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

For the past week or so, I’ve been trying to relieve your fears about surgery. Hey, you never know. One day you might NEED one of these procedures, and it would be a shame if you were terrified, due to misperceptions, misinformation, distortions and urban myths. It’s also a good idea to know just what your options are, so you can make an informed decision, should that day ever come.
 
So, I’ve attempted to give you the straight dope, tell you exactly what’s done, in each of the most common surgical procedures for the knee. As I’ve said before, when you KNOW the finite dimensions and the finite duration of an experience you fear, it helps a lot to put it in perspective, help you face it and help you handle it. 

Today, to round this all out, is the ultimate option: ARTHROPLASTY, more commonly called joint replacement. Though the term actually means “creation of a joint,” it’s come to be identified with joint replacment, and is now virtually synonymous. This was initially TOTAL knee replacement, but today, through many technical advancements, it encompasses PARTIAL or UNICOMPARTMENTAL joint replacement, as well. These options are explained in great detail, though in layman’s language, in my LITTLE GREEN BOOK at http://drbillsclinic.com/eliminate_knee_pain.html
 
This is really a misnomer, though. Unlike a total hip replacement, a total knee DOES NOT replace the entire joint, nor does it remove the bony segments of the joint. Instead, only the SURFACES are replaced with man-made shells of polished metal, articulating on very tough plastic. Technically, the operation is a joint resurfacing arthroplasty. If there’s severe arthritis on only one side of the joint, then only that side has its surfaces replaced. The so-called UNI (unicondylar knee replacement) can be done through a very small incision, sometimes even on an outpatient basis. The trick is for the surgeon to balance the ligaments and align the knee properly, so the kneecap tracks properly.
 
Small power saws are used, with special saw guides and alignment tools, to cut thin slivers off the ends of the bones, the femur and the tibia. This removes the arthritic surfaces and “opens up” the spongy (cancellous) bone, for acrylic cement intrusion, which holds the implants in place on the respective bones. The properly sized implants are then selected and implanted. 
 
A total knee replacement, like the name implies, resurfaces all three compartments, medial lateral and patellofemoral. It’s done for more extensive, or end stage disease, in two or all three compartments. It needs a larger incision, generally involves somewhat more pain, swelling and potential bleeding. It has a greater potential to develop adhesions, and limited motion, after surgery.
 
In both cases, weight bearing is initially limited by pain, and the use of crutches or a walker. Motion is started right away. Pain is controlled with medications, and physical therapy and rehabilitation are essential. Many of the exercises used are those I teach in my PAIN-FREE PROGRAM, at   http://drbillsclinic.com/exercise_eliminate.html
 
But here’s the thing. Although the success rate, in the right hands, is very good with joint replacement, you NEVER do this without the right indications. The truth is, nothing made by man is as good as what God gave you. Man-made parts can wear out, can get loose, even get infected…and there’s always the chance of a technical problem or human error, even in the best of hands. 
 
So you need to be SURE that if TKR or a UNI is recommended, it’s NECESSARY. And if you can get relief from ANY more conservative methods, conventional, alternative, or complementary, provided you don’t have a lot of bone loss in the joint or severe deformity, then it’s an UNNECESSARY SURGERY and should be delayed, or avoided. And it was to help you do just that, that I wrote my new healing program, HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html
 
Well, I hope that this series on knee surgeries has been informative for you and that I accomplished my goal: to tell you exactly what goes on in the O.R., give you some perspective and relieve your anxiety and fears about surgery. If you NEED surgery, by all means, accept the risks and get the benefits.  Odds are, you’ll do great. But if you’re not sure, or if all non-surgical measures have NOT been exhausted, then there’s at least the possibility that you may be headed for an UNNECESSARY SURGERY.
 
In that case, get my program and be prepared. Don’t guess, when you can KNOW. Click on the link and get HOW TO AVOID KNEE SURGERY today, right NOW, at   http://drbillsclinic.com/avoid_knee_surgery.html   to relieve your pain, restore your function and do it WITHOUT SURGERY.
 
Til next time, my friend, be well and have a great weekend.
 
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

As you know, before the last few days, I’d been giving you the “Readers’s Digest” version of a number of different types of knee surgery. The purpose is to alleviate your fears, based as they are on misinformation, exaggeration, outright distortion and your own imagination, by telling you exactly what’s done. This gives the fears limits, as reality limits imagination, and helps you to cope, if you actually DO need one of these procedures at some time.
 
We’ve already covered basic arthroscopy, as well as patella debridement and realignment, partial meniscectomy for a torn meniscus, and, most recently, arthroscopically assisted ACL reconstruction. Today, I will finish up the description of other miscellaneous arthroscopic procedures, that are often done simultaneously. 

