December 21, 2009

After our recent soujourn in the City, where we enjoyed New York, in all its Christmas finery, it was time to head back to Florida. We’re having the family over for Christmas, so we have a bunch of work to do, before the homestead is fit for company. And besides, the bride was missing her “babies” and needed a fur fix, bad.
 
So, after setting the Southampton thermostats down to subsistence levels, we headed out to the airport. As a matter of convenience, we use Southwest Airlines, out of Macarthur Airport in Islip, because it’s the closest to Southampton. It’s two hours (depending on traffic) to the closest City Airports, LaGuardia or JFK, so Macarthur, it is.
 
We arrived there in plenty of time, to discover that the flight to Orlando was packed. Not a spare seat on the plane. And we were reportedly heading out just ahead of a massive Winter snow storm (even though it isn’t officially Winter, yet). “Global Warming,” right?
 
Fortunately, I had the foresight to buy “Earlybird” seating, which is Southwest’s idea for giving you early boarding for open seating. They claim that this saves them money, though I have never understood how. Anyway, this gives you a better choice of seats, as you get on the plane sooner. With the flight so packed and no empty seats, it usually let’s us pick our seats, get our stuff stashed sooner, with less hassle. 
 
If Jetblue could ever get into that airport, we’d be on that airline, all the time. They have more comfortable seats, they have those cute little TV screens, on the back of the seat in front of you, and the planes are always clean. They also have assigned seating, none of this “lining up” crap.
 
Normally, we head right for the mid-plane exit row. There are several reasons why we like that: 1. The seats have considerably more legroom, 2. If, God forbid, there IS an emergency evacuation of the plane, I want the limiting factor to a quick exit to be cool, fast, competent hands, ie., MINE, not those of some panicky, bumbling moron, and 3. When the plane is NOT packed tight, we can often have an empty seat between us, the closest you can get to “First Class” seating on these “cattlecar” flights.
 
This time, however, someone had beaten us to our favorite row, a big burly guy. And there he was, all spread out in the window seat, with his knees open and his shoulders and arms spreading over the armrest. Great.
 
Now, you need to undetstand that the bride does NOT sit next to strangers, anywhere, if she can help it. No. That’s MY job. So I settled in, as best I could, between my wife on my right and King Kong on my left. Great.
 
Guy never budged. No tendency for accomodation, at all. And he was a big guy. He was pretty broad. He actually took up that space, and then some. It’s not like I could ask him to move over. There WAS no “over.” So, I twisted slightly in the seat, insinuating my left shoulder behind his right.  And so I sat… the entire. miserable. flight.
 
This would have been bad enough, but that slight twist was enough to set my warped, previously fractured spine off, causing some cramping and aches and pains, that I normally don’t have. Part of it was that my wife didn’t have enough of my POWERHOUSE OMEGA FORMULA  http://www.favoriteformulas.com  with her on this trip (I thought she packed them, she thought I’d packed them…), so I lent her some of mine.  And now, I could FEEL the difference of the lower daily dose.
 
If you ever doubted that pharmaceutical grade fish oil really DOES have natural anti-inflammatory properties, just try being without your accustomed dose for a few days and then talk to me. They’re real, alright.
 
So, to take my mind off the discomfort of my contortions, I started doing some of the isometrics that I teach in my all new, expanded PAIN-FREE PROGRAM exercises and stretches, like quad setting and seated calf raises, http://www.drbillsclinic.com/exercise_eliminate.html   which have the added benefit of moving the blood through the lower legs, reducing the risk of a DVT (deep vein thrombosis, clots that can form in the veins of the legs, from long sitting in one position). 
 
Between these little leg exercise sessions and a few chest compressions (where you press one hand against the other and tense your pectoral muscles, while breathing deeply) and even a few head rolls, side to side and round and round, to loosen up my neck and spine, and a few cat naps, I finally made it. Hallelujah!
 
