♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Oh 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.
- How to tell if your knee pain is
meniscus or a ligament injury.
This is an updated video, we did it once before,
we're gonna try to improve upon it, make it better.
- That's right and we will, Bob.
- By the way, if you're new to our channel,
please take a second to subscribe to us.
We provide videos on how to stay healthy, fit, pain free
and we upload every day.
Go to our website, BobandBrad.com, 'cause we're always doing
a give away, what it is, I don't know.
Look and you'll find out, go to the give away section.
You can also find the give away, it'll be announced,
it'll be pinned to the top of the page on our Facebook page.
Go to Twitter or Instagram or TikTok if you want
a 60 second version of our program.
- All right, Bob.
No give away?
Oh it's the future.
- Yeah, you gotta figure out what it is.
- Oh that's right, okay.
Let's get on to this.
Knee pain and people are always wondering, you know,
"jeez, I wonder is it my meniscus."
- Well cartilage, if they say meniscus, cartilage.
- There you go, cartilage or is it that darn ACL
or is it a ligament problem?
So we're gonna show you that very clearly.
- The ACL is a ligament by the way.
- Yeah, exactly, but you know there's three other ones
that could be the problem
and that's what we're gonna show you.
First of all, let's take a look at Sam here.
- Let's do a little anatomy, just real quick.
- So all the muscles are removed, we've got the bone
and we do have the tendon to the patella.
We're gonna take that patella and the tendon,
remove it, pull it over here.
- [Bob] You got it?
- [Brad] And then we're gonna open up the knee joint
and we're gonna look at the meniscus first.
So that's this cartilage and it's between the tibia
and the femur and to me, they always look
like kind of two horseshoes, the bigger one--
- [Bob] Yeah and they aren't that pointed,
like this thing is.
It's a little weird.
- [Brad] It's a little exaggerated
but the shape is pretty much there,
it's pretty similar to that.
That is there for a cushion, it stabilizes the knee,
offers some cushion
but we're gonna jump now to the ligaments,
there's four ligaments that stabilize the knee
and we've got it open, the ACL, which is
probably the ligament that you hear about in sports,
very often being injured and oftentimes tore.
- [Bob] Or stretched.
- [Brad] Yep.
Surgery can replace it, it's right here, it's this one.
Then also right next to it, there is the PCL.
ACL means anterior cruciate ligament,
PCL, which is, I'm gonna move this out of the way.
It's hard to see but it's back there,
it's the posterior cruciate ligament and they work together.
They stabilize the knee from moving forward and backwards.
- [Bob] And cruciate means cross, so the ligaments do cross.
- [Brad] Yes they do.
This doesn't show that real well but believe us.
Now we're gonna look also at the MCL,
the medial collateral ligament
and here it is, right here.
What that does is that stabilizes your knee,
so it doesn't go out this way.
What would that be?
- [Bob] That'd be valgus.
- [Brad] Valgus, what's the, what's the?
- [Bob] Not varus.
- [Brad] Knock-kneed would be the slang term
and then the LCL, the lateral collateral ligament,
does just the opposite, keeps it from going
in this way to get, if you're like, bow legged.
- [Bob] Bow legged, right.
- [Brad] So that's the anatomy.
- [Bob] That's the things that can get injured.
- Right, now we're gonna talk about symptoms
and there is somewhat of a clear difference in symptoms.
For example, meniscus--
- Or again, cartilage.
- Yep, or cartilage.
You like the cartilage, I like meniscus
but you're probably right, most people think--
- I think a layperson's gonna think...
- Yeah, you're right
but if the cartilage actually gets tore, it can flip over
and if you ever hear someone say "my knee locks up,"
and then eventually it unlocks
and then it feels pretty good again and they're fine
and then it happens again.
I had one patient, up and down steps, always locking up
and she did it right in front of me, I had some stairs
and she locked up and she went like this.
- And got it back in place.
- And then we're fine and I said we're done.
I did a few other things but I said you've gotta go
to the doctor, I feel confident it's a meniscus and it was.
The next thing is, usually a meniscus
does not have any bruising or ecchymosis, we call it.
- So for the recent injury, you may get some bruising
with the ligament but not as likely with meniscus.
- Also with the meniscus, it can kind of happen
without any particular reason.
Over time, it just starts getting sore
and then some little thing might happen or maybe nothing
and then it's just there
and you get the locking and whatnot.
- I'm just gonna add this too, Brad.
You know, if it's an acute injury, one that just happened,
you may hear a pop with the ligament.
You probably aren't gonna hear one
with meniscus or cartilage.
- Exactly right, very common with ACLs, you know.
People at football stadiums say, "I heard it in the stands!"
- I heard it in the stands, yep.
- Meniscus typically is not gonna have that
but also with ligaments, whether it's ACL, MCL or LCL,
usually it's a traumatic episode or incident.
Oftentimes it's sports but it doesn't have to be.
- Yeah they don't often tear over time.
It's usually, yeah like you said,
it could be an athletic event or trauma.
- Right, yeah a fall, et cetera.
Ligaments will feel unstable--
- When you're walking, right.
- Slow things down, that leg just does not feel,
you don't feel comfortable on uneven surfaces,
that kind of thing.
- And we should point this out too.
It's very common to often injure
a ligament and meniscus together in an athletic event.
- Right, that's a good point.
- The terrible triad, you can take it--
- Oh yeah, that's right.
Yeah and oftentimes there's gonna be a surgery
and they'll address it all while they're in there
and take care of it.
Now we've gotta talk about some tests.
So should we go through the meniscus first?
- Sure.
- Now these tests, there's three of them
we're gonna show you, you can do all by yourself
and they're relatively easy.
I like to do them, I use them on my patients
on a regular basis.
The first one is the Thessaly.
- Sure.
- Okay, so Bob's gonna do it and I'm gonna do it.
First of all, you do it on the leg that doesn't hurt
and see how it responds and then the knee that does hurt.
You're gonna stand on one leg, have the patient
hold on to the wall or you may have a stick or whatever.
Bend the knee five degrees, which if you see--
- Very slight.
- Yeah, you just get it so it starts to bend
and then rotate your body like this.
We call this, like in the other video, the disco dance.
- Yeah and think about, you're grinding the joint together
while you're doing this.
- And that's kind of an overstatement.
Hopefully you're not grinding it, if it's a healthy joint,
it's not gonna be a problem.
If you do have a meniscus or a cartilage tear,
it may cause problems and cause pain
and then you're gonna go to 15 degrees,
just a little bit further, not a lot
but just like what Bob did, repeat the test,
looking for a problem or a tear in the cartilage
in a different area.
Now if it hurts, it's positive,
if it doesn't hurt, it's not.
The next one,
Childress, Childress sign is I call it the duck walk.
So feet are about a shoulder width or a little wider,
keep your toes in a natural position.
Mine go out more, some people will be more straight.
You're gonna bend the knees,
about 'til you're in this position
and so at that much flexion in the hips to the knees
and you simply do the duck walk
and you only take about four, five, six steps
and if that creates pain in the knees,
that's a positive sign.
Now with these meniscus, we're going through
three signs or three tests right there,
that you can do at home. I've got one more to show you.
Oh Bob, we might've did this a little early.
Oh that's right, oh no it's not, I'm sorry.
- No it's not early.
- Yep it's called the pair sign and this one, you lay down,
you can do it on the floor.
Take, this is the knee that's suspect of an injury,
put the foot right there on the knee
and let that leg drop down, just by gravity
and that stretches the knee and if that also creates pain,
if all three of those tests created pain,
it's a pretty good chance you got a meniscus injury,
not 100% but fairly good.
- [Bob] Or cartilage or,
as some patients call it, cartridge.
(laughing)
- In your cartridge.
- [Bob] Yeah.
- Exactly.
I'm gonna show you, shall we show them the two tests?
- [Bob] Sure.
- These are two tests that you probably are not gonna
do at home.
- You want to get in position for the Apley?
- Yeah, we'll do the Apley's.
This is what a therapist or a physician may do with you,
just so you know.
This is called the Apley's Compression Test.
This is the knee in question, a towel roll,
I've got a nice cushion here, I put right there.
That just keeps it a little more comfortable
for the patient and what I do is, I put pressure down,
I rotate and then I go down like this with pressure,
with internal rotation and external rotation
and that will become uncomfortable and the patient will
complain of pain with that and that would be positive.
