♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(Bob clapping)
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Today, we're going to talk about
why does my knee click with squatting and stairs?
And when we say "my", we mean you,
is it serious, and how to fix it?
- That's right, Bob.
Joints commonly make noises
with motion, moving around.
And is it a problem?
Is that clicking-
- Often weightbearing.
- Right.
And we're going to talk about that
and you'll find out all the answers.
- By the way if you're new to our channel,
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- That's right.
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And while I walk over here,
Brad why don't you tell what else we have.
- Well we also now have our podcast out there,
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with books and authors and therapists.
- People are smart!
- Yeah.
- As opposed to us.
- So Bob, we got to get to the knee.
- Alright.
- Let's jump,
jump the topic
to the knee that clicking, clacking,
does your knees ever do this?
- It did when I was younger, it's funny, they stopped.
- Yeah?
- They used to click all the time.
- Right, right.
But we've had a lot of patients over the years that come in
- Yeah, right.
- with questions what's going on with this knee?
And the big question, I guess, is it going to hurt my knee?
- Right.
- What do I need to do about it?
- Exactly.
- People are usually more concerned
than they have to be, but not always.
We can talk about
what actually makes
that clicking and clunky noises or the...
- Sure.
- ...responsible party, if you will.
So the first thing is cavitation,
- And that's the one I think I had.
I think you kind of buildup of gas, right?
Nitrogen?
- Yeah.
It's actually when the joint,
like when you crack your back
or crack your fingers,
there's nitrogen in a liquid form,
and then when it goes into a vacuum,
it pops into a liquid form and that makes the noise.
- Sure.
- So that's, that's cavitation.
- And usually it has to build up again
before you can crack it again,
that's why you can't just keep cracking.
- Yeah.
So if it cracks, and then you can make it crack right away
within seconds afterwards, it's not cavitation.
- Yeah, right. It's something else.
- Right.
Then the next thing is arthritis.
- Right.
- The joints,
the surfaces that slide against each other,
- It's supposed to be nice and smooth,
And they've roughened up.
- Yup.
- Or they even have a little tear.
I guess that's the next one isn't it, Brad?
- Right.
And the arthritis could come from the aging process,
or maybe from the type of work you're doing,
abusing the joint.
- I'm bringing Sam over.
- Yep. Come on over Sam.
We're gonna need you.
And the the next one,
- That was sick.
- What?
- "Need you", knee. Knee.
- What did I say?
Oh, knee.
- I think it's funny,
you didn't even know you made a joke.
- Oh yeah, see? I'm a natural comedian.
- I thought you were thinking knee.
- I get it.
Oh Bob, you're killing me.
OK, the meniscus!
- Right, the cartilage.
To the lay person.
- Right, exactly.
So if we look at the knee, do we need the knee?
So we're going to get the knee cap,
or the patella out of the way,
and look at the cartilage.
If you all recall,
meniscus between the knee and it acts
like a cushion it stabilizes the knee somewhat,
but this meniscus can tear,
- [Bob] Yes.
- [Brad] it can get damaged.
And when that happened, the smooth motion
of the knee becomes clicky or can clunk.
- [Bob] Or it could even be a piece of it could break off.
- [Brad] Yep. They call that a floater.
- [Bob] Or mice, I've heard it called.
Yeah, I have. You've got mice in you.
- Of Mice and Men.
I remember that book in high school.
Anyways, that has nothing to do with it.
So, but if you do have a floater
one thing about a meniscus is often times it's painful.
- Yeah.
- Or your knee will lock where it doesn't want to move.
- Right.
And then you move it around,
and all of a sudden it frees up.
It's a pretty good sign
that it is a floater or a meniscus problem.
And then the next thing is the knee cap itself.
Now this knee cap
the brown represents the tendon that connects
to the quad and it connects down to the tibia.
There's the knee cap
and the knee cap isn't tracking properly...
- [Bob] Right.
...over the femur.
They call it the epicondyle.
And so that may be clunky.
- [Bob] Real common cause of clicking and pain.
So you can see when he moves to the side there,
there's a little tractor.
- [Brad] Sure. Yep.
- [Bob] So if it's running off the side of the track,
that can cause grinding and clicking
and it can wear out the underside of the knee cap.
- Right.
- Brad, why don't you tell when, when is it
that you should be concerned about clicking?
- If you're have pain associated with the movement
and the click, and it's like you feel it clicking
there's a little pain with it, even a little bit
cause the chances are, it may get worse over time.
