♪ Bob and Brad ♪
♪ the two most famous physical therapists on the internet. ♪
- Hi folks.
I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapist on the internet.
- In our opinion, of course.
- This today, Brad we're gonna talk about how
to rehab after meniscus surgery.
- Right.
- And this is for Jim.
- Jim. Absolutely just had a mini-
- Hi Jim.
- He just had a meniscus surgery, rehabbing right now
and we're gonna help him out
how to follow through with this, you know.
- As we will help out anybody else
who is new to our channel, by the way
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- So you know more. Okay, now this is a type of surgery.
It's typically, you go in one day
they do some deep breathing, the meniscus maybe tore
or have a flap that's up on it one way or another.
They just, it's a simple surgery, nowadays.
- Deep breathing.
They're cutting part of it away.
- Right. Exactly.
- Trimming it out might have folded
over and it's causing a, you know
your knee to lock up.
- Exactly just getting some
of the rough edges off to smooth it up.
And so the rehab is not real complex.
It doesn't need a lot of therapy off often times.
But it is important to get started on the right track.
- A lot of it you can do on your own.
- Exactly. The first couple, three days.
This is pretty simple.
It's the "PRICE" theory.
- Or theory method.
- Let's go through this quickly, Bob.
You don't have to have one of these wedges
but it helps keep the swelling down.
And it's very comfortable.
Why don't you put both legs on there, Bob?
- And that'll help.
So you don't irritate your back.
Get a cold pack.
Here, we have a nice one here,
but you know, you can make your own.
We've got some videos on how to make your own for very-
- [Bob] So rest, ice, compression, elevation.
What's the "P" again?
- Protect.
- [Bob] Oh, protect. Okay.
- "P R I C E" protect it.
In other words
you may need to use crutches possibly depends.
- Sure.
- Now, once again, all this depends
on what your surgeon gives for cautions.
Every surgery's is a little bit different
so you need to follow what they say first.
If they say weight bearing as tolerated range of motion
as tolerated, you can follow everything we're doing here.
- Right.
- And as tolerated means,
if you get sharp pains with it, that's not tolerated.
Little pain, little stretching pain.
That's okay.
Use good judgment.
Don't overdo it.
- Yeah. Listen to your doctor.
- Exactly.
- Like you said, they're all different.
They all have their different ideas.
- Right. So, if they give those instructions as tolerated,
here's how we're gonna start. Now later on in the program
as you rehab this and your knee get sore
because you decided to overdo it, you thought, well
I'll see if it makes it through the pain.
Then you need to come back and do the "PRICE" again.
Elevate, rest, ice.
Okay. Now, Bob why don't you lay down again?
Let's go right on.
- One of the big things
about rehabbing a knee, whether it's this surgery,
an ACL surgery, is we need to get the quadriceps fired up.
- [Bob] Right.
- We need to get those muscles working again.
Cuz they're so important for walking.
And so what we're gonna do, can you grab the blue?
We're gonna use this half roller here.
Cause it works really nice
but you can put anything under your knee.
Okay. What I want you to think about doing is squishing.
If you got a little Nerf ball
under your knee, that works good.
And see Bob is squishing
down and he's what he is thinking about.
And I like to see the patella move upwards
and he's got his pants on.
So we can't.
But if you have a pair of shorts on in the clinic
that's what I'm always looking for.
And then you can see the quadriceps muscles tightening.
Oh yeah.
Look at those.
Go ahead Bob.
Oh, they're just bulging out.
- [Bob] Oh, I bet they are. - I bet you they can see it.
Okay. Now the next thing, if that starts working good,
this is gonna be hard to see
but let's go like this and you can put a ball
under your knee or something like this.
Now think about pushing down on that.
There you go.
- [Bob] And lifting up.
- Yep. A short art quad we call that.
And we're do sets of 10 of these.
Once you get the, the squishing and the kneecap going up
then you can put the boundary here.
Do 10 of those couple sets.
If you'd like to even three sets.
If you're feeling really good.
- I feel really good, Brad.
- Yeah. All right. (laughing)
Now the next set weight bearing as tolerated.
So why don't we do some exercises?
- [Bob] Did you wanna do straight leg raises or not yet?
- Oh yeah. We might as well do those while we here, thanks.
- [Bob] Yeah.
So just while bending this knee, usually.
So the non-involved leg.
- Right.
Get the opposite leg up like this.
It makes a lot easier on your back and the whole.
- Now you're gonna need to have a fair amount
of strength to get to this point.
I mean, you're gonna have to have been doing the
the quad sets and the short art quads,
before you can start lifting the leg here.
- And one thing you'll hear
if you hear a term saying a quad leg
that means when you do this
that knee is unable to get fully straight.
And that's a quad leg.
If you lift up
and you can't get a full extension, that's that's normal.
But the whole deal is, is to get away from the quad leg.
Then, you know, you got an adequate-
- Right.
Don't be lifting like this.
And doing these, get it out straight.
- Right. okay.
