This morning, I was going through some old boxes stored in my garage (no basements in Orlando–the water table is so high that you can strike water eighteen inches into the ground). I’m trying to get rid of some stuff that has been lying around for far too long and to do that, I have to go through it all. I’m trying to be ruthless, but it’s hard.
 
I’m a “pack rat” by nature. I save books, old notebooks from school, articles, pages cut from magazines, illustrations that took my fancy, paintings, posters, art prints, sculpture, electronics, tools, guns, coins, items of clothing, weights, exercise equipment, office and tax records, you name it. Then, there’s the stuff my wife likes, like multiple sets of china, clothes, pocketbooks, and enough shoes to give Imelda Marcos a run for her money. And on top of all of that is furniture and more furniture. You name it, I’ve saved it. Never know when it might come in handy….
 
In digging through this stuff, it’s like being an archeologist, or treasure hunting. Every new box I open is filled with stuff. Everything I touch evokes a memory. Which is why it’s hard to part with this stuff–it’s like throwing away a part of my life, in a way. But it’s got to be done.
 
The trouble with stuff is that after a while, you don’t own your possessions–they own YOU. We’re now married for over 34 years and I still have stuff from Grammar School, Junior High, High School, College and Medical School for God’s sake! Little by little, like barnacles on the hull of a ship, the stuff accumulates. This, of course, makes every move a nightmare. So the stuff has to go.
 
But, as it’s contrary to my nature, I can’t simply pitch everything. No, I have to go through it, to be sure I’m not throwing away some long buried treasure from my past. It’s sick, I admit it. In my own defense, I don’t smoke, I don’t drink and I don’t fool around on the bride–hey, you’ve gotta do SOMETHING, right? Could be worse.
 
So, while I’m digging through the boxes, I came across my old bones collection, from the office: near perfect skull, probably a young woman, a femur, tibia, a vertebral body, a bag of foot bones. Thing is, these are REAL human bones. Can’t get these any more. The countries that used to produce them, chiefly India, under Indira Ghandi, outlawed the practice many years ago. 
 
Today, plastic models are the best a young medical student can do. Not the same thing, though–they can’t capture the subtle details, especially in the delicate internal bones of the skull. So I’m thinking, good thing I didn’t just throw these out. Can you imagine these bones coming to light in the garbage dump? I can see the cops knocking on my door now….
 
Then, I came across my old knee model. This IS plastic and shows the menisci and all the ligaments. I used to use this to explain why someone was having pain, to demonstrate which part of the joint was damaged. Then, under these items, I came across my teaching handouts. I used to give these to the patients as “take aways” so they’d remember some of what I told them during their office visits. Even though I could tell what was wrong with someone and formulate a treatment plan in under a minute, I would often spend the next hour or so explaining everything to the patient and family. But as studies done at the University of Florida showed years ago, people just don’t remember what they were told. They retain less than 27%, especially stuff like complications of surgery, after only 24
hours. 

So, my handouts were my way of reminding them. Each one was a single page, with all the pertinent information we had just discussed. One for each of the most common clinical problems I treated. And then, there was my physical therapy prescription. The therapist loved my Rx, because I gave them the diagnosis, the surgery (if any), with exactly what was done, and specified exercises and modalities to be done. This was the prototype of the exercises I teach in my PAIN-FREE PROGRAM, which you can get at
 http://drbillsclinic.com/exercise_eliminate.html
 
The therapists liked this because most docs sent them a prescription that said “P.T.” They left pretty much everything up to the therapist, who of course had NO clinical information about the patient. Incredible. How could they help, if they didn’t know what they were treating? Made no sense to me. So they generally gave the patients knee extensions, or leg presses with resistance, to strengthen the quads, followed by ice and later, hot packs and electrical stimulation. Hard to go too wrong with those.
 
