- So this video is all about knee pain.
I will share with you
some tests you can do at home
to which help to determine the cause
of your knee pain.
I will also share with you
the best therapy you can do at home
to get rid of your knee pain.
And I will give you some exercise
as well you can do at home.
Again, it would just help you
with the rehabilitation of your knee.
Now the knee is quite a complicated joint.
So I've narrowed things down
to the most common causes of knee pain.
And essentially, I've subdivided them into pain
on the inside of your knee,
pain on the outside of your knee
and pain generally in your knee itself.
So you will find in the description box,
you'll find a time stamp feature
that will help you to scroll forward
to the relevant section for you.
Okay, let's get started.
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First structure I'd like to discuss
with you is the medial collateral ligament.
And every ligament in the body
is like a piece of rope.
It's designed to keep all the joints
nicely tucked in together
and you don't have too much movement in a joint.
Now the medial collateral ligament sits
on the inside of your knee.
You see I've drawn it on my knee here,
and it connects your thighbone to your shinbone
and it protects you from
too much movement inwards.
Now have a quick look at this video.
You're now looking at your right knee
from the front.
The bony bit you can see
in the middle of this knee is the kneecap
or medical terms, called the patella.
The inside of the knee is
on the right side of your picture.
And the outside of the knee is
on the left side of your picture.
And when we rotate this knee,
when we turned this picture, we could clearly see
the medial collateral ligament.
And that's the one that gets injured.
Now, very common injury mechanisms
are when you get a blow
to the outside of your knee.
For example in football, in rugby,
in American football, that overstretches
that ligament and that can cause the pain
or rupture of the ligament.
And another very common mechanism is skiing
where you're twisting and turning.
Okay, now let's do some testing for this
to see if you're struggling
with a medial collateral ligament irritation.
Now let me demonstrate this really simple test
you can do at home to see if you are struggling
with a medial collateral ligament damage
or irritation.
So you need to lay on your back.
I'm gonna demonstrate on my right leg
and I've drawn it actually on my leg,
so you can see which structure we are testing.
So place your foot on the outside of your bed.
Turn your foot outwards, keep it fixated,
and now push your knee in.
And if this recreates the pain
or you feel a clicking,
it means you have a positive test
for a medial collateral ligament irritation
or sprain and a positive test means it's painful.
So, if you have it,
let's move on to the therapy.
Now, if you sustained an acute injury,
so it's just happened,
the first three to five days,
two protocols become active.
The HARM protocol, HARM and the POLICE protocol.
Now HARM stands for...
This is for three to five days.
Stands for avoid Heat, avoid Alcohol,
sorry to say but alcohol unfortunately
negatively influences the healing process.
Avoid Running and avoid Massage.
And the other protocol is the POLICE protocol.
And the POLICE protocol, the P means Protect.
So make sure you don't bang it too much
and give it relative rest.
OL means Optimum Loading.
So you do want to try
and walk as normal as possible.
Even if you have to with crutches.
It's shown now that if you load the tissues,
if you walk as normal as possible,
the tissue tends to heal quicker.
Then we have the I of Ice,
always use a bit of ice.
So have yourself a cold pack.
Make sure you wrap it in a towel or something,
so never put the ice directly on the skin
to avoid frostbite and apply the cold pack
for about 20 minutes, five times a day.
The C in POLICE stands for Compression.
So you want to add an elastic band
or something, compression on this knee.
And what that does is reduces the swelling
and it reduce the joint stiffness
and is now shown that if you reduce joint stiffness,
you are moving quicker and better
through the rehabilitation phase
because you knee moves more normal.
And the E stands for Elevation.
The same thing.
We want to reduce the swelling
in the knee to get as quick
as possible back to normal movement.
So the first three to five days
is HARM and POLICE protocol.
And then you continue after five days
with the POLICE protocol.
So three to five days after you sustained the injury,
you continue with the next bit of therapy
which is called cross friction.
And cross friction helps
to maintain mobility in the knee
and it prevents the formation
of scar tissue in the ligament.
Now, what you need to do
is you need to have a towel
you can rest your knee on
and make sure your knee
is a nice and a relaxed place.
Then I've drawn up the medial collateral ligament.
So you can see that on my knee.
And what you need to do now is you need
to find the tender point and go across it.
So 90 degree angle on the way the ligament runs.
The ligament runs like that.
So you're gonna go across it.
Now, your fingers or I prefer
to use the back of a knife
'cause it saves your fingers.
So you find the tender spot
and all you do is you go across it
like this for one to three minutes a day.
Only once a day.
And it's going to be a little bit sore
and you're going to have some swelling.
