♪ 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 therapists on the internet.
- In our opinion, of course, Bob.
- Brad, today we're gonna talk about knee pain
and we're gonna show you the top three critical things
you should do right now.
All right, these are the things
that when I get a knee patient,
these are the things I go over with them the first day.
- Sure.
- These are the things you want to do
to try to help calm things down
and get things so that the knee pain goes away.
- Right, and the healing starts.
- By the way if you are watching this on YouTube,
the reprodcast, please take a second to subscribe to us.
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- Take those things bouncing across the street.
- Yeah. If you aren't over there already make sure you do.
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- All right.
The first thing, Brad, when you're having knee pain,
the first thing you need to do is get things calmed down.
And this, the nature of knee pain itself
if it's arthritis or, and really anything.
If it's a meniscus or even patellofemoral syndrome
it tends to flare up and it tends to calm down.
- Sure.
- So you need to see what you're dealing with.
So you need to get it to calm down.
One way to get it to calm down,
if you're a younger person
is maybe use crutches or a crutch.
If you're an older person, you might wanna use a cane.
- Sure.
- And I know, you know, I can't tell you how many people
they'll come in and they're in their fifties or sixties
and I'll say, you know if you used a cane for a while,
it'll make a big difference.
And they look at me like I just told them, you know,
I'm from Mars because they're not gonna use a cane.
But it really makes a big difference.
If you feel better using a walking stick,
you know or carved stick, you know, something that
maybe makes you look like an English gentleman,
you could do that.
(both laughing)
So, but it makes a big difference.
I've had people that, Brad, literally got better.
Their arthritis felt better just from using the cane.
- Because it takes weight off the joint.
Therefore not in, you know irritating the tissues.
And it gives a chance to calm down.
- Right.
- Just quit irritating it.
- And the thing about arthritis
you need to understand about arthritis.
People think I have arthritis.
It's just gonna keep getting worse and worse.
No, they've done studies on it Brad.
After like, a couple years, they've seen some people
that actually their arthritis got a little bit better.
- Sure.
- And some stayed the same.
Most got worse.
Maybe like 60%, but don't automatically assume
that it's gonna just keep getting worse and worse.
- Right.
It's not always a dead end road.
- No, it's not.
Do you wanna show how to use a cane, Brad?
- Sure, Bob.
- Quickly.
- Yeah.
- This is the Hugo
and this is the Hurricane.
Remember the one thing we didn't like
about the Hurricane, Brad.
- Yeah.
- I dunno if you could see this Lonnie,
but if you step on it,
it actually could come loose when you're walking.
- Yeah.
So yeah, you know, it's a good cane
but you know that's a possibility,
first of all make sure it's adjusted right.
If you stand with your arms down,
the handle should come right across your hand.
So that's too tall for me.
- It should hit you right on the wrist.
- Yep.
Right there would be good.
I'm gonna use it at this height
even though it's a little tall
just to save some time.
So here I got my right leg, I got the brace on.
There's a sore one.
I'm gonna use it in my left hand,
the opposite of the leg, always.
And the cane goes with the sore leg.
And typically what I do with people,
I just give them the cane and I tell them
to use it in the hand they should and automatically
- I tell them to walk, yep.
- the sequencing just falls into place.
If I verbal kill them and say,
make sure the cane goes with this foot.
Then they think about it.
And then it gets confusing.
- Yeah.
- So just walk with it normally
and chances are automatically,
your body will do what it's supposed to do.
- You could do it like Dr. House too,
if this is my sore knee,
you can do the limp along thing like this, if you want.
- Yeah, good old Dr. House.
- And Brad, by the way, does have a brace on,
yeah, braces are fine.
You could try a brace cause I don't think
it makes a huge difference in a lot of people
but it does make a difference.
- Right.
- I, generally it does,
you know, do a little bit of things for calming it down.
- If you put it on and it feels better when you walk
and it just makes you feel more relaxed, I would wear it.
Try not to depend on it for long term,
it's just for that initial phase of being sore.
And as you get stronger, you'd hear, you'd take it off.