Bear in mind that once you’ve entered the joint through those tiny arthroscopic portals (mini-incisions), there’s almost no limit to what you can do in there. And the postop morbidity (pain, swelling, stiffness, disablity, etc.) is pretty much the same, regardless of how much you do inside the knee, UNLESS you cut, drill, abrade, puncture, or otherwise violate the bones. 
 
If you DO get into the bones, you automatically increase postop bleeding, pain and swelling–which makes sense, right? Otherwise, however much you do, the postop limitations are a function of those tiny portal incisions. That’s the great advantage of arthroscopy and why it’s been a transformative concept in modern surgery, that’s made outpatient surgery possible.
 
All these procedures are described in much greater detail, including the conditions that require them, in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN,  available now as a book and an audio CD, too, at  http://drbillsclinic.com/eliminate_knee_pain.html
But for now, let’s look at a few other conditions for which arthroscopic surgery is often recommended, how they are treated surgically and whether other options and NON-surgical treatments are available.
 
First up is SYNOVITIS, an inflammation of the lining of the joint (any joint that has freely moving parts, not just the knee). I alluded to this with a brief remark, last Wednesday. When the lining of the joint gets irritated, it gets bigger, actually grows, often in an irregular way, resulting in flaps, shelves, clumps and masses, that can flop around inside the joint, occasionally getting trapped between the moving parts. This entrapment causes pain, and further swelling and inflammation. The irritated membrane produces lots of joint fluid, resulting in “water on the knee,” as well as pain.
 
The arthrocopic removal, or resection, of this diseased membrane is executed with an electronic motorized shaver. This is a stainless steel tube, with a small window at its end. The window encloses a rotating (or reciprocating) blade, that nips off small morsels of synovium, which are then sucked out by a vacuum pump and collected in a trap, for pathological study. Using this technique, you can systematically resect almost ALL the lining, as in cases of Rheumatoid Arthritis, or Bacterial Infection, where you want to rapidly “debulk” the mass of diseased membrane. But guess what? A new membrane grows back very rapidly, hopefully in an uninflamed, relatively normal state.
 
DEBRIDEMENT is a French term, meaning “house cleaning,” and it’s pronounced “De-BREED-mont,” not de-BRIDE-mont. I had an Australian professor once, who use to say “Da BRIDE is whut walk down de aisle wit’ de groom. Gentlemen, it’s deBREEDmont.” This refers to shaving off loose shreds of degenerative cartilage from the articular surfaces, to smooth them out. It’s important to remember that you can only REMOVE tissue; you can’t put anything back. 
 
Normally, the shaver is used to do this and it’s combined with synovectomy and LAVAGE, essentially washing out the joint with irrigation fluid. This is controversial in the treatment of arthritis, but if you’re there for other reasons, you might as well “clean house.” Today, you can also do this with radiofrequency probes and lasers, too.
 
And, as I also mentioned last Wednesday, LOOSE BODIES and FOREIGN BODIES can be grasped by forceps and extracted through the arthroscopic portals.
 
Areas of bare bone, if they’re small enough, can be treated through the scope to restore some kind of cartilage covering, but as I mentioned above, the morbidity and pain is greater once you penetrate the bone surface. Arthroscopic awls are sharp, pointed steel spikes that are used to put multiple shallow punctures into the bone, a procedure called MICROFRACTURE. Another way to do the same thing is to use a high speed burr to “sand” the surface and stimulate bleeding. This is called ABRASION CHONDROPLASTY. Both these techniques result in blood clot, which is changed into fibrocartilage over the bare area.
 
An alternative is to restore actual hyaline cartilage, in one of two ways: CHONDROCYTE TRANSPLANTATION, in
which cells initially harvested from non-articular parts of the knee are cultured, then reimplanted to grow new cartilage; and OATS (Osteochonral Articular Transplanation ) which transposes plugs of bone, with its articular cartilage attached, into drill holes in the bare area. Pretty cool stuff, no?
 
And, really, NOT so scarey, now that you KNOW what’s involved, right? Whatever it is in your life, if you KNOW what you have to deal with, you can DO it, if you have to.
 
But, there are many times that you DON’T need any of these techniques. Those are the times that surgery ISN’T warranted, because conservative methods will work to relieve your pain and restore your function just fine, thank you very much. If you want to AVOID An
UNNECESSARY SURGERY, then you need my newest healing program, HOW TO AVOID KNEE SURGERY. Get it here, at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Next up, osteotomies and realignment surgeries. Talk to you tomorrow, my friend. 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

Just yesterday, I came across an article on one of the sports blogs about the various knee injuries seen with a number of sports, including basketball, soccer and football. With the Olympics in full swing, it’s easy to focus on the more dramatic sports that get much of the press, when it comes to knee injurues, acute and chronic.
 
