May 12, 2008

Spring has sprung. And the season brings with it an increase in sports and training, after the forced inactivity of the long winter months. And this increase in athletic activity brings with it a motley assortment of attendant injuries. The most common reason for these injuries is inadequate preparation.
 
You know, the young are fiercely competitive and still believe in their own invincibility: they tend to push harder, farther and faster, impatient to be the best.  Sometimes, they push a bit too far, a little too hard, and injury results. A little forethought, a little preparation, and they could avoid the pain and disability of a sports related injury. But, rushing in, in the heat of competition, is what being young
is all about. 

Wisdom and youth are rarely associated. So they don’t prepare; they just jump in. The sudden twist of the knee, the lancing pain, the fall or collision in the heat of play, the sudden buckling and giving way, the head on collision–all are examples of the kinds of injuries so commonly seen in sports. And that doesn’t even count the repetitive training injuries, that add their own toll.
 
Part of the problem is that most of us, not just the younger athletes, tend to ignore a relatively minor injury, until it becomes a major problem. Continue to ignore that swollen knee, and that aching kneecap, or minimally torn cartilage, that might have responded to conservative, non-operative treatments, or specialized exercises, like those I teach at   http://drbillsclinic.com/exercise_eliminate.html
and those intial injuries can become permanent joint damage, with time and further insults, not so easily cured.
 
So, what to do? It’s true you can’t put an old head on young shoulders (God knows, I certainly didn’t pay attention to my elders, when I was a teenager), but maybe you can convince them to slow down long enough to protect themselves. Here are a  few tips to help the young athletes avoid injury:
 
1.) By far, the best thing you can convince them to do is to stretch, during the warm up, before playing. Prevention is always better than cure.
2.) Train for flexibility and agility, as well as strength and power. A stiff athlete is an accident, just waiting to happen.
3.) Increase resistance in strength training gradually.
4.) Avoid deep squats, or forced flexion in training.
5.) If you get a pain, do NOT work through it. Pain is a warning that something is wrong.
6.) If injured, follow the RICE protocol, as discussed in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN  http://drbillsclinic.com/eliminate_knee_pain.html 
7.) If in any doubt as to the severity of the injury, go directly to the local Emergency Room for evaluation, x-rays and   preliminary treatment.
8.) If pain and swelling do not subside with initial care, or if the injury is severe, or if symptoms reoccur or become chronic, go see an orthopaedic specialist.
 
Remember that the goal is not just to relieve the initial pain, but to prevent permanent damage to the injured joint. Because of the nature of the cartilage that coats all the joint surfaces, permanent damage, leading to arthritis, is a real possibility if an accurate diagnosis is not recognized, appropriate definitive treatment is not applied and correct rehabilitation is not prescribed. So, encourage your kids to warm up, first. And stress good technique, whatever the sport. A little investment of time and effort before every practice and every game will pay big dividends. That’s my tip for the day. 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 29. 2008

 Ever wake up in the morning and notice a “kink” in your neck? I know I have. Not so much any more, now that I’m no longer subject to the constant tension of being in practice, combined with the peculiar positions you can get into when you’re trying to do surgery. But when I was working, every so often, I would awaken in the morning to find I had a stiff neck.
 
The stiff neck was bad enough. But then, it would begin to spread down to the inner border of my shoulder blade, and the trapezius muscle on that side would knot up, like it was being goosed with an electric current. And any slightly quick turn, or any other head movement, was met with a painful spasm that would take my breath away. I dreaded the rest of the day, because it would only get worse and worse, as time went on and I became more and more active. You just haven’t lived til you’ve tried doing arthroscopic knee surgery with a wry neck. Sometimes the spasms would just make me nauseated. And I couldn’t take any serious medication–hey! I was operating! Just the pits….
 
For years, I attributed this occasional problem to an odd position I must have adopted during sleep. And that probably did play a role in triggering the spasms. But it turns out, I also had a very common problem: a chronic bulging disc at the C5-6 level. I only found this out later on, when I chanced to have an MRI scan, which demonstrated the pathology, clear as a bell.
 
Of course, I should have realized what the problem was. The pattern of pain distribution is classic: C5-6 nerve root radiates to the inner border of the scapula  (shoulder blade). But like I’ve mentioned before, physicians have big blind spots when it comes to their own health conditions, and I’m no different.
 
But I did learn a few things that help, which I’ll pass on to you now. First, if possible, eliminate stress. If you can lie down with a rolled face towel under your neck, cross-wise. A bath towel is too thick and a hand towel is too small. The face towel is just right. If you have a heating pad, use it–nothing soothes like pleasant warmth. Place the heating pad under your neck and upper back. Turn it up for about 20 minutes at a time. 

