If you’ve been a reader for a while, you know that I’m a long time comic book collector. I used to work as a professional artist for the comics, back in the 70′s for a brief stint and I’ve always maintained a serious interest in the art form, collected original art and kept up friendships with some of the best pros in the business.
 
This, of course, has always been a source of great embarrassment to my wife, who shares the opinion of many, who know no better, that comics are for kids, geeks and retards. I would patiently point out that there is an entire wing in the Louvre dedicated to graphic arts (ie., comic art)and many very highly creative, very wealthy and intelligent men, like George Lucas, Steven Spielberg and Clint Eastwood, to name but a few, have collected original paintings and drawings of some of the best modern illustrators, painters and comics artists. So I feel I’m in good company.
 
Anyway, as soon as I arrived back in town, in Orlando, I went straight over to my local comic shop, ACME SUPERSTORE in Longwood, to pick up the latest issues which had come out during my recent absence. While I was in there, seeing what else had come out that I might want to read, I overheard a middle aged guy talking to Penny, one of the store employees.
 
Penny had had arthroscopic surgery for her own knee in the past, after a number of conservative measures failed to relieve her very significant and disabling knee pain. I had reviewed her preop studies and her intraoperative photographs, and there’s no question she had a defined pathology that needed surgery to fix.
 
This guy knew about her experience and was asking her for advice. So, since she had come to me for advice herself and since I was there, she called me over to meet this man. Sure enough, he had episodes of pain and swelling that would come and go, after what he called a “blowout,” that is, a traumatic injury that ruptured his ACL (Anterior Cruciate Ligament) and gave him a torn meniscus.
 
Despite this, though, what bothered him the most was what he described as a sudden “shift” inside his knee and the insecure feeling this gave him. What he was actually feeling was the typical instability that results from a ruptured ACL. Naturally, he was concerned because he didn’t want ACL surgery, if he could avoid it.
 
I pointed out to him that there ARE ways to treat this condition nonsurgically, BUT there is a price to be paid–namely, if he doesn’t have arthritis yet, he soon will. The articular cartilage is damaged every time he experiences that “shift,” which is really a slippage of one bone on the other, that is usually prevented by an intact ACL.
 
However, if he is willing to accept that fact, and if his daily activities are not affected, then a number of conservative conventional treatments, combined with alternative methods, that help to relieve knee pain and resolve inflammation, appropriate bracing and vigorous specialized exercises, especially for the hamstring muscles, may be all he needs. 
 
He was amazed at this information, which was all new to him, and which is revealed in detail in my new healing program, HOW TO AVOID KNEE SURGERY (see here at http://drbillsclinic.com/avoid_knee_surgery.html )
 
He didn’t even realize that CRUCIATE means “crossed” in Latin, or that the cruciate or crossed ligaments, ACL and PCL, hold the interior of the knee together and prevent excessive, abnormal motions, front to back and back to front, between the femur and the tibia.
 
The anatomy and basic functions of these ligaments are presented in my LITTLE GREEN BOOK, together with lots of inside information on the many root causes of knee pain and disability. See what I mean at   http://drbillsclinic.com/eliminate_knee_pain.html
 
So, at the end of my “comic shop consult,” this man realized that he has options he didn’t know he had. I gave him my card and suggested he visit my website  http://drbillsclinic.com/avoid_knee_surgery.html  for more detailed information and advice. Hopefully, he’ll take my advice and get knee pain relief and joint stability back in his life.
 
At that point, I said, “My work here is done!”  Then I grabbed my comics and leaped out into the night…up, up and away……Heh.
 
Have a great weekend, my friend. I’ll be spending mine shooting the DVD version of my PAIN-FREE PROGRAM
 http://drbillsclinic.com/exercise_eliminate.html   Til next time, 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 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

Just a few minutes ago, while sitting in my study and reviewing my emails, I came across an article on one of the health care alerts about Tiger Woods. You may recall that Tiger has been out of the tournament circuit since his ACL reconstruction. As a result, we haven’t seen or heard much from him or about him in recent months. And the sport of Golf has been the poorer for it.
 