The next one is the McMurray's test.
- Watch my microphone.
- I gotta shift you over a little bit, Bob.
If I can squeeze in, all right.
This one, again, therapists or doctors,
it takes some practice on this one.
We're gonna rotate the leg and I gotta be honest with you,
I don't use this one very much and I never have
since I learnt it 'cause I have a hard time with it.
- Sure.
- You drop it down, I have seen some surgeons do it
on a regular basis, they get real good at it.
I've had really good luck with my other tests
that I feel confident without it.
- You know what I do, Brad, when I do this one is
I actually put my hands right on the joint.
- Oh you do?
- And then you can feel clicking.
- Oh okay, so you're feeling around that joint.
Which, you know, to know where the joint line is,
that takes practice.
Most people cannot just say, "oh there it is."
I remember learning that initially as I...
- Yeah, so it's kind of a tough test to do.
He's turning it, grinding it.
- Yep but they may do that to you.
Now let's look at the ACL, MCL, PCL--
- Sure.
- And LCL tests.
These, you're pretty much you're gonna be a therapist
or a doctor to do.
It takes a little bit to learn it.
I'm gonna show you two of them for, well one for the ACL.
- And actually, a lot of times you'll do it on the good leg,
the non-involved leg first, just to see
what normal feels like.
- Right.
- And then you test it on the involved leg.
- So if this is the in question leg,
I'll do the other leg first but the exact same thing.
I'm gonna grab under here and this is called
the anterior drawer test and I'm gonna pull this way
and that's gonna see if the, that's gonna test the ACL.
My thumbs right here are on the joint line
and you can actually feel movement.
I can feel Bob's tibia come towards me as I pull on it.
- And if it's tore, it's gonna move more on this one
than it would on this one.
- Exactly and you can feel it
and there's not always pain associated with it either,
like you may think there is.
Then the PCL, which I've never worked
with anybody with a PCL injury.
- I haven't either, to be honest with you, Brad.
- Yeah but it does happen, not very often.
You simply push this direction and compare the good one
to the bad one and you can palpate the joint line
and see if there's more mobility.
Now the LCL and the MCL, can you scooch over this way, Bob?
- Sure.
- Usually they take you to the side of the bed,
I'm gonna do his LCL first.
Can you just relax, Bob?
There you go, thank you
and we do a little bend on the knee and I'm going to push
this way with this leg or this hand
and push this ankle in this way to this hand
and we're stressing that ligament right there.
You're pretty tight, Bob.
- I got good ligaments.
- I don't feel anything there.
- Never had any trouble, always look good.
- Now normally, I'm gonna, normally I'll do the MCL this way
and the MCL, I don't know if that one is injured more
than the LCL or not.
- I think it is often with other ones.
- I'm going to--
- With the ACL.
- Oh right, I understand what you're saying, a combination.
Along with possibly meniscus.
Normally I stand in front but you can't see what I'm doing,
so I'm gonna do it here and I'm going to hold here,
slightly flex the knee to about five degrees.
I'm gonna push out this way, so I'm pushing his leg
out that way and then I can assess
the integrity of that ligament there.
Again, done by a therapist or a doctor
and you'll know what they're testing for.
- But you can see that they're just putting
stress on the ligaments and if they're tore or stretched,
there's gonna be a lot more movement in this one,
the injured one, than the non-injured one.
- Exactly.
- So and that's the problem is the knee gets sloppy then
and over time, if you don't repair it,
it can put more stress on the cartilage and wear it out.
- Yeah, premature arthritis,
could lead into other issues there.
- Yeah I have two friends that had ACL tears
and didn't repair them, one was a physical therapist
and he's now had a knee replacement
and the other one, he's a friend
and he's had a knee replacement.
(laughing)
So you get to our age, it starts to show up.
- And a knee replacement, I think they take the ACL out
and it's non-existent, so they didn't have to do that
on that part of the surgery.
I wonder if they gave him a discount.
- That's right, I doubt it.
There's no discounts in this world.
- All right, very good.
Good luck with your knee pain assessment.
- Yeah, thanks for watching.
(gentle beats)