If you’re sitting up, slowly bend you head forward and feel the stretch in the neck and back. Then slowly begin to roll your head from side to side, back and forth. Eventually, you will loosen up enough to roll your head around in a circle. Go five times one way, then five times the other. if you have a “knot,” a tight spastic focus that’s painful in the upper back, get someone to massage it with deep thumb pressure, until it loosens up.
 
Tylenol can be taken for some pain relief, without making you groggy, or affecting your judgment. OTC medications like Advil or Aleve not only relieve pain,  but they are really NSAID’s, that will reduce inflammation, too. Just be sure you take them WITH FOOD, to protect your stomach. Be sure you take some oral calcium, magnesium and potassium supplements to minimize muscle spasms. A glass of tonic water,
which contains quinine, will often help with spasms, too.

If the episodes become too frequent or too severe, go see a doc. Sometimes, a shot of cortisone, right into the “bullseye” of the painful spasm will break it for good and give you long term relief. So if you ever have this curse, or know someone who does, you now have a whole litany of methods to relieve it. Use them in good health! 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 16, 2008

You know, whenever we’d be in surgery, I’d have the radio playing, or if that was boring, some CD’s. Depending on my mood at the time, I’d ask the circulator nurse to play rock ‘n’ roll, or classical. My tastes ranged from early Beatles, Stones, The Moody Blues (I still think that “Nights in White Satin” may be the most sensual song ever written), Queen  (honestly, doesn’t everyone just love “Bohemian Rhapsody?”), Dire Straits (“Sultans of Swing”),  and Meat Loaf. In fact, after any major surgery was finished, “Bat Out of Hell” was my closing music. The idea was to close the patient’s incision and be entirely finished with the sutures, by the time the CD ended. That high voltage anthem to youthful angst kept me bookin’ along, I can tell you.
 
Sometimes, though, I’d ask them to play Beethoven, generally the 3rd Symphony, or the immortal 9th, anything by Bach, but especially the Brandenburg Concertos, or Handel’s “Water Music.” Right after the film, AMADEUS played, I was on a Mozart jag for months. And after I saw Phantom of the Opera, I’d have them play the entire score, over and over and over again. We’d actually have sing alongs in the OR, kind of like surgical kareoke.
 
Now all this may seem a little bit much for anyone who thinks the Operating Room is all serious and deathly quiet, with a loud beeping from the EKG in the background, and terse, staccato orders from the surgeon: “Scalpel… Sponge… Wipe.” I mean, nobody talks like that in the OR. I can tell you that although  there ARE some guys that do like to work in a scene like that, I always found that to be torture. I’d make fun
of anyone who tried to play that Hollywood scene in my presence, for sure. They would have to be pretty stuffy guys, to start with. All that crap you see in the movies is pure fantasy, to build up the drama. It’s usually much more like “Mash,” than “Not As A Stranger,” though that’s really a reflection of the personality of the surgeon, who is “captain of the ship,” once  surgery is underway. 

Personally, I hated dead silence and tension in my room (that is, any OR where I was working). Hey, if I had to be there, I wanted to have a good time, while I healed the lame and cured the sick. And the nurses, anesthesiologists, my assistant and the OR techs, all loved being in my room, ’cause they knew that the surgery would go smoothly and they’d enjoy spending their time in there, with us. 

I only remember two times in over 23 years in practice where I told them to shut off the music. When it really “hits the fan,” you DO need to concentrate. But the rest of the time, I liked the music in the background, and good conversation with my friends and coworkers, while I operated. In fact, when the patient was awake, under regional, epidural, spinal, or local anesthesia, we’d even offer a choice of tunes to the patient. 
 
What can I tell you–the music relaxed me, so the surgery would just flow. When you’re in “the zone” and you’re exercising your skills in an effortless flow, the result is going to be superb. If you’re comfortable and confident in your abilities (and lack of confidence was never one of my faults), you really don’t need to think much. You just do what you were trained to do, relax and let it flow through you….the goal is
effortless excellence.

This carried over into my office, too, where we played music, or a T.V. for the patients. Occasionally, we’d play DVD’s for them, as well. I always found that this  approach put patients at ease and made my job easier. Lots of folks came in, scared to death. Let’s face it, if you think about what I was actually doing to them, it IS scary. So I saw part of my job as putting their minds at rest, by instilling confidence in me and
by allowing them to relax in pleasant surroundings.
 
