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Posts Tagged ‘end stage arthritis’

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