I just read the transcript of a conference call interview of Tiger Woods with CBS Sports Sunday. The reporter asked Tiger a few questions about his recent surgery of only two weeks ago, done on June 24th. As I’m sure you’re aware, Tiger underwent Anterior Cruciate Ligament Reconstruction by the surgical team in Park City, Utah, under the direction of Dr. Thomas Rosenberg. I’ve written about Tiger’s ACL injury and Dr. Rosenberg in the recent past. But what caught my interest about this interview was Tiger’s responses to questions about his current status and his future in golf. 

Asked about the degree of discomfort he is experiencing now, Tiger replied, “I’m not liking it very much. Probably peaked about two days ago at its worst, but I think I’m on the good side now, and actually doing better.”
 
The actual surgery was reportedly a hamstring tendon reconstruction, with the tendons harvested from his right thigh, for use in his left knee. This is one of the two major methods of ACL reconstruction. The other uses a graft harvested from the kneecap with part of its attached patella tendon. Each method has its good and bad points, but both are highly effective methods of duplicating the function of the ACL.
 
But both methods require drilling tunnels into the bones of the knee, the femur and tibia. These tunnels are technically fractures, and you may recall, stress fractures were the source of his pain during the US OPEN; the ACL rupture was chronic, by that time, and pretty much painless. 

It’s the drilling and the resultant bone pain that makes recuperation after this surgery a challenging experience. My friend, it DOES hurt–a lot, especially  in this early, subacute postoperative period. At this point, his knee is trying to clear any residual blood and fluid within the joint, and resolve soft tissue swelling and inflammation.
 
Asked about his plans to return to golf, Tiger said, “…I just hope I can get up out of bed and go to the bathroom; little things like that are a challenge….”
 
“So for me to think about playing golf, that’s so far away. I’m just looking forward to walking again and putting weight on this leg for the first time. That’s actually a ways off.”
 
“As far as golf is concerned, I really don’t know. I don’t know how my body is going to heal from this…”
 
“It wasn’t very fun, but I’m on the good side now and can start sleeping more than an hour at times and can get a little more rest, which is good. I’ve been laid up pretty much every day all day, moving from the bedroom to the couch and back to the bedroom again, with maybe a few bathroom stops along the way, but that’s pretty much how my day goes.”
 
Now, Tiger sounds a bit down about his current status, but, having experienced some semblance of his pain myself, without the additional bone pain from drilling, I can empathize. It’s tough to see the end result, when you’re at this stage of recovery.
 
But Tiger Woods is a champion. He will get past this stage and he’ll work hard at his therapy. And in the end, he’ll be back–and better than ever. Hell, he just won the OPEN with a torn ACL and two stress fractures. Just imagine what he’ll do without those handicaps! My money’s on him. 

Once he’s able to tolerate some weight bearing stresses on the operative knee, he will probably start formal physical therapy. In my own ACL cases, I tried to restore motion rapidly. The faster you can get the knee moving, the faster you can get the swelling to resolve. Then, comes the gradual strengthening of the muscles around the knee, as well as progression of the extremes of motion (maximal flexion and maximal extension). The trick is to achieve these goals without overstressing the new graft or its fixation, until it is fully healed. It’s a balancing act–not too much, but just enough.
 
Now Tiger is a world class athlete, who makes tremendous demands on his body and his “bad” knee. So in his case, the surgery to reconstruct his cruciate ligament was definitely necessary. But there are times, if you’re a normal person, without instability in daily activities and in the absence of a need for high demand performance, when it isn’t. 

And it’s for THOSE times, when knee surgery might NOT be necessary, that wrote my newest book, the aptly named HOW TO AVOID KNEE SURGERY   http://drbillsclinic.com/avoid_knee_surgery.html

If you’re a regular guy or gal, you might respond to specific exercises and/or bracing as an alternative approach to a chronic ACL injury. And degenerative changes, like those Tiger had in addition, might be helped by certain nutriceuticals, dietary changes and alternative methods. All this and more is in my new book, HOW TO AVOID KNEE SURGERY. Go see at
 http://drbillsclinic.com/avoid_knee_surgery.html
 
Follow some or all of the recommendations in this book, or listen to the full length audio CD, while you’re stuck in traffic, to relieve your knee pain FAST and do it WITHOUT a trip to the operating room. Or, try the same exercise program I sent to Tiger, to help him fully recover, AFTER his own doctors and physical therapists have cleared him to return to his sport: DR. BILL’S PAIN-FREE PROGRAM   http://drbillsclinic.com/exercise_eliminate.html
Try one of these great programs 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, 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 any reader or fan of the popular Harry Potter series knows, the Cruciatus Curse is one of the four “unforgivable curses” of the Dark Arts, used by followers of the Dark Lord, Voldemort, to inflict indescribable agony on the subject. You just point your wand at the target and say “Crucio,”  to magically torture your victim. Of course, if you’re not a fan of J.K. Rowling, or haven’t read her novels about the adventures of the young wizard in training, and all his friends, then you have no idea what I’m raving about.
 
