How broken Nadal was rebuilt with the help of blood spinning to achieve one of sport's greatest ever comebacks.

The latest print out from the ATP ranking computer put the seal on what has been, without doubt, one of the great sporting comebacks of this or any other year.
Having been out of tennis for seven months suffering from what were perceived to be potentially career-threatening knee problems, Rafael Nadal is back at world No 1, amassing a remarkable 65-4 match record - including two Grand Slam titles - since his return.
We already knew that the 27-year-old Spaniard was an amazing player, with his combination of technical skill, power, athleticism and extraordinary concentration. The question so many have asked in conjunction with it all is: how has his body been able to cope with the demands placed upon it, most notably on the hard courts that have previously caused his joints such damage?

Comeback: Rafa Nadal came back from months on the sidelines to win two Grand Slams and reach the top of the ATP rankings

Treatment: A variety of methods have been used to propel Nadal to an amazing 65-4 record since his return

Even in this most punishing environment he has thrived, and Sunday’s defeat in the Beijing final to Novak Djokovic was only his first defeat of the year on what has usually been his weakest surface.
Sportsmail has spoken to his camp plus several independent medical experts, including an eminent knee surgeon, to try and establish answers and sort out fact from some of the rumour that has surrounded his latest career surge.
The enabling factors behind a spectacular run of form appear to lie in a combination of hard work, constant rehab, two space age training machines and the use of Plasma Rich Platelet therapy, often known as bloodspinning.
It should be stressed that the latter process, which involves taking blood and then re-injecting it around the knee tendons, is now entirely legal and in widespread use. The latest research, interestingly, suggests one by-product of it is the natural production of performance-enhancing Human Growth Hormone in the body.

Title: Nadal beat Novak Djokovic to the US Open title in September

Nadal did not play between Wimbledon last year and this February. In that time he took delivery of two devices to try and help him overcome the tendinitis around his knees.
According to his spokesman Benito Perez-Barbadillo, one of them is a state-of-the-art contraption that controls, via computer, the exact amount of pressure being placed on muscle groups.
The other is a running machine that encloses the body from the waist down and creates an atmosphere which lessens the pressure on joints. It has the effect, apparently, of making the body feel like it weighs 30 kilos less than it actually does.
The Nadal camp is comfortable admitting that, as part of his ongoing regime, he undergoes PRP therapy, and there is no reason not to. Infact it has become so mainstream that health insurer BUPA these days will pay out for it to be used for ordinary citizens tackling tennis elbow.
According to the experts we spoke to it is quite possible that the combination of his prolonged rest, PRP and exhaustive physiotherapy on the tendons, sometimes termed as eccentric strengthening exercises, could have an extremely good outcome, at least in the short to mid-term.

Glory: Nadal also won the French Open for the eighth time

As treatments go, PRP has an interesting past, and may yet have an interesting future.
It was banned by WADA in 2010 due to fears it may have performance-enhancing effects similar to those involving larger transfusions. It was then made legal again at the start of 2011 as those fears receded due to the relatively small amount of blood involved.
During last year’s Wimbledon Championships Fernando Verdasco gave an interview to the Wimbledon Live internet channel telling of how he and Nadal had, on occasion, gone through the treatment together which involves spinning blood in a centrifuge and breaking it down. 
'They take your own blood, they mix it and take the best part of your own blood, the best cells,' explained Verdasco to Annabel Croft. 'Then they inject it in your tendon. With these injections you recover much faster.'
Many other athletes from other sports have used the same technique, including the likes of Tiger Woods.

Bloodspinning: Tiger Woods is another athlete who has undergone the controversial treatment

Research into its effects is still far from exhaustive, but is being added to. According to papers published in the American Journal of Sports Medicine this summer it may have much wider benefits to performance. Doctors Amy Wasterlain and Jason Dragoo found that Human Growth Hormone ‘increases dramatically within the first 24 hours after PRP infiltration’. They said that their trials had shown its effects can include ‘rocketing both anabolic and catabolic growth factor release’.
They concluded that ‘our observation of statistically significant increases in multiple growth factors over multiple days after local PRP treatment points to a real systemic effect that cannot simply be ignored.’
The topic is sure to be among those discussed at WADA’s World Conference in Johannesburg next month.
How much of a benefit this might be to Nadal or any other athlete cannot be fully known, the same as with what part, if any, it might play in the ability of some to recover incredibly quickly from gruelling matches and bounce back for the next one.

Rare defeat: Nadal suffered a rare loss this year to Novak Djokovic in the final of the China Open

Form: Nadal is showing a confidence in his physical health that could keep him at the top for a long time

The treatment remains entirely above board. It should also be emphasised that the restored world number one has repeatedly called for all drug tests under tennis’s increasingly beefed up anti doping programme to be made public, as he is fed up at being associated with an issue that has increasingly come to the fore in tennis over the past twelve months.

In the meantime the Spanish superstar is maintaining a very full programme until the end of the season comes next month at London’s O2 Arena. After this week’s Shanghai Masters being booked to play in Basle and the Paris indoor Masters before the Barclays ATP World Tour Finals.
His schedule would have been unthinkable twelve months ago, but then the long absence from the tour should have led to a pent up desire to play at a time of year when many of his peers normally show signs of flagging.
What is beyond doubt is that, as Nadal heads towards his late twenties, he is showing a confidence in his physical health which suggests he could remain at the top and be a thorn to his rivals for a long time to come.