Does anyone think DRmark has way to much time on his hands?

[TahoeAk1]

I know this is going to create some serious controversy but WTF....

So, with so much damn time on your hands...I have come to the conclusion you are basically spaming your own practice on this site! By my last count you have had at least 3 folks from this site come to see you. That equals a lot of $$ from insurance co.

It does not stop from you,. You respond to basically everyones blog with mostly negative crap, perswading them to do your techniqes! You do have some descent advice from time to time but you need to remember its purly your opinion. Thats it. We all know what opinions are like. We all have one.

I brought my lap top into PT today to show your comments off a bit as you had me concerned for a bit....

Everyone at PT, including DRs from Tahoe Fracture, the physical therapist etc., all call BS on the majority of your comments...truly...you should call them as they are your associates are they not? They actually mentioned you tactics are 1990's

This will create some controversy from your buddy "Fredstrees" and others, but...I am calling as I see it....

Any Dr with as much time on his hands as you to be responding to ALL of the blogs that you do, cannot be doing that much real Dr work.

As for your most recent CPM advice.....I have news for you. Who is going to do there own heel slides for 10 hours a day anyway. The CPM machine does have mixed results but how can you knock it. It is only a bonus to have if your insurance covers it,

You should start reading the journal of sports medicine. It where the Dr's who truly are cutting edge actually compare and post ideas, results, etc.

As mentioned after looking for advice on many topics that you have questioned, i am calling bs on you. I wouldnt be surprised if you didnt get a call from Dr Steadman himself.....

Oh yeah, your aggressive recoveries, you said it best, the chickens will come home to roost after a year or so...The best recoveries on knees only take time...period. you cannot push them or else they will fail in the long run.

Not that it matters at all, but I own and operate one the largest heli ski operations in the country. I have a ton of time on my hands now due to my own knee and am on a quest for knowledge.

About 90% of the people whom I have spoken to about there own knee issues say the exact opposite of you.

I live in the mountains here in Squaw Valley, Lake tahoe when not in AK. Reading your blog responses remind me of following someone down the road who is throwing his lit up cig or cigar out the window as I whatch the sparks fly into the woods.

[Woodlandclown]

try a search..there is an entire thread on this on page 2

[L7]

To think just yesterday I noticed a lack of posts by DrMark and wondered if he had stopped posting. Maybe because of the last eerily similar thread to this created by jackasses with so much time on their hands they have to start threads about how much time other people have on their hands.

At least drmark provides useful knowledgeable info and is likely bright enough to now how to use the search function. You on the other hand......

[drmark]

Last I heard, we still had free speech in the USA and you are welcome to ignore what I say because from this point on I just might ignore your posts.

BTW, I have been receiving the American Journal of Sports Medicine for over 20 years and have never missed reading an issue.

My results speak for themselves, and you are certainly welcome to visit the rehab section of our clinic in steamy Houston at any time. I will even buy you a steak and a single malt. The techniques that I employ have been validated in peer reviewed articles in the American Journal of Sports Medicine for years now.

Heel slides are a terrible way to exercise the knee. Cannonballs work way better.

You can feel free to have Dick Steadman call me if you want. I am certain that my number is in his roledex and I have his cell in my speed dial.

[TahoeAk1]

After reading your posts woodland...I could not agree with you more.....!

Drmark...I really like the way you call your associate by his alias....His name is Richard. That comment of yours says everything. To call Dr. Steadman that, is unbelievable from you. His is the leading Dr in the country for ACL reconstruction. HANDS DOWN!!!!

NFL, NBA, NHL, MLB, MLS...they all refer to him. I wish he could have done my knee, however his associate did from Tahoe Fracture did. They all learned from each other. If your really trying to be a Dr., quit the BS on this forum. We are gimps purely exchanging our own experiences here with each other. Unless someone does what you think is best, its no good. YOU HAVE A LOT TO LEARN MR.

Your a spammer!

Ignore my posts, thats even better. In fact you should ingore everyones and get back in school. I am sceptical on your practice and curious if its even legit.....

Will dig deeper to see what I can find....trust me.

[drmark]

Dr. Steadman is a fine man. I am certain that if I was a patient I would refer to him as Dr. Steadman. Amongst his Orthopaedic Surgery colleagues he is known as Dick. He is actually a very personable friendly guy.

Don't confuse your beef with me, as a beef between me and Dr. Steadman (whatever way you perfer to address him)

At my last attendence in Church, the preacher said that when you point a finger at someone you point three back at yourself.

Get over yourself all ready.

Now I will follow my own advice and not respond to you again, unless you apologize for your rude internet behaviour.

[Lacy Underalls]

What a totally useless thread I've wasted my time reading but before I ignore it from now on let me just say that I've been operated on twice by Dr Steadman and he goes by the name Dick.

[L&AirC]

Quite frankly I'm thankful that drmark is here to answer questions and because of his insight I have been taking a different approach on my PT and surgery. Maybe it's just my new mindset but I know that when I go to PT on Wednesday, my extension will be under 10 deg. I can tell that it is already.

If I lived in TX I would be in his clinic.

He's letting us ask him questions

He's answering

He's letting us challenge his views

He's coaching and motivating

Of course he's posting his opinions. Who's else would he be posting?

I never noticed him to say his word was gospel. I do kow that the things he feels strongly about he repeats ("get full ROM before surgery"). Just because he went to med school doesn't make him or any other doctor infallable so if you don't agree with any doctor, challenge his "opinion" or change doctors.

If by the way it happens to drum up some business for him, good for him. My Ortho Dr. is very good but is hard to get ahold of. Even when I got my second opinion, that Ortho Dr. said I was in "Very good hands."

The problem is his brain and personality are that of a computer and no sense of humor (found that out the hard way). That means 20 minutes after my appt starts I'm out of contact with him and if I have a question I have to call the office, get a nurse wait for a call back and then because of the answer have another question and have to wait for another call back! It's exhausting.

If you don't like what anyone, including me, posts on the site, skip it. There is no reason to lash out at anyone or ruin something for the rest of us. Just because the other Ortho Dr.s aren't doing it (posting), doesn't mean drmark is wrong, it just means he's passionate.

Thank you drmark!

[Cal_skier]

Dr Mark,

I looked through website, and find your opposite knee graft and aggressive rehab plan for ACL reconstruction quite interesting. Watching some of the videos, it's amazing how fast some of your patients regain full ROM. In any case, I would like to ask you a few questions though:

1) Why don't professional athletes in the NBA/NFL/NHL/MLB etc take this approach for ACL recontruction? I'm sure the teams and athletes would want to return to sports as soon as possible (you mention as soon as 4 months for your patients), yet they all take approximately 9 months for full recovery. In addition, if they use autograft ACLs, they all take them from the same knee (which sounds quite understandable since why would a pro want to open up the other good knee). I also asked a few orthopedics about the choices most pros and their teams use, and they said BTB patellar autograft from the same knee is the most popular, and allografts are used by a few teams.

2) Doesn't Dr. Steadman recommend the gold standard BTB patellar tendon autograft from the same knee?

I appreciate you taking time to answer my questions as I'm very curious as to the above info.

[drmark]

There are lots of professional athletes who have the opposite patella tendon graft. The principle advantage is that there is less pain. You brain only feels the pain from the most painful place. So if two spots are nominally painful, its a lot better that a heap of pain in one sport. Actually the ACL leg hurts about as much as an allograft, and the graft leg, hardly hurts at all. Since a guy is sentenced to a few months or rehab anyway, both legs go to the gym at the same time.

The man that is most famous for it and popularized it is Dr. Donald Shelbourne, who, at least up to a year or so, was the team doc for the Colts.
I have probably done the second most opposite PT grafts and have done it on many professional guys, but no famous football player to date. In ten years, if some new stem cell solution isn't found, I am certain that the opposite graft will be the standard amongst those who install the patella tendon.

The Steadman-Hawkins Clinic has dozens of doctors, and they most certainly don't walk in lockstep with each other. If I remember correctly Dr. Dick Steadman only uses the bone-tendon-bone autograft on his patients and although his partners are doing them, he is most certainly not a fan of allgraft ACL reconstructions. Amongt the white haired household names in Sports Medicine, there are nearly no allograft proponents.

