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

December 9, 2009

Eary yesterday, while I was reading my email, I came across an article from News 8 Austin with the provocative title: “Doctors Eliminate Arthritis Without Surgery.” Wow. Who knew? That would be news to me and I should know. So, I clicked on the link and read the article.
 
Talk about your misleading headlines!
 
It was actually a pretty good, if superficial, review of what is known about arthritis: that the most common form is osteoarthritis, it affects more women than men, the hip and knee are the most commonly affected joints, it is made worse by increased body weight (ie., obesity) and in its advanced form, it can result in joint replacement surgery.
 
But as for eliminating arthritis, without surgery? Uhh…No.
 
They also reported that researchers at Tufts University (my old stomping grounds in Boston, where I did my fellowship in joint reconstruction, at the New England Baptist Hospital) had found that older people (above age 65) did better with Tai Chi. They described Tai Chi as a series of slow, rhythmic Chinese exercises. They also found similar benefits with walking, swimming, bike riding and other, comparable low impact exercises.
 
All this is very nice, but it’s old news. Nothing new in the whole thing. 
 
It’s been known for many years that low impact exercise is the thing to do with arthritis. The shock of impact with running, for example, will not cause arthritis. But if there is any pre-existing degenerative change in the cartilage surfaces of the joint (and who of us at, in, or past middle age doesn’t have some form of degeneration in our joints?), the impact will ACCELERATE the arthritis. This is the source of joint pain that seems to come suddenly, “out of the blue.”
 
I’ve been saying for years that low impact exercise is the way to maintain your joint motion, while improving your heart and lung reserves and lowering your blood pressure and blood lipids, like cholesterol and triglycerides. Stretching also helps to improve and maintain your joint motion, an important element in preserving joint function.
 
But, in addition, resistance exercises are needed to increase the mass and tone of the muscles around the joint. Why? Well, stronger muscles help to share the load of body weight borne by the joint surfaces. In addition, they provide increased dynamic joint stability and in the knee, alter the functional dynamics of the kneecap (the source of over 50% of all knee pain, in my experience).
 
These are the same principles I teach in my PAIN-FREE PROGRAM, which you can get here:
 http://www.drbillsclinic.com/exercise_eliminate.html
 
But if you truly want to eliminate the SYMPTOMS of arthritis (not the same thing as eliminating the disease itself, which we cannot do, at present), then you need to add other conservative measures to the exercises. 
 
There are many conventional and alternative treatments which reduce the pain of arthritic inflammation, slow the progress of the disease and help to preserve the cartilage which remains. All of these elements together may prevent, or at least delay, the need for joint replacement surgery.
 
Remember, I spent nearly a quarter century DOING such joint replacement surgeries (total hips, total knees and revisions) and arthroscopies. Who better than a surgeon to teach you how to avoid surgery?
 
That’s the idea behind my newest healing program, HOW TO AVOID KNEE SURGERY, which you can get here:
 http://www.drbillsclinic.com/avoid_knee_surgery.html
 
One such simple example is the use of fish oil, which contains omega-3 fatty acids, that have natural anti-inflammatory properties, in addition to its known and proven heart and brain healthy effects. My POWERHOUSE OMEGA FORMULA, an ultra pure, highly concentrated, pharmaceutical grade fish oil   http://www.favoriteformulas.com 
 
has even addressed the problem of the fishy aftertaste, or the dreaded “fish burps” by the use of a special enteric coating, which virtually eliminates this problem. That’s why I take it myself, twice a day, every day.
 
So while that headline was misleading, or at least premature in its optimism, there are a LOT of things than CAN be done. You can reduce pain and inflammation, slow or stop the progress of joint destruction, and preserve your function, so you can continue doing what you want to do for many years to come. And, in most cases, you can do it without surgery. Get one of my life changing products 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 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

The phone rang the other night and I almost missed it.  It’s a big house, so if I’m not right next to the phone I have to run to the nearest one, without running the cats underfoot. But, I got it just as the answering machine picked up. Then, I had to wait for the recorded message to finish before I could hear and be heard.
 
It was one of our good friends, who is a female cop. She’s a sweet girl, but she’s one of those people I don’t hear from, until she’s got some medical problem.  I have more than my share of those. But, hey, it’s good to hear from them, regardless of the reason they decided to call.
 
It seems she was playing racket ball and suddenly felt this lancing pain in one of her calves. Because it was this sudden, hot poker sensation, she was a bit scared.  Who could blame her? She had heard of painful clots in the calves that could be dangerous (deep vein thrombosis), so she was pretty anxious.
 
Well, I asked her a few questions, so I could try to figure out what had happened to her. You may not realize this, but it’s tough to diagnose anything, sight unseen, over the phone. Lay folk simply don’t share the same vocabulary with medical people, so it’s hard for them to accurately describe what they feel, or what actually happened, or even what something looks like.  So, pity the poor doc who’s trying to make sense of what he’s being told and trying to make an intelligent diagnosis, based solely on this questionable information.
 
I’ll give you a great example of what I mean. My father-in-law used to tell me that the outer part of his hips (the trochanteric region) felt “numbish.” Now, to a physician, “numbish” indicates a decrease in sensation; that’s what “numb” means to us–a possible neurological problem. What he actually meant was “dull pain,” which indicated a bursitis, but he didn’t know how to accurately describe it to me. Took me a while, and a physical examination, to figure out what he really meant. The point is, I had to interpret what he said into what he really meant. So, when you’re trying to do this over the phone, it just adds another layer of difficulty to a tough situation. 

Anyway, this sharp, hot pain at the back of her calf was familiar to me. I asked her if she felt a “pop” when she felt the pain. “Oh, yeah,” she said, “now that I think about it, I DID kind of feel a “pop,” when it happened.” I also found out that she was able to walk on it, even though it hurt, and that her calf swelled up and was tender. I should mention that she’s in her forties, now, too. 

Assembling all the pieces, I felt pretty confident that she had experienced a rupture of the plantaris tendon. Given her symptoms, her age, the activity she was engaged in and my past experience with these same symptoms, it was most likely that she had popped her plantaris tendon. So, I first reassured her that she most likely didn’t have anything really bad, and she probably wasn’t going to need any surgery (for a discussion of this and other posterior knee conditions that can be treated without an operation, please see my newest healing program         HOW TO AVOID KNEE SURGERY    http://drbillsclinic.com/avoid_knee_surgery.html )

Then, I explained what had happened to her and why.  And then, what to do about it. First, she needed to get over the acute inflammation, and I gave her a host of the conservative mainstream and alternative methods to reduce inflammation and relieve pain, all the most effective treatments from my new program at  http://drbillsclinic.com/avoid_knee_surgery.html
 
Once the tenderness and swelling were gone, then she could begin the stretching and strengthening exercises taught in my PAIN-FREE PROGRAM, which you can see at   http://drbillsclinic.com?exercise_eliminate.html   The good news is that she’ll be back in action in a few more weeks with no disablity. And she won’t have any residual weakness. 

Of course, she could still rupture the OTHER one…. But with the proper warm-up before any exercises, and the recommended stretching and strengthening, hopefully, she’ll avoid it.

Well, that’s it for today. 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

February 15, 2008

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

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

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

That’s it for today, my friend. Til next time, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
http://drbillsclinic.com/exercise_eliminate.html

P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to   http://drbillsclinic.com/advanced_masters.html
 
FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved