♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- I'm Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our opinion of course, Bob.
- Brad is your knee pain
or anybody's knee pain is it really coming
from a meniscus tear or from a ligament sprain.
- How to tell?
- That's a good question.
- Yeah.
- As a matter of fact, some people,
I think you really need to understand the mechanics
and it's very, it's not that complicated
once you dissect it a little bit.
- Right.
- Well, that's what we're here for.
We're here to help dissect it.
- Exactly, say no more, Bob.
- Is it dissect or dissect? Nevermind.
- Say no more, Bob. Don't get,
I'm not an English major.
- All right.
- All right, Bob.
- So we're gonna look at the ligaments first?
- Well, yeah, let's look at the ligaments first
because so many people jump right to the meniscus,
I think, because I'm not sure it's just more popularly used
or something of that nature. But if it is a ligament-
- So someone hurt their knee and they're wondering
is it the ligament,
Is it the meniscus, or is it just muscle?
- And oftentimes people hear the ACL
which is one of the four major ligaments of the knee,
we wanna know about all four of them.
- Right.
- Okay, let's, here we've got our knee here
that we took from Bonaparte Leopold.
- Leopold, now you got me saying, Napoleon.
- Napoleon, okay.
- Napoleon Bonaparte
- So here we got the knee now.
- [Bob] Do you want me to hold anything?
- No, well, so far I'm doing good.
I'm gonna take the patella off.
- [Bob] So that's the knee cap.
He's taking that right off.
- Yep, just get that out of the way
so we can look in there, okay?
Now, we're gonna look at this.
- [Bob] So this is the left leg.
Here's the femur.
And here's the knee right here for me
so they can see, I think they can see that.
- And down here's the foot obviously.
So we're gonna focus in right on the knee.
And here you can see this is how the knee bends.
Now, if you look at the blue Kinesio tape
we used here cause it works well for this.
Those are your, this would be your MCL
your medial collateral ligament
- [Bob] Medial collateral ligament
- And your LCL, lateral collateral ligament.
Okay. Now the ACL and the, and the PCL are inside.
Yep. And I don't, it was really hard to,
it's hard to put tape to represent those.
So we're gonna show you how to test.
- [Bob] They're inside and they make, they form an X.
- Yep. So, and so you'll see that more clearly
as we show you the test.
Now for these ligaments you can see
they support lateral motion.
So this one's, your leg cannot go this way.
Now this tape is actually stretchy.
Now your ligaments are, they don't stretch at all.
- [Bob] Right.
- They they're very strong and they're attached
to the bone and it prevents this
from happening or this from happening.
Okay. So, and then the ACL and the PCL.
Bob, I've got one little thing here to do.
And while I do that, why don't you mention
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Right? Brad, we're likable people.
- Yeah. Please like us because I'm likable,
I don't know about Bob.
- Well, anyway
- Put a half a like
- We're giving away stuff all the time.
And right now I'm gonna put up a picture,
A photo, and it's the Napo memory foam
lumbar support pillow slash cushion.
It's for low back pain relief
for home, office, and car use.
And we're gonna be giving away three of these
Brad, can you believe that?
- Yeah, that's a good a deal.
- And we're gonna do that over the next week or so.
So all you're gonna have to do is go in
and like the picture and you're in the contest.
We make it very simple.
- Excellent.
- So, alright, now we're back.
- Okay. So we talked about the support of the MCL
and the LCL, which support the knee this way.
Now, if you look at the knee from the side view
we need support so the knee doesn't slip forward,
- [Bob] Forward or back
- Or backwards, so the ACL is responsible for
- [Bob] Forward
- This direction, so it doesn't allow this
to come off and then your, you would
have a big problem and get short in a hurry.
And then the PCL, posterior cruciate ligament
prevents it from going this way.
So we got support this way
and we've got support this way.
And now that I've got the knee apart, Bob
we may as well look at the meniscus, right?
- [Bob] Sure.
So those are the four ligaments that
you know that's the problem.
There's only four ligaments holding the knee together.
And that's why each one is so crucial.
- Exactly, exactly.
- [Bob] So then we got the cushions
between the joints right.
- Right, which is, we're calling them
- [Bob] Between the bones
- Between the bones, which is your meniscus.
And the meniscus is attached
to the tibia, the lower part.
And I've got it red here.
And in real life, it's actually white.
Okay. But this shows up much better.
And you got the lateral side
and the medial aspect of the meniscus
and it's shaped, they're shaped
kind of like this
- [Bob] Lateral and medial.
- Oh, I'm sorry. Sorry. I've got the leg mixed up.
Yeah. But their shaped kind of like a horseshoe.
And actually, if I would've did a better job
cutting my construction paper, you would see that here.
But the big thing is you know where they are
and when they come together that, that's
now we can't put 'em together like that
in the knee because we have
- Oh, well we can go like that.
- There you go.
The femur actually squishes down on there.
And there's a cushion between the two bones
and that's part of the job of the meniscus. So,
- So you can see if one of these gets torn
and even flips up like this.
- Yeah
- It's gonna block the motion.
- Yep
- And, and it's, it's gonna be painful.
- Right.
- And your knee's not gonna be able to