[Cal_skier]

There are lots of professional athletes who have the opposite patella tendon graft. The principle advantage is that there is less pain. You brain only feels the pain from the most painful place. So if two spots are nominally painful, its a lot better that a heap of pain in one sport. Actually the ACL leg hurts about as much as an allograft, and the graft leg, hardly hurts at all. Since a guy is sentenced to a few months or rehab anyway, both legs go to the gym at the same time.

The man that is most famous for it and popularized it is Dr. Donald Shelbourne, who, at least up to a year or so, was the team doc for the Colts.
I have probably done the most opposite PT grafts and have done it on many professional guys, but no famous football player to date.

The Steadman-Hawkins Clinic has dozens of doctors, and they most certainly don't walk in lockstep with each other. If I remember correctly Dr. Dick Steadman only uses the bone-tendon-bone autograft on his patients.

Dr. Mark,

Thanks for the info. I did also look at Steadman-Hawkins clinic website, and they had this to say:

Which is the best graft to use for an ACL reconstruction?
There are advantages and disadvantages to the many technical aspects of an ACL reconstruction including the type of graft, methods of securing the graft, and rehabilitation protocols. There is no clear consensus as to which graft is best. In the end, the surgeon's experience with the chosen technique and the patient's commitment to the rehabilitation program are probably more important factors in a functional outcome.

They didn't dismiss the allografts as poor choices, nor did they claim the BTB patellar graft as the best choices, stating that there are pros and cons to all of them. Having also spoken to other surgeons, they have told me that allografts would be fine provided patients are willing to sit out at least 9 months to a year. After that time, they should work just as fine and be as reliable as a patellar autograft. (Interstingly, they all recommend either the BTB patellar autograft or an allograft if you are willing to sit out longer, but not the hamstring graft.) A lot of patients aren't willing to sit out that long, thus chose the BTB patellar autograft. For the allografts, some docs are now using achilles tendons, which are the strongest and thickest tendons in the human body. Still, it takes upwards to 1 year for an allograft to be at its strongest, and the patient has to wait that long before returning to sports. Do you also agree that if a patient is willing to sit out that long, that an allograft will work just fine afterwards as the gold standard BTB patellar autograft? As stated, the time to sit out before returning is already a big negative to allografts for a lot of people, so that in itself may not be acceptable to them.

Thanks again.

[drmark]

I think first you have to differentate between the Steadman-Hawkins website and Dr. Steadman, himself. Those are two different entities.

I have sucessfully done allografts on athletes and did so throughout the 90s.
If a guy sits out the required year, the sucess rate amongst my patients was 80%

With the autograft is about 95%.

So the allograft can be ok, but you need more luck. And that stands to reason, there is a biological process, or call it an extra step, that needs to occur that doen't have to occur with autografts.

Disease transmission is another issue. Dr. Don Johnson (you might call him the Canadian Dick Steadman) pointed out that we test allograft for all the diseases that we know of. Unfortunately, we don't test them for any of the diseases out there that we haven't isolated yet. So, if allografts had been popular in the late 1970s how many folks would have gotten HIV?

Its for certain that the germ kingdom is smarter than us doctors, and the germ kingdom will continue to evolve and create smarter and newer diseases every year. Maybe not in 2008, but soon there will be alot of very sorry people and families out there. The question is, is not having to do a few months of exercises, which an athlete would be doing anyway, worth the risk?

[Dexter Rutecki]

I think that Tahoeak19103901 starting this thread is unnecessary. There was already one guy who started a similar thread, and Dr. Mark explained how he manages to post. I also sincerely doubt that the slots the three patients he 'gained' here would have been empty had those people not made informed decisions to seek his help.
For each of my five knee surgeries I was one surgery in a day of surgeries for my ortho, and I would guess it's the same for Dr. Mark. He's already stated that he doesn't need the money from whatever few patients he gets from here, and there is no reason to disbelieve this. He obviously believes (strongly) that his methods offer the best chance of success and shares that here--I don't know why anyone who really thinks about this would think there's something nefarious about his posting.

