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Posts Tagged ‘end stage arthritis’

The Most Important Factor In Treating Knee Pain

Thursday, April 4th, 2013

July 26, 2012

Late in August, the bride and I are going on a nice cruise, as a mutual
birthday gift. It falls midway between my birthday and hers. So, rather
than waste dough on something I really don’t need, or getting her yet another
piece of jewelry, or something else she really doesn’t need, we will spend
our funds on a nice relaxing change of venue, which we DO need.

Even if it’s just a break from the cats, it will be welcome. And speaking of
the cats, I had to contact our Pet Nanny, to look after our brood, while we
are away, basking in the Caribbean sun.

Well, it turns out that she’s had a series of medical challenges, including
an end stage knee, meaning end stage osteoarthritis. She had been cleared for
surgery and had decided to go ahead with it. She found a good surgeon, in whom
she has great confidence.

She got her underlying medical conditions stablized, obtained clearance,
and was actually on the operating table, with her leg anesthetized, when…

A nurse ran in with a urinalysis, done on admission, and said “HOLD EVERYTHING!”
Turns out she had a urinary tract infection. So, despite much weeping and wailing
and pleading to proceed, her surgeon kindly, but firmly, advised her that he
simply couldn’t.

Which, of course, was the right decision, in view of the fact that this is, after
all an elective procedure, not an emergency. Given that she’s a diabetic, which
makes one much more prone to complications, including infection, wound healing problems,
and nerve injuries, this was the right move.

So, the poor thing did NOT have her surgery and she is now completing her course
of oral antibiotics. She doesn’t know what the organism is, as yet, but odds are
good it’s ether an E. coli (common in women, given the proximity of the female
urethra and the anus), or a staph bug (the most common skin bacteria).

While we commiserated about her situation. she asking me for my advice.
Given that this was my area of real expertise for a couple of decades, I gave
her my best tips, which I will now share with you.

First, surgery is not magic. It’s simply a mechanical alteration of the arthritic
joint, so as to resemble the natural joint in its normal state, without disease or
deformity. I think the surgery is worth about one third of the final result.

The second factor is exercise, usually physical therapy, followed by a home
exercise program. Now, when it comes to regaining motion and function, knees
are much harder than hips.

Here’s why: bending the knee after surgery HURTS. No other way to describe it.

Many people anticipate the pain, or are so frightened of it that they fail to push
for that desired degree of motion. As a result, they get a stiff knee, with persistent
swelling, constant pain and they develop adhesions (internal bands of scar tissue),
which increase the feeling of tightness and further inhibit motion.

Failure to get the knee to fully straighten is even worse. Then, the knee develops
what is called a fixed flexion contracture (FFC), which really slows recovery,
makes walking more difficult and may extend disability for many months.

It also shortens the limb, functionally, and fatigues the patient, because
the not fully straightened knee requires the use of muscle power to support
the body, while the fully straightened knee can “lock out,” without any
muscular effort.

So both extremes, extension and flexion, must be maximized to get the best
result and they need to be achieved early after surgery, BEFORE the advent of
adhesions. BUT, if you’re doing it right, they both HURT. No doubt about it.

However…if you embrace the pain and push the motion, to get beyond 90 degrees
of flexion within the first three days after surgery, your result will be much
better and you will keep the motion gained forever. Ditto for full extension.

Here’s how. First, take however much pain medication you need to blunt the
pain enough to accomplish those extremes. That’s what it’s for. You will NOT
get “addicted” in three days and after that, pain falls off dramatically.
Also, as you get used to the increased motion, the extremes no longer hurt.
And the swelling falls rapidly, as well. And wound healing is enhanced.

Do NOT be afraid that the wound will burst apart. It only feels that way. It
will NOT. And that sensation will also rapidly decrease in those first few
days, if you keep pushing the limits.

When at rest, place your padded heel on a pillow or two, without support under
the operative knee. Gravity will passively straighten the joint, as the muscles
fatigue. The patient can also gently press down on the thigh, above the knee
to encourage full straightening. It’s supposed to feel very tight at the back
of the knee joint. That’s the idea.

Now, sit up at the edge of the bed, cradle the operative leg with your other
leg and allow gravity to bend the knee, passively. That’s the fastest way to
hit 90 degrees. Just let gravity do the work. Do some deep breathing to relax
the muscles, as you exhale.