Talk about “flying the friendly skies…” this was one of the worst flights it has been my experience to suffer through, in quite some time. Thank God it was over. The bride, of course, was just fine. Just as well, though.  Don’t want her turning nasty…I’d still be suffering
 
Well, we picked up the luggage, retrieved the car and got back to the homestead, without incident. Luckily, it was fairly cool for Orlando, about 68-70 degrees, with a nice breeze, so I didn’t have to hear about the insufferable heat and humidity. But a helluva lot better than the 30′s we left in New York and the snow storm we had just missed, by my reckoning. I hate the cold. She hates the heat. How did we stay married for over 35 years? Just lucky, I guess….
 
Well, time for the big push, this week. Christmas is nearly upon us, so lots to do before the big guy in the red suit squeezes down our chimney, once more. Hope you’re getting your shopping done early. Talk to you soon. 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 conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved

December 17, 2009

Recently, I was part of a marketing seminar, where I go periodically, to learn to present my information and products to the widest possible audience. As part of that training, we all participate in an early exercise session. I mean EARLY, as in 5:30 AM. 
 
The instructor put us through a series of gentle exercises, which are designed to generate internal power and flexibility. Then, we moved to a series of stretches, designed to promote greater range of joint motion and flexibility.
 
Oh my…I realized as I struggled to straighten my knee, while holding my foot, that my strength is still pretty good, but my flexibility needs some work.
 
And I’m not alone.
 
You know, in Nature, anything you don’t use on a regular basis, is lost. This is always true, but you see it on an accelerated basis after surgery.
 
I saw this phenomenon many times in my patients, after surgeries that I had done to replace their arthritic joints. I noticed that it was easier to regain motion, after a hip replacement, than it was after a knee replacement. Same thing, if I had done an extensive open knee surgery, to realign the kneecap, or reconstruct ruptured ligaments.
 
Why is that? Well, if you think about it, you eventually HAVE to go to the bathroom, and sit on a toilet, to answer Nature’s call, man or woman. This is even truer for women, who sit to urinate, as well. And every time you sit, you’re stretching your hip joint into flexion.
 
But you can sit without deeply flexing your knees, especially if the surgery only involved one knee. So, it’s not uncommon for patients with a relatively low pain threshhold (those who are more sensitive to pain) to resist bending the operative knee. In a very short time, adhesions form, which subsequently tighten and make motion even more restricted and painful.
 
Then, there’s the opposite problem–knee extension, or stretching straight out. This results in the inability to full straighten the knee joint, what we call a fixed flexion contracture, or deformity. This is even worse than lacking full flexion. Why?
 
Well, you can walk with a fully straight, but stiff knee. But a knee fixed in flexion functions shorter and lacks the strength and stability of a fully extended knee.
 
Here’s a very simple, but very effective way to achieve full extension. You simply have to sit on the floor, or some other firm surface, with a pillow under your heel. Then press down on your thigh, above the knee. You’ll feel the tightness in the back of the joint. Deep breathing, with consistent pressure, will gradually stretch out the capsule of the knee and all the hamstring tendons, until it is fully straight.
 
Naturally, there are many other, more sophisticated stretches that you can do, to achieve this end. For that matter, there are a number of gentle, but effective stretches for knee flexion, as well. I teach them all in detail in my new, completely revamped and expanded PAIN-FREE PROGRAM, which you can order here:  http://www.drbillsclinic.com/exercise_eliminate.html
 
Stretching is as important as strengthening for relieving knee pain, realigning the kneecap, and restoring full function. I can see I have to start doing more stretching myself, if I want to keep up with the youngsters in the group.
 
One way to help is to increase my intake of omega 3 fatty acids, like those in my POWERHOUSE OMEGA FORMULA http://www.favoriteformulas.com   The natural anti-inflammatory properties of this ultra pure, enteric coated, pharmaceutical grade fish oil are proven to reduce or eliminate joint pain of arthritis, or other inflammatory conditions, in addition to a long list of proven heart and brain healthy benefits, including reduced risk of heart attacks and strokes, cardiac arrhythmias, blood pressure, some cancers, and platelet adhesiveness, resulting in a lower risk of clots. It’s the best, simplest thing you can do for your health.
 