- All right.
- Good job.
- Where are we at Brad?
- Next weight bearing.
Okay. If you can weight bear
you've got some range of motion.
We're gonna get into some more range
of motion right after this, but half squats.
So we're not gonna do squats way down.
Like this is gonna hurt.
It's gonna be not appropriate and just flare it up.
So go behind a chair or a cupboard.
And you're just gonna gently squat.
And we're not going down like this
cuz we're not working the back of the hips.
We want to keep that good tall posture.
And you go down as far as tolerated.
If you get down to here and it starts, oh
hurting a little sharp pain
this is all you're gonna do for now.
But if you can get down a little farther right
to here and that's how the farther we're gonna go
for right now within the first 10 days of surgery
as long as it doesn't create any unusual.
- And they've done studies on this
Brad, where you're really not putting hardly any stress
on the meniscus when you only do a, I think it's
I don't remember what the do is less
than 45 or something like that.
- Right, and that's why we're exactly, it's a good point.
That's why we call a half a squat, a full squat-
- Cause you're, you're not putting any stress on the
the surgical site or you know
where you were head breathing going on such.
- Exactly.
The next thing, here Bob why don't you take this chair.
- All right.
- [Brad] Is get the range of motion going.
So if you wanna stay up with the times
it's nice to get some, a device like this.
- It just, it just happened
that we invented this too, by the way.
- Right, yeah, yeah.
- It works really well.
You can put a towel down
on the floor and just scrub the floor works reasonably well
but on carpet, it doesn't.
So this device works well in anything, and.
- So I'm showing the flat version.
- Right, so as you start out, okay go ahead.
And you can see it works really nice.
And you just, and the nice thing about this
this is looks a lot easier
after a knee meniscal surgery, pulling it back.
Like this is not gonna be so easy the first few days.
- This looks easy because I haven't had surgery.
- Right. But we wanna get it to bend more.
If you can go this far and it feels fine.
You may have to slide the device in a little bit
but you wanna get your foot under the chair.
And you get some good bend or range of motion on there.
Again, it's as tolerated.
If you're getting sharp pain
you do not want to do it that far yet.
Wait till the next day.
And the next day it'll get farther a little bit every day.
If you're having problems with that.
The nice thing about this device
the knee glide is you can put it
on an angle and go downhill
and it actually makes it a little bit easier.
- [Bob] Right.
- [Brad] Yep.
And it changes the resistance.
- [Bob] A lot easier rolling a ball downhill. Isn't it?
- [Brad] Exactly.
On the other hand, when you start getting stronger
on the flat, you can do that for a couple minutes.
You're pulling it under farther.
You simply, exactly, what Bob did.
And I'm gonna do put it in the opposite direction
and you'll be amazed at what this little incline will do.
- [Bob] Now. You're working a lot harder.
- [Bob] Hamstrings, yeah. - [Brad] Hamstrings.
- [Brad] Hamstrings.
And that's a critical muscle to strengthen
after any knee surgery.
So work this and even of the healthy knee
you do this for a couple minutes
and you feel those hamstrings working.
- [Bob] Surprisingly you do.
- [Brad] It is. It is really amazing.
- [Bob] Yeah.
- [Brad] So there you go.
Knee glide sold by OP TP.
They're the only people that sell it.
- [Bob] Yeah. I'll put the link down below.
- [Brad] Good. Once you gain your full range of motion.
- [Bob] Nice handle by the way.
- [Brad] Absolutely. It's a beautiful device. Yeah.
- Pat ourselves on the back.
- We really did invent it.
It's patented.
Okay. Let's go to the next one.
Once you get full range of motion and, and Bob
let me just demonstrate, okay, right here.
This is the other nice thing about it.
I did want to mention this early on.
You can go like this.
- [Bob] Oh sure.
- And this is a one that a lot of therapists
and doctors will have you do in bed right away.
This is a lot better than dragging your heel across the bed.
- [Bob] Right, exactly.
- That's for, okay.
So, but once you get it up and you can pull your knee
as soon as Bob gets out of the way, it there like this
you can go up like this
and you can gently bring your knee full range of motion.
Is this. Assuming it was that way before surgery
but you're not gonna grab your knee and pull like this.
Right? Anytime, unless it's pain free
you can gently bring it up.
Gently, bring, bring it here.
And that would be full range of motion.
Like your opposite leg.
Assuming this is a healthy knee.
And again, make sure you can go fully straight.
So fully straight, full flexion.
We got full range of motion.
- [Bob] Were you gonna do hip abduction
and adduction on the bed right away?
- Sure. That's a good idea, Bob.
- [Bob] So now we can start some strengthening, some
of the other muscles, some of the other muscles that are
on the side and on the inside of the knee.
- Right. So, so you know, we're working
on the hip now because even though it's a knee injury
the hip abductors almost always get weakened
and it causes a limp.
- [Bob] And you have the IT band going across the knee.
So you're getting some strength in each.
- Yep. A good, good point.