The point is that “The Cruciatus Curse” has an analog in the real world, in the Ruptured Anterior Cruciate Ligament. This injury is very common in the twisting, cutting and sudden hyperextension movements the knee is subject to in a number of sports. And when it is acute, it can be an agonizing injury. Usually, the key sign is a sudden, excruciating swelling of rapid onset, after an injury, and the player is NOT able to return to play, or even bear weight on the affected knee. 

In the normal knee, the ACL prevents excessive forward motion (translation) of the tibia, relative to the femur. It also stabilizes the knee joint in rotation and pivotal motions. It’s indispensable for stability in most running sports. In its absence, the knee is unstable in these activities and untreated, the knee will develop rapid degenerative changes. It’s an injury that is often associated with a torn meniscus, and sometimes with injury to the medial (inner side) collateral ligament, as well.
 
This injury was brought to the fore (you should pardon the pun) by Tiger Woods’ recent knee surgery and the endless speculation about whether or not he can make a full recovery and return to be the force on the professional golf circuit, that he was prior to his injury. Now, in his case, the cruciate rupture was a chronic injury (over 11 months old) and the acute pain he experienced during the Open was due to a double stress fracture in his tibia (shin bone). Just think about that for a minute–the guy WON the U.S. Open, with constant pain from a double fracture, as well as the instability from a chronic ACL rupture. Amazing.
 
Anyway, he underwent an ACL reconstruction by Dr. Thomas Rosenberg and his team in Utah. And he is likely deep into prescribed rehabilitation by this time. As I mentioned a while ago, I sent Tiger a copy of my PAIN-FREE PROGRAM exercises http://drbillsclinic.com/exercise _eliminate.html )   for him to use, after his course of postoperative rehab is complete. It’s great advantage is that these exercises are clinically proven to WORK, based as they are on my nearly quarter century of clinical practice. And I used these exercises myself, after my own knee surgery.
 
Now, not all ACL ruptures require reconstructive surgery. If you’re NOT a competitive athlete and you have NO instability during normal daily activities, you may get by without surgery. That doesn’t mean without treatment, though. But if you would like to try a non-operative appproach, see what measures are available to you in my newest program, HOW TO AVOID KNEE SURGERY, at
 http://drbillsclinic.com/avoid_knee_surgery.html   also available as a full length audio CD.

As if that wasn’t enough, today is the start of my 4th of JULY HALF PRICE SALE! For one week only, ending at MIDNIGHT, on Monday, July 6th, my PAIN-FREE PROGRAM,  and best of all, THE ADVANCED MASTERS’ PROGRAM,  ARE HALF PRICED!!!   http://drbillsclinic.com/half_off.html
 
So, if you’ve been waiting for the price to come down to get one of these outstanding, life-changing, pain-relieving programs, now’s your chance. But it won’t last forever, and supplies are limited, so if you want one of these, ORDER NOW! http://drbillsclinic.com/half_off.html
 
Til next time, my friend, be well.
 
Yours for a pain-free tomorrow,
 
Dr. Bill 

P.S. For DR. BILL’S LITTLE GREEN BOOK ON ELIMINATING KNEE PAIN, a concise, but complete handbook on the root causes and the various options for treating knee pain, go to http://drbillsclinic.com/eliminate_knee_pain.html
 
P.P.S. For DR. BILL’S PAIN-FREE PROGRAM: EXERCISES TO PREVENT OR ELIMINATE KNEE PAIN, please go to
http://drbillsclinic.com/exercise_eliminate.html
 
P.P.P.S. For the giant, comprehensive ADVANCED MASTERS’ COURSE: HOW TO ELIMINATE KNEE PAIN–ONCE & FOR ALL!, everything you need to know on causes and solutions for knee pain and the complete exercise program, too, go to
 http://drbillsclinic.com/advanced_masters.html

FREE BONUS CD with any order: THE HEALING POWER OF POSITIVE PAIN PERCEPTION
 
Copyright, 2008 by William Thomas Stillwell, MD
All rights reserved

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