The miracle was that many people got better, anyway. That’s a tribute to the power of exercise to relieve pain, even if done in a very general way. Better, by far, if exercise is done strategically, to alter the dynamics of the knee, according to the pathology causing the problem. That’s what the PAIN-FREE PROGRAM does. See it at http://drbillsclinic.com/exercise_eliminate.html 
 
Well, back to the junk heap. I’m sure I can get rid of a lot of this stuff. Just have to keep digging…. 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

A good friend of mine emailed me today for advice.  He’s a doctor of chiropractic who’s developed severe pain in his hip joint. He saw an orthopaedist, who got an MRI, but it was inconclusive–could be edema, or it could be a more serious disease that could result in surgery. 
 
Trouble is, the picture doesn’t look like what you’d expect if he had the more serious disease. Typical of the problems one sees in clinical practice–cases often don’t follow the textbook presentation. So it makes it tough to know exactly what to do.
 
Seems the guy has asthma and he’s been taking steroids (prednisone) for some time to try to control the symptoms. But one of the potential and most dreaded side effects of longer term systemic steroid use, typically seen in asthmatics, rheumatics, or people with chronic allergies or skin diseases, is a bone disease called avascular necrosis.
 
Avascular necrosis is a kind of weird disease that no one’s ever heard of, until they get it, or know someone who did. It refers to the death of bone cells inside a bone. It’s variously called aseptic necrosis (meaning it is NOT caused by an infection), ischemic (meaning it’s due to oxygen deprivation) necrosis, or avascular (lack of blood supply) necrosis, or just plain old osteonecrosis (or “dead bone”) where “necrosis” means cell death. It commonly affects the hip, knee, shoulder, or ankle, in roughly that order.
 
For any number of reasons, this happens because there is a blockage of the blood supply to the bone of the affected joint. Think of it like a dam in a river. So everything “downstream” that is normally fed by the blood supply is suddenly cut off. The cells, deprived of oxygen, begin to die. The surrounding bone then begins to deteriorate. In the case of the hip, this area is recognized as “dead” by the body and special cells go to the site and begin eating away the dead bone area, so that new healing bone can be laid down.
 
The problem is that as that dead bone is removed, support for the overlying joint surface is is removed, too. The pressure across the joint surface causes the joint surface to collapse under the pressure. Think of a house that has its foundation eroded by an underground river, or a sink hole. What happens to the roof? Caves in, right? 
 
Same thing.
 
When the “roof” caves in, that segment collapses, the hip suddenly hurts like Hell and the resulting irregularity rapidly chews up the rest of the joint, causing rapid onset of arthritis. Very bad news, indeed.  Once that happens, nothing short of a hip replacement can relieve pain and restore function.
 
If you recognize the disease early enough, you can do a small surgery that can often save the joint from collapse. Through a tiny stab wound incision and under fluoroscopic control, a surgeon can drill a hole from the side of the hip bone into the femoral head, just like coring an apple. This relieves pressure inside the femoral head, which is believed to be responsible for cutting off the blood supply to the femoral head. Not as big a deal as total hip replacement, but, hey, it’s still surgery, right? You want to avoid it, if you can.
 
So the doctor’s dilemma is to get an accurate diagnosis quickly enough to do a lesser surgery and head off joint collapse, but not to do an unnecessary surgery, if it isn’t needed. And he has to try to relieve the hip pain, while all this is going on. Not always an easy thing to do. And made much more difficult when the picture isn’t typical. Tough to know what the right thing is to do…
 
Same thing occurs in the knee, but there, because the knee is a larger joint (in fact, the largest joint), it’s a lot more forgiving and less likely to collapse than the hip. So there, conservative non-surgical treatments make the most sense, like those I teach in my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Meanwhile, I recommended my friend reduce the forces across his hip joint by using a cane. Same thing for a painful knee. Sometimes, the simplest things are the most effective. That, combined with a number of the alternative and conventional non-surgical treatments  to relieve pain, that I describe in detail at http://drbillsclinic.com/avoid_knee_surgery.html  may be very helpful to him. Even though the program was written for the knee, the methods I use are systemic, that is, they work for the whole body, hip included. And that program comes with a FREE Special Report on HOW TO RELIEVE HIP PAIN, too.
 
So, I wished him luck. Hopefully, he’ll recover soon, and avoid all those problems. We’ll just have to wait and see…
 
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 last time, we discussed what’s really involved in arthroscopic knee surgery. My thesis is that you’re far less likley to be afraid of necessary, needed surgical procedures, if you understand what’s actually done. Otherwise, your imagination creates a lot of nightmares that are much more intimidating than the real thing–by far!
 
Although the procedure I described was for treating a painful, degenerative kneecap, the same basic techniques are utilized when dealing with torn menisci, loose bodies, inflamed synovium and even ACL ruptures and tibial plateau fractures. The specifics are different for each type of pathology, but the basic approach is the same.
 
Let’s look at torn menisci first, for today. As I point out in the section on menisci in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN    http://drbillsclinic.com/eliminate_knee_pain.html   these cushions have no blood supply, except for the peripheral 25-30%. So many tears on the inside of the knee simply won’t heal. Therefore, treatment is basically removing the loose, torn fragment. 

After inserting the arthroscope into the joint, as we discussed yesterday, and identifying the loose torn piece of the meniscus, the surgeon uses small nippers, called “basket forceps” to nibble away the offending fragment. The little pieces of the meniscus float around inside the joint, until they’re sucked out by a power shaver (basically a tube with a rotating blade, attached to suction).  This shaver is also used to cut away overgrown and/or inflamed synovium (joint lining membrane), or shredded, fragmented articular cartilage (a process called debridement, or “house cleaning”).
 
Loose bodies, usually fragments of bone coated with cartilage, which have “fallen out” of the articular surface by disease, have been grown inside the synovial membrane, or have been “knocked out” of the joint surfaces by trauma, are removed by long grasping forceps. These are basically “grabbers” that the surgeon uses to capture the loose body and extract it. If it’s too big to pass through the arthroscopic portal (the little incision used to introduce the scope into the knee), either the incision can be enlarged, or the loose body can be broken up into smaller pieces and remove them, one by one.
 
Anyway, as you can see, you can do lots of different things through the arthroscope, but since nearly all the stuff inside the knee is devoid of nerves (or blood), the minimal disability is about the same, no matter WHAT you do inside. And THAT’S what the arthroscopic revolution is all about. And that’s why the pain is so minimal and recovery so rapid after this type of surgery. Pain and disability are functions of the size of the incisions and the amount of internal bleeding.  Minimal incisons, minimal disability. Simple, no? Pretty cool, too. It’s really transformed surgery!
 
Now, you know the worst of it. Not so scarey, is it? But that doesn’t mean you want to have surgery if it isn’t really necessary. That’s the key: you don’t want to be irrationally afraid of surgery, because there ARE times it’s needed. But you DO want to AVOID the UNNECESSARY surgery. This is a common sense, rational approach and the same one I used for lo those many years in practice, which resulted in my treating over 90% of my patients, WITHOUT SURGERY.
 
If you want to give your body the chance to heal naturally, if you want to stay OUT of the operating room, if you want to improve the odds of conservative treatment working, or use alternative methods to relieve your pain, then you need my newest healing program, HOW TO AVOID KNEE SURGERY, which you can see at   http://drbillsclinic.com/avoid_knee_surgery.html
 
Now, I had planned to continue with a description of joint replacement — what it is and what it isn’t–with the same idea: you will be less afraid if you understand what it really is. But I have a special treat for you instead. My friend, Fred Nicklaus, a veteran of 30 years in the martial arts and a guy who has HAD a hip replacement himself, is going to have a special offer on his Combat Endurance course, a proven method to give you a core of steel. But more about that tomorrow…
 
Meanwhile, if you have knee pain and you’re keen to stay out of the O.R., try HOW TO AVOID KNEE SURGERY at
http://drbillsclinic.com/avoid_knee_surgery.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

April 24, 2008

The other day, I had to take my car in for new tires. Not all of them, just the front two, which were worn down on their outer margins, just enough to make them dangerous. This wouldn’t be such a big deal except that it’s a leased  car, which I plan to give back in December. I know it’s silly, but it just frosts me to have to buy new tires for a car I’m giving back. I already bought the rear tires a year ago.

