Tiger Woods has done it again! Only a couple of months after arthroscopic surgery on his left knee, for “cartilage damage,” he came from behind to win the U.S. OPEN. Wincing in obvious pain throughout the tournament at Torrey Pines, San Diego, Tiger fell behind earlier in the game, with a couple of bogeys, but then went on to pull even, with a couple of simply spectacular shots, that apparently defied the laws of physics, and resulted in eagles. After 90 gruelling holes of golf, Tiger finally clinched the title from opponent Rocco Mediate in sudden death on the 91st hole. This is one for the ages!
 
So Tiger pulls it off again, against a great player, with a real physical and mental handicap. He’s now won his 3rd U.S. Open and his 14th Major Title, hot on the heels of Golfing Great Jack Nicklaus’ Lifetime 18 Major Titles. And Tiger is only 32 years old (though I bet his left knee is a lot “older”). 

I’m not a big golfer, personally (tough to do when you have a fractured spine and crushed discs), but I fiercely admire excellence and achievement, especially when wrested from adversity. This was the third time that Tiger had this same knee operated on. He had a benign tumor removed in the late nineties, and arthroscopy in 2002.
 
If you were watching him walking in the Masters, he was wincing and in obvious pain from that left knee. It’s very possible that the distraction lost that tournament for him, but even there, he almost pulled it off and finished second. This guy is unbelievable! No matter
how you cut it, he is a true champion.
 
The “cartilage damage” referred to could refer to degenerative or traumatic damage to the articular cartilage, manifested as shredding, crevasses or flaps. If widespread, this could be consistent with arthritic changes, despite the fact that Tiger is only 32 years old. On the other hand, it could refer to a tear or degenerative shredding of the meniscal cartilage. No real details have been made available, so it’s anyone’s guess. But his pathology was likely one of these, or both.
 
What happens when the cartilage is damaged? Well, in brief, whether from direct impact, or from slow, progressive degeneration, the ice smooth resilient articular cartilage coating of the bearing surfaces of the knee joint become softer than normal and eventually begin to fragment and shred. Once the cartilage is physically disrupted, this unravelling of the protein fibers of collagen (that normally give support) speeds up and progresses. This is discussed and illustrated in detail in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see it at   http://drbillsclinic.com/eliminate_knee_pain.html)
 
If the damage is to the crescent-shaped meniscus, it’s usually a tear. Thing is, any cartilage damage is a problem because cartilage, once physically broken or torn, cannot heal without very sophisticated surgical techniques (at least with current technology).  But there are a number of supplements, herbs, OTC medicines, and even food choices that can have a positive or negative influence on inflammation and
pain.
 
When Tiger was walking the links in pain, something within his knee was catching in that joint, causing traction on the capsule of the joint and/or the lining membrane. Problem is, if the thigh muscles are weakened by the persistent pain, they can’t stabilize the joint and help absorb the shock of walking (especially up and down the rolling hills of a golf course).
 
The solution, both before and after knee surgery, is to strengthen the thigh muscles, the quadriceps, so they will be able to absorb shock and supplement the ligaments to priovide optimal stability. To do that, a number of exercises designed to increase muscle tone, strength and power, and stretches for the antagonists on the opposite side of the thigh, are necessary. But not any old squatting motions will do. No, you need to strengthen your thighs strategically, based on the type of pathology you have. 

As an orthopaedic surgeon and, more important, as a knee surgery patient myself, I’ve collected the best and most effective exercises, specially modified to prevent or eliminate knee pain, in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html
 
Using a combination of the movements described in my PROGRAM, anyone can improve the stability of their knee and relieve their pain. Of course, as I mentioned yesterday, you actually have to DO the exercises. Nothing happens without effort. But if you do them, your thighs will grow strong and your knee pain will get better and better. Try it 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 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

“…To boldly go where no one has gone before…,” like, up the stairs, without pain. When you have sore kneecaps,  that’s a potential source of real aggravation. And yet, properly used, the stairs can be a great training tool and a means of strengthening your knees and actually ridding yourself of that very problem.
 
First, try to get a handle on why you’re having pain.  A number of conditions either in or around the kneecaps can be responsible for the pain you experience. The number one contender is chondromalacia patellae, a degenerative softening of the cartilage behind the kneecap. This can happen as a result of any number of things, including direct injury, like a fall or a dashboard impact on the knee, maltracking, where the kneecap is pulled off its central path (usually to the outside, or lateral side), or degeneration. I have a more complete discussion avalaible for you at   http:drbillsclinic.com/eliminate_knee_pain.html
 
Other potential sources of peripatellar pain are prepatellar bursitis, infrapatellar bursitis, fat pad syndrome, and “jumper’s knee,” also called patellar tendinitis. While the distinctions are discernable to an acute examiner, the bottom line is, you HURT whenever you bend the knee under a load of bodyweight, as when climbing the stairs.
 
The good news is that the treatment for all of these sources of knee pain is the same. Acute inflammation requires rest and avoidance of foot over foot stair climbing. Instead, try climbing one at a time: up to heaven with the bad (or worse) leg, down to hell with the bad (or worse) leg. Clearly, what you’re doing here is is avoiding direct compression of the patellofemoral compartment.
 
Local heat, avoiding other activities that can worsen your pain, like kneeling, squatting and the like, and anti-inflammatory medication, OTC or prescription, will also help to improve your pain. When the acute pain recedes, it’s time for rehabilitation exercises to strengthen the muscles, improve muscular balance and restore central tracking, like those I teach at   http://drbillsclinic.com/exercise_eliminate.html

Eventually, stairs can be used as an exercise, to strengthen the quads and toughen the cartilage. Begin with stairs with a shorter rise and a less acute angle of ascension. Those leading up to court buildings or monuments are ideal for this. As strength improves, try stairs with a more acute angle, like those in many homes. Once stair climbing is well tolerated, you can even use them in lieu of a hill for sprints.
 
Til next time, my friend, all the best and 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