- So, today we're gonna explore what is causing
your knee replacement to click or clunck.
- Or click and clack.
- There we go. (Brad laughs)
- We'll let you know.
♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On internet ♪
- Okay, we have an expert Brad,
that's gonna answer this question
and we'll let him play now.
- He's an knees surgeon?
- Right? - All right, let's go.
- I would say, I would say there's probably
the majority of knees click in some way or fashion.
And the part of that is just the nature
of how your knee mechanics work.
So, you know your knee is not like a hip,
where it's just a ball and socket
that stays tightly bound to itself the whole time.
Knees pivot, they turn.
It's not just a perfect,
straightforward impact joint.
And so there's rotation that happens.
Your ligaments are elastic, right?
So they are supposed to stretch some,
so that your knee can pivot
and bend and move into different positions.
And so, when that happens,
if you have two hard surfaces
and metal and plastic next to each other.
As those pivot and twist and turn and stretch,
you're gonna feel and hear little clicks.
So I see that in most patients.
Some people don't notice it or don't care.
Some people, it really does aggravate them a little bit.
And I would say 99% of the time
those clicks and noises are completely normal.
- [Bob] Gotcha.
- You do see some patients where,
you know as we're trying to
surgically recreate their stability,
we underestimate that
and there can be too much movement in the knee.
- [Bob] Gotcha.
- So those tend to have more clicking and clunking,
but they also tend to have a lot more other symptoms.
So swelling, potentially pain, you know,
giving way where their knee wants to
kinda cave in on them.
So there can be a problem there,
but like the vast majority of clicking is not an issue.
- You can't do anything about it, right?
I mean...
- No, you really can't.
You know, I kind of actually have learned as
I've done more of this, you know.
You'd think the tighter you can get those ligaments to be
and the more stable it can be the better.
But I think a little bit of clicking in your knee
is actually probably expected
and probably a good thing.
Because really if you look at natural knee mechanics,
there is stretch and pivot and movement in your knee.
And if you want it to, you know...
If you're looking for that function,
that's something that is actually probably a benefit
after your knee replacement.
- Okay. That was Dr. Dan Hanson, by the way.
- Ah, I know him. - A Norwegian.
- Oh, wonderful. - And he does
a great job, I thought.
But in addition to that,
if you are feeling clicking
and you are having pain along with it,
you should definitely see your doctor on.
- Right, right.
I've had a number of patients over the years,
clicking after surgery, they're a little concerned,
no pain with it.
We just continue with it. - Right.
- Get it stronger.
And things fall into place,
and everything is good.
- Yeah, we have found the stronger knee,
the less clicking there is.
- That's right. - So we're gonna show you
a couple strengthening exercises right now too.
- I'm gonna get outta your way Bob.
- All right. - 'Cause I can see
you've got a mission.
- All right, the first one is actually
to strengthen the quadricep,
the muscle on the front of the thigh.
- Sure.
- So all you do is take a pillow
and fold it in half.
And what you're gonna do is,
actually push the knee down to the bed.
- Squish that pillow. - Yeah.
And while you're doing it you're tightening this muscle,
the quadricep.
- [Brad] So basically, it's kind of like an isometric,
'cause as you hold it-
- Somewhat, yeah. - Yup.
Probably not holding it quite that long,
but how many repetitions Bob?
- Oh, at least 10.
- Yeah. - We like 10.
Right? - You can't go wrong with 10.
- Three sets of 10 probably.
- [Brad] Hm-mm.
Again, no pain.
You should feel those quadricep muscles fatigue,
get tired, and that's fine.
- A great one to do.
- All right Bob, after you get your
quadricep strengthening done, we wanna work on
the opposite muscle group, the hamstrings.
In the seated position, is one good way to do it.
So we could just here...
And your hamstrings work when you pull your foot
towards you like this.
It's all hamstrings.
So when you work with this, particular in the beginning.
You don't want so much resistance
because you don't have the strength.
- You probably can't tolerate it.
- Right?
So if you have carpet, you can put something slippery down,
like this piece of plastic, it's a clipboard.
We've had people use plastic bags, cookie sheets,
and you go back and forth.
- Just a dish rag on it, if it's a vinyl floor.
- Yep. Yep.
Vinyl floor, wood floor, plastic floor.
I don't know, whatever they are.
And you also wanna do your range of motion,
and use the other leg to pull under.
Now- - Get more stretch.
- One thing that works well to increase resistance
as you get stronger,
is we wanna go uphill, add some resistance.
We are gonna show something that
we've shown many times in the past.
And it's because it works well.
This does the same thing, it's our knee glide.
But it does have this option as a stilt.
And this works very well for increasing resistance
on that hamstring.
And you get good range of motion in the knee.
- [Bob] It's definitely more a challenge.
- [Brad] It is.
And as you get stronger, you can simply put some weight
to add resistance,
you know using an ankle weight like this.
I've got a nice little three pounder here,
we're gonna add.
And again, we're gonna do 10, you know, 15 at the most.
And that makes quite a difference.
And where you position your body helps.
- Right? - You'll learn.
- You can also have
your toddler grab onto your leg and swing on
back and forth. - There you go.
- You know how they do that?
- Yeah. You know, this is actually,
you can flip it other way around too.
And this is- - And work on the quadriceps.
- Yeah, and then you got quadriceps.
- [Bob] Yeah.
- There you go. - Works out well.
- Alright, well, very good.
What's next? - Give it a shot.
That's it, Brad.
- That's it, say no more
- Stop the cocking, unless you wanna do a sit to stance.
- Well, maybe we should add that
because it is in the chair,
and it's a real functional,
you're getting your hips involved, quadriceps.
And it's simply, stand up to here and back down.
Use a armrest.
If you can do 10 of those, it's pretty easy.
Then it's time to take your hands away.
The next step is to the knees,
make sure you get up nice and tall.
So you're aware of good posture
as you get stronger,
hands go up to here.
10 of 'em again.
And at that point, you're good to go.
- You're good.
- Yeah.
- There we go.
Yeah, we could fix just about
anything, Brad. - Oh yes, except for-
- A broken heart.
I thought you were gonna work on it.
- Yeah, I was last night.
I was thinking about it,
and then I said,
the heck with it. - That's what stopped you.
- I'm gonna have some ice cream instead.
- Good for you.
Thanks. (bright music)