♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi, 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.
- Brad, what are we talking about today?
- Okay.
Today we're gonna talk about people that have had a stroke.
Okay? And we're talking about how they walk
after the stroke and specifically on the knee.
This is a common problem.
- Problem that happens to people.
- Knee hyper extension.
- Right.
- Okay.
And it's one of those things that we're gonna talk
about a fix that works very well
that is overlooked a lot of times, I think.
- Right.
- Okay.
- Should I show hyperextension?
- Yeah. Let's go. You can do pretty good.
- I think so.
- Yep. So this is the knee that was involved.
- Right.
- You know, you got some weakness here.
So what happens I step,
and it goes back like this.
- You do hyperextends very well, Bob.
Nice.
Nice imitation.
- One thing that it shows you is,
do you wanna go to the problems of this?
- Yeah. You bet.
Let's go to the problems it can cause.
- One thing is it can throw you
off and actually throw your balance off,
and you can fall because it catches.
- Right, exactly.
- 'Cause sometimes it doesn't do it every time either.
- Right.
- But with most people it does.
It goes like this.
- Yep.
- Like this, like this
The other thing it's gonna do
is it's gonna actually start to damage the knee over time.
- Right.
- It's really jamming that joint.
- Exactly.
- When you do that and it's stretching out
the structures behind.
- Yep.
- I've seen people who've had this where
the knee starts bending the wrong way.
- Yep.
- It really is kind of a little grotesque.
- Right. It looks like it hurts just having 'em walk.
- And also it takes a lot more energy to walk like this.
- Right. Right.
- It's just not efficient walking,
so it's gonna cause you more stress.
- Exactly. So what are we gonna do to fix this?
A lot of times people think
about putting a brace on right away.
- Right.
- Put a nice brace on with lateral supports and all this.
And I just had, early this spring,
had a gentleman, severe stroke.
He was hyperextending and we went,
"Hey, let's try an AFO."
A plastic ankle support.
- Yeah. So instead of trying to correct it at the knee,
we're correcting it at the ankle.
- Right, exactly.
And it worked beautiful for him.
He loved it, it felt better, he was walking better.
He was so happy that we got that instead
of having to wrap that knee support on.
- Again, they do have knee braces.
They also have what are called Swedish Knee Cages
that help hold it.
- Right.
- But they're very expensive,
and they're very bulky.
- Right.
They're not comfortable compared to this.
- No, they're not comfortable, right.
- So if you.
- And plus you can see 'em,
where this thing you can actually put this on
and for a lot of people you can't even see it.
- Right, it's in the shoe, underneath the pants.
So this is just a standard AFO
- Ankle foot orthosis.
- Right.
- It's an ankle brace, basically.
So you can see it here.
- The way I like to do is I get a standard one like this,
this is kind of off the shelf.
It'll fit a number of different sizes.
And if it works, then you get a custom one made,
which are quite a bit more expensive.
- Or sometimes you can just make
slight alterations to these ones off the shelf
and they work fine.
- Yep. That that's true too, Bob.
- In fact, some of the prosthetic guys will
sometimes just make adjustments to these.
- Sure.
- For 'em.
- Okay. So what happens is let's do,
again just showing you, you know,
once this is all in place,
and if you put the pant leg down,
it's very, you're not gonna be able
to notice it at all, basically.
- Right.
- That a person even has a brace on, so.
- Why don't you stand up, Bob?
Let's explain why it works, first of all.
- Okay.
- So this one is probably a little flimsy to work,
but it may help.
What happens is when the knee comes back to
do that hyperextension right there,
the brace right here,
go ahead and hyperextend, is holding it.
So it will cushion it.
- [Bob] Right.
- And it may not take care of all the movement,
but it's gonna cushion it so you don't get that snap.
- [Bob] Right. It's gonna slow it down.
- Exactly.
- [Bob] Yeah.
So it'll look like more of a normal pattern.
So instead of going, snapping back,
it'll just slowly come back like that.
- [Brad] Right.
- [Bob] You won't even see the difference.
- [Brad] Exactly.
- [Bob] See a problem.
So, it's a very simple solution, but it's very effective.
And also then if you have some weakness at the ankle
it's gonna also help support that.
- Right. 'Cause a lot of times they're dragging that toe,
so it's gonna help keep that toe up.
So it's a win-win situation for the knee and the ankle.
A lot of times people think of it just for the ankle, so.
- [Bob] The other thing I've done sometimes, Brad,
is I put maybe just a small cushion in the heel
to raise the heel up a little bit.
If the heel's up like this,
it's not gonna back knee as easy.
- Sure. Yeah.
- [Bob] So you can take just a piece of quarter inch foam.
- Right.
- Or sometimes people just take a piece
of carpet and cut a heel shape out of it
and put it in their heel, in their shoe.
And that gives them enough bend and that doesn't back knee.
- So that's in the shoe underneath the AFO.
- Underneath the brace, yep.
- Yep. That makes sense.
- So those are all little tricks to, to use.
- So, yeah, I think there's a number
of people out there who can benefit from this.
And if you're watching, go ahead and see
if you can find someone that has the AFO.
A lot of times a therapy department has old ones
laying around that were used,
but you can clean 'em up and do a trial.
- And do a trial of it, yep.
I mean the whole thing is you don't wanna keep backneeing.
I know that for some people,
they think that's a solution,
but it's gonna cause trouble over time.
- Right. Exactly.
- You're not gonna get away from it.
So. All right.
- All right. Very good. Good luck with that AFO.
- Thanks for watching.
- Oh Bob, why.