- By the way,
if you have some questions on Facebook,
we'll try to answer those at the end of the program here.
- Sure.
- We're gonna go through the program first
and then we'll we'll address those issues.
All right.
The next thing Brad,
so you've tried to calm things down, now,
so the next thing we're gonna do is,
we're actually gonna do
a couple different treatments you might try.
One is range of motion/ stretching.
You're gonna try to get a little more motion in it.
And the second thing is you might try some massage,
- Right.
- depending on what you have.
- You mean to get it? Yeah.
- To get, well this is actually treatment now.
So a lot of times what we find out in,
with you have an arthritic knee,
or maybe even a knee with a patella,
I mean a meniscus problem.
Sometimes you're lacking motion,
and when you lack motion, what happened to my stool?
- No, here it is, Bob. Fear not.
- So if your knee doesn't straighten out all the way,
let's say you put up, you know,
both legs like this and one knee is up like this,
and the other knee is straight.
That lack of motion there can increase your pain.
You're not spreading the forces out completely
when you're using the knee
and that's gonna make things worse.
So you wanna, you're gonna wanna regain that motion.
Same with bending Brad.
If you can bend one way up here
and the other one only goes this far,
you want to regain that motion.
- As long as you can do it within reasons.
- As long as you can do it without increased pain.
- Right.
And Bob is gonna show you a couple of tricks for that.
- Yeah. Let's first start off with the one,
let's say it doesn't straighten out it all the way.
Again, we gonna go ahead and put it up on a stool.
- Why don't you pull your pant leg up?
- Oh yeah.
- It's a lot easier to see it on the camera.
- Yep. Good point.
So I'm gonna do what we call pressure on pressure off.
I'm gonna push down, you know,
you can push on both sides of the knee like this
and push down pressure on pressure off,
pressure on pressure off.
We actually have you say the words,
because when you say the words
that tells you how long you should do it.
- I'm not doing this to compare legs,
but I just wanted to show you the profiles
cause from that angle you may not see it as well, but
- You got more of a tan than I do.
- Well Bob, I've been out tanning and you know how it is,
you know, eating bond bonds and stuff like that.
I got some paint down there.
- So the other thing you can do
- So he's doing this
- By the way, you can do straight,
you can do with the toe straight up
and then for a little variation,
you can also try turning the foot out a little bit
and then pressure on pressure off.
And you can also turn the foot in this way,
pressure on pressure off.
- Just remember pressure on,
if it puts you in the sharp pain,
don't get the idea no pain no gain
and try and push through it.
- That's where you may actually try the variations of it.
Let's say it hurts straight on, Brad.
Then maybe try it a little bit straight out this way,
with it turned out and then try it the other way
and see which one is the least thorn of pain.
- Right.
- But if you can regain even a little bit of motion,
quite often that decreases the pain in the knee.
I've seen it many many times, Brad.
- Okay.
- All right. Flexion is the same thing.
You gonna actually work on bending the knee.
So, we're gonna go ahead
and we're gonna work on getting more bend in the knee.
And this is a Mulligan technique we're gonna try here.
Actually Brad, do you mind if I use that stool?
- I do not mind.
- So this works out well for me for this height.
So what you're gonna do is you're gonna work on
you're actually gonna
you're gonna grab the lower tibia here
the bones right here, and I'm gonna turn them.
I'm gonna turn them this way.
If you, you wanna show
Brad, it's actually counterclockwise.
- Sure.
- So you're turning it that way and you're,
no, on yours it would be the other one.
- Oh, I was ready, got the other leg up.
- You got the wrong, other leg up.
- That happens with therapists.
- Yeah. We're turning it in towards the other leg
- Right.
This direction, I'm sorry.
- So I'm going this way, counterclockwise.
And I'm going in
and I'm bending my knee at the same time while doing this.
And this is, this will work sometimes
if you have a little bit of junk in your knee,
let's say the there's little
- Junk?
(Bob laughs)
- Well, you know, they call a mice sometimes.
When the meniscus have broken off a little bit.
- Right. Float, floaters.
- Floaters.
- Yep.
