♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the Internet ♪
(clapping)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the Internet.
- In our opinion, of course, Bob.
- Our opinion, or opinion?
- Today, we're gonna talk
about knee pain, top three critical things you need
to do now, treatments and exercises.
And this is an updated video, we did this before
but now we're older and wiser so we're gonna,
maybe, add some things or at least we're
gonna make it clearer. - Right.
We got better mics,
and we're better looking now. (laughs)
- I would like to think that's true.
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- Yes, yes - So..
- For the impatient people. (chuckles)
- So we're keeping our hands warm
with our little device today, aren't we, Brad?
- Yes we are, that's a really nice warm, I just wanted
to put this, yeah - Get rid of that, okay.
Let's get started, Brad.
- Okay, so knee pain.
Now, this, we're referring to some
of the people who maybe have arthritis,
and you get that pain, that kind of comes and goes,
and you get that flare-up,
and you need to calm that down
but not just that, you may have knee pain
that you may not think is from arthritis,
or from an injury, and you could try some of these as well.
- Yep, they all will help
- Right - Possibly, will help
- So regardless of the cause of the knee pain,
the number one thing, we mention three critical things,
the first one is to unload, or take the weight off the knee.
- Typically, when you walk is when you put stress
through the knee, it increases the pain,
if that's the situation--
- Now we're trying to get it to calm down.
It's flared up, let's get it calmed down, a lot of times
that causes increased swelling, so,
a simple,
device would be a cane.
- Right - Or a walking stick.
- Exactly, so if it's the right knee that hurts,
you're gonna use the cane in the left hand.
- Okay, don't pay attention
to that show that used to be, Dr.House--
- Right, gives you more of a normal gait pattern here.
- Right, and I went through a whole course
on how this unloads the opposite leg, particularly
in the knee and the hip,
and it really, scientifically works,
and we know in the clinic people realize as well.
So you're gonna walk with that cane,
get it adjusted right--
- Yeah that cane's a little high for you.
- Yeah, it is.
This handle should come right at the wrist
when we stand tall with the arm down.
So use that cane, it's not you're gonna use it forever.
- You're just gonna use it until that knee settles down
and then you're gonna put it back in the closet.
- My wife had a huge flare-up of knee pain
and she's like, at first, we got her a walking stick,
she was like "I am not using that walking stick, I am not."
She ended up using it, 'cause it got so bad.
And then it calmed down,
so I mean, you know, it'll humble you.
- And if it's really bad, you know, crutches are a great way
to unload - Right, crutches are too.
- A lot more cumbersome but you'll use them
if you need them, you know? - Yeah, exactly.
- You can walk so you can get around.
So the other thing is, sometimes and I find is more so
in the senior population, is
off the shelf brace.
You don't have to get a custom one, you can just go
to the pharmacy or online and pick one up.
It's a sleeve brace, or sometimes the Velcro ones,
but they're not really-- - Or both.
- Right. - That's what this is.
- Exactly.
But again they may have
some supports on the side, they may not--
- They might have staves on the side.
And you know, we're not advocating one brace
over the other, just find one that fits well.
- And a lot of times it seems like it just gives a bit
of help to people.
- Right - You know?
- So, if it works better, the person feels better,
it may be a psychological thing.
But if you can walk, the pain is less, go ahead and do it.
I'm not saying go get yourself a brace
but if you have one around or you wanna try it.
They're not too expensive.
You know, it may be worth-- - It may be worth a try, yeah.
- And then, the other thing, if you've got steps
or uneven surfaces,
typically that's gonna increase the stress
on the knee, it's gonna hurt.
Just avoid those if you can.
- Heels too, I mean-- - Heels too.
- This is the time to go out
for walks uphill.
You know trails
that are really steep and rocky.
- So if you've got steps you have
to get up at the house, one step at a time.
- You know, up with the good leg, go down
with the sore leg first. - With the bad leg yeah.
And that takes a lot of stress off.
The next thing is, check your range of motion of your knee.