The combination of fish oil and the stretching and strengthening exercises I teach is a good way to resolve that nagging knee pain, once and for all. Try it yourself 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 conventional and alternative treatments and exercises to relieve knee pain without surgery click on http://drbillsclinic.com/avoid_knee_surgery.html 
 
P.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, 2009 by William Thomas Stillwell, MD, FACS
All rights reserved

Well, the Holiday Season is upon us, recession and all. I just now got back in from Costco (though I still like to call it Price Club–much more euphonious, don’t you think?). I had to stock up on some essential things, prior to taking the flight back to New York, tomorrow night.

Then, the very next day, I get to drive back to Central Florida with the bride, and a bunch of cat carriers, so we can take the last of the brood to New York. The plan is to see Christmas in, here in Florida, then drive the last batch of kitties to the Northern Command.

You see, it’s cold up there, will soon be freezing so naturally, the bride (who LIKES the cold) wants to winter there (while most sane people are COMING to Florida, for the relative warmth and sunshine). Don’t ask me–I just live here (and there, whatever), but I digress….

But before we drive back up north with the cats, we get to festoon the house with Christmas decorations, and that means cleaning the whole place, top to bottom, in preparation for entertaining (though admittedly, it’s a whole lot easier with fewer cats in the house).

And that’s on top of getting in some late Christmas shopping. I always start early (I think I got my wife’s first present in July), but it’s finishing that’s the problem. I’m getting more exhausted, just thinking about all I have to do.

So, with every spare minute accounted for already, naturally I have requests for articles and product reviews and other projects coming up, out of the blue.

This situation reminds me of a handwritten sign we used to see in the O.R. every so often: “The difficult we do immediately. The impossible takes a little longer!” Words to live by. I think the sign was put up by one of the male nurses, a guy who used to work in the Psychiatry Ward, but transferred to the Operating Room. As you might expect, this gave him a rather unique perspective.

His name was Tim, and he was the resident wit and cartoonist of the place. His droll and dry sense of the absurd saw us through many rough times. No one was exempt from his pen–when I was injured (falling through a high ceiling and fracturing my spine, if you’re a newby), he posted a cartoon of me falling behind a couch, with a line of cats all holding up signs with scores (8.9, 9.6, 9.2, 9.8…) just like an olympic event. I saw this my first day back. It WAS pretty funny. Certainly pointed out, in a humorous way, the idiocy of my predicament. But anyway, I think he posted that sign.

Together with the other members of my team, I took that motto to heart. We did some of the most truly outrageous surgical reconstructions ever seen in our region. Stuff that really did border on the impossible. I remember one little wizened lady, deep into her seventies, with horrible rheumatoid arthritis, that had BOTH knees so contactured, she couldn’t even stand.

A contracture is where the joints, in this case both knees, are literally scarred into a fixed, bent position, in her case, well beyond 90 degrees. And no amount of stretching, or force, can straighten them. In this lady, her bones would have shattered before the scar tissue gave way.

Because of ignorance and neglect, very gradually over time, her knees became more and more bent. No one thought to have her evaluated by a doctor; no one had started her on stretches and exercises, like those in my PAIN-FREE PROGRAM http://drbillsclinic.com/exercise_eliminate.html or got her braces, or splints to keep her knees straight. So eventually, the poor thing was stuck in a Nursing Home bed, in a fetal position.

I don’t remember how I came to care for her, but I remember that the older, wiser heads in the Department all gravely assured me that she was beyond hope, that it was impossible. Luckily for her, I was still in that early phase when I believed in my heart I could do anything–and so, I did.

If there was ever a case that exemplified the necessary surgery, this was the one. I had to release virtually every ligament and muscle around her knee, and cut away a significant amount of bone to allow the knee to both straighten and accept total knee implants. At one point, her leg was literally hanging in the breeze, connected only by the posterior nerve and blood vessels. I should have been scared out of my wits…but you see, it never occurred to me that this could fail. So it didn’t. The ligaments, once released, found their own correct levels and went on to heal at those spots. When we were done, the leg was straight and the knee was stable.