- It sometimes can help push it back into
the spot it should be and even reabsorb.
- Sure.
- Now again, the whole thing with this, you're gonna turn
and you're gonna hold it the whole time you're bending
and the whole time you come back again.
- Okay, so that constant rotation.
- Constant rotation while you're doing this
and critical, it can't be painful, it has to be pain free.
- Okay.
- Absolutely no pain.
So you can do a good set of six to 10 of these
and you can do them twice a day.
- Sure.
- And you can see if that, you know,
starts increasing your knee motion
and starts decreasing your knee pain.
- Right.
- Again,
works with a good percentage of people that we have rather.
- Sure.
- It works out really quite well.
So, when would you try massage?
I'll take this back now.
- All right.
- If you go to your knee
and you find that there's tenderness right below the knee
on the tendon right here,
you're gonna try some cross fiber massage on that.
You're gonna just rub right across the tendon here.
- And that's that little hollow spot
but you can feel the tendon there, it's a little
- Yeah. It's going from the kneecap,
the tendon attaches to the tuberosity here.
Now, the other spot that often is,
this is the one that I had,
is a little quadriceps tendonitis.
So I was tender above the knee, right here.
And that often responds really well to massage too.
- And look at the direction he's going,
the fibers of the muscle go this way
and it's a cross fiber so you go 90 degrees.
- Quite often with this,
it takes so much work that you get fatigued in doing it.
So like, we have the Purewave Massager,
this works really good for this.
This is what I used on it.
And I just worked it back and forth like this.
And with this setting, that softer setting,
I could go right into the kneecap and didn't even hurt.
- Yeah.
So the head of that massager got a little cushion to it,
so when you hit the bone it's,
it doesn't irritate and get pain from it.
- And it's got a pointier one too that you can actually do.
You can work on the tendon underneath.
So,
we have that one.
We have a cheaper one here, a less expensive one.
The Nursal Massager.
If I remember I'll try to put some links down below Brad.
- Sure.
- But again, this one works back and forth.
You can work it on the quadriceps.
Boy, that really works it well.
- Yeah. That one has a little bit different mechanics
to the massage.
So it may be, have its own benefits.
- All right.
If you know, if there's no tender spots outside the,
it's all inside the knee, the massage is not gonna help.
- Yeah. If it's in the joint.
- Yeah.
The other one I missed on range of motion Brad,
is if you're having a patellofemoral syndrome,
which it's really under the kneecap itself.
You do wanna stretch that kneecap.
Cause a lot of times it's tight.
- Sure.
- Especially it's tight on the outside here.
So a lot of times you do,
I know this is really creepy to a lot of people.
They don't like pushing their kneecap
but if you get onto the edge of the kneecap
and I'm gonna push it this way and stretch it.
- Yep. Then now,
the thing critical about this is the kneecap will not move
unless your quadriceps are completely relaxed.
- [Bob] Right. You can't be tightening up your knee
while you're doing this.
You won't
- [Brad] And a lot of people kind of have a lot of anxiety
about this and they, they're not even aware that their
their quads are tight.
So I'll have to tell them just relax, relax.
And all of a sudden, relaxed, the kneecap starts to move.
- [Bob] Yeah. Quite a difficult one to do.
They can stretch it that way.
You can actually stretch it down toward the toes, Brad.
- [ Brad] Sure.
- [Bob] And you can actually stretch it up to
the head too here.
- [Brad] Yeah. Four different directions.
- [Bob] Yeah. Yep.
And that's just especially, you know,
if you have what we call kind of globally tight kneecap,
you get all the directions.
One thing I missed Brad, by the way,
when we talk about how to calm things down
we could have used the ice pack. Couldn't we?
- I've noticed, I sat right on a kind of cold.
It's like, yeah.
When you're exercising it or later in the phase of it,
if it starts to swell up a little bit,
maybe you overdid it, you went for a walk,
you went too far.
Get the cold pack out and a nice gel cold pack
and wrap it right around.
Well that feels even good on a healthy knee, Bob.
- Yeah. And sometimes we, if you you're worried about,
cause sometimes there's not a lot of, you know,
fat or protection underneath the kneecap itself.
Sometimes we do fold up a paper towel and put it right
on the kneecap and then put the, that over the top of it
so it's a little less sensitive.
That's up to individuals
if they get too red around the kneecap.
- Yeah. When the bone, that patella gets too cold
it can be a little uncomfortable.
- So step one is we calmed it down.
Step two is we treat it with range of motion or massage.
And now step three is you wanna start some strengthening.
- Right.
- So the, you know, kind of the universal ones Brad,
is that we start, is usually isometric
where we start with a straight leg raise.
- Sure.
- So if I'm on the mat here like this
and I'm just gonna go ahead,
I'm strengthening this one right here.
I'm gonna go ahead and just lift it up like this.
And you can do hundreds of these if you want,
to be honest with you Brad.
- [Brad] Well, that might be exaggerating but
(Brad laughs)
- I, when I have young patients, athletes,
I tell them they can do hundreds of these.
- Really? Okay.
- Literally. Cause you know, it's not that much work.
- Yeah.
- And it's when they're laying around watching TV,
they can go ahead and do this.
- Sure.
And he's got the knees straight,
the quadriceps are really working. And
- So then you can, I'm gonna go onto this side,
strengthen this one.
You can go ahead off to the side like this too.
I know we're getting hip here too, Brad,
but we're getting across the IT band.
You can go onto the stomach and you can get up this way.
And we're starting to strengthen this way here too.
- Yeah. Getting the hip back here,
a little hamstring in there.
- Little hamstring.
And then the final one.
It's called four way cause you're in four directions.
You can actually go up this this way here too.
- Sure, all four quadrants.
- So now beyond that, you can start doing,
you wanna show shallow squat or should I, Brad?
- Sure.
- Maybe that fits me better, huh?
- [Brad] Yeah, it does on that wall.
- You wanna watch the Facebook to see if we're
- Yeah. You bet.
I'm getting right in the way,
I'm blocking people's view Bob,
they're probably getting nervous and excited.
- Now, with most most deep pain you can do shallow squats.
You don't wanna do real deep squats
but you can do shallow ones and still not have pain.
These are what I did for my quadriceps tendonitis.
So I put it against the wall. These are really nice
because you can put the feet forward
and the knees aren't going beyond the foot
when I'm doing this squat.
- [Brad] Now,
Nancy's asking about if people are balance challenged.
You could do this one if you're balance challenged,
particularly if you use a cane
and you're leaning up against that wall.
- So,
and this is why it does work well for balance challenged,
as long as you have some good tennis shoes on.
- [Brad] Right.
- Because yeah, the ball is gonna give you support,
and again, you just do shallow squats.
My wife and I, we do lots of these.
I mean, she was, had a hamstring issue
and it just took it away
because she does this so often it's helped strengthen it up.
So, the other one that was nice for the ball
is you can actually do some hamstring strengthening.
So you just lay down on the ground like this
and you get the knees fully straight
and then you can work on,
you can do it first without even lifting your butt up.
You can just pull it back and forth like this.
- [Brad] Yep.
And once again Nancy, this, you don't need balance for this.
You're laying down.
- Right.
- [Brad] You're, it eliminates that part of the equation.
- And now I'm lifting the butt up which makes it harder.
Now I can put one foot on the other,
which makes it really hard on one of them.
And the last progression is to go ahead
and lift the foot up like this and really lift the butt and
- [Brad] They're in good shape if you're doing that.
- Yeah. That one will work the hamstrings really well.
You can also do shallow lunges.
So you can actually just do, you know,
lunges like this where you're bending down like this
and bending down like this.
Again, it works out well to have something
to hold onto while you're doing those.
- Right. Yep.
That's where even a cane or something,
Monique from Canada says Hi to us on Facebook.
- Hi Monique.
Any other questions on Facebook?
- No, that's all we got right now, Bob.
- Okay. All right.
Well thanks everybody for watching
and remember Brad and I can fix just about anything.
- Except
- For a broken heart.
- Here it comes.
- But we're working on it.
(both laughing)
So thanks.