All that being said, there is a definite lack of agreement among orthopedists over what is best for certain aspects of knee surgery/rehab. Since I'm not an MD I don't feel comfortable making judgments about such things, but I have posted study results and opinions from other orthopedists that aren't in accord with Dr. Mark's conclusions. To me, as long as everyone posts in good faith and is reasonably diligent about their sources, it's probably helpful to share what is out there.

Now for the really important question (from my point of view): What's wrong with heel slides? I've done them every time I've rehabbed, and I've had several different physical therapists. Right now I'm doing three varieties of heel slide. What's a cannonball?

[drmark]

lay on you back. Pull the back of you distal thighs up to your chest. Relax you quads. Concentrate on a guy friendly event that regularly occurs before marriage. Concentrate on exhaling, too.

As you your knees up to your chest, your knees will bend all the way down
without any special attention.

[Woodlandclown]

i dont get the comment on the heel slides or cannonball. maybe you have to actually have knee surgery and wake up each morning with a stiff knee to understand the benefits of heel slides.

[Dexter Rutecki]

Heel slides are just a ROM exercise--you can do them lying down, or against a wall with your leg up on the wall. And I'm actually only doing those two types, I was thinking of the ROM exercise that I do on my stomach using my hamstrings to pull my heel toward my butt--and then using the good leg to 'encourage' a few extra degrees of range.
Even more fun at PT when they push the hell out of it and you lie there sweating and gritting your teeth feeling like you're a Guantanamo Bay detainee.

But I still don't get the Cannonball--shouldn't you pull your foot down at some point when you max out your (gimped out) range?

[drmark]

Remember when a kid would jump of the diving board and doa cannonball?
Thats it. Bring the knees up to the chest, and they bend.

[Rideski]

Not that it matters at all, but I own and operate one the largest heli ski operations in the country. I have a ton of time on my hands now due to my own knee and am on a quest for knowledge.

Really, which one? You sound like you're 16.

I would suggest that anyone that seeks free advice from Dr. Mark asks in a different thread, and leave this one to the 16 year old.

[TahoeAk1]

Sorry to offend all of you. I would just be weary about all the "free advice" Thats all.....Much of the advice given is contrary to what most of the Dr's and PT guys we see in in Tahoe are saying.

Again, my appologies if you feel offended by my thread. This is a waste of time....

PNH, Cordova AK to answer you rideski.....

[lemon boy]

I would just be weary about all the "free advice"

it makes me tired too.

[whisky]

Remember when a kid would jump of the diving board and doa cannonball?
Thats it. Bring the knees up to the chest, and they bend.

That is what my Ortho does to me each visit!

[Woodlandclown]

Remember when a kid would jump of the diving board and doa cannonball?
Thats it. Bring the knees up to the chest, and they bend.

i got that--i do that plus heel slides. i didnt get the comment about the guy friendly event before marriage. maybe you have to be one the get it.

[splat]

Remeber folks, you're always free to get a second opinion.
It's free professional opinions that are hard to find.
Thanks for hangin out here, Dr. Mark. I know a lot of people here appreciate it.
I would be more consciously suspicious of PT therapists who pat themselves on the back at the expense of others who are more highly qualified.

[L&AirC]

i got that--i do that plus heel slides. i didnt get the comment about the guy friendly event before marriage. maybe you have to be one the get it.

I'm not sure of drmark's exact meaning but since I've been married over 18 years, I feel qualified to take a stab at it. "Sex"! The exact position or method doesn't matter. What does is the frequency diminishes over time after marriage.

That's also why I choose to watch comedies while stretching. If I did drmark's method I would be all dressed "up" with no place to go.

[whisky]

I'm not sure of drmark's exact meaning but since I've been married over 18 years, I feel qualified to take a stab at it. "Sex"! The exact position or method doesn't matter. What does is the frequency diminishes over time after marriage.

That's also why I choose to watch comedies while stretching. If I did drmark's method I would be all dressed "up" with no place to go.

Atleast you saw the humor in it!