Some surgeons use a CPM (Continuous Passive Motion) machine to gently bend and
extend the knee. With your surgeon’s permission, crank it up a degree or two,
every time it starts feeling too comfortable, until you’re over 90 (and preferably
100 or 110).

Then, you can do some straight leg raising and quadriceps setting exercises, to
develop thigh strength. You will initially have a physical therapist to help
guide you in this and to help you walk (initially with a walker, or crutches,
or cane, depending on your balance).

From there on, you follow any selection of the many proven knee strengthening
exercises, like those featured in my PAIN-FREE PROGRAM.

These are the same exercises I prescribed for my own patients, before, after,
or instead of knee surgery, from arthroscopic procedures to full total knee
replacements. I even used these myself, to rehab my own knee, after arthroscopic
surgery in 2005.

Now, if my friend follows my advice, and her surgeon does a good job, she
should enjoy an excellent result. Artificial joints have a 90-95% average good
to excellent result. And that’s pretty good shootin’.

It all depends on the last and perhaps the most important factor in treating
knee pain–ATTITUDE.

The attitude of the patient plays as great a role in success as the surgery or
the postop rehabilitation. You have to think positively and WANT to succeed.
Then, you most likely will.

Like Henry Ford once said, “Whether you believe you can, or believe you can’t…
you’re right.”

Now if you have knee pain and want to avoid surgery, these same exercises have
the best chance of helping you do just that, while relieving your knee pain.
All YOU have to do is click the link. GET IT HERE. And do it, NOW. Why suffer
for even one more day?

Til next time, my friend, be well.

Yours for a pain-free tomorrow and yoiur optimal health,

Dr. Bill

P.S. Multiple studies have shown that exercise is far MORE effective
for long term relief of knee pain than analgesics, or NSAID’s. And,
they burn no bridges. If YOU have knee pain and want FAST relief, then
click this link. GET IT HERE.

P.P.S. Please use THIS LINK to “LIKE” Dr. Bill’s Clinic on Facebook.
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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

After The Fact, Then What…?

Thursday, October 9th, 2008

When I switched on the compouter this morning in my study, I clicked on my email, as I usually do, to see what, beside spam and junk, was in the inbox. As you might imagine, I get lots of emails and referrals and requests for advice about knee pain, hip and back pain, arthritis and all the rest of it. Whenever possible, I try to help, if I can.
 
Oftentimes, that means referring the enquirer to one of my healing programs or books. Sometimes, I can give them some short term advice that may help. Of course, I’m limited by the fact that I can’t see, much less examine them, and I’m further limited by their description of their problems. 
 
Lay people know what they mean, but they often can’t express it well enough for me to understand what the problem is. We don’t share the same vocabulary when it comes to medical problems. That’s one of the most important contributions of my LITTLE GREEN BOOK (see it  at http://drbillsclinic.com/eliminate_knee_pain.html ), which translates a number of medical problems from “medicalese” into everyday plain English, so the average person can understand what we’re talking about.
 
Anyway, recently, I’ve had a number of questions from people who have already HAD surgery, usually arthroscopic surgery, but STILL have pain. As is typical in my experience, many tend to blame the doctor for screwing up the surgery. But in fact, persistent pain may be from residual arthritic changes inside the joint. And it’s now well accepted, backed up by two large studies, that arthroscopic  surgery for arthritis is pretty ineffective. So, it’s not uncommon to have persistent pain after that procedure.
 
Let me give you an example of what I mean. This is the most recent email from someone in this very situation:
 
“I have had arthroscopic surgery on both knees. My right knee is in really bad shape after surgery. I think the surgeon really must have botched it because I am in constant knee pain after being on my feet for a few hours. How will your exercises help with no meniscus left in my knee? By the way, I am 57 and the surgeon says I am too young for knee replacement. Can you help me strengthen my knees through exercising?  Thanks…”
 
And here was my reply:
 
“…Your problem is not uncommon. You may have had a torn meniscus, which the surgeon probably removed PARTIALLY (you generally try to leave some of it as a cushion, unless it is already completely shredded from degeneration).  However, most likely, he did NOT “botch it.” It’s just that you undoubtedly have ARTHRITIS in that joint, which arthroscopy CANNOT CURE. That’s the most likely source of your pain. 

“57 is NOT too young to have a total knee. But, there are a number of proven, very effective non-surgical methods that can help to relieve your pain, and restore your function, at least for a while. You may wish to get my newest healing program, HOW TO AVOID KNEE SURGERY   at http://drbillsclinic.com/avoid_knee_surgery.html
 
“Exercises help by increasing the stability and the support of the arthritic joint by increasing the mass and strength of the surrounding muscles. But they are only one method, among many others, that can delay surgery. If you have end stage arthritis, eventually you WILL come to a total knee. 
 