If you look at your knee
and you're sitting down
and you have a hard time getting your knee straight
and it kinda locks up or just doesn't go,
what we wanna do is try and regain full range of motion.
You can compare one leg to the other if this leg goes down
and this leg you can see, it doesn't go as far.
We wanna increase that range of motion
and one thing you can do is while you're
in a chair, take another stool like we have here.
Put your foot up there
and then we're just gonna gently, press.
Put some pressure on that knee, just straighten it
Now, if you get sharp pain
when you do this, you're not gonna do it.
It's not right, but if you can do gently pressure on
and pressure off, and you notice it feels better,
then I would say no more than ten repetitions,
by the time you get to three or four
and you're starting to feel better
and range is getting better,
then you're right on, you're gonna do 10 of those
and you're gonna do those through all today,
and if you get good success
with it every time it feels better
when you're done, the range is regained, you could do
that every one or two hours
and within a couple
of days you'll probably have regained the range back
and your pain more than likely is gonna go down with it.
- Yeah, the lack of extension, the lack
of straightening could be subtle, just slightly more
than the other side,
and yes it really is important, that you do it quite often.
Like you know, five times a day or whatever, so.
- And then check your range of motion
into flexion or in other words, bending the knee
This can be done laying down in bed
and you're gonna grab your knee and see if you can pull.
Bob is gonna give a little demonstration there.
- And I can compare it to this side
and maybe this one doesn't bend as much.
And that's not uncommon, to the one that's sore.
So you wanna regain that motion too.
- And so laying down, go ahead Bob, why don't you show them?
Right in bed you can, you can do this getting up
in the morning.
- You can get a towel If you need to or sheet
and pull down like this in, pressure on, pressure off,
pressure on, pressure off.
Yeah, 'cause some of you can't reach
that well, and this will give you a
little more leverage, like that, so.
Same thing you can do that throughout the day.
I'm gonna show a mobilization just right, do you mind?
- Yeah, sure go ahead, Bob.
- So this is a little more advanced now,
but it has worked for a lot of patients of mine
that were having quite a bit of pain
and lacked quite a bit of motion.
So you're gonna put the foot up on the chair,
this is the one I'm having trouble getting the motion.
I'm gonna grab the lower bone here.
Two bones there are actually down there, tib, fib.
And I'm gonna turn them, towards the other side,
towards the opposite leg.
So I'm turning them
like this, which should be, counterclockwise right?
- From your perspective.
- Yeah, from my perspective.
- So I'ma turn and then
as I'm turning I'm gonna bend the knee.
- Obviously you have to have pretty darn good balance.
You have to be a pretty mobile and fit person to do this.
- I'm turning the leg the entire time I'm bending it.
So I'm keeping the pressure on the entire time.
- And you're gonna do this,
if you do it without the rotation,
and it hurts, and then you do it
with the rotation and it
[Bob and Brad] Feels better,
then you know you're gonna do it,
if it feels worse, that is a red flag,
that exercise is not gonna be done.
- So if I'm gonna do the left leg,
now I'm gonna turn it toward this leg,
this will be clockwise, from my perspective.
I'm turning it, I'm kinda grabbing
on the ridge of the bone here
with my fingers. - Yeah right there.
- Turning, and I'm bending forward again here.
- Again, really this has worked wonders
with some of my patients.
- Again only do it if it makes it feel better
and you get more range of motion.
- You know, you may not be doing it right
or you just might not be the, your joint might be--
- It may not be conducive for your problem, I mean,
but it is not a no pain, no gain, if there's pain, you stop.
We're never ones for increasing the pain.
- (chuckles) Right.
- So--
- Okay and then the other one--
- Number three.
So this is the third critical thing you need to do.
- Well, I'm going back to number two
- Oh, sorry. - This is a real simple one
Just, what a leg, huh?
(laughs)
[Bob] My god.
- Yeah look at those socks, they're my work socks actually.
- But anyways, look at your knee cap.
Get your quadriceps to relax and then you can see
if your kneecap has its mobility right to left,
and sometimes it's gonna be a little tight
so you're gonna work it back and forth
and get it to move better,
or you can kinda grab it like this
and work up and down with it.