Ideally, she should have had both done the same day, so she could walk. But she couldn’t tolerate that much anesthesia at one time–”The impossible takes a little longer.” So initially she was left with one leg bent up and one leg down and straight (kind of like Superman, when he flies up, up, and away). Next week, we took her back for the other side. This went faster, with the lessons learned from the first go round.

Some months after she was discharged from the hospital, I was giving a talk on knee replacement in a public forum and this same lady WALKED up and thanked me. And damn! Those knees were straight! What a transformation. She was now very talkative and lively, where before she had sunk into a torpor and would surely have died from lack of stimulation and despair. And I knew that THIS was why I did what I did.

Those older wiser heads still shook their heads: “just lucky,” they said. Well, yeah, but better lucky than smart, eh?

The lesson here is that she need not have ever reached that point. Today, we know that there are many ways to prevent knee surgery, or at least delay it. You can combine effective conventional and alternative treatments from across the entire medical spectrum to relieve your pain and restore your function, like those I teach in HOW TO AVOID KNEE SURGERY  http://drbillsclinic.com/avoid_knee_surgery.html

If that patient had only had worn a simple extension brace at night, she might have avoided the magnitude of that complex surgery. In like manner, if you ever have a knee injury or a knee surgery, get your full range of motion back as soon as you can. And KEEP it, even if you need bracing to do it.

Til next time, my friend, be well.

Yours for a pain-free tomorrow,

Dr. Bill

Bright and early Saturday morning (well, 10 AM IS early to me these days), I suited up in my green scrub suit, donned my long white coat, just like the good old days, and drove up to the Fitness Center of the Alaqua Golf & Country Club, in the community in Central Florida, where I live. 
 
The plan was to shoot the necessary footage for the new DVD edition of my PAIN-FREE PROGRAM exercises (which you can check out and purchase, if you wish, by clicking on this link:   http://drbillsclinic.com/exercise_eliminate.html )
 
I had lined up a suitable model, Jennifer Kunzig, a personal trainer, to demonstrate the exercises, with the special modifications I’ve developed to prevent or eliminate knee pain. Let’s face it. No one wants to see some middle aged guy doing these exercises, when he can look at a pretty young woman, right? She had been dieting and restricting her water intake over the last week, so her definition would look good on tape.
 
I had also retained a videographer, to produce the DVD, a great guy named Jonah Travik (Jonah–now there’s a name you just don’t hear every day). I had worked with him before, shooting the DVD version of my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN
 http://drbillsclinic.com/eliminate_knee_pain.html  (That has yet to be edited, but I expect it to be ready early in the New Year) and he’s great to work with.
 
Finally, I had secured permission to use the Golf Club’s Fitness facilities from the owner and developer of the community, a really nice guy named John Ritenour. His kindness gave us a super venue for the shoot, not to mention very convenient for me, as I live about two minutes  down the street.
 
So all was in readiness, the cast of characters was assembled and the sun was shining brightly. We were ready to roll. I got there on time (not too hard–I WAS only two minutes away) and met Jonah. We set up the lights and planned the camera angles, while we waited for Jennifer to show up, which she did about a half hour later. This was planned–no point in having her sit around while we were setting up.
 
Finally, I placed a neat little sign on the door of the Fitness Center: QUIET PLEASE. PRIVATE VIDEO SHOOT  WITHIN. THANK YOU. This was to discourage the curious and the club members, who might otherwise enter while we were shooting.
 
But with the sign and the obvious evidence that a professional crew was engaged in a project, you would think that once we started with the “lights, camera, etcetera, etcetera…” that anyone with good sense would respect our privacy and return later, after we were done, if they felt the burning desire to work out. Just common courtesy, right?
 
I mean, if the situations were reversed and I came across a film crew working when I showed up for my exercise session, it would never even occur to me to barge into the middle of things.
 
So, you know where I’m going with this, right?
 