So the hip duct connect to the IT band, which goes
to the opposite knee and there's a lateral support.
So when you do this, make sure your toe is here.
Not like this.
The body naturally wants to do this because it's easier.
And like anything, we go for the easiest route.
It's kinda like water.
As it flows down the down the hill
it takes the easiest route.
- [Bob] So stop doing it the wrong way.
- Yeah. Thank you.
Wow. See that therapy drives in nuts.
Doesn't it Bob?
And, then you want get the adductor.
You have to turn on this side, get this leg out of the way.
- [Bob] And then you're lifting up like that.
- [Brad] Yeah. This one is kind of an awkward motion.
- [Bob] A little awkward but it's a good one to do.
- [Brad] You can tell by my grunting, it's not easy.
All right.
And now this is a nice one to do.
Important,
particularly to get your legs stronger
for going up and down, steps is you can go up
you can have a stool like this, a six inch stool-
- Or you can go to a step.
- You can go right to a step.
And if there's a hand rail right there,
you can hold onto it for balance
and line up everything and go straight up and straight down.
- [Bob] So this is the knee that had operated on.
- [Brad] Right.
So this is my surgical knee and this is gonna happen
you know, more than 10, couple weeks after surgery
more than likely and up and down.
And I wanna see if Bob, you wanna to hold that there?
- [Bob] Sure.
- [Brad] Okay.
Do, do not let your knee go past this line.
Okay. So see-
- [Bob] Look, this line is lined
up with the front of his foot.
- [Brad] Yep.
- [Bob] So you don't want the knee
to go past the line.
- [Brad] Right.
- [Bob] When you're doing these.
- [Brad] Think about hanging a plum Bob down there.
- [Bob] Jim were like that.
And that's with all the squats,
- [Brad] And we go down to here
- [Bob] with the wall squats too.
- [Brad] Exactly, exactly. Sure
- [Bob] Keep that. So.
- [Brad] Okay. And you can do about 10 of those.
You probably won't be able to do 10 right away.
Especially if you use good posture.
Like I was doing.
- [Bob] You wanna do some ball?
- [Brad] Yeah, let's do.
Let's finish up with the ball on the wall.
Alright.
If you have a slippery wall, like a varnished door.
- [Bob] Yeah.
- You can go on that and just slide up and down the door.
- Same thing.
Try to not let the knee pass the foot.
- Yep. No good.
That's gonna really cause that knee problem.
Okay. See how that catches on the wall.
- [Bob] Yeah. It doesn't work well.
- Yeah, not desirable.
- [Bob] Ball on the wall works great.
- Yep. Take the ball.
Put it on the wall. (laughing)
So it is the ball wall squats.
Bring your feet out a little bit.
Make sure your feet grip to the floor.
So you don't slip out, fall on your bottom side.
Good posture down.
Not further than horizontal.
- [Bob] Right. And to start off with
you can do shallow ones on this too.
- Right. Why don't you throw me that cane Bob.
Cause it's a really nice way to start.
If you got a piece of furniture, a cane
like this makes a big difference.
So you have something to balance with.
If you're not used to it
and you can push up with it makes a big difference on this.
So if this is my sore knee, no pain.
Remember go down.
If it starts to get pain, that's far enough
and just do half fun or half squats as you get further
and further along, don't go this far down ever.
- [Bob] Right.
- That's no good plus-
- [Bob] Don't need to.
- Right. Right.
- [Bob] Why don't you show hamstring strengthening that tube
right now.
- Oh, good idea.
Seeing how we we're on a roll and we got the ball.
- [Bob] We got the ball.
I think you really should do these too.
- Yeah. Cause this is more advanced hamstring.
This is the next step up from the knee glide.
With the ball
you're laying on the floor, carpeted floor.
And you're gonna lift up your butt a little bit
and roll it in and you will feel the hamstring work.
- [Bob] You could start with the butt
down even can't you Brad? If you
just push your heels into the ball.
- Yeah. This is actually a good range of motion as well.
Look at that knee.
- [Bob] Right. Yeah.
- Yeah. The ball is a wonderful tool.
- [Bob] I just like pointing at things here by the way.
- Pardon me?
- [Bob] See the knee?
How it's bending.
I like pointing at things.
- Oh, isn't there a nice pointer, Bob?
Be careful with it though. I got tell you.
- [Bob] Then go to-
- I need my safety glasses.
- [Bob] You're gonna go to one.
- Oh yeah. Oh yeah.
This is it.
Once you get to these
and it's easy and you're feeling kind of cocky, then lift
up one leg and then try it out and see what you can do.
- [Bob] Or you can crossover to start off
with you don't wanna be quite as hard.
I do it this way.
- I thought I'd go right to the hard stuff, but yeah
it's a good point, Bob.
This is not as hard as this.
You could hear the grunting and that means it's hard.
- [Bob] All right.
Well with that grunting, I think we'll bring this to an end.
Thanks everybody for watching.
And please subscribe if you haven't already.
- There you go.