♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- All right, Brad, you got your mic going there?
- Check, check, check, yup!
- All right.
Today we're gonna talk about to fix patellar tendinitis.
No more pain, it's a self treatment.
This is really effective, we've been using this for years.
- Right.
- Good old Dr. Cyriax,
he's the father of orthopedic medicine.
He came up with this, brilliant man.
- Right.
Long time ago, and the test of time
has proven it successful,
but you need to follow steps we're gonna go through.
- All right.
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Go to the giveaway section,
we're givin' away a beauty this week.
- Ah yes.
- I'll tell it to you in just a minute,
you can also find it on Facebook, Bob and Brad,
it'll be pinned to the top of the page,
the contest that is.
You can also find us on Twitter and Instagram,
60 second version of us also.
- Tattoo!
No TikTok!
TikTok!
- Tattoo?
- Anyway, we're giving away a massage from Renpho.
Renpho does a really good job, really high quality stuff,
we really like their stuff.
This is adjustable head on here, look at that.
You can use it to get underneath
in those difficult spots, Brad.
You can do it under the arms.
- Oh yes!
- There we go.
It also has like four settings
and it's got a whole bunch of different heads,
I think like six of 'em I believe.
- Six is right.
- And it's got a good percussion.
- Right.
And you're going to see actually, it's very versatile.
We're gonna use it on our diagnosis today.
- Oh yeah, that's right.
- But put that away for now Bob, we got work to do.
All right so, patellar tendinitis, infrapatellar tendinitis
refers to the tendon below the knee cap
or the patella and let's show on Sam first.
- Sure, let's start with that way.
- Give a little anatomy lesson.
I have my official pointer here.
There we go.
Okay, so here we have, now keep in mind the patella
or the knee cap is part of a tendon
that connects all four quadriceps.
All four of them connect to the patella
which then connects to the infrapatellar.
- [Bob] The tendon below the knee cap.
- Right, so it's a short tendon
and it takes a lot of stress.
- [Bob] Yes it does.
- Particularly if you're doing squats.
If you're doing repetitive motion like running,
particularly up and down hills or steps.
- [Bob] They call it jumpers knee,
because a lot of high jumpers
or people that do repetitive jumping,
like basketball or something like that,
quite often get it.
- And actually the location of where the tendon
has the irritation or the rupture
if you want to call it that,
is we'll get the tendon out of the way
as where it connects to the bone.
You don't have a piece of elastic
in your body like this by the way.
- You got a bony tuberosity.
Now the thing is, when he said a rupture,
generally it's kind of like a minor tears.
- Right, that was an overstatement.
- Yeah, if you have a rupture
you probably won't even be able to use a knee.
The other thing you want to be a little
careful about is Osgood-Schlatter.
That's a disease, I'm sure named after
Osgood and Schlatter probably.
That actually can cause pain in the same area.
Especially over the bump and you're gonna want
to make sure that's ruled out
because that's a whole different animal.
- Right and often times the tibia,
the bone, is kind of a big bump there.
It can turn into one.
- It gets inflamed
or it gets a little bony overgrowth there.
- Right, so this is not a rash or a big zit on my leg.
I actually colored,
I sacrificed my skin, colored it red.
That is the location of my infrapatellar tendon.
And the black marks represent
where the tendons connect to the bone.
And typically, that, above or below
is where that irritation starts
and if you really palpate or poke on it,
the tender spot is usually there.
If it's really bad the whole thing starts to hurt
and you kind of get that detailed.
So, we talked about the repetitive motions,
squatting, high intensity, high repetition
can cause the irritation.
And once it gets inflamed it can be really tender.
- Yeah.
- And when it's at that point,
the first point of treatment
is gonna be, and I like this the best,
you want to use some cryotherapy,
cold-packs but actually the ice-massage
or that ice-cup I like the best.
Particularly, on this because there's a superficial injury
and it really cools down the injured site quickly.
So, you take a cup of water,
put it in the freezer,
take it out and tear away the sides of it.
This is a styrofoam cup.
- You can use a styrofoam or a paper cup.
- Yup, expose the ice, rub it down a little bit.
I don't know where my towel
went but don't worry about it.
And then you just ice over it for five minutes
and that's gonna adequately cool down the area.
It's gonna decrease the inflammation.
The pain is gonna drop down.
Oh, thank you Bob.
And it's a good way to treat it.
Now when it's in acute phase
or when it's first injured and real tender, you may--
Fell right out!
But don't worry,
it won't make a big mess because it's ice.
You'll do that, you can do five minutes every
hour, that's kind of the extreme.
Most people do it a few times a day.
It's more typical.
- Right and the other thing that Brad should
mention is that you want to decrease
your activity level.
- Oh that's right.
- Yeah, I mean the first you want to do,
I'm afraid to say this because it's very
difficult and coming from Brad it's very
difficult because he won't take care
of his pectoralis injury.
- That's another story.
- Yeah, but you got to calm it down
and to calm it down you need to decrease
your activity level.
So if you're playing basketball is causing it,
you're gonna have to decrease playing basketball
for a while, until it calms down.
- Right, if you're squatting
and it irritates it to squat, you're gonna have to,
you should just stop for a few days.
- You can't work through it.
- Right.
- It's gonna keep getting worse and worse.
And it can even be tearing some tissues.
- I can attest to that because I'm the kind
of person that'll do that.
- Yup.
(laughing)
- Anyways, so let's carry on,
so you're gonna cold pack, ice-massage,
cut down the intensity
or stop the activity that's irritating it.
And then you're gonna go to the cross-friction massage,
which Bob referred to before by Dr. Cyriax.
- Yeah.
To me this is the big crux of the treatment here.
This thing can really make a difference.
I've done, you know, in the past, before I used to use
that I'd do all these other things
and it seemed like nothing was really helping.
And I started the cross-fiber
and it seemed like within a couple of days,
a great improvement.
- It worked better than phonophoresis
and all these fancy things that we do
in the therapy department
and they cost a lot more but this you can do at home.
The fibers of the tendon go in this direction.
We're doing a cross-friction,
so we're gonna take the massage and go across the fibers
and you can just use typically, not one finger
but two fingers because you're going to get in fairly deep
onto this tendon.
And then you're going to go back and forth.
- You can do one finger on top of another.
- Yup.
- If you want to give a little more higher pressure.
- Three fingers, yup, however you do it.
- You really want to get into the tissues.
- Yeah.
- You don't want to be superficial on this one.
You're gonna really dig in.
- Now, what you're going to do
is after about 30 seconds,
if it hurt when you first start but after 30 seconds
it's like hurting more and more,
it's too early, you got to go back to the cold-pack,
leave it to settle down for a day or two.
But typically, you know you're doing the right
thing is after about 20 to 30 seconds
the pain levels off or it gets better
or it kind of gives a numbish feeling.
- Then you're golden.
- Then you're gold,
then you're going to keep doing it
'till your fingers get tired and sore.
- You rubbed the red right off!
- I know, see it's getting better!
I feel better!
- Now normally what's happening,
I guess on a micro-level,
you got the scar tissue and it heals
in an erratic fashion, almost like a spider web.
- Sure.
- And supposedly, by doing the cross fiber massage,
you're realigning those fibers,
they're stronger so they won't break open again.
What happens typically, is that it starts to heal.
It heals in an erratic fashion.
You go and do something, it breaks apart again.
- Start all over.
- Yeah so, if you massage it,
it's supposed to heal one quicker
because you're getting more blood flow to the area
but two it heals stronger and so it's less likely
to break open again and so you don't fall into that pattern
of like crap, every time I go back to my activity
it starts hurting again.
- Yeah and yup.
Back and one step forward, two back.
Now, your fingers I mentioned get sore.
- Yeah.
- Because Cyriax it says you can go up to 15 to 20 minutes
of cross-friction but your fingers
will never last that long.
- Right.
- So, that's when, if you buy a massager,
we've got two of them here,
here it is, two options that we like.
We like the Renpho because they work well
and they got a great price on 'em.
And they're built well.
It's a win-win situation.
- And this is a less expensive bottle,
the Renpho massager, well a link style for both of them.
This one's a lot more expensive
but this is like high quality.
This is like...
- Well I think they're both high quality.
- They're both high quality but this is like Dewalt.
- More aggressive. - Yeah.
You can, it's more percussion on it.
- Yeah.
- I just think it's gonna tolerate heavier
forces Brad, in my opinion.
- Well, I'm saying this,
I like this one if I'm on a smaller muscle.
If I'm on a bigger muscle, I definitely want this one.
- Sure, gotcha.
- But I think they're both good quality.
- I concur.
- Concur!
- Yeah. - So, I'll show you,
now with something like this that has a lot of percussion.
If I go on this and it's percussing this way
and I go straight on, it's not gonna be good.
We need to adjust it.
Plus, it's percussing this way, we want that cross--
- [Bob] Cross-fiber
- Motion, so we're gonna go at an angle this way.
And this is working good
and I can adjust the intensity by how much pressure
I push down, as well as if I angle up a little bit.
Again, I'm not gonna go like this,
I'm gonna go like this and work that cross friction massage.
Now, my fingers can put up with this
for 10 minutes or whatever.
- That's the thing is like you can watch T.V. or,
you know, binge on Netflix or whatever you want to do.
- You can watch Bob and Brad on Netflix
to fix your knee.
- Right and the thing is you're just not gonna tire you out.
- You're right.
- When you do it this way,
you do it for a minute or two
and you're like okay I've had enough, you know, so.
- And, you know we have been promoting these
for about a year now.
So if you already have one of these,
don't fret, you can use it and it will work.
But it's just not quite as aggressive.
It doesn't have the displacement.
It could've been cheaper than the other one too.
- Yeah, it is.
- So yeah, they're both options.
- Yup.
- All right Bob, what say you?
- Well, we didn't talk about going back to activity Brad.
- Well, we kind of did already.
Ah, so once it's feeling better the thing you
do not want to do, if you're a jumper,
say playing basketball,
you're not gonna go in and play a game.
- At full force.
- Right, you want to go in and progressively
work if you're a runner, you know,
start out, if you've been running
10 miles a day, you may go back to one or two
miles a day at a slow pace.
- Maybe run-walk.
- Right.
- And you know Brad mentioned before in other videos
that you want to increase on a 10% ratio.
- Yeah.
- So, like if you've been doing a mile,
the next day you do a mile and a tenth.
- Right.
If you're doing 10 miles,
which you wouldn't but I mean, you know 10%.
And that's on a weekly.
That is hard to discipline yourself,
particularly if you're a competitive person,
you're trying to get back to an event.
If you're like us, where we just do stuff for fun--
- But this is a big part of recovery,
is allowing the body to heal.
- Yup.
- Otherwise, it'll just break open
and you'll be starting all over again.
- Yeah.
Younger people can get away with it.
People like us, you got to be a little slower.
- Thanks for watching folks.
- Be careful!