First, a nice middle aged woman came in and wanted to get her workout in while we were still setting up. So, she got on the treadmill, then did a few dumbbell exercises, and so on. But she never held us up, as we worked around her. And she was properly deferential and only too happy to get out when we were ready.
 
We started shooting after she left and we had hit a nice, productive rhythm. We were moving right along, with me doing the talking and voice overs and Jenn doing the exercises. And just as we were hitting our stride, the door opens and in walks an elderly guy, presumably right off the golf course, walks over and turns on the T.V., and then gets on a treadmill and proceeds to begin walking on it, filling the room with the mechanical noise of its motor and the thud of his footsteps on the track. 
 
I couldn’t believe the stones on this guy. I guess he either didn’t see the sign, was oblivious to it, saw it but didn’t give a crap, or he thought that “quiet please” just meant, “don’t speak” (which he didn’t). And he DID keep the volume on the T.V. real low. 
 
Well, of course, everything we shot during this time had the rumble of the treadmill running through it. And I couldn’t throw the guy out. After all, I was a guest here, myself. But, still….
 
I was frosted at the impeturbability of this guy and his utter disdain and disregard for what we were trying to do. Maybe it’s just me, but I think he was a rude, thoughtless S.O.B., at a minimum. 
 
I let him live. But it required some considerable restraint. And the other members of the crew felt the same–we were all grinding our teeth at the nerve of this guy.
 
Finally, he finished and left. Unbelievable. One good thing about older guys–you know their workout won’t last too long. But of course, he had broken our rhythm and we had to reshoot all the footage that his treadmill sounds had screwed up. His little workout cost us at least an extra hour.  Thanks, pal.
 
Anyway, we finally got it done–a little later than I had planned, but finished. And I have to tell you, I think what we shot was great! I was really pleased. And I hope you will be too, when I unleash the final product as a set of DVD’s, sometime, early in 2009.
 
And in addition to the video, I reshot all the still photos, with professional lighting, and added a bunch of new stuff: more stretches, more exercises, the proper ways to use the stationary bike, canes, braces, taping, ACE wrapping, a real expansion of the program. It was a lot of work, but it should be great!
 
This is going to replace the current PAIN-FREE PROGRAM, so this current version is going to become a collector’s item. If you haven’t gotten yours yet, NOW’s the time, while you still can. Go to http://drbillsclinic.com/exercise_eliminate.html  and order your copy 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

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

 How would you like to be Retief Goosen today? “Who is he?” you ask. Well, he’s the guy from South Africa who finished 14th in the field at the US Open, which was won by Tiger Woods. He was quoted as saying, or at least implying, during an interview that Tiger’s knee pain was exaggerated, or put on, during the recent competition. Unfortunately for Mr. Goosen, Tiger was found to have a torn ACL (Anterior Cruciate Ligament), as well as a stress fracture of the tibia (you can learn all you need to know about ACL injuries at  http://drbillsclinic.com/eliminate_knee_pain.html  ).   So, it seems that his pain was genuine, his pathology quite real, and his spectacular win burns that much brighter….
 
Despite his subsequent remarks that he was just kiddin’ about Tiger faking his pain to win over the crowd at the Open, Goosen looks churlish, at the very least.  Nothing quite like revealing yourself to be a shmuck on national TV….
 
Now Tiger is going to have to undergo ACL Reconstruction surgery and that means missing the rest of the season. As it happens, he couldn’t be in better hands. His doc is Dr. Tom Rosenberg, who was one of the pioneers in arthroscopic surgical techniques and an associate of Dr. Robert Metcalf, both of Utah. I actually trained in these techniques back in 1982, at the Arthroscopic Surgery Workshop,
taught by both these fine surgeons, under the aegis of the University of Utah, in Salt Lake City. Dr. Metcalf is gone now, but Dr. Rosenberg is still working–one of the best there is, by all accounts.