And if it is getting worse over time for certain,
you need to get into see the doctor and get it assessed
before it gets too bad...
- Right.
- ...and causes some problems
that wouldn't need to be caused.
- And if your knee locks up.
- Oh.
And even if there's no pain, if it locks up,
you'll wanna get it checked out.
- Right. Yep. Exactly.
But however, there's some-
- Things you can try.
- Right. I was gonna mention, Bob,
if there is no pain with it,
and it's going on for a long time,
over time there's been some research saying that the
if you have one knee that's clicking and clunking
and the other one doesn't and this one it's not painful,
there's no symptoms.
If that happens over time
there is some indication that that would be the knee
that's probably going to wear out first.
But we have some exercises.
We can show you how to do some exercises yourself.
Oftentimes it's tight hamstrings, tight quadriceps.
Perhaps some weakness on the muscles that support the knee.
And we're going to show you those right now.
- Let's get started.
- All right, Bob, here we go.
I think I need the plant.
- Sure. Yep.
- Well, let's see.
- The first thing you wanna do
is you wanna assess range of motion.
- Exactly. So if I were sitting on a chair and I had a stool
in front of me.
There's a chair right there.
Why don't we just pull that chair over Bob,
so that we do it properly for these people.
Wow. It's a heavy chair.
(Bob chuckles)
If you have a stool that moves that's really ideal,
a lot of people don't, but if you put it on here
we're going to look for, does your knee fully straighten?
If it doesn't that could be a problem
and you should address it.
You can check both knees together.
And you know, if I go like this and this one, you can see
there's a difference in level.
We need to get this one down to here.
Then we need to address that.
So we're not going to show you all the exercises
you can do it with this
- Right. If you have trouble straightening it,
check out our videos.
But we're going to show you one here at least.
- Yep. And it's a simple exercise.
And it is one that oftentimes works is we're just
going to pressure down.
- [Bob] Now don't put on- push on the kneecap itself.
- [Brad] Yep. So here's my kneecap.
Don't cause that'll just- that can irritate it.
We're above it here.
And not really aggressive pressure either.
Especially if it's painful.
That has got to be light pressure when you hit the pain
relax and do that 10 times and then-
- First day that's it.
- Yeah.
- 10 times.
Next day you might be able to do 20 times,
or do it spread out throughout the day.
- Right.
You wouldn't do it the next day if it made it sore.
- Right.
- Cause that's why we start out gently just to assess it.
Don't overdo it.
- The nice thing about this
is eventually you can do this five times a day,
six times a day, and you'll get better, a lot better results
if you spread it out and continually do it.
- Right, short little segments at a time
versus working at it 15 times.
- Brad do you know that, I saw this on a video like,
when you straighten your knee
you should be able to lift the heel up.
- Yep. Right there.
- And so if you compare your two sides and one lifts up
and the other one doesn't,
that actually is lacking some extension,
and you do want to work on that stretch.
- Yep. Exactly.
The next thing is, does it bend the same amount, both sides.
You know, typically you can bend.
A lot of people can get their heel
almost to their buttocks and touch.
And if you, this one goes all the way up and one knee
it goes to here and at the end range, you know,
maybe a little painful in that knee,
that's something you can address.
- You can often tell if one feels tighter.
- Yep. Exactly.
- And that would be the same thing then, right?
A stretch?
- Right. And we're gonna show first this stretch,
but we've got a couple other ones
that are going to affect both of these as well.
- Sure.
So here, I always, if you do like this with your hands
and you can do it in the chair,
you're going to scoot your butt out a little bit.
- Yep.
- Closer to the knee.
You could try it down, but I start closer.
And then you just come up and try to get it to bend in.
And again, pressure on and off.
And the same rules is with a straining.
Don't get too aggressive.
If it's sharp pain, don't push into it.
10 repetitions, wait, see how it responds the next day.
If the next day it feels okay and you feel like
oh, it's a little closer now,
then you're going to start doing it
10 repetitions, you know, three or four or five times a day,
as long as it doesn't flare it up.
- You know, it's interesting why we're doing this is
because you're lacking motion,
which means you're wearing out a smaller range of the joint.
- Yep.
- So we're trying to spread the forces out so that you
you got along the entire surface.
- Right.
- And that often decreases pain,
and it may also decrease your clicking. So.
- Exactly.
The next thing.