He made history by winning the Masters, against an outstanding opponent, while in constant pain from a double stress fracture of his tibia AND a chronically torn Anterior Cruciate Ligament. Despite wincing in obvious pain, he never gave up. He never considered quitting. He said he just put the pain aside and focused on his goal. No question but that he has the heart of a champion.
 
He was asked about whether or not he thought he’d be ready to compete this Spring. And, not surprisingly, he said he would be. He also reported how hard he was working on his rehabilitation. He obviously truly understands the necessity of doing the hard work of exercise, after a major joint reconstruction, in order to get an excellent postop result.
 
There are a number of lessons to be learned from Tiger’s behavior and his attitude. First, he accepts the reality of his situation and pays the freight up front. He pulled out of further competition this year, in order to give himself the best chance of a good long-term result with surgery he realized was unavoidable. 
 
His case is an excellent example of a truly necessary surgery. There are times when the mechanical problem demands the mechanical solution, especially when the patient is an athlete, making high level demands on the injured knee during his sport.
 
Next, he recognizes the need for HIS commitment to the aggressive postop rehabilitation program. Exercise is key to an excellent result. This is especially true after ACL surgery, where some of the most common complications include a stiff knee (arthrofibrosis), with loss of motion, recurrent instability and weakness. It’s only through range of motion exercises and strategic strengthening exercises that the potential created by the surgeon can be realized.
 
Finally, his attitude is exemplary. The man always focuses on his future goal. He never even considers not achieving it. In his mind, it’s not a question of IF he recovers and returns to his sport, but WHEN. There is little you can’t accomplish if you BELIEVE you CAN and WILL achieve your goal.
 
So don’t be surprised when he comes back, stronger than ever, next year. In his mind, he’s already SEEN it, he’s already DONE it.
 
Now, on the other hand, over the years, I’ve seen a number of patients who had a chronic ACL injury who were not athletes. They had no pain, no history of instability, like giving way or falling, and they were doing just fine with normal, everyday activities. In these people, although some surgeons would talk them into ACL surgery, I always tried them first on a strict regimen of exercises, like those in my PAIN-FREE PROGRAM, which you can see at  http://drbillsclinic.com/exercise_eliminate.html
 
You see, there are people who have alignment of their capsular tissues (meaning the direction the fibers run) that can compensate for an absent ACL. These combine with other factors, such as the position of the MCL attachment, and are collectively called “secondary restraints.” They provide another level of stability, even without the ACL. In these people, surgery may indeed be unnecessary. They may do just fine with a number of the non-surgical methods I present in HOW TO AVOID KNEE SURGERY, which you can get here at  http://drbillsclinic.com/avoid_knee_surgery.html
 
The key is that you need to distinguish between what is necessary and what is unnecessary surgery. And the way to do that is to see how you do with a conservative, non-surgical program, first. Hey, like a haircut, you can always cut more, but once cut, you can’t put it back. So, to relieve knee pain and restore knee function, go to   http://drbillsclinic.com/avoid_knee_surgery.html
 
And it should go without saying that you should get a professional evaluation, preferably by an orthopaedist, if you have persistent symptoms, especially buckling or giving way, or if you have snapping, catching or locking of the joint. Those are mechanical signs and may need further evaluation. Get your doctor involved early. And don’t be afraid–no one can operate on you, or make you do anything you don’t want to do. But that’s the best way to get all the facts. THEN, you can decide what you want to do.
 
That’s it for today, my friend. Til next time, 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 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

Well, Labor Day is over, again. It’s back to work and the daily routine until the Holidays, which will be here before we know it. Every year, it seems to me that subjective time is highly variable, depending on the time of the Season. 

Right after Labor Day, time seems to speed up. First, come the Jewish Holidays (which you’re aware of in New York and Florida, even if you’re not Jewish yourself, just because the roads are deserted). Then, suddenly, it’s Halloween. Now it really speeds up, and BAM! it’s Thanksgiving. And as soon as you see Santa Claus waving at the end of the Macy’s Thanksgiving Day Parade on TV, time seems to hurtle on: you barely blink and suddenly it’s Christmas Day, blink again and it’s New Year’s Eve.
 
Then, just as suddenly, right after New Year’s Day, time slows to a crawl and stays in slow mode until St. Patrick’s Day (which I have always thought of as the “unofficial start of Spring,” even though it has nothing to do with reality), when it begins to pick up speed a bit, until the beginning of Summer, at Memorial Day. 