That's absolutely fine.
And then after one to three minutes a day,
you need to use an ice pack,
wrap it up in a towel again
and cool it right down for about 20 minutes
'cause it's going to be a bit sore
and you're going to have some swelling
and the ice pack helps that.
Now, what you could do as well,
is you could use a little bit of olive oil
to reduce the friction that you created
with the back of your knife
so your skin doesn't break.
So you can use a bit of olive oil for that.
So once you've done this we need
to do some exercises and that's going to be next.
So we need to start exercising as soon as possible.
We need to prevent this knee from stiffening
and losing the range of motion.
So some discomfort, you're going
to feel some discomfort with these exercises.
Don't worry about it.
Just do them little and often,
and do as much as the pain allows you to do.
So the first exercise, pretty simple,
put in a half sit, again,
you can see my right leg here
with the medial collateral ligament.
Place a towel around your foot
and then pull your foot towards you
and wherever you feel discomfort,
hold that position for about 10 seconds.
And straighten your knee again.
And the same thing, so you're holding,
you pull the foot towards you,
hold it for 10 seconds and straighten again.
And you do about five repetitions
and you do three sets.
And again, you do this little and often.
Okay, the second exercise I'd like you
to do to keep that knee mobile
is you need to lay on your back,
straighten the affected knee
and then lift your knee up
one to two metres above the horizontal.
Hold this again for about five seconds
and come down again.
The same thing, straighten the knee up.
You raise up five seconds and come down again.
And the same thing applies here.
You do the same exercise
for about five repetitions
and you do about three sets.
So I'm going to demonstrate the third
and final exercise you should be doing
when you're dealing with
the medial collateral ligament issue and pain.
You need a wall or a door.
Make sure your feet are
20 centimetres away from the door.
And all we're going to do now is a squat.
Now what's important when you do the squat
is don't come further down the 90 degrees angle
in the hips and 90 degree angle in the knees.
But also, this is even more important,
make sure that your knees don't come in.
They need to go straight over your feet.
So come back up again.
Again, you come down, up to 90 degrees,
you might feel a little bit of discomfort.
Absolutely fine, no problem at all.
Remember, we're trying to give them mobility
of the knee, maintain mobility of the knee.
Hold this for five seconds or 10 seconds.
Come back up again.
And you do this about five repetitions
and you do three sets, little and often.
All the exercises are little and often.
So you can do it throughout the day.
So the second anatomical structure that often
causes knee pain is called
the lateral collateral ligament.
And it sits on the outside
of your knee as I've drawn here.
So it connects your thigh bone to your shin.
Common mechanisms of injury are a blow
to the inside of your knee.
So the knee comes out
and you irritate the ligament on the outside
or a twisting and turning like with skiing.
Let's have a quick look at this anatomical video
so you can see where the ligament exactly sits.
So we're gonna turn the knee now
more towards the outside of the knee.
And you can clearly see the ligament sitting here.
So again, with acute injury,
you're using the same mnemonic
as you did for the medial collateral ligament.
So those were the mnemonics HARM and POLICE.
Okay, so now let's move on
to the the quick test you can do
to see if you are struggling
with the lateral collateral ligament damage
and some therapy you can do as well.
Let me show you a quick test to determine
if you're struggling with an irritation
of the lateral collateral ligament.
And what you need to do is lay on your back.
Place the heel of the affected leg
on the outside of your bed.
Turn your foot inwards
and now push your knee outwards.
Now, if you're now experiencing either a pain
or a clicking sensation in the outside
of your knee, you have irritated
the lateral collateral ligament,
and we can move on to therapy,
and I'll show you some exercises as well.
So we're now moved on
to a therapy that you should be doing
if you're dealing with
a lateral collateral ligament irritation.
We're going to use cross friction again.
Again, cross friction, it reduces the formation
of scar tissue in the tissue,
and it helps to keep the the joint mobile.
I've drawn the ligament
on the side of my knee here.
Ligament runs this way so cross frictions
means you're going from top to bottom.
Either use your finger
or use the back of a knife.
Use a bit of olive oil
to reduce the friction in your skin
so you don't irritate your skin.
And you go up and down, find some tender spots.
Just go up and down for one to three minutes.
That's all you need to do once a day,
all you need to do.
And then afterwards,
make sure you cool it with ice.
Ice reduces the swelling
and it reduce the inflammation.
After you've done this,
you can move on to the exercises
and the exercises are exactly the same
as what we did for the medial collateral ligament.
So you need to get some mobility in the knee,
make sure you don't lose mobility in the knee.
You get your range of motion back.
