So this morning in my study, I was going over a number of health related blogs, reviewing them for any potential for commentary and teaching points. A number were pretty good, most often involving the back injuries one sees in sports or exercises or stretches for general fitness or specific injuries. A few had to do with joint replacements of the hip and knee, which happened to be my specialty in practice. 
 
But then, I read one that was incredible. Not good incredible, as in ‘Wow! How amazing!” but incredible as in, “I can’t believe they have this thing out there on the web!” It concerned ACL injuries and rehabilitation and it was so full of factual errors and frank mythology that I couldn’t believe it.
 
I wanted to tactfully reply, correct the most obvious misconceptions, hopefully without insulting the author, or hurting his feelings. It wasn’t a scam, or a deliberate attempt to misrepresent facts for some nefarious purpose. It was obvious that the author was sincere. He was just wrong.
 
For example, one guy said that an ACL rupture wasn’t painful. In fact, it’s one of the most painful and disabling injuries you can suffer. What he meant was that a CHRONIC ACL disruption is painless–the damage has already been done. But the resulting instability, the “wobbly knee” that results from absence of the ACL, CAN indeed cause pain, from secondary tears of the menisci, synovitis, and arthritis.
 
Further, there ARE some people with an ACL injury who DON’T require surgery. This fact is almost entirely ignored in these articles. Specific exercises, especially leg curls and calf exercises, can often compensate for people who make low demands on their injuredknee. The point is, there are options that can be offered.
 
Unfortunately, it was a major pain to reply. First, you have to register in order to reply. Then, the registry doesn’t accept the information and erased all the info I had just input. Finally, I just gave up in disgust. Too bad. Some people are going to read that blog and accept what it says uncritically. As a result, they’ll absorb information that’s just incorrect. And who knows what the consequences will be?
 
Funny thing is, people will believe almost anything they read on the net, even though it’s well known that there’s no filter. That’s one of the internet’s chief charms. But it’s also one of its chief problems, when you really have a need to know the facts about a topic. Without a bit of comparative research on your own, there’s often no way to tell what’s fact and what’s fiction.
 
You may read it on a website, but “it ain’t necessarily so.” But the written word has power to persuade, whether it’s accurate or not. So, especially in seeking medical information, it’s best to go with a trusted source. Hey, that’s one of the major reasons for the existence of Dr. Bill’s Clinic. I’m here to try to provide some guidance and practical advice, based on my nearly quarter century in clinical practice in orthopaedic surgery. That’s why I wrote my healing programs: to help those of you with knee pain, grinding, instability, arthritis, water on the knee, deformities, and any other problems with a variety of treatments, conventional, alternative, and complimentary, from across the entire medical spectrum.
 
DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN is a concise, but complete guide to all the root causes of knee pain and the treatments that I know from experience, professional and personal, do work. You can get your own copy, including an audio CD, at  http://drbillsclinic.com/eliminate_knee_pain.html
 
But, just so you know, the LGB does NOT include the recommended knee exercises. Those are given in a separate companion manual: DR. BILL’S PAIN-FREE PROGRAM, a selection of exercises and stretches that helps to prevent or eliminate knee pain–once & for all! You can get it here, at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
Most recently, based on what people seemed to want, I created my newest healing program, HOW TO AVOID KNEE SURGERY, in both written and audio CD formats. This is a blend of the former two programs, and in addition, adds a great deal of new material, especially on herbs and nutriceuticals and other alternative treatments to help you avoid the unnecessary knee surgery, or at least delay the most invasive procedures, like total knee replacement, in the case of end stage disease, like arthritis. 
 
If you’ve been thinking about having surgery, but would like to delay or avoid it, you can get it here: http://drbillsclinic.com/avoid_knee_surgery.html
 
So, above all, don’t believe everything you read. DO your due dilligence before you accept whatever is out there on the net. The right advice can make a big difference in your life, but you need to be sure of the facts, before you act.
 
Well, that’s it for today. Til next time, my friend, be well. And have a great weekend!
 