In those early days, arthroscopic surgery was primitive, especially in Long Island. I had done a few cases using borrowed Neurosurgical instruments as grasping forceps,  to remove loose bodies and simple meniscal tears, but nothing serious. I still had to look through the
eyepiece of the scope, by sticking my big fat NONSTERILE head into the sterile surgical field, to see inside the joint. But most cases were still done ”open,” meaning through a real incision–although my 1-1/4 inch incision was tiny. Most guys used a 4-6 inch incision for the same operation. And I could be in and out of the knee in 25 minutes flat, including a plastic closure (meaning a tight approximation of edges, with ”buried” sutures undermeath the skin, that resulted in a thin, hairline scar). But these patients had to stay in the hopsital for three days, because of the incisional pain and the resultant need for injectable narcotics.
 
But the new arthroscopic techniques promised far less pain and much quicker recovery, enabling the patient to return home ON THE DAY OF SURGERY! This was unheard of.
 
In fact, initially, I didn’t believe the claims about the technique–I was a real skeptic. But my professor from my Fellowship, Dr. Turner, encouraged me to get into it. So based on my respect for him, I did. My problem was that I couldn’t wrap my mind around the idea that six 1/4 inch stab wounds hurt far less than a 1-1/2 or 1-1/4 inch incision. I thought, intuitively, but incorrectly as it turned out, that they should be additive. Turns out they’re NOT. Who knew?
 
Anyway, I went to this course and hands-on workshop and spent nearly a week in Salt lake City. Besides opening my eyes to the possibilities of arthroscopic surgical techniques, miniature cameras, specialized instruments, motorized shavers, and the like, I learned everything I now know about The Mormons. There wasn’t a whole lot to do in the down time between classes, so I went to the presentations given by the volunteers of the Church.  It was pretty interesting. I was fascinated to learn that their Prophet, Joseph Smith, had his visitation from the angel Moroni (that’s the golden angel with the trumpet you see atop any of the LDS Churches and Temples) in upstate New York. The volunteers were as clean-cut and earnest as you could ask for–downright wholesome. It was really quite interesting…but I digress.
 
This course opened up a whole new world of possibility to me. After this, I was a believer (in arthroscopic surgery, not LDS). When I came home, full of enthusiasm, I laid out 30 grand of my own funds to buy all the new equipment that I would need to bring this technique to
my patients. I was the first surgeon in my region to do these procedures, but my first few dozen cases drove the nurses in the OR nuts! I mean, I’d have water running on the floor, out the door and down the hall, over 2 hours when I first started, on a case that would have taken me  25-30 minutes “the old fashioned way.” They couldn’t understand why I was doing this–clearly thought I was crazy. Problem was that this kind of surgery used a different skill set than standard surgical procedures.  Took me a year to develop the reflexes and sychronize my hand movements with what I saw on the video monitor.
 
But once I did get it, my time plummeted down to my pre-arthroscopic limits, and the patients WENT HOME, the very same day. After a few years of that, none of us could even remember how it had been before the advent of arthroscopy. It was that big an innovation. New
arthroscopic assisted techniques followed, developed by leaders in the field, like ACL Reconstruction. So patients today can enjoy results that were undreamed of years ago. 

So Tiger will likely have a great procedure and postop result, if all goes well. Then, it’s a matter of rehab and time to heal. As with the quality of his surgeon, I’m sure he has the best therapists to work with. But after his initial rehab, he needs to maintain the gains he’s made, even when he’s on the road. That’s when a lot of cases lose ground. Here’s where I think I can help….
 
You have probably gathered by now that I’m a big fan of Tiger Woods. It’s not hard to understand–I admire excellence, especially effortless excellence, which he epitomizes. I feel terrible that his career is on a forced hold, that we’re deprived of his talent and that he has to suffer through yet another surgery. I’d really like to help him.
 
So, to express my admiration and to offer some help that he WILL need, tomorrow I’m going to send him an autographed copy of DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN http://drbillsclinic.com/exercise_eliminate.html
 
With my program of isometric, free hand exercises for strength and stretches for improved flexibility, that he can take with him and do anywhere in the world, I believe he’ll be able to maintain an excellent post-surgical result, and stay on top of his game. There’s been a lot of speculation in the press about  “can he come back after ACL surgery?” Well, it’s true enough that four surgeries on the same knee within ten years is a lot of surgery. But if anyone can confound the naysayers, and come back even better than before, it’s him. My money’s on Tiger! 
 