I used to think it was just me. Turns out there’s actually a scientific explanation for this subjective phenomenon, though. As we age, each moment becomes a smaller and smaller fraction of the whole experience of our lives. That’s why, when you were a kid, the summer vacation (only two months long) seemed to be a long long time, full of rich lazy days; but as a busy adult, that two months goes by in the blink of an eye.
 
So, we’re in that timeless moment at the top of the long slide, just before we slide faster and faster, down the slope to the end of the year. We just watched Obama’s apotheosis, dodged a bullet in Hurricane Gustav, which could have been much, much worse, await Hannah, Ike and Josephine, any of which could be trouble for the East Coast and Florida, and wait to see how the GOP handles their convention, bookended between hurricanes. 
 
And we currently watch with incredulity, as the Media works itself into a hypocritical lather over the pregnancy of Bristol Palin, unmarried 17 year old daughter of GOP Vice Presidential Candidate, Sarah Palin, in a blatant effort to discredit her mother. Disgraceful–the Media, not the girl.  “Judge not, lest ye be judged.” 
 
Props to Senator Obama for taking the classy route and stating the obvious: it’s not an issue, it’s a private matter, and families should be off-limits.  He, himself, was the product of such a union. This is laughable. I mean, how many in the Press, or the general population for that matter, HAVEN’T had sekks at seventeen? They normally CELEBRATE this. But I digress…
 
As I was saying…before I was interrupted by all these events, you need to know about knee surgeries, for your own good. Things you know about have finite dimensions and durations, and are easier to deal with than the unknown, which imagination can grow to truly frightening proportions. Today, let me tell you briefly about ACL Surgery, Anterior Cruciate Ligament Reconstruction.
 
The first thing you need to know is that a complete rupture requires reconstruction, with a graft, rather than repair, which implies suturing the torn ends of the ligament together. This latter doesn’t work. It’s like trying to sew mop ends together–you can’t get any purchase in the shredded tissue. And, because ligaments have lousy blood supplies, you can’t get them to heal and restore structural integrity.
 
Instead, you use grafts, strips of fibrous tissue taken from the patient (autografts), usually a 10mm wide strip of patella tendon, attached to two plugs of bone at either end, from the patella and the tibia, or the lower end of hamstring tendons, or from fresh cadaver donors (ie., dead guys). This surgery is described in detail in my LITTLE GREEN BOOK  http://drbillsclinic.com/eliminate_knee_pain.html
 
But I’ll give you a brief overview here.
 
An arthroscopically assisted surgery is performed.  The scope is use to confirm the tear of then ACL, prepare the joint, clean it out, and then position the bone tunnels, that are drilled through the tibia and the femur, as receptor sockets for the graft.  Small accessory incisions are used to introduce the drills and to pass the grafts within the knee joint. 
 
Whatever the source, the graft is strung between the femur and the tibia, to mimic the path of the original ligament, tensioned and then fixed within the tunnels. The knee is pumped FULL of local anesthetic for postop pain control and to minimize bleeding.
 
Postop, gentle limited motion and limited weight bearing are used. This is followed by rehabilitation, with gradually increasing resistance exercises and gradually increasing range of motion with bracing for many months, while healing occurs. Does this all hurt? You just drilled two holes clean through the bones of the knee–of COURSE it hurts! But, only initially, and this can be eased considerably with pain and anti-inflammatory medication. 

Now, this is the recommended surgery for active athletes who want to return to sports, or people who cannot normally function, without giving way. Some people DO NOT need to have this surgery. And if you would like to see whether you’re one who can AVOID this procedure, you need to see my newest program, HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html
 
Tomorrow, we’ll look at other arthroscopic surgeries.  The day after, we’ll start on the arthroplasties: the so-called “replacement” surgeries, which as you will see, are somewhat misnamed, as far as then knee is concerned. Remember, surgery is sometimes the only, or the best available treatment for knee problems. But it must be indicated and necessary. If you want to know whether YOUR problem is one that can be addressed, your pain relieved, WITHOUT surgery, get my new program, HOW TO AVOID KNEE SURGERY now, at http://drbillsclinic.com/avoid_knee_surgery.html
 
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 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