I do need to lay down for this one, Bob.
- Sure.
- Without the pillow. Is you check your hamstrings.
Maybe it's a tight muscle.
- [Bob] Sure.
- For whatever reason.
And it may go up like this.
Let's say I can only go this far with this leg
you feel the hamstrings.
And then this one, well, it goes straight.
So we've got an obvious length difference.
A nice way to stretch out is you can take a belt,
and put it around your foot.
I'm going to use a stretch out strap
because it it works really well.
And then we're just going to pull up here and stretch.
The nice thing about the strap
is you can put your hand in there you do not have to pull.
It's just easier.
And I'm gonna put my head down.
And you could hold this 15 to 30 seconds at a time.
You know, if you want to do pressure on,
then pressure off 10 times.
But you will feel the hamstring,
you have to keep the knee straight.
Don't let it bend like this,
cause then it will not address the hamstring tightness.
- So I don't know if you can see this,
but you know the hamstring crosses the knee.
You can't see this, but the sort of the quadriceps.
So if both of these are tight, can you see how
it puts more compressive force on on the knee joint?
- Yep.
- So you want it-
yeah you want these muscles pliable and stretched,
so that they're not as putting as much stress on the knee.
- Sure.
Exactly.
Now let's show you how to test the quadriceps
if they're tight.
- Sure.
- We're going to lie down.
Prone or on your stomach.
You can do this on your bed
or the floor, may be a little better on the floor carpeted.
And you're going to go and see if you can pull
and see how close your heel gets to your butt.
And then if the other one is really tight
let's say it's getting tight there.
- [Bob] It seems like it is.
- Yeah. It might be a little tight.
Does it look tighter on that side?
- [Bob] Yeah it does, Brad. You have trouble getting to it.
- Oh yeah. So I would stretch my left one.
This muscle, there's a few different ways to stretch it,
we'll show the one lying down like this.
- [Bob] You can even do it side-lying.
- Oh, sure.
I'll show both ways.
- [Bob] Sure.
- So we start out here, and just relax.
And again, you could use a belt with this
and loop it at the end,
and just relax and stretch and relax.
- [Bob] It's nice because,
I don't think the hamstring will cramp
as easy on this one right, Brad?
I get cramping in the hamstring-
- Yeah, had that happen over the weekend actually.
- [Bob] Oh did it?
- But I wasn't doing this.
- [Bob] Oh.
- But yeah. Cause you're able to relax,
especially lying down like this.
- [Bob] Sure.
- [Brad] You know, you can...
- [Bob] You can go side-lying.
- [Brad] Yep. You can use your hand
if you can reach that far back sometimes.
And then pull the knee back this way.
Don't get it in front of you.
- [Bob] Right.
- Like this we need to-
- [Bob] Look at the stripes of his pants,
how he's pullin it the knee back, the leg back.
(Brad sneezes)
- Excuse me, Bob. I couldn't help that.
(Brad sneezes)
- All right.
- Oh my goodness, you better finish this video.
- Sure, next one is the IT band.
That's another band that actually crosses over the knee.
Now, it's actually attaches to the tensor fasciae latae,
and you might want to roll out the tensor fascia Lata.
- [Brad] Sure.
- Cause the IT band you won't be able to stretch it,
cause it's too thick.
But, sometimes that band gets adheased down.
- Yep.
- So then you, by rolling it,
you can maybe break up some adhesions.
Not in the band itself,
but attaching to the surface below it.
- Right. Kind of like the myofascial release idea.
- Yeah. Exactly.
- So you take a roller, a six inch roller.
Probably not a really hard one
cause that's a little aggressive.
- Yep.
- These bluer ones are really about the right for me,
you know, for beginner.
- [Bob] He's rolling right along the band there.
Again, in case it's adheased down...
- Yep.
- [Bob] ...and causing stress on you.
And you'll sometimes get pain from the IT band
all the way from its attachment down here.
- And you could actually, see now you have this,
roll your quadriceps.
- [Bob] Sure.
- And roll your hamstrings.
- [Bob] Yep.
- And that will help loosen them up a little bit as well.
And you're going to spend, you know,
two to three, up to five minutes doing a leg with this.
And typically people respond well,
you can make things feel nice and relaxed afterwards.
- I was going to show one more thing, Brad,
but I think we'll cut her off.
We're running late here, 15 minutes.
- Oh my goodness, yes,
we better save that for another video.
- Sayonara.
(Outro music)