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

I’ve been sitting here in my study for the better part of three hours, just surfing the net, while looking for articles and news bulletins that will inspire me to write about some topic that will teach you something about orthopaedics. And what should I see but a study that shows a trend that orthopaedists have been aware of for some time: that ACL Injuries are far more common in women athletes than men.

According to our parent organization, the American Academy of Orthopaedic Surgeons, the incidence of ACL ruptures is about 4-6 times greater in females than in males. In some studies, the incidence is as much as 8 times greater in women. 

Why? Well, there are anatomical differences between men and women (THERE’S a newsflash for you!). As you are probably aware, the female pelvis is wider, so the angle of the knee is more valgus (slightly knock-kneed) than that of a man. As I’ve pointed out in the past, this has implications for the kneecaps. But it also increases shearing forces across the joint. In addition, there are demonstrated neuromuscular imbalances in women, that cause them to land with their knees slightly inward, which exaggerates their anatomical tendencies and rely more on their quadriceps.

Men, by contrast, tend to land with their knees straight in line, or slightly outward, with more balance between their quadriceps and their hamstring muscles. And finally, there are some studies that implicate estrogen spikes in the bloodstream, a consequence of the menstrual cycle. The theory is that the increased estrogen may weaken the ligaments, making them more prone to injury.

Regardless of the actual cause, it’s apparent that some factor or combination of factors results in a significantly higher incidence of Anterior Cruciate Ligament ruptures among young women. This is especially true in those playing basketball and soccer, where sudden deceleration, combined with sudden change of direction, applies increased force to the ACL.

The need to slow forward progress and tolerate directional change simultaneously requires strengthening of the posterior muscles: the hamstrings, the gluteals and the gastrocnemius. These can be affected by backwards walking, back pedalling on the stationary bike, walking lunges and kicks, and bounding from leg to leg.

In the past, all the focus was on the quadriceps, in an effort to stabilize the knee and increase power and performance. But the modern recognition of the danger of ACL rupture has led to a rethinking of this method of training, in favor of a more balanced development of both front and back thigh muscles. Exercises, such as those I teach in my PAIN-FREE PROGRAM http://drbillsclinic.com/exercise_eliminate.html can be selected in such a way as to result in balanced development, with strengthening of quads in front and glutes and hams in back. And I’ve always been a strong proponent of calf development, since the gastrocs cross and therefore help to stabilize the knee joint.

The same program, used to rehabilitate the postoperative knee after ACL reconstruction, can also be used to PREVENT the ACL injury from occurring. By using these exercises, together with other measures before the fact, we can often AVOID KNEE SURGERY. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
In this as in many other cases, merely taking a different perspective on “old” training methods can result in great new benefits. Today, the emphasis is on prevention, rather than cure.

BTW, today’s the LAST DAY you can get my classic LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN at  http://drbillsclinic.com/eliminate_knee_pain.html
At midnight, the “introductory price” is gone for good. So, if you want it, make your move NOW. Click on: http://drbillsclinic.com/eliminate_knee_pain.html 

That’s it for today, my friend. Be well. Talk to you soon.

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

As any reader or fan of the popular Harry Potter series knows, the Cruciatus Curse is one of the four “unforgivable curses” of the Dark Arts, used by followers of the Dark Lord, Voldemort, to inflict indescribable agony on the subject. You just point your wand at the target and say “Crucio,”  to magically torture your victim. Of course, if you’re not a fan of J.K. Rowling, or haven’t read her novels about the adventures of the young wizard in training, and all his friends, then you have no idea what I’m raving about.
 
The point is that “The Cruciatus Curse” has an analog in the real world, in the Ruptured Anterior Cruciate Ligament. This injury is very common in the twisting, cutting and sudden hyperextension movements the knee is subject to in a number of sports. And when it is acute, it can be an agonizing injury. Usually, the key sign is a sudden, excruciating swelling of rapid onset, after an injury, and the player is NOT able to return to play, or even bear weight on the affected knee. 

In the normal knee, the ACL prevents excessive forward motion (translation) of the tibia, relative to the femur. It also stabilizes the knee joint in rotation and pivotal motions. It’s indispensable for stability in most running sports. In its absence, the knee is unstable in these activities and untreated, the knee will develop rapid degenerative changes. It’s an injury that is often associated with a torn meniscus, and sometimes with injury to the medial (inner side) collateral ligament, as well.
 
This injury was brought to the fore (you should pardon the pun) by Tiger Woods’ recent knee surgery and the endless speculation about whether or not he can make a full recovery and return to be the force on the professional golf circuit, that he was prior to his injury. Now, in his case, the cruciate rupture was a chronic injury (over 11 months old) and the acute pain he experienced during the Open was due to a double stress fracture in his tibia (shin bone). Just think about that for a minute–the guy WON the U.S. Open, with constant pain from a double fracture, as well as the instability from a chronic ACL rupture. Amazing.
 
Anyway, he underwent an ACL reconstruction by Dr. Thomas Rosenberg and his team in Utah. And he is likely deep into prescribed rehabilitation by this time. As I mentioned a while ago, I sent Tiger a copy of my PAIN-FREE PROGRAM exercises http://drbillsclinic.com/exercise _eliminate.html )   for him to use, after his course of postoperative rehab is complete. It’s great advantage is that these exercises are clinically proven to WORK, based as they are on my nearly quarter century of clinical practice. And I used these exercises myself, after my own knee surgery.
 
Now, not all ACL ruptures require reconstructive surgery. If you’re NOT a competitive athlete and you have NO instability during normal daily activities, you may get by without surgery. That doesn’t mean without treatment, though. But if you would like to try a non-operative appproach, see what measures are available to you in my newest program, HOW TO AVOID KNEE SURGERY, at
 http://drbillsclinic.com/avoid_knee_surgery.html   also available as a full length audio CD.

As if that wasn’t enough, today is the start of my 4th of JULY HALF PRICE SALE! For one week only, ending at MIDNIGHT, on Monday, July 6th, my PAIN-FREE PROGRAM,  and best of all, THE ADVANCED MASTERS’ PROGRAM,  ARE HALF PRICED!!!   http://drbillsclinic.com/half_off.html
 
So, if you’ve been waiting for the price to come down to get one of these outstanding, life-changing, pain-relieving programs, now’s your chance. But it won’t last forever, and supplies are limited, so if you want one of these, ORDER NOW! http://drbillsclinic.com/half_off.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