Right down the hall from my office was the Department of  Physical Therapy, where I was also the Medical Director.  I had the OR, my office and P.T. all in the same building (really cut down on my commuting time). I would often drop down there, between office visits to check up on my patients. After joint surgery, and even before, in many cases, the physical therapy was critical to a good result. I’ve seen many cases where the surgery was a success,  but the end result less than satisfactory, because of stiffness.

So I’d go down to encourage them and prod them, when necessary. I had a prescription specifically for my patients, that the therapists had to follow. Besides the usual range of motion and strengthening exercises, they had to stretch tendons and the iliotibial band, which might otherwise have a tendency to contract and limit motion. These exercises and stretches were the forerunners of my current PAIN-FREE PROGRAM     http://drbillsclinic.com/exercise_eliminate.html     And even here it was common to have music playing in the background (although they had to keep it down more than we did in the OR, so it didn’t sound like a party to the adjacent offices). 

Even today, I like to have something playing in the background, when I do my work, or my exercises. If you find that you’re having a hard time buckling down and doing your own exercises, try playing something you like on the radio, or CD player, and make it fun. If  it helps you relax, like it does for me, it’ll seem less like a chore, and more like a pleasure. And DOING the exercises is key, if you want to prevent or
get rid of your knee pain. And that’s the name of that tune! 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 other day, in response to my earlier request that all my subscribers send me their single most important question about orthopaedics and knee pain, or arthritis in particular, for a future teleseminar, I received a question about a “frozen kneecap.” Assuming that the woman hadn’t been buried in an avalanche, or fallen into a vat of liquid nitrogen, I was forced to ask what she was talking about.
 
Turns out that she was asking about her patella tending to track laterally, that is, on the outer side of her knee. From her point of view, the fact that her kneecap was stuck in a lateral track, she interpreted as being “frozen.” Now, I’m not picking on this lady, who I’m sure is very nice and who,  in any case, needed help. In retrospect, I can sort of see the reason she chose that word, but the point is, it makes no sense to anyone else, like me, and therefore, does not accomplish what words are supposed to–communication.
 
This episode reminded me of how many times I had to try to draw out of my patients what their real complaints were. Sometimes, it was like pulling teeth. I don’t mean or expect that a lay person will describe their symptoms or complaints in technical terms that I would use to another orthopod. No, I just mean plain, descriptive English that actually tells me what’s wrong.  Vocabulary is one of the main barriers between  physicians and their patients. It’s sometimes hard for the patients to make the doctor understand what they mean.
 
My father-in-law is another great example of this. If he’s asked whether he has any hip or leg pain, he replies that his leg is “numbish.” Now, you would think that this would imply some decrease in sensation, like when something is “numb.” But no, what he actually means is that he has a dull  ache in his hip. This took me quite a while to pull out of him, trying different definitions, or outright guessing what he was trying to express. The point is, it takes time and effort to figure out what the problem is. And today, a lot of  doctors either don’t have, or won’t take, the time to try to interpret what you’re trying to say.
 
“Uh-huh. Take two of these twice a day. See you in two weeks.” Bam! Out the door. Next patient.
 
Because you don’t share the same vocabulary with your doctors, it’s important that you be as clear as possible. DON’T try to be “creative.” Just name the part, state what you feel, describe what happens, in as simple and lucid a fashion as you can. If it hurts, say so. Then, try to describe what kind of pain it is: sharp, dull, deep, superficial; then, what brings it on, what makes it worse, or better.

It helps if you have some understanding of what the possibilities are. For example, if you’ve read my LITTLE GREEN BOOK, which you can get at   http://drbillsclinic.com/eliminate_knee_pain.html    you will know what the most likely diseases are, since they’re presented in the approximate order of frequency that they occur.

In the case of the woman who wrote to me about her “frozen kneecap,” her problem was really a lateral tracking syndrome. This is usually due to weakness of the VMO (vastus medialis obliquus) muscle, the only one of the quadriceps that attaches directly to the inner, upper margin of the kneecap. When that muscle is weak, the other muscles pull the kneecap outward, and over time, the soft tissues contract and become tight. 

To correct this, you need to stretch the outer soft tissues by massage, and sometimes by using a brace. You also want to build up the strength of the VMO, with the specially modified exercises I teach at   http://drbillsclinic.com/exercise_eliminate.html   None of this can occur if the problem isn’t first accurately defined.

So, what’s in a word? Everything.

That’s my word for today. Hope all is well with you. Til next time my friend.

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