And it should be free in both directions
within a few centimeters.
[Bob] If it is free you don't need to do this one.
This is great for people who have patellofemoral syndrome,
specially if they're tight,
what we call globally, it works great for that.
- So you're gonna loosen up, again one of those things,
as you move it around it should feel better
and loosen up with less pain,
otherwise, you're not gonna do it.
- All right,
so that was under number two, regain full range of motion.
Now we're moving on to the last one,
which is you wanna strengthen the knee.
The stronger the muscles are
around the knee joint, the more they can protect the knee.
- Now this is one you really need to be careful with
because if you're gonna do some squats,
it's gonna strengthen your knee
but you need to do them gently,
'cause if you do deep squats,
it's gonna increase the problem.
So what we like to do is use the ball,
and two reasons why you do that,
you control your motion, plus it takes
some of the weight off of the knee.
You wanna demonstrate, Bob? - I can, sure.
- I wanna get that ball with the Booyah Stik.
(light thud)
- There you go.
- Wow, what a throw!
- It's kind of fun.
- So, the big thing with this, you know,
is that, you don't wanna have your feet way back like this
and the knees go way past the front of the foot,
if you're dropping a plumb line.
Brad, why don't you go ahead and show that?
- Yeah, there we go.
- So I don't wanna go like that,
that's what's nice about the ball.
You wanna make sure you got shoes
that grip well enough so
that you don't go sliding like this.
But I can go down now, and I can keep the knee
behind the front of the foot real easily now.
- And you're only go down,
if the knee starts to hurt, don't go
that far, maybe shallow squats.
- Yeah, and that's my suggestion
to most of you is probably start with shallow squats,
because you're not putting as much,
you're not getting down
to the point where you're really putting
that much stress on the joint.
You're just strengthening your muscles
without really hurting the knee.
- And some of your body weight is being,
you know, taken up by the ball,
so it just inherently takes less stress
on the knee for that effect alone.
- You didn't show them the long arc quads.
- Oh no we're not done yet!
- Oh okay.
- Yeah the long arc quads. - Long arc quads, yeah.
- Long arc quads now,
and this is just simply, I just tell my patients
to do these kicks, you know,
'cause long arc quads doesn't make a lot
of sense unless you're a therapist.
Out like this, and down
and sitting on a chair you wanna make sure your foot goes
at about a 90 and you kick it out straight,
but don't put ankle weights on.
And I say 10 to 15 of these kicks or long arc quads
and it's good for people who have arthritis,
and you've been sitting for a while
and then you're gonna get up and walk--
[Bob] Get it warmed up
- Yup, do about 10 kicks with each leg
and that's gonna decrease that pain when you get up
and walk anywhere. - The only thing Brad,
even when you bring it up once, you know bring it up
like this, give it a little squeeze, you know,
I mean, the muscle should tighten.
- Oh right, right, so you gotta make sure those quads--
- Yeah they're kicking in - Yeah exactly.
Got a little feedback there by feeling it.
And the last but not least,
now this is a good quad strengthening exercise
that's not aggressive on the knee joint.
Simply lay down
with one leg up like this, straighten the knee out
and we call them straight leg razors.
[Bob] Nice to do right before you even get out of bed.
Get some strength even in the morning.
- And this one also works that quad,
works the hip flexor, little abdominal,
and it's a good general exercise.
But 10 of them is all you really need
and then do the other one
and use good control motion, don't flutter it
around like you're swimming or something of that nature.
(exhales) Bob, I'm feeling better already!
- All right, well good because you know, it's hard
to get around when your knees are bothering you.
- I mean, they really will cripple you up by...
Oh, can I still say cripple?
- I don't know you're getting
into a gray zone there, Bob. (laughs)
- As a verb, I'm not using it as a noun.
- Oh really?
Oh, good.
The English majors will get after us
if we get something like that wrong.
- All right, all right, thanks everybody for watching.
(quirky music)