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

Tiger Woods has done it again! Only a couple of months after arthroscopic surgery on his left knee, for “cartilage damage,” he came from behind to win the U.S. OPEN. Wincing in obvious pain throughout the tournament at Torrey Pines, San Diego, Tiger fell behind earlier in the game, with a couple of bogeys, but then went on to pull even, with a couple of simply spectacular shots, that apparently defied the laws of physics, and resulted in eagles. After 90 gruelling holes of golf, Tiger finally clinched the title from opponent Rocco Mediate in sudden death on the 91st hole. This is one for the ages!
 
So Tiger pulls it off again, against a great player, with a real physical and mental handicap. He’s now won his 3rd U.S. Open and his 14th Major Title, hot on the heels of Golfing Great Jack Nicklaus’ Lifetime 18 Major Titles. And Tiger is only 32 years old (though I bet his left knee is a lot “older”). 

I’m not a big golfer, personally (tough to do when you have a fractured spine and crushed discs), but I fiercely admire excellence and achievement, especially when wrested from adversity. This was the third time that Tiger had this same knee operated on. He had a benign tumor removed in the late nineties, and arthroscopy in 2002.
 
If you were watching him walking in the Masters, he was wincing and in obvious pain from that left knee. It’s very possible that the distraction lost that tournament for him, but even there, he almost pulled it off and finished second. This guy is unbelievable! No matter
how you cut it, he is a true champion.
 
The “cartilage damage” referred to could refer to degenerative or traumatic damage to the articular cartilage, manifested as shredding, crevasses or flaps. If widespread, this could be consistent with arthritic changes, despite the fact that Tiger is only 32 years old. On the other hand, it could refer to a tear or degenerative shredding of the meniscal cartilage. No real details have been made available, so it’s anyone’s guess. But his pathology was likely one of these, or both.
 
What happens when the cartilage is damaged? Well, in brief, whether from direct impact, or from slow, progressive degeneration, the ice smooth resilient articular cartilage coating of the bearing surfaces of the knee joint become softer than normal and eventually begin to fragment and shred. Once the cartilage is physically disrupted, this unravelling of the protein fibers of collagen (that normally give support) speeds up and progresses. This is discussed and illustrated in detail in my LITTLE GREEN BOOK FOR ELIMINATING KNEE PAIN (see it at   http://drbillsclinic.com/eliminate_knee_pain.html)
 
If the damage is to the crescent-shaped meniscus, it’s usually a tear. Thing is, any cartilage damage is a problem because cartilage, once physically broken or torn, cannot heal without very sophisticated surgical techniques (at least with current technology).  But there are a number of supplements, herbs, OTC medicines, and even food choices that can have a positive or negative influence on inflammation and
pain.
 
When Tiger was walking the links in pain, something within his knee was catching in that joint, causing traction on the capsule of the joint and/or the lining membrane. Problem is, if the thigh muscles are weakened by the persistent pain, they can’t stabilize the joint and help absorb the shock of walking (especially up and down the rolling hills of a golf course).
 
The solution, both before and after knee surgery, is to strengthen the thigh muscles, the quadriceps, so they will be able to absorb shock and supplement the ligaments to priovide optimal stability. To do that, a number of exercises designed to increase muscle tone, strength and power, and stretches for the antagonists on the opposite side of the thigh, are necessary. But not any old squatting motions will do. No, you need to strengthen your thighs strategically, based on the type of pathology you have. 

As an orthopaedic surgeon and, more important, as a knee surgery patient myself, I’ve collected the best and most effective exercises, specially modified to prevent or eliminate knee pain, in my PAIN-FREE PROGRAM  http://drbillsclinic.com/exercise_eliminate.html
 
Using a combination of the movements described in my PROGRAM, anyone can improve the stability of their knee and relieve their pain. Of course, as I mentioned yesterday, you actually have to DO the exercises. Nothing happens without effort. But if you do them, your thighs will grow strong and your knee pain will get better and better. Try it and see for yourself.
 
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 9, 2008 

Lately, I’ve been asked a lot about neck problems. Among these are muscle spasms, trigger points, the radiating pain down an arm, from cervical disc disease, and the ever popular wry neck. One guy in the fitness group, for which I have the honor to be medical advisor, wrote in to ask for help for his chronic upper back and neck pain.
 
It seems he was doing a forward bridge, with side to side neck stretches, and apparently overdid it. He suddenly got a catch, a spasm between the shoulder and the base of his neck. This was a few months ago. He’s tried massage, stretches and cable expanders for his chest, in an effort to relieve his pain. But he’s still suffering with a wry neck–limited motion, pain, sudden catching with muscle spasms, and all.
 
Believe me, I can empathize with him: “I feel your pain!” Actually, I really have felt his pain–I had this same recurrent problem for years, thanks to a chronic disc problem at the C5-6 level. I would awaken with a stiff neck and pain in one sore spot on the inner border of my shoulder blade (scapula), a typical pain presentation for a C5-6 disc. Throughout the day, the muscles would gradually get tighter and tighter in spasm. And it really sux! 

You haven’t lived until you’ve tried to operate with a stiff neck and severe muscle spasms. The pain can be so bad, that you actually feel nauseated, not to mention the sudden stabbing spasms, if you move in such a way as to stimulate a trigger point. And arthroscopic surgery, in particular, requires you to twist your head and neck around, as you manipulate the instruments.
 
Why would I operate in this condition? Well, I wasn’t really sick, or dying, I just hurt. Like Peter O’Toole, playing Lawrence of Arabia, said in the classic 1962 David Lean film, “Of course it hurts. The trick is not minding that it hurts.” My patient was depending on me to relieve his pain, the OR staff was depending on me to not screw up the schedule. And I was in SOLO private practice, no partners. So, yeah, if I could
function, I went to work.
 
Did it adversely affect the surgery? Nope. I just went a little slower than normal, in anticipation of, and attempting to avoid, triggering a painful spasm. But I only know one way to do the procedure–and that’s excellent! The patient got the very same result he would have, had I been at 100%. The point is, I  understand, first hand, what this guy is going through.
 
But he made several mistakes that have cost him a prolonged period of pain. First, he was doing a forward bridge. A forward bridge allows direct bodyweight pressure to travel down the neck bones and discs.  If you look at the neck bones, they are smaller and lighter than those of the lower back. This is a clue that they are not designed to bear weightbearing forces.  By contrast, a back bridge does the opposite: pressure goes down the back of the neck and actually stretches the spine, relieving any pressure on the discs. So, if you have neck problems, you might want to avoid the forward bridge.
 
Second, while bearing weight on his head and neck, he overdid the neck stretches from side to side. This is putting a lot of strain on the muscles and ligaments, as well as the discs, and is just asking for trouble.
 
Third, he did not mention the first thing you should do if your are injured–REST. In case of any acute neck injury (assuming it’s not very serious like a car wreck, where a fracture is possible), first STOP what you are doing, and rest your neck on a transverse rolled towel.
This places the neck in a slightly extended (ie.,gentle backward bent) position with even support, to allow the muscles to relax.
 
Local ice for 48 hours and the other anti-inflammatory measures I describe in detail (albeit for the knee) at
 http://drbillsclinic.com/eliminate_knee_pain.html   will help to relieve pain and resolve the inflammation.  This can then be followed with GENTLE head rolling exercises and GENTLE stretches, again to relax the muscles. But if there is little or no relief in a few days, you need to see a doctor, preferably an orthopaedist. You could have a herniated disc, or some other more serious problem and only a thorough medical
evaluation, with x-rays and perhaps an MRI or CT scan, can identify them.
 
Never let an acute injury become a chronic wry neck (torticollis). You’ll be sorry if you do. 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