♪ 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, Bob.
- You try saying that fast.
- Today we're going to talk about strengthening exercises
to help stop kneecap pain.
We're talking about patellofemoral pain
That's the patella, it's the kneecap
and the femoral bone is the big bone underneath it.
- Right.
- So if you haven't already done
so you might want to watch "what is causing your
knee pain, patellofemoral pain syndrome or kneecap pain?
How to tell?" it's part of our program series.
- Right.
- You go to bobandbrad.com go to the programs
and under that, you'll find ones on knee pain,
- Right.
- and you find the one,
"what is causing you knee pain,
patellofemoral pain syndrome."
And that way you can see what we're talking about here.
- There'll be a whole list of videos, all in that file.
So you can go through
and pick out the one that works for you.
It's a beautiful thing.
You can go, there's a PDF printout
for each video, gives a preview and a list
of the exercises that we'll show
in the video. Works out very well.
We do it absolutely free.
We don't even ask for your email.
- Alright
- Shall we carry on?
- Let's carry on.
So I'm not going to really explain what this is
I'm going to assume, you know what it is.
- Right.
- But we start right on the exercise.
Number one.
Now this is a six week program
and it's designed to help stop kneecap pain.
It was created by a specialized group.
- Yep.
- I don't remember who it is
but it was a specialized group.
But anyway, weeks one and two
these are the exercises you're going to do.
I'm going to check, check, go over those.
First one,
You're going to lie on your back
and you're going to do straight leg raises.
- Right. So this is the painful knee.
This knee is straight.
You lock it out and bring it up.
Just like Bob is doing, the 45 degrees--
- Yeah, don't go too high because it's a little easier
and you just hold it right in the middle there
a good five second hold.
And we do three sets of 10.
- Now, I think what we, you could bring this knee up.
Couldn't you? If it feels better on your back--
- Right, right, It'll stabilize your pelvis.
- Right. And then you can go up to about the same level.
- Right, right.
- That is a good rule of thumb.
- Yep. Good point, Brad.
- So how many of those, 10?
- I knew I kept you around for--
- Well, you know, Bob,
my wife says I'm good for something well
- Three sets of 10.
We're going to do those.
- Okay.
- Now, all of these, you know,
if you do four sets, that not,
we're not going to send the police
out to get you but
okay, next one!
Next one is the easy one you can do
in your chair, actually is isometric quadriceps
with the knee pad, actually knee bent to 90 degrees.
- So that's like,
- Yeah.
- right there.
- So all you do is, I'm going to strengthen the left leg,
left knee, so I'm going to cross my right ankle
over the left and I'm going to hold it.
- So you're going to kick out with the left.
- Yeah, if it wasn't there, this would be shaking out.
- Sure, yep.
- 1, 2, 3, 4, 5, 6, 7, 8, 9, 10.
- You're actually strengthening your hamstring that way.
- Yeah, that's right.
You're getting a double bonus here.
So we're doing two sets of 10.
Okay, oh, I'm sorry.
A three second hold.
You don't have to hold it for five seconds
- Okay.
- if you don't want it.
- So count faster.
- Usually, usually when you count to five
it's going to only be three seconds.
- Right, yeah.
- So, all right.
Mini squats to 40 degrees.
Brad, do you want to show that, maybe?
- Yeah. So we're just gonna, so this would be 90 degrees.
That's, you want to go half of that distance.
So you know, this whole progression
and it starts out easy
and every two weeks it gets a little more difficult.
The exercises do, so--
- Yeah. Well, we find when you do mini squats
like this or shallow, not shallow squats,
yeah, shallow squats.
You're not putting as much stress on the kneecap
- Right, right.
or the knee itself.
You can actually get by with--
- Avoid this.
- Right.
This is a common mistake.
You want shoulders back up with the trunk
stay vertical of good posture.
And you know, if you start going down and it gets painful
on that painful knee, don't go that far, only go
up to the pain or just before it starts and then go back up.
- Now, this is one of the programs where you really
probably are going to want to print this out
because it'll tell you all the sets
- Right, right.
- and it'll tell you the description
of what you're supposed to be doing on.
Probably have a picture on some of these.
So you'll be able to see what, what
what the exercise is.
- Right.
- Next one is hip abduction.
So, you know, when you strengthen the hip
you're, it affects the knee.
And so we're doing,
I'm going to strengthen the right side here.
And all we're going to do is work on is gone
out to the side here, again,
a good ten second hold works out really quite well.
I'm going a little faster than 10 seconds.
- Yep. And he's got his toe pointed straight out.
- Yep.
Not up like that. - Not like this,
- that's not good. I don't like that.
- We're trying to work with the hip abductors.
- Right.
- All right. From leaning,
go right into clamshell.
Now you can do these with resistance, put a band around
but you're probably going to start them
without resistance to start off with.
So you, just like a clam, talking to you here.
- So the, the right hips doing all the work here
the feet stay together
and you go slow like this with good motion control.
And you're going to find
that this is much more difficult than it looks.
- Yeah. I definitely wouldn't start
with the resistance band.
You can get very sore from these.
These are small muscles that are externally rotating the hip
and you got long lever arms.
So--
- Yeah.
- Yeah. You line up the ankles completely,
line up the legs completely.
And, and you could do both sides, obviously.
All right.
Last one.
You can do--
- A fire hydrant!
- Two sets of 15.
Yeah, fire hydrant!
So this is just like a dog going on a fire hydrant.
- So hands and knees, we call it quadruped.
- And what you're doing, you're lifting up the leg
like you're going to go on to the--
- Yeah, but I wouldn't go.
- Yeah. Don't go--
- Yes, Bob's holding it.
You hold it for just a second
or two and then come down with good control.
- I don't have the greatest external rotation.
Do I, Brad?
- Well, you're a little
tight there, Bob, but that's all right.
So we're working a lot of hip muscles and all this is,
you wondering why we work in the hip
with the knee is because the IT band right where
this white line is connects to that knee.
And we need to stabilize the hip properly to take stress
off the knee as well.
- Now on those
we're going to be doing two sets of 15, 10 second hold.
- Okay.
- Again, print this off so you can know what to do
- Right, it's all very clear.
Actually, we're reading it off the smart screen right now.
- Yep.
- Okay, so the next thing, phase two
on weeks three and four,
- Weeks three and four--
we're going to do wall sides.
So this is like we were doing 45 degrees
on the first two weeks.
Now we're going to progress it.
Lean up against this, a smooth wall
or a slippery door actually works better.
Your feet, shoulder width wide out
about a foot from the wall or the door.
Good posture, shoulders back.
And you're going to go down until about 60 degrees.
So you're going to have to use your judgment
on this.
Should not create any knee pain.
If it does, don't go that far down.
Go up to that point and then go back up.
So there is about 45, a little bit farther.
That would be too far.
- You can use a towel behind your back sometimes too
- Yeah.
- if it's a slippery surface. Or--
- Yeah. If you happen to have a ball, it doesn't have to
be this big of a ball.
Actually smaller ones work okay.
But you do the same thing.
And this actually works really well.
- Really well, yeah.
- Yeah. Good posture.
You can put your hands on your thighs for a little support.
If you'd like, if you feel wobbly on the ball, you know
you grab a cane or a stick of some sort or a chair where
you can hold and that helps stabilize.
You do three sets of 10 of those.
- What's the name of that ball?
- What?
- What's the name of that ball?
- Oh, this is a wonderful ball.
Let me take a look, oh, look at that.
- Look at that.
- It says Bob and Brad.
These are rated at 600 pounds.
- Oh wow.
- Oh weight before they would burst.
So they're really a good quality ball.
Anyways, Shelly,
get onto that number two - Yeah get onto it
- To step up and down an eight inch step of--
- Yep , so we've got a step here.
If it's not exactly eight inches, it's not a big deal.
Now with this particular exercise,
let me go this way once, Bob.
- Sure.
- You put your foot up on the step
and make sure when you, I'm going to use a Booyah stick.
If you're out of steps, you can use your hand rail.
- That's the best thing--
- Something to stabilize yourself.
But watch my knee.
It's going to stay right over my toes.
Don't, the tendency is, is that it goes in for most people.
It'll kind of, and I'm exaggerating a little bit.
Not necessarily for some people. Keep it in line.
You're going to go up and down slow.
So keep that in line, go from the profile.
- Yeah, if you see it from the side, you need to hold,
so if I run a plumb line here, he's trying to keep that knee
behind the toes.
- We're not going like this.
- Right.
- So, up
- Yep.
- and down, and nice and slow.
We're not bouncing like this.
Good, slow control.
And you're going to take a rest between each set on five
on those three sets of five.
If you can't make five, take a break or you only do
two sets to start out with and build yourself up.
- And how about a lunge, Brad?
- Ah! The lunge.
- I don't do lunches anymore.
I haven't done them for awhile.
- You don't want to do them?
Well, I was just having pain.
- Oh yeah.
Okay. You want to move?
Because I'm going to use this for lunges.
You can use a cane or a stick or just go up to a piece
of furniture.
Like I'm going to do here.
You're going to step out. Balance yourself.
You know, you may want to have something on both sides
and then don't let your knee go past the toe
of the vertical line there.
Once it gets to the toe, you can look
down with your eyes--
- [Bob] You can see on the stripes of the pants--
- Yeah.
- [Bob] That shows really well.
- Exactly. We're only going to 45, so it's a shallow lunge
- [Bob] Yeah.
- and we're just going to go up and down 10 times.
And you know, I would go ahead.
Even if your other knee is not painful and do that
it doesn't take much longer.
- [Bob] Right, want to stay balanced out even--
- Three sets of 10.
And then you can just keep going back
because the other leg is resting
while the other leg is working
in front and give yourself a break.
And the last one, this is a fourth.
One is the pelvic drop.
This is an interesting one.
- Yes, it is.
- Your, you can go back on the steps.
If you hopefully have some steps or a stool like this
you're going to want to hold something
on this one for balance: handrail, a stick of furniture
- [Brad] You know, a chair that you can
move and hold onto the back rest.
Now this knee stays locked.
Okay. This would be the sore knee.
And that, see, it's locked.
Now, watch what happens with my hip right here.
I'm going to drop it down and bring it up.
- [Bob] So what was the subtle movement?
- [Brad] It, really you'll feel it
after you do 10 of these with good control like this
it's working your hip abductor, the glute medius
which is real important stabilizer with your hips
which is going to help control that knee
and forces that knee as well.
Two sets of 15 of these ten second hold.
So we're going to go up and hold.
That's a long hold, Bob.
- That's a long hold.
- I don't know.
- You don't know if you're willing to do that.
- You know, if you don't feel like going 10 seconds
hold for five and then build yourself up.
- Sure.
- Yeah but it's only two sets, so that's good.
But that's going to be a really good stabilizer
for that pelvis.
So we've got this piece choice is made for this.
If you don't, you have the buy one, you could use a,
I've already used something like a piece
of the cushion or pillow or the couch.
- [Bob] I was going to say you could use a pillow.
- [Brad] Or a pillow, yeah.
Something that's soft and squishy.
It forces you to balance.
This is called, you're balancing your proprioception
which is really important.
So let's go back to my involved knee.
Okay. We're going to go for 30 seconds
with your eyes open and you know, have a stick,
a cane holding out to a cupboard or something.
So you've got your balance.
And the idea is you're going to eventually
be able to do it without that.
- This is week five and six, by the way
this is starting a week five to six.
You're not doing the other exercises anymore.
This is an advanced one you can do
with your thighs close too if you're
but be careful when they fall on, somebody fell on us.
So make sure you're holding onto a countertop
or a Booyah stick or something.
- So a countertop would be here, one hand, here
one hand over here on something.
And then when you feel confident, you know
then you can take your hand off just above the countertop
lift that cane or the stick up, you know
when you can go 30 seconds, I would put it on your,
on your cell phone and put the timer.
So that at 30 seconds
it beeps so you don't have to look at a clock.
I like doing it that way.
It works well with my patients, as well as myself.
- All right, then you're going to simply do some walking
and progressively increase that, the amount of
you know, the speed and probably the distance
- Walk on a flat surface, not up and down hills or on a road
if it has a Canberra for the drainage
or the water that is going to make a difference
on your knees.
So try to, a nice flat sidewalk
or something that is relatively flat
and not hiking in the woods either.
- Right.
Then you had to also progress to running
if you're going to be a runner - Sure!
you could, same thing, distance, you know
progressive - Sure.
- and probably speed.
- Yep.
- And you know, by that point
if you've followed all along
that kneecap should be doing better.
Hopefully it's staining in its to groove.
- Right. Exactly right.
It's behaving, is feeling good and life becomes good again.
Back to the activity, as you wish, what do you say, Bob?
- I can't get your kneecap to behave.
I can only get my partner to behave so well.
- Well Bob, that's an issue my mother worked with
for many years and she pretty much--
- She failed.
- Yeah, no, she didn't feel, she said--
- She gave up.
Well, she had to, it's not that she's a quitter.
She just, she had no choice.
- Well, so, I do.
- All right, thanks for watching.
(gentle music)