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Posts Tagged ‘bone-on-bone’

What’s That Horrible Crunching Noise In My Knee?

Wednesday, December 3rd, 2008

So here I am, sitting in the study of the Southern Command Post, reviewing emails. And I came across one from a nice lady who is very concerned because she has knee pain, she is very heavy, given her size and worst of all, she has noises inside her joints that can actually be heard by people around her.
 
She was quite properly concerned because she’d like to get rid of her knee pain, and she wanted to get a copy of my newest healing program, HOW TO AVOID KNEE SURGERY (which you can get here at this link:  http://drbillsclinic.com/avoid_knee_surgery.html ), but she was afraid that it was already far too late for her–that the noise in her knees meant that all the cartilage had worn away completely, and that she had a “bone-on-bone” condition. This is what we in the trade call an “end stage knee.”
 
When articular cartilage, that normally coats the joint surfaces, is so diseased that it has eroded away and exposed the underlying bone, the naked bony surfaces grind upon each other with a deep, hard grinding sound and sensation that, once experienced or heard, is difficult to mistake for anything else.
 
It really is like rubbing two big rocks together, with grinding, rubbing and at times a mechanical ratcheting sensation. And, since the bone is where all the nerves reside, it hurts like hell! And that doesn’t count the extra pain from the inflamed lining membrane (synovium) that adds its own component to the pain.
 
So whether it’s osteoarthritis or rheumatoid arthritis, it’s at this end stage of disease, with exposed, bare bone, when major surgery IS truly indicated. Because at this state of the art, at this time, we cannot yet regrow new, healthy articular cartilage in a totally arthritic joint. The best we can offer is total knee replacements. And when they are indicated, they can be wonderful: pain relief, restoration of function and correction of deformity, with good to excellent results in over 95% of cases.
 
BUT…it’s major league surgery, with lots of risks and potential complications. So you don’t do it if you don’t HAVE to. 
 
However, all noise from within the joint doesn’t necessarily mean that your joints are finished and you need major surgery. Other conditions can cause noise, as well. When the lining of the joint becomes inflamed and swollen, its folds become thickened and enlarged. They rub upon each other, making a finer, more delicate crunching that we call crepitus or crepitation
 
If the membrane is restored to normal, the inflammation resolved, the swollen folds stop rubbing together and the noise stops. But if the condition persists for a long time, the membranous folds may become replaced with fibrous tissue (they become bands of scar tissue) and they then must be cut away surgically, to eliminate the sensation and the sound.
 
Then, there is degeneration of the articular cartilage surfaces, which may break apart into shredded beds of cartilage fronds, appearing like areas of “crab meat.” When these fragmented or fibrillated regions rub, one upon another, they too produce a crunching sensation, like walking in a gravel pit. 
 
This condition is called chondromalacia (“soft cartilage” grade III) and once this point has been reached, where there is physical disruption of the cartilage surface, it can never again return to a pristine, smooth surface. I discuss this disease and the various types of arthritis in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (manual and CD). Get it here at: http://drbillsclinic.com/eliminate_knee_pain.html  However, even though the knee is noisy, it doesn’t mean that it will immediately go on to full end stage arthritis. The knee can stabilize in this state for a long time, sometimes pain-free (if a little noisy), if treated with the exercises I teach in my PAIN-FREE PROGRAM. See what I mean at this link:   http://drbillsclinic.com/exercise_eliminate.html
 
The point is, this lady has nothing to lose and everything to gain by at least trying all the conservative measures that are available, to relieve knee pain. One of them, or some combination of them, may give her the knee pain relief she seeks, and buy time, until she can lose weight and make an eventual surgery safer and more likely successful. 
 
So the next time someone, maybe you, says, “Hey, what’s that horrible crunching noise in my knee?” now you know what some of the reasons might be. And some may well be treatable by non-surgical measures, like those in HOW TO AVOID KNEE SURGERY: http://drbillsclinic.com/avoid_knee_surgery.html   Noise doesn’t necessarily mean it’s the end of the line, or that a total knee is the only option.
 
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

The Best Advice I Can Give

Tuesday, August 12th, 2008

Just the other day, I got an email from one of my subscribers, who also happens to be one of my friends from the “old days,” back when I was living in New York and practicing orthopaedics. It seems she was looking for some helpful advice for a friend of hers who apparently has arthritis of her knee. 

The woman had apparently developed gradual onset pain of her knee over the last several years. She had seen a physician and apparently had x-rays. The x-rays reportedly showed “bone-on-bone” in the inner aspect of her knee (the medial compartment). She was told that she needed a total knee replacement. But she clearly didn’t want to have surgery. So she asked my friend to ask me what she should do.
 
Well, I wrote back that once you have an x-ray that demonstrates “bone-on-bone,” you are pretty much committed to having a joint replacement, eventually. However, that procedure can be DELAYED, or postponed.

You see, “bone-on-bone” means that the bones of the knee joint, that you see on the x-ray, are touching each other. And that means that their protective cartilage layer has worn away. Since cartilage is invisible on an x-ray, the normal appearance of an x-ray is one of the bones appearing to “float” apart. In other words, there is a  joint “space” between them. Once the cartilage is gone, there’s nothing to hold them apart anymore–hence, the bones touch, ie., “bone-on-bone.” 

The problem is that once the cartilage has worn away, and the underlying bone is exposed, the cartilage isn’t going to grow back. That’s one of the key factors about cartilage: it lacks a blood supply. And without a blood supply, healing, or regrowth of the tissue CANNOT take place. 

Yes, yes. I know there are methods out there being promoted that CLAIM to regrow cartilage. They even show x-rays, reportedly “un-retouched,” that seem to show a new “joint space” re-formed. I saw one just recently in an in-flight airline magazine and I’ve seen them before on various web sites, which market to the credulous. 

Unfortunately, that is absolute crap! No known non-surgical method can regrow cartilage, once it’s been destroyed. 

What these magazines and websites show is actually a “before” weight bearing x-ray, in which the bones are touching, followed by a NON-weight bearing x-ray,  in which the bones APPEAR to be separated, because there’s no weight on them to press them together. 

So their claim is technically true: the x-rays ARE un-retouched. But the new “space” is  NOT from new growth of cartilage. And they’re even cleverer than that–they never actually SAY that they grow new cartilage. They show the pictures and let YOU make the inference.

Now, mind you, there ARE non-surgical methods that can help relieve pain, and forstall the need for surgery. But actually re-grow cartilage? No. ‘Fraid not. Maybe some day, with stem cells or some such, but not now.
 
So the best advice I can give this lady is to follow the many measures, from across the entire medical spectrum, that I teach in my newest healing program,  HOW TO AVOID KNEE SURGERY, which you, too, can see at http://drbillsclinic.com/avoid_knee_surgery.html
 
These methods, conventional and alternative alike, when used together, create a SYNERGY, where the combination is far more effective than any single component alone. And these methods are proven and safe. They won’t grow new cartilage. Nothing short of a very sophisticated, two-stage surgical technique can, at this time. But they CAN give you relief of pain, buy you time, and delay a joint replacement. See how at  http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s all for today, my friend. Talk to you soon. Meanwhile, 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