an inch or so long & has 2 rows of bones, so 3 rows of joints. Each row needs a certain ammount of mobility, otherwise the others overwork.
A short top tube & higher handlebars would also help.

It might be benign positional vertigo. If the Doc thinks it is the hallpike manoeuvre to check the side & Epley’s manoeuvre to treat it has a fair chance of success.

Sadly it seems likely she is a 39… Went mad on some lakes in the end from wiggle.

There is a bargain above waiting to be had.

http://flatoutcycles.co.uk/new-fizik-m5-donna-ladies-mtb-shoes-size-38eu-5uk-27967?fee=5&fep=2516&gclid=CIKvzOGw474CFSXnwgodHbAA6Q

The link gave a price in euro’s, my 1st pair of sod shoes os over 14 years old & still going…..

They look like the sort of thing I was thinking about – does she like them & how is the fit?
(She is a 38 I think)

IIRC the requirement for a lymphatic system is a consequence of Starlings law, the lymph from the lower body draining into the cisterna chyli. I can see how foot massage could affect local lymphatic drainage – but sinuses??

Although I have never tried reflexology I used to think that there might be something in it – my understanding was that the points on the foot corresponded to the ends of acupuncture meridians. Then I saw that the map of points was effectively a front view of the body, rotated 90 degrees & distorted to fit the shape of the feet – a happy (& to my mind extremely improbable) coincidence or expedience?
If someone has plausible reasons for this I am open to persuasion, until then as far as I am concerned it is no more or less than foot massage.

@instant hit I agree that feet are neglected & that their function can have a significant effect on the rest of the body – but in a strictly biomechanics sense. Just because something is natural or old doesn’t make it automatically effective or even safe.

@ DezB – There are 7 months left to improve on it, anyone for a ‘what public school for my Tarquin’ thread?

@ sweaman2 – You forgot the requirement for me to retain all my organs!

I’ll check out Sainsbury’s/ Tecsco tomorrow.

‘Anterior knee pain’ is a description of the site of pain, not a diagnosis of it’s cause. Check to make sure that whoever you see (Osteopath/ physio/ chiro is probably the place to start) has an interest in the athletic knee. The cause of the problem may well be in your foot/ ankle or hip, so as a bare minimum they should be checking these areas as well & ideally checking your bike & cleat position, together with your pedalling technique. I would avoid people who want to inject it or advocate nothing more than rest – there will be a cause which should be addressed.

Thanks for the info so far. It looks like I’ll have to bite the bullet – anyone have any indication of a decent price/ m2?
The painting suggestion is because we are on a hill – think of water being fired at the house at over 30mph (& up to 99mph!!!) for most days in the last 2 months.

I’ve been to Taghazout with Surf Maroc. Car & accommodation only, 4 of us stayed at Killer bay. Great location, staff helpful, cheap food, but we had no tuition so can’t comment of that. The impression I got is that the surf camps are for those mid 20’s & under, but I might be wrong. Easyjet, with boards, was surprisingly painless.
Nov to Feb is generally best as more offshore days – check Magicseaweed for the stats.

They are great – I have an old maverick with remote lever. The most useful feature is the ability to get the seat back up to the perfect height without having to think about it as that is more critical than how much it is dropped. If there is any possibility of mud I use a mudguard to keep it & my ar$e clean. No mudguard in the wet = asking for trouble imho

Check out Heston B’s chilli recipe, lots (most) of it is a ludicrous faff, but how he cooks beans in a pressure cooker really works.

…..the same goes for the otterbox.

A quick google shows Lifeproof cases cost from £17-£60 – any way to tell which are the genuine article (other than just going for the ‘reassuringly expensive’ route)?

It might be worth your while to go & pay to see someone who knows what they are doing to make sure your knee (and adjacent bits) gets properly rehabilitated – most off the peg postoperative care is non-existent or rubbish.

The Allman Brothers at the Beacon…………..Twice in March!!

I “row” to rugby games – 7500m per 1/2. The most I have managed is 30K on consecutive days (World cup 1/4’s last year). It serves the dual function of alleviating the tedium of rowing long distances & stopping me feel guilty for watching, not doing, sport. All done at a gentleman’s pace mind you – I’m old, fat & don’t like pain.

Duane Allman
Muddy Waters
Lightnin’ Hopkins

Check out ‘mr smooth’. It helped me.

+1 for Medano. There used to be a good restaurant in Los Abgigos overlooking the sea- but it might all have changed, I’ve not been there for years.

I bought a Tojiro DP from nipponkitchen & am very happy with it……and it’s a thing of beauty.
They suggest ceramic disc sharpeners which are very easy to use.

Jam bo unless you are a lightweight surf god & only out in clean conditions probably. It’s no fun & knackering falling off all the time. I’d try something around 9’6″ (I fancy an Al Merrick Caddi 9’7″ : http://www.youtube.com/watch?v=3LyUgVXn8hY – but £££).

West Witterings is one of my local breaks & I have never seen it at 8′ unless it was windsurfing weather, head high (3+ft) & clean is all too rare.

What you should get is dependent on your size, previous experience on surf/skate/windsurf boards, intended use & usual conditions….
We have 3 – 11’2″, 9’8″ & 8’5″ x 30″. I am 90+Kg & mostly interested in surfing (south coast slack waves). I use the 2 smaller ones the most, but couldn’t have stood on the 8’5″ let alone paddle it to start. Of the boards you mentioned the Drive would be my choice – Magheroarty is a nice wave & it would be OK on the flat. The windsurf attachments can be useful if it’s too windy to paddle.
If you have no other board experience &/or will be in choppy conditions a lot a wider board (32″+) will help.