On the other hand, considering the consequences of a blow-out at high speed on one of Florida’s beautiful highways, getting new tires is cheap at the cost. But if you’ve ever leased a car, did you ever notice that something always falls apart, or wears out, just before the lease is up? Maybe it’s just me, but it seems to me that this happens every time I lease a car. And the fact that it’s an alleged “luxury” car just makes it more infuriating. I mean, nothing on these cars is cheap anymore. Once upon a time, if you had an electrical problem, you replaced a 75
cent fuse–now, you have to relace a $2000 electronic module. This is progress?! I remember my first automobile. My mother bought me
a red Toyota Corolla (for about $2000) for my internship at Medical College of Virginia, in Richmond. This was the first car I ever owned, having borrowed my parents’ cars for dates and the like, while I was going to medical school. I wrapped it around a telephone pole
at about 2 AM, having fallen asleep at the wheel, while trying to get to my little apartment for a few hours of sleep, after (no kidding) a 72 hour shift at the hospital. Only the lightning fast reflexes of my youth saved me. One more time I was very lucky to be alive.

Oddly enough, I wasn’t worried about nearly being killed, or wrecking my new (and only) car. No, I was scared to death that the chief resident was going to kill me for being late for rounds at 7:30AM! That’s how bad the brain-washing was. I got my new car fixed and got to work (with precious little sleep) and resolved to sleep in the hospital next time I was that exhausted.

When I finished my fellowship, years later, and drove into town to start my practice in Long Island, I was driving a little gold “Champagne Edition” Volkswagen Rabbit. Cars were just transportation to me then. Later on, my accountant had me go get a red Jaguar: lots of steel to
protect me, heavy, fast, and beautiful lines, with chrome wire wheels. Unfortunately, it had an electrical system from the 1940′s–before the war! Spent a lot of time in the shop, we did. And one day, the mechanic (an interesting Yugoslavian guy, who had flown a Messerschmidt for the Nazis in WW II) told me that The Jaguar was indeed beautiful, but it couldn’t hold a candle to a Mercedes-Benz, which he said was the
best production car in the world. He showed me a little part from one, off his back bench–it was “printed” with circuits and sealed with a bead of rubber all around. I had to admit it looked pretty impressive.

So, in 1984, I got my first Mercedes-Benz, used (or “pre-owned,” as they say today). Yeah, it looked boxy, compared to the Jaguar, but man, what a ride. No more spending half a lifetime in the shop, either. And protected by two tons and more of steel. I was sold. And I’ve driven them ever since.

But now, the price has gone beyond ridiculous, with no end in sight. And every year, they add more and more high tech gadgets, which proceed to break down and cost the proverbial arm and a leg to service, even with the warranty. The damn driver’s seat is like the cockpit in a jet fighter. And I’ve had it with those electronic modules. Like my old professor used to say, they “complicate simplicity” for its own sake. So, after this lease is up, I’ve had it with that bunch. I just got the bride a nice tight little Toyota RAV4 (the circle closes…how “Zen”).
It’s clean, peppy and reasonable to run. And I don’t need to mortgage my house for servicing.

Well, back to the tire shop. I got their name from a local bodyshop man, who told me that was where all the pros took their own cars. I got two great tires for less than half of what Mercedes would have charged me. And these guys had this down like a science! Two guys, one on each side, took off the wheels, stripped the old tires off and applied the new ones to the rims, inflated them and put ‘em back on the car. Zip-zip! Ten minutes, no more, I was out of there. Unbelievable.