But surprisingly enough, one of the most frequent causes of chronic and acute knee problems is… GOLF! Now, golf is a gentleman’s (or gentlewoman’s) game, no doubt about it. And it looks like the players mainly walk around, when they’re not riding in their electric golf carts. They don’t even carry their own golf bags–a caddy does that for them. But if the knee problems generated by this sport aren’t as dramatic as some, they’re no less real. 

You see, golf applies more subtle forces across the knee joint, that are often internal. Walking on uneven terrain, rolling hills, even sand traps, induces the same irregular joint forces as walking on a beach. And the torque, or twisting forces, imposed on the knees with every drive are tremendous.  In fact, it’s that twisting stress, with full body weight on the knee, from every swing of the driver that’s responsible for most of the injuries.
 
You normally don’t even think in terms of golf injuries until some high profile player, like Tiger Woods, is knocked out of competition by his bad knees, or some specific knee injury. But the danger is always there, maybe especially for the average player, who isn’t conditioned as well as the professional athletes.
 
You go into any golf club or country club locker room and all you’ll hear about is aches and pains of shoulders and knees. Well, part of that is simple aging. Lots of boomers and seniors play golf, which aggravates dormant conditions, like arthritis, or synovitis, or chondromalacia patellae (for a complete run-down of the many problems of the knee, in layman’s language, see my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN   http://drbillsclinic.com/eliminate_knee_pain.html ).
 
But part of it is newer injuries, like ligament sprains or ACL tears, or especially torn menisci, caused by that repetitive twist. Pain in the knee is so common in this sport that I call this chronic knee pain “Golfer’s Knee.”
 
While Tiger had a completely ruptured Anterior Cruciate Ligament, as well as a meniscus tear and articluar cartilage damage, all of which require surgery, in many cases, proper conservative treatment of Golfer’s Knee can avoid knee surgery. As it happens, my latest publication provides golfers and anyone else with all the tricks, tips and effective techniques from across the entire medical spectrum, conventional, alternative and complementary. It’s called HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html
 
Acute pain is treated first by anti-inflammatory measures and joint stabilization, while long term treatments focus on specialized exercises and stretches, to improve strength and stability. These are supplemented by nutritional measures, herbs and nutriceuticals, to enhance healing and retard the development of arthritic changes. 

Yes, there are situations where surgery is needed. But my goal is to teach you how to prevent an UNNECESSARY surgery, of which there are far too many. So, if you have knee pain, from Golfer’s Knee, or any other source, learn how to relieve your pain and restore your function, with the best conventional and alternative non-surgical methods. Go see how at   http://drbillsclinic.com/avoid_knee_surgery.html
You’ll be glad you did. 

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

Well, here we are in Orlando, where it’s cloudy but not even raining yet. And the press has worked itself into a lather over the approach of Fay, a tropical storm with hurricane potential. Now, it is true that Fay has spawned some tornados, apparently killed ten people and should be taken seriously. But so far, virtually nothing that has been predicted has happened.
 
I’m well aware that meteorology is an inexact science. That’s rather like saying King Kong is a large monkey. I mean, these guys are wrong so often that they could probably do better if they flipped a coin. They know it’s raining when they look out the window. For all the sophisticated computer models, specialized radars and scientific analysis, they are clueless about what’s going on in the real world.
 
See, the problem is the computer models. The models are accurate ONLY if the premises on which they’re based are valid. Wrong assumptions, wrong results. Since the facts on the ground (or rather, in the air) are always changing, it makes it tough to accurately predict what’s actually going to happen. You see, I understand their limitations, but talk about your overpaid guys!  They get paid whether they’re right or wrong! In fact, most people expect them to be wrong. Meanwhile I was supposed to be perfect–any deviation from perfect is assumed to be defacto evidence of malpractice. Feh! Makes me sick!
 
Don’t get me wrong. I’m glad we don’t have to deal with a major hurricane. It’s just annoying that every prediction these guys make is presented with a certitude that keeps us all in a state of fear. That was the premise of a very good book by Michael Crichton, he of Jurassic Park fame, of the same name (State of Fear). His theme was the constant “state of fear” that the media tries to keep the public in, with one dire prediction after the next. And it’s absolutely true.
 
And here’s something else to think about: this is the same “science” that supports those who buy into the whole apocalyptic “global warming” business. Almost all of it is based on computer models, just like the day to day weather, apparently with the same degree of accuracy. 

This would explain the phenomenon of melting polar ice caps, rising seas (which, given Al Gore’s time line, should have swallowed several coastal cities by now) et al, which are a product of extrapolated computer models. Same problem: if the assumptions on which the models are based are faulty (ie. warming, such as it is, is the product of man made activity, greenhouse gases and the like), the results are, too. This is why the polar ice caps of Mars are also observed to be receding, absent ANY man-made activity (so far as we know). And it explains why our polar ice is now INCREASING, contrary to the predicted findings of the models.
 
People who are fully invested in the whole global warming enterprise are aware of these disturbing variations in the real world from the computer models. That’s why you now hear more about “climate change,” than global warming these days. Here’s a clue: the climate is ALWAYS changing–that’s what it does. And all climate is a function of the activity level of the SUN, the source of all energy on earth. The amazing thing is not that climate varies now and again, but that the narrow range necessary to preserve life on our little planet is remarkably constant.
 
So while the meteorologists and weathermen appear to be fey on Fay, I’m going to look out my window, onto the real world, and see what the weather’s doing. Still cloudy, still no rain, mildly breezy here in Orlando. But the radio says twisters were noted in Southern Florida. Which way will it go? They have NO IDEA, though they have plenty of predictions. Ah well, let’s hope it misses us. We’ll soon know…
 
Speaking of the crappy weather of the Hurricane Season, ever notice that your joints ache when it’s about to rain? Or that you feel sleepy when it’s cloudy and damp? Well, that’s a function of specialized nerve endings in the tissues around your joints that respond to a fall in barometric pressure (baroreceptors). Any inflammation, as from synovitis, arthritis, a chronic sprain or strain, a recent fracture (even if healed) aches with damp weather.
 
You can ease those aches and pains with some local heat applications and the various anti-inflammatory measures I teach in my newest program, HOW TO AVOID KNEE SURGERY    http://drbillsclinic.com/avoid_knee_surgery.html
Using measures from across the medical spectrum, you can relieve pain, reduce inflammation and restore function in your painful knee–without surgery. 

Til next time, my friend, stay dry, stay safe, 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

A few days ago, one of the members of an exclusive fitness group, for whom I serve as a medical advisor, emailed me with a knee injury. He had been participating in his jiujitsu class and was close to the end of his class, when he experienced a “pop” within the inner aspect of his left knee. He didn’t feel pain when it happened, but he was smart enough to stop what he was doing and not finish the class. He was also able to
bear weight without difficulty.
 
But by the next day, the knee was aching and swelling.  He iced his knee through the night, took just a couple of Aleve caplets and wondered whether he should visit a doctor. Then, he asked for my advice.

Since I had no way of seeing him or examining his knee, I had to base my differential diagnoses (ie., educated guesses of the likely source of his pain) on his history alone. Now, even in a clinical setting, history is THE most important factor in determining a diagnosis. But the physical examination adds important mechanical information that leads the examiner toward one possible diagnosis and away from another.
 
In this instance, the leading contenders were a snapping synovial plica (a thickened band of lining membrane of the joint, that is plucked like a banjo string over the end of the femur), or a torn medial meniscus (the inner cartilage cushion, between the femoral condyle and the tibial plateau). Both of these can cause popping and be initially painless. And both can result in a delayed inflammation, manifested by stiffness, pain and swelling.
 
This man was smart–he stopped doing the class immediately after his incident, suspicious that he had sustained some injury. He iced his knee a number of times over the next couple of days, took it easy and took just two Aleve caplets. Then, he decided to ask for my advice.
 
I advised him to follow the usual conservative measures, as I have described in detail in my LITTLE GREEN  BOOK  (http://drbillsclinic.com/eliminate_knee_pain.html)   These included switching to local heat, increasing his use of Aleve to 2 caplets twice a day (with FOOD or MILK, to protect your stomach from the side effects of NSAID’s), and selected exercises to preserve his quad strength, while avoiding motion, like those at   http://drbillsclinic.com/exercise_eliminate.html
I also advised him to consider going to see an orthopaedist, if his symptoms don’t improve pretty soon.

Then, he asked a very good question: “What about bracing?” 

As it happens, bracing is a very good idea. But you  don’t need an expensive, custom brace. No, just an elastic or neoprene sleeve, to provide some extra support and a gentle, generalized compression of the knee joint. Compression is important as a counter-pressure to the swelling and fluid generation of the inflamed knee. The external squeeze tends to minimize the production of excess joint fluid. 

Unless you have a specific ligament problem (which, based on his presentation, he does not), you don’t need hinges on the sides of the brace, either. A central hole, a patella cutout, is warranted if you have pain in the kneecap, but is otherwise not necessary. But this simple and inexpensive addition to the usual anti-inflammatory regimen is a great help in relieving pain and restoring function after a knee injury. And
I heard today that, sure enough, he’s getting better already.  Hopefully, he’ll be back in action again, real soon.

Well, that’s it for today, my friend. Have a great weekend and, 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