So again, the rehab goes a lot quicker afterwards.
So the fourth structure that often causes
a pain in the knee is the ITB band.
And the ITB band runs on the outside,
runs from your hip all the way down
to the outside of your knee.
And it's often caused by an overuse injury.
So we see this a lot in cyclists
and runners and stuff.
Now, I've drawn it here on my knee.
That's the ITB band.
This blue structure I've drawn on there
is your lateral collateral ligament.
So it's important for us
to distinguish between the problem,
between the lateral collateral ligament
and the ITB band.
And to do that, we need the Renne's test.
The Rennes' test goes as follows.
I've got a chair here for my balance.
I'm putting my thumb into the ITB band,
need to press quite hard.
Come down to about 45 degrees
and then come all the way up, push high,
come all the way up.
And if this now reproduces the pain and it hurts,
then you have a positive Renne's test,
which means that the pain in your knee
is caused by ITB band irritation.
And if you have it,
let's move on to the therapy for that now.
So again, we've done this before,
cross friction is the preferred therapy
for a band issue, an ITB band issue.
Again, I've drawn it on the side here.
So make sure you have the correct structure.
Use a bit of olive oil
to reduce friction on your skin.
Use your finger or use the back of a knife.
And the band runs from top to bottom
so you need to go across it to find a tender spot,
often it's a bit lower down
and you just go there for one to three minutes
for a little bit of cross friction every day,
and then use ice afterwards to reduce it.
And try to find some tender spots
in this ITB band and use the friction
on it every day.
And then on top of this,
you should do some foam rolling,
which I'll demonstrate next.
So this is a quick demonstration
on how to foam roll your ITB band.
So remember it's the right side which is affected.
What you need to do is have a foam roller,
place your left foot in front of you,
tilt your pelvis up.
Now my right leg is
in straight line with my body.
I've bent my knee and all I'm doing now
is roll up and down for a few minutes
to really loosen off this ITB band.
You can go all the way up and down from it.
You can even go from your hips,
down to the bottom of your knee.
You can do this for about three
to five minutes a day.
Really, really effective
in reducing that ITB band pain
on the outside of your knee.
So the final structure
I'll be discussing with you
which is a common cause of knee pain
is the meniscus.
And a meniscus is like a half moon-shaped sponge
which sits insides the knee
and it helps cushioning shocks.
So when you're walking
it cushions the blow every time.
Now, the five symptoms of a meniscus tear
are you have stiffness in the joint,
pain and tenderness around the joint line there,
you have a popping sound.
You might have difficulty extending the knee.
So straightening up the knee.
And the last one is sometimes you might feel
that the knee locks,
like you can't get through it.
It just stuck in a certain position.
So there are two tests you can do for this,
the Tessaly test and the Ege's test.
I'll demonstrate the Tessaly test first.
So for the Tessaly test, you need
to have a chair just to balance yourself.
Stand on the affected leg,
bend your knee about five degrees.
Fixate the foot, so the foot shouldn't be moving.
And all you do now is turn your body in and out.
And if this reproduces your pain
or you hear a popping sound,
then that's a positive test
and it might mean that you have irritated
your meniscus a little bit.
Now the next variant makes it a bit harder.
You need to bend the knee now 20 degrees
and do the same thing.
So now you turn in and out
and see if you can hear this popping sound,
feel a popping sound,
or if you have a pain in the knee.
And that is a positive test as an,
"Okay yes, there is a problem with the meniscus."
So the next test is the Ege's test,
quite simple actually.
All you need to do is turn your feet outwards
and then you do a squat up to 90 degrees.
And if you turn your foot outwards,
that tests the inner meniscus,
so the ones inside of your knee.
And then what you need
to do is turn your feet inwards
and do the same thing, do a squat again,
and that will test the structures
on the outside of your knees,
so the outer meniscus.
Again, a positive test means
if you hear a popping sound
or you get some pain along the knee line,
is a positive test and you might have
an irritation in a meniscus.
Now therapy-wise, I know there are some exercise
people say you could do for it.
My experience as a physio and a chiropractor,
I've never really seen a very positive result
from from these exercises.
Thankfully, the meniscus will heal on it's own.
Takes about nine months unfortunately,
but it does heal on it's own.
Or you could have some keyhole surgery,
very simple, very short recovery time,
very effective as well for these tests.
So that would be my recommendation in all fans,
if you have these problems,
go and see your specialist and get it sorted.
I hope you've enjoyed this video.
I hope you found value in this video.
If you have, please don't hesitate
to leave me a comment in the box below.
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And take care of yourself,
take care of someone else as well if you can
and bye for now, bye-bye
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