One guy had a dirty Ace bandage wrapped around his knee. As you might expect, the leg below was pretty swollen. I suggested that he unwrap this ACE and reapply it smoothly, toes to thigh. The way he had it on it was like a tourniquet! Even better, he should have gotten an elastic or neoprene sleeve–that would give him the support he needs, but without the risk of gangrene (just kidding, but you CAN get clots in the veins from a too tight constricting wrap). If he had read my LITTLE GREEN BOOK, which he could at
http://drbillsclinic.com/eliminate_knee_pain.html    he’d have known that and I wouldn’t have had to tell him. Well, hopefully, if YOU have knee pain, you’ll know what to do. I wouldn’t steer you wrong. 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

It was 1975, during my first residency year at St. Luke’s Hospital in New York, that I saw for myself, for the very first time, the destructive nature of a torn meniscus. While not as intense as internship, orthopaedic residency was still a lot of scut work for the junior guys on the team. In that year, that was me and my mates. But there were a few opportunities
for us to relax and have some fun. One of the ways was basketball games, between the orthopaedic residents and the general surgery guys.
 
One of the senior general surgery residents was a real good, aggressive player, who was terrific at jump shots. During one game, he suddenly twisted, and spun away, in an effort to avoid the player guarding him and set up a jump shot at the basket. Suddenly, everyone heard a loud “pop,” as he screamed in pain and fell to the floor. He wasn’t able to finish the game and, in fact, had to be helped off the court by two other players.  He had real difficulty putting any weight on his knee, as well as severe pain.
 
He had to sit out the rest of the game on the sidelines, with his leg elevated and packed in ice. Later on, he was carried in to see my old professor, Dr. Bob Zickel  (a very famous guy in orthopaedic circles), or “Zick,” as he was affectionately known. In those days, there was no such thing as an MRI scan. Plain x-rays, physical exam and clinical judgment was the extent of diagnosis, at that time. And according to Zick, one of the best and wisest clinicians around, our surgical pal had really done a good job on his medial meniscus. 

Zick ordered an arthrogram for the knee, to confirm his clinical impression. This was the test that was used, before there was such a thing as the MRI scan. These were specialized x-rays, taken after the knee was injected with an iodine-containing dye. Iodine blocks x-rays, so the liquid dye would outline all the normally invisible structures inside the knee joint, and sink into any abnormal crevices, like a tear in the meniscal cartilage, thereby making it visible. You got even more contrast and greater accuracy, if you also injected air into the joint. Only problem with this procedure was that it HURT, and of course, there was a small risk of infection from the needle. But it was pretty accurate.
 
Anyway, the test confirmed that sure enough, our friend had a nice “bucket handle” tear of his meniscus, and at that time, the only treatment was to surgically remove it. Well, the man wasn’t happy, I can tell you that! He was in this great training program and he wasn’t about to lose time by having surgery. Besides, his swelling and pain had gone down, and his knee was feeling pretty good, by this time. So, he refused surgery and went about his business for the next few weeks, including our basketball sessions.
 
But three weeks later, during a game, his knee locked up in flexion, and down he went. This time, he couldn’t even stand up and couldn’t straighten his knee. He was in agony. They carried him straight up to the OR, where I assisted Dr. Zickel in operating and removing the locked and torn meniscus. Here’s the thing: in just three weeks, the torn meniscus had severely shredded the cartilage coating of the femoral condyle. In other words, he got full blown arthritis in just three weeks!
 
That’s the danger of ignoring a torn meniscus. If not treated, it can destroy your knee. Fortunately, today we have MRI scans that are noninvasive, don’t hurt, and are super accurate at diagnosis, and surgical techniques to repair bad tears, instead of just removing them. You can learn even more about these injuries and many others  in my LITTLE GREEN BOOK, which you can get at    http://drbillsclinic.com/eliminate_knee_pain.html 

Our friend ended up doing well in the short term. He worked hard at the physical therapy, the forerunner of exercises I teach in my PAIN-FREE PROGRAM today, at   http://drbillsclinic.com/exercise_eliminate.html
But, he had severe and permanent damage. I lost track of him over the years since then, but I’ll bet he has a knee replacement by now. Well, it made an indelible impression on me. And I hope it made one on you, too. The lesson is, don’t ignore a knee injury–or you may pay a higher price than you needed to, in the future. 

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

My wife and I have recently decided to resurface our pool in Florida. The old Marcasite coating was worn away in over 20 spots, so it was long past due. It’s just one of those things that you tend not to think about, until it’s almost too late to fix.
 
So first, they have to empty the pool. Fortunately, they have a strong professional pump that sucks the water out fast! Then, they sent over one single tile guy, to remove all of the old tile just above the water line. He got most of it off yesterday, and the remainder, today. Then, he laid down a scratch coat over the bottom and sides, in preparation for
the finished DiamondBrite coating that we chose. 

While he was out there, laying a level line for the new tile, I went out to offer him a drink. I noticed that he was wearing knee pads. So, I casually asked him a question.
 
“Say, I notice that you’re wearing rubber kneepads. Do you have a problem, or are you trying to prevent one?”
 
“No. Nothing wrong with me, right now,” he said. “But I’ve seen a lotta older guys who have sore knees, or arthritis now, ’cause they didn’t use them, back when. I don’t wanna be like them.”
 
Hallelujah! I felt like Diogenes who had finally found an an honest man. Only I had found an intelligent young man–usually an oxymoronic phrase. In fact, in all the years of my orthopaedic practice I had never run across anyone who “got it,” the way this young man did. Usually, the very worst offenders were the ones who were the most at risk: bricklayers and masons, pavers, tilemen, flooring men, plumbers, electricans, and my personal favorite, carpet layers.
 
Did you ever see what these guys actually do when they lay a carpet? First, they kneel on a hard wooden subfloor and nail down wooden tack strips around the periphery of the room. These strips have angled sharp tack points to catch the carpet from below. Then, after attaching the carpet to one side of the room, they stretch the expanse of carpet to the other side,
by using a “kicker.” This device is a long, toothed metal “comb” of sorts, with a leather pad at the other end, into which the worker repeatedly BASHES his knee, to progressively tighten the carpet across the room. Not surprisingly, these guys often showed up with severe kneecap problems, but were highly resistant to suggestions that they use knee pads.
 
Now, direct trauma to the kneecap, that’s a part of all these listed jobs, is a great way to develop chondromalacia patellae and eventual arthritis. You can read more about these conditions, and how to avoid them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN. To get your own copy, Go to   http://drbillsclinic.com/eliminate_knee_pain.html
But the simple use of rubber kneepads is a great way to avoid these consequences. 
 
This young man intuitively understands that; most young men just don’t. They feel immortal and invincible. When they finally begin to develop pain, the damage is done. From that point onward, they can improve, but they can’t ever be normal again.
 
So this one simple thing will have a profound impact on this guy’s life. He won’t develop the pain and degenerative disease that other workers will. Just by the application of a little intelligence–that’s the BEST way to avoid surgery. Good for him.
 
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

February 19, 2008

AARP sent me a membership card fully three years before I qualified for one, by age. I was outraged! “Hey, don’t rush it, guys! It’s going fast enough,” I thought. But then, I discovered the substantial discounts they offered, and I wasn’t so outraged anymore. In fact, these discounts are a fairly nice perk for aging. Not as good as getting younger, but since that’s not likely, this will have to do.
 
So last night, my wife decided to go to a local buffet for dinner. She just didn’t feel like cooking, and she had a yen for the buffet. Now, this is almost always a mistake. The fact that we affectionately call it “the pig-out” should give a clue as to the problem with it. Even though we both know better, once we’re there, the “buffet mentality” takes over–you feel like you just have to get your money’s worth. Even though I qualify for the senior discount.

I still keep hoping they’ll “card me” (oh, sir, you couldn’t POSSIBLY be that old), but to the kids who are the cashiers, we probably look pretty well qualified. The only good thing about this (in addition to the discount) is that there are a host of folks there who are not only considerably older than us, but in much worse shape, as well.
 
There are enough walkers and canes in this place to open a store. One old woman came in with a cane and, even through her pants, I could see a severe knock-knee deformity. Damn thing could barely hold her up. This is probably indicative of arthritis, and probably needs total knee replacement, at this stage. The sad thing is that she might have put off the day she needed surgery by the use of a few conservative measures.

First, she might have used a medial (inner side) heel and sole lift on her shoe, to counter the tendency to knock her knee. She might have also used an unloader brace, which, as the name implies, shifts the body weight to the other, less involved side of the knee. Both these measures might have bought her time. She and her family would have known about these options if they had read my LITTLE GREEN BOOK.   She might also have strengthened the muscles around her knee with the exercises in the PAIN-FREE PROGRAM, which I teach at
http://drbillsclinic.com/exercise_eliminate.html
 
But, that’s water under the bridge, as they say. At this point, the deformity is too pronounced and it indicates destruction and loss of the bone on the lateral (outer) compartment of the knee joint. Once you’ve got bone loss, nothing will do but replacement.

But even there, if there are medical or social issues that argue for a delay in surgery, you can buy time by viscosupplementation. That’s a fifty dollar word that means injecting the knee joint with a gel made of hyaluronic acid, a constituent of normal joint fluid.  Although it won’t restore the correct angle to the knee, or stability, it may relieve pain for months at a time, with virtually no side effects. This and
all the measures I noted above are discussed in detail in my handbook for lay people, DR. BILL’S LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (please see   http://drbillsclinic.com/eliminate_knee_pain.html  )
 
And, oh yeah, cut back on your eating. Extra weight increases pain and disability in arthritis. The buffet is the last place she should be.       And me, too….

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

February 15, 2008

The other day, while I was waiting for my wife at the airport, I waited for a while just outside the wall of glass that separates the Security Checkpoint Area from the rest of the terminal. While I was sitting there, just people-watching, I was closest to the wheelchair access and disabled passenger line.
 
I happened to see a number of people who were in wheelchairs, and more than a few who were in various kinds of knee braces. One thing common to the latter group was the tendency for those in braces to hold their knees in a slightly flexed position. They never fully straightened their braced knees out while they were walking or standing. And, of course, when they were seated, the knees were flexed even more.
 
What these people don’t realize is that after a very short time, they will not be able to fully straighten their knees. The fibrous capsular tissues will contract, and tighten, the tendons and muscles behind the joint will shorten in contractures, and the muscles in front will progressively weaken, so they are unable to counter the gradual tightening of the posterior structures.                                                                                                                                                                                                    
This condition is called a FIXED FLEXION CONTRACTURE and it has functional consequences. It’s a problem, because if your knee is not fully straightened, then it can only support you by continual activity of the quadriceps muscles. By contrast, the normal knee locks out straight, without the need for continued muscular contraction.
 
That’s why a soldier, with a normal straight knee, can stand at attention for hours, without the fatigue you’d  see if muscular effort was required the whole time. But the person with a FFC fatigues, due to the constant use of the muscles, and the knee can then buckle and give way.
 
This is just one of the problems encountered when people try to treat themselves without guidance. It really IS what you don’t know that will hurt you. If they had read my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,
( http://drbillsclinic.com/eliminate_knee_pain.html )  they would understand the dynamic forces around the knee and why balance is needed.
 
And if they had used my recommended exercises and stretches as seen in my PAIN-FREE PROGRAM (please see
http://drbillsclinic.com/exercise_eliminate.html ),  they would know how to strengthen and stretch their knees, so they don’t develop this slight flexion contracture. 

But they didn’t. So, what can they do now? Well, the longer the FFC is allowed to exist, the stronger it becomes and the more difficult it is to correct. A simple way to stretch it out is one I recommended to many patients who had undergone surgery. 

Just sit on the floor, with your back against the wall or a couch, and your leg out straight, a pillow on top. Then, get your spouse, or significant other to SIT on your knee. The floor will act as a back-stop, so you won’t fear back-bending (it won’t happen anyway, but many people are afraid it will). Their bodyweight will gradually stretch the posterior structures of
the knee. Yes, it does hurt a bit at first, but I’ll  bet you and your SO can think of some ways to distract you, while the knee stretches out straight.

That’s it for today, my friend. 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