♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ on the internet ♪
- Hi folks, Brad Heineck, physical therapist.
- And I'm Paul Reiterman, physical therapist.
- Absolutely.
I'm exactly one half
of the Bob and Brad Physical Therapy Channel.
Bob is here.
He's actually back there,
but we've got someone very interesting here.
Paul is here to visit us
and give us some excellent information
about how to take care of knee pain at home,
just like the title refers to.
But before, we gotta giveaway a thing, Paul.
- Great.
- And Paul's not familiar with the giveaway.
- Nope.
- So this is,
what we're doing here
is we're giving away the Wall Anchor.
Here is a sample of a wall anchor
on a little model of the wall.
And behind you have to have a wooden two by four
and the screws you can see, go into there.
Look over here.
Once you get it mounted on the wall,
you get four of them in a set,
and that's what we're giving away.
You can use these for large loop bands.
You can use them for these bands
to do all kinds of exercises,
whatever you'd like to do.
So sign up.
How does that go, Bob, again?
Sign up and-
(Bob talking indistinctly)
Oh, that's right. We're not,
we're giving one internationally away
because we've been getting comments.
People from the UK and Australia, all over the world,
they're disappointed that we're...
and it takes a little bit of finagling.
So we're, we got you this time.
And also we're given a set to United States people, as well.
So enough of that,
let's get onto the subject matter at hand.
Before we go on, Paul and I
and Paul, you actually doctored physical therapy, right?
- Yes. That is correct.
- And you teach at university?
- I teach at the University of Wisconsin-La Crosse.
- Ah, I went there! - Hey!
- As a matter of fact,
Paul was my clinical instructor 25 years ago.
- Wow. (Brad laughing)
- You look exactly the same, Paul.
(Paul and Brad laughing)
- I wish I did, Brad. - Me too.
- I wish I did.
- And, and plus, what else are you doing now?
- So I also continue to practice physical therapy.
I have a small clinic down in La Crosse, Wisconsin,
and then also teach two physical therapists.
So I teach people who are studying
to become a physical therapist
and then also teach two current physical therapists
- Continuing education - Different classes.
- Continuing education courses on different topics.
- Right. As a matter of fact,
I took two courses, a neck and a back course from you
and they're both excellent.
- Of course they were.
(Brad laughing)
- That's what I like.
- You have to say that, don't you?
- Confidence. You need to be confident.
Okay. So we talked about this
and Paul was,
you seemed pretty excited,
and actually, you started telling me about this treatment.
This is perfect for our audience
because knee pain that comes for any age,
but if you like, a runner or you go out
and do some gardening and you haven't, you know,
from the spring time, when you're,
you get sore knees from doing activity
that you haven't done before or whatever,
you explain it.
- Right.
So there's a lot of causes of knee pain.
Obviously, the ones that involve trauma,
where there's actual injury to the ligaments,
to the meniscus,
to the structures around the knee
that require surgical intervention.
This is not for you, okay?
So this is, though, for people,
maybe who've had surgery,
have scars around their knee now that are somewhat tight,
cause some irritation when they do activity,
this is for you, the post-surgery.
Okay. But also for the individuals
who, let's say, want to start an exercise program,
and they're starting to develop some irritation
around the knee cap or in the front of the knee
that is limiting their ability to carry out
what they want to do and their exercises.
This is perfect for you,
as a source to try
or as a method to try
and alleviate some of that irritation around the knees,
so that you can work out a little bit better.
- I'm going to show my knee.
I'm not being inappropriate, Paul,
it's a family show.
So we're talking about maybe knee pain around the knee cap,
above- - Correct.
- And these quadriceps muscles - Correct.
- Could it be like if someone has an arthritic knee
and they get some joint pain that radiates up?
- Yes. So joint pain occurs a lot of times,
right where the two bones come together at the joint line,
but then there's people who have arthritis,
like you know, you and I,
who tend to be a little older.
You can also develop a lot of tightness of the muscle
in response to that arthritis.
So even though they may have a little bit of discomfort here
a lot of people complain more
about the discomfort above the kneecap.
And that's a lot of times,
the muscles reaction to the pain
that they're having in the knee joint.
So it's this chicken and egg,
they start developing here,
but then secondarily develop here.
This sometimes goes away,
but then they're left with a lot of the soreness
of the muscle around the knee joint itself.
- So what if the person was just having pain here?
Could you still do this technique up here
with hopes that the muscles are loosened up and it helps?
- Absolutely. - Okay.
- So the benefit of this technique is,
A, it does no harm to the structures around the joint
or in the joint itself,
whether it be the knee cap itself or the knee joint,
and B, it is certainly worth a try
for a lot of different patients
who have this kind of non-traumatic knee pain
to see if by addressing the tightness around the knee
helps to alleviate some of the pain that they have.
- So, the patients that you've worked with this,
you'll show them how to do this
and have them do it at home by themselves?
- Correct.
I'll always kinda try it in the clinic first,
see how they tolerate it - Yup.
- And then teach them how to do it on their own.
And the beauty of this technique
is that you can use a lot of things
that you can find in your home
to carry out the techniques that we're going to show.
- I think people are waiting to see the techniques.
So let's go on to that point.
- Alright. Can I just mention too,
you had mentioned earlier on,
we didn't talk about it as much,
but anyone who's a runner,
who's maybe trying to increase their distance,
anyone who's kind of a weekend warrior who,
whether it's from gardening or biking or whatever,
starts developing this kind of vague knee pain.
Again, those people who do increased activity,
that's who this is mostly for.
- Sure. Okay, good.
All right.
So I've got knee pain, Paul.
- All right. So let's give this a shot here.
So let me just go through a little bit of quick,
really general anatomy.
So you have the knee cap right here,
and then you have a joint where the two bones come together.
There's been a lot of interesting kind of studies
that have looked at the irritability of the tissue.
What tissues tend to become the most irritable
in the presence of knee pain
and how do we decrease that irritability
or that sensitivity?
So the most common area is right in through here.
We call it the retinaculum,
where there's fibers of tissue
that hold that kneecap in place.
And those fibers
become continuous with the muscle itself.
So if you can address the fibers around the kneecap,
but then also address the muscles above the kneecap,
give it some, like Brad said, flexibility,
but also help bring blood flow into the tissue.
And that helps decrease some of the sensitivity.
'Cause all of these structures are innervated by nerves,
and if we can decrease the sensitivity of those nerves,
that helps to alleviate some of the discomfort
and pain that they have.
- Sure. - Okay.
- Can I go, can I do it?
- Let's do it. - All right.
- Let me show you first.
Is that all right?
- Yeah, absolutely - Or do you wanna do it?
- Well, whatever you think.
- All right.
So this is a special tool that you can purchase.
We're going to show Brad though how to do it
with a simple butter knife.
- Oh, good, I got lots of them.
- Let's do this.
This one's probably better. - [Brad] Yup.
- Okay.
So you can use any sort of cream.
So this is just Palmer's Cocoa butter formula
that you can buy at any Walgreens or any drug store,
but you can also use any sort of lotion
that works and you just apply that liberally,
- [Brad] Just a little lubricant.
- [Paul] Yes, that's all it is.
It's not any magic potion at all.
It's just enough to kind of create a lubricant for the tool
as it goes across the tissue, okay?
So when you do this,
you always start at the knee and work your way up.
So for you, you're going to be pulling,
not pushing. - [Brad] Yup.
- So you pull and you start on the outer part,
work on the middle part
and then on the inner part, okay?
So for you, you're going to use two hands
and you're going to hold it like such.
So always start at the knee cap
and work your way up. - [Brad] Okay.
- The second thing you have to remember is,
think about, we're in Wisconsin or Minnesota.
You want to shovel, not rake. - Oh!
- So this is shoveling. - Yup.
- This is raking.
- So the angle.
- The angle needs to be in a way
where the instrument is angled away from you.
- [Brad] Sure, I get it.
- [Paul] So you're going to use two hands,
start there and work your way up.
- You want me to use,
go with a knife?
- [Paul] Yes. So let me just show,
So there's traditional butter knives.
So don't use the sharp side,
use the handle of the butter knife
and you're going to hold it like such
and then you're just going to go in those directions
around the knee itself.
- How hard do I push?
- So that's the great question.
It's whatever you feel like you can tolerate.
So what you're looking for though
is an increased tissue redness.
So if you're not getting the redness,
then you need to push a little bit harder.
- Yes. I'm pushing fairly hard.
- Okay. - And if I push too hard,
it's a little uncomfortable.
So I'm not going to go into that range.
- No. So let the symptoms be your guide
as to how much you push.
- Feels pretty good at first and then it feels okay.
And then I'm waiting for,
actually it looks like on this side,
the redness is coming a little faster
than over on the other side.
So we don't go up on the bone.
- Don't go up on the bone at all.
But you start kind of right where that bone is.
There you go.
Long strokes.
And you can work all the way up,
kind of halfway up there into the muscle itself.
- This is kind of fun.
- Yeah.
- Actually, it's starting to feel good now.
You know, can I try one of these tools?
- You bet. - I just want to see
and we want to hold it this way or...
- Hold it either way. - Either way.
- Yes, so this is,
so if you hold it this way,
you're going to have a smaller surface area.
If you hold it this way,
you're gonna have a much larger surface area.
So the smaller the surface area,
the more aggressive it is,
the larger the surface area...
- [Brad] So, you can do it whatever way feels the best.
- Exactly. There's no magic to how the tool is held
or any of that.
- So typically, once a person starts doing this
on this treatment, you may be here for 10 minutes,
a half hour?
- No more than about three to four minutes.
- Well, you know me,
if a little bit's good,
a whole lot's better, you know,
but that's probably...
- So let the response to the tissue be your guide.
- Okay.
- So notice how you're getting all that redness.
- Oh, wow.
- You're done. - That's it?
- You're done there.
Yep.
Not much redness here,
so you can work a little bit now there.
- Will this,
could this cause a permanent, like a bruise?
- So there's a possibility
that this always could cause a little bit of a bruise
for about 24 to 48 hours.
That bruising is not bad.
But what that does though, is, you know,
you want to not do this again,
until that bruise starts going away.
- So that is just some blood
that has broken, little baby vessels.
- Yes.
- So there's actually some physiological rationale for that,
but we won't get into it.
But some clinicians actually liked the bruise.
They'll actually go to the bruise,
but you don't have to do that yourself.
But a good redness means that there's good blood flow
into the area now and that helps to, again,
improve the flexibility and the sensitivity,
decrease the sensitivity of the nerves.
- This works a little bit than a butter knife
- It does.
- But the butter knife does okay,
I mean, I wouldn't hesitate to use that.
So I just wanted to mention,
I remember when I took a class from you in the neck
and you did show doing this to a shoulder blade,
and you mentioned once that someone did it to a patient
and it got the red and the bruise,
but she's like in a wedding. - Yes.
- And she had a low-cut dress
and it wasn't a good thing. - No, no.
- So be careful with things like that,
if you overdo it.
- Be careful if they're a knee model,
you don't want to do this and have a shoot for the next day.
- I'm done 'cause that's red and it feels good though.
- So notice how long that took.
Probably, we didn't time it, but you know,
three, four minutes or so.
But you were starting
to increase the pressure of the tool, I imagine,
as you felt more comfortable with it.
So what you're doing right now is a really good test.
So identify something
that caused some of your pain before you did it.
- Like maybe going up and down steps.
- Going up and down steps,
running on the treadmill.
So this is a great,
again, if running is an issue for you,
do it before your run
and then go onto the treadmill
and see if your pain decreases and changes
- Right after you get done. - Right after you get done.
- So you've got a benchmark.
- You got a benchmark of where you start
and then see how it responds after you do it.
- Oh, it's kind of fun.
Okay. Bob was asking back there,
can this just be used for tightness
and make muscle relax and elongate?
- Yes.
Yes. So it isn't intended as much for post exercise.
Actually, some of these nice devices here
are for post exercise.
This is actually intended for pre exercise
to enhance blood flow prior to the activity that you do.
But it also can work well for people, like I said,
who've maybe had a period of immobilization
where that knee is just tight and stiff.
They've had surgery,
or they just feel like for whatever reason,
that quad is really tight right now.
This will help improve the flexibility of that muscle.
- So I'm assuming, you do this
and see how it goes over the next 24 hours
before you would do another treatment.
- Yes, so usually, when you first start out,
you want to wait about 24 to 48 hours
before you do it again.
If there is any bruising,
then it's about 48 to 72 hours before you would do it again.
- And honestly, you did it and you had some good success.
I mean, once a day would be enough
until the symptoms are gone.
- Once a day or actually as the symptom starts subsiding,
then you start decreasing the frequency that you do it.
Probably once every three to four days
is all you would need to do it
to eventually where you would only do it
as you start feeling symptoms.
- Just kind of a maintenance as needed. Yup.
- So notice that you can feel
there's probably an increased tissue temperature.
- Yeah, absolutely.
- And that again, is a good sign.
- Yeah. So-
Do you want to mention your clinic, Paul?
- Sure.
It's a pretty small clinic.
So it's called Specialized Physical Therapy of La Crosse.
I work out of the Bell Square Clinic
in La Crosse, Wisconsin,
and I only see patients for about four to five hours a week.
That's really it,
because my primary job is at UW, La Crosse
in the physical therapy program.
But you can certainly look me up on Facebook
and on Facebook, you can see where,
how you can schedule appointments.
- Sure.
You may have people coming from all over the world.
- Oh, I hope so.
- Paul, he's a good therapist.
I think you treat people
to educate them how to treat themselves at home.
So when they go,
they have an idea of how to keep care of themselves.
- Yeah. My main intent,
if you were to see me as a patient
is really to educate you
on how you can manage these symptoms on your own
and become self-reliant.
And this is a great example of how that's done.
- So it looks like we could probably do this
in other parts of the body.
- Absolutely.
You can do this really anywhere
that you can access with your hands.
So elbow pain works really well with this.
And again, the general rule of thumb
is always move away from the bone.
So here's the bone.
You don't want to go towards it,
'cause that's just not fun to bring a little tool
or instrument over that.
So always away and always think of shovel, not raking.
- Not raking - Yeah.
- Winter time, not fall.
- So the other thing you have to be worried about
is if there's any open wounds or anything like that,
or if there are sutures or scars that haven't fully healed,
never do that over any sort of open wounds or scars.
But as long as skin is intact, you're safe, okay?
- Cool. - Yeah.
- All right. Well, thank you so much, Paul.
- You're welcome.
- This is really wonderful addition to our repertoire.
We're excited you could come.
So, very good. Take care and be careful.
Anything you want to say, Paul?
- No. - No. (Brad laughing)
- Good.