” But that day can be delayed in many cases–I had one patient I carried in this way for TEN YEARS,before he finally got it done. But remember, everyone is different, so you can’t predict how well these methods will work for you. Still, isn’t it worth a shot? 
 
” BTW, be sure you have your Total Knee done by a specialist in joint replacement, when the time comes. It’s a very technique dependent procedure, so a guy who’s doing a LOT of them will have better results and fewer problems and complications. Hope these  tips help. Good luck to you!…”
 
Hopefully, he’ll take my advice and click on   http://drbillsclinic.com/avoid_knee_surgery.html  He’s likely to find a highly effective combination of conventional and alternative measures and exercises that will give him FAST RELIEF from his knee pain and help him AVOID SURGERY, if that’s possible. How about you?
 
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 Not-So-Secret Six

Tuesday, September 16th, 2008

Well, as might be expected, the article in last week’s New England Journal of Medicine has spawned dozens of additional articles and blog posts across the infosphere. This, of course, was the article by Canadian researchers that found that arthroscopic surgery offered no real  benefits, when used to treat arthritis. And, as I pointed out a couple of days ago, this study reiterated the findings of earlier studies which found pretty much the same thing.
 
Dr. Robert Litchfield, the head of the Kennedy Fowler Sport Medicine Clinic and the one of the study’s co-investigators, suggested that in view of their findings, “surgeons need to think about other ways of treating patients, rather than jumping immediately to surgery.”
 
Well, DUH! I was always under the impression that that was what we were supposed to so ALL the time. Ah well, the fat’s in the fire, now. Every purveyor of alternative measures is out there, beating the drum for their own special brand of remedy. Physical therapists, in particular, are in high cotton over this report, since exercise is one of the alternatives that the study found to be just as effective as surgery in improving arthritis symptoms. And it is. And so is exercise without the benefit of a therapist, like the exercise I teach in my PAIN-FREE PROGRAM at http://drbillsclinic.com/exercise_eliminate.html
 
Now the NEJM article has led to a derivitive article in U.S. News & World Report, that promotes “six alternatives to surgery for treating arthritis.”  These not-so-secret six are well known to everyone, and in fact are included in my newest healing program,
 HOW TO AVOID KNEE SURGERY, as you can see at   http://drbillsclinic.com/avoid_knee_surgery.html
But the trick is knowing HOW and WHEN to use them, and in WHAT MANNER.
 
The six alternatives treatments that are known to be effective include 1. weight loss & exercise,  2. physical therapy (read, supervised EXERCISE),  3. medications, 4. glucosamine & chondroitin (read, NUTRICEUTICALS), 5. Viscosupplementation and 6. total knee replacement.
 
Given the message that arthroscopic surgery for arthritis was to be avoided, I was kind of amused that the sixth “alternative” to arthroscopic surgery was total knee replacement. I mean, that’s the definitive treatment for end stage arthritis, from virtually any source. But that’s pretty major–it’s as big a surgical intervention as there is, with regard to arthritis. So their recommendations range from exercises and naturopathic measures to complete joint replacement. That’s quite a jump!
 
The fact is, no one in their right mind would suggest a total knee, unless ALL other measures had been exhausted, first. It’s kind of axiomatic. It’s what I refer to as my “Ladder Principle:” you start at the bottom rung, with the least invasive, least aggressive therapy you can find. Then, you “climb the ladder” until you find that treatment that works for you.
 
The problem is that you don’t need information–there’s a world of information out there. But without a filter, without a guide to teach you what’s effective and what’s not, you’ll be spinning your wheels a long time and wasting a lot of money in the process. That’s why I wrote my healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
It’s a guide to all those treatments that are out there, conventional, alternative, and complementary, that shows you, step by step, what to do, how to do it, how much of any medication or nutriceutical to take, and most important, what to AVOID. You see, you don’t need more information. You need ADVICE. And that’s what I provide. That’s what I do.
 
So, if you or someone you care about has arthritis, or some other type of joint pain, and you want to know what to do to get FAST relief of knee pain and do it WITHOUT SURGERY, click on this link for my latest and best program http://drbillsclinic.com/avoid_knee_surgery.html
 
That’s it for today. 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