Yours for a pain-free tomorrow,
 
Dr. Bill
 
P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
 http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

 I just read the transcript of a conference call interview of Tiger Woods with CBS Sports Sunday. The reporter asked Tiger a few questions about his recent surgery of only two weeks ago, done on June 24th. As I’m sure you’re aware, Tiger underwent Anterior Cruciate Ligament Reconstruction by the surgical team in Park City, Utah, under the direction of Dr. Thomas Rosenberg. I’ve written about Tiger’s ACL injury and Dr. Rosenberg in the recent past. But what caught my interest about this interview was Tiger’s responses to questions about his current status and his future in golf. 

Asked about the degree of discomfort he is experiencing now, Tiger replied, “I’m not liking it very much. Probably peaked about two days ago at its worst, but I think I’m on the good side now, and actually doing better.”
 
The actual surgery was reportedly a hamstring tendon reconstruction, with the tendons harvested from his right thigh, for use in his left knee. This is one of the two major methods of ACL reconstruction. The other uses a graft harvested from the kneecap with part of its attached patella tendon. Each method has its good and bad points, but both are highly effective methods of duplicating the function of the ACL.
 
But both methods require drilling tunnels into the bones of the knee, the femur and tibia. These tunnels are technically fractures, and you may recall, stress fractures were the source of his pain during the US OPEN; the ACL rupture was chronic, by that time, and pretty much painless. 

It’s the drilling and the resultant bone pain that makes recuperation after this surgery a challenging experience. My friend, it DOES hurt–a lot, especially  in this early, subacute postoperative period. At this point, his knee is trying to clear any residual blood and fluid within the joint, and resolve soft tissue swelling and inflammation.
 
Asked about his plans to return to golf, Tiger said, “…I just hope I can get up out of bed and go to the bathroom; little things like that are a challenge….”
 
“So for me to think about playing golf, that’s so far away. I’m just looking forward to walking again and putting weight on this leg for the first time. That’s actually a ways off.”
 
“As far as golf is concerned, I really don’t know. I don’t know how my body is going to heal from this…”
 
“It wasn’t very fun, but I’m on the good side now and can start sleeping more than an hour at times and can get a little more rest, which is good. I’ve been laid up pretty much every day all day, moving from the bedroom to the couch and back to the bedroom again, with maybe a few bathroom stops along the way, but that’s pretty much how my day goes.”
 
Now, Tiger sounds a bit down about his current status, but, having experienced some semblance of his pain myself, without the additional bone pain from drilling, I can empathize. It’s tough to see the end result, when you’re at this stage of recovery.
 
But Tiger Woods is a champion. He will get past this stage and he’ll work hard at his therapy. And in the end, he’ll be back–and better than ever. Hell, he just won the OPEN with a torn ACL and two stress fractures. Just imagine what he’ll do without those handicaps! My money’s on him. 

Once he’s able to tolerate some weight bearing stresses on the operative knee, he will probably start formal physical therapy. In my own ACL cases, I tried to restore motion rapidly. The faster you can get the knee moving, the faster you can get the swelling to resolve. Then, comes the gradual strengthening of the muscles around the knee, as well as progression of the extremes of motion (maximal flexion and maximal extension). The trick is to achieve these goals without overstressing the new graft or its fixation, until it is fully healed. It’s a balancing act–not too much, but just enough.
 
Now Tiger is a world class athlete, who makes tremendous demands on his body and his “bad” knee. So in his case, the surgery to reconstruct his cruciate ligament was definitely necessary. But there are times, if you’re a normal person, without instability in daily activities and in the absence of a need for high demand performance, when it isn’t. 

And it’s for THOSE times, when knee surgery might NOT be necessary, that wrote my newest book, the aptly named HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html

If you’re a regular guy or gal, you might respond to specific exercises and/or bracing as an alternative approach to a chronic ACL injury. And degenerative changes, like those Tiger had in addition, might be helped by certain nutriceuticals, dietary changes and alternative methods. All this and more is in my new book, HOW TO AVOID KNEE SURGERY. Go see at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Follow some or all of the recommendations in this book, or listen to the full length audio CD, while you’re stuck in traffic, to relieve your knee pain FAST and do it WITHOUT a trip to the operating room. Or, try the same exercise program I sent to Tiger, to help him fully recover, AFTER his own doctors and physical therapists have cleared him to return to his sport: DR. BILL’S PAIN-FREE PROGRAM   http://drbillsclinic.com/exercise_eliminate.html
Try one of these great programs and see for yourself… 

Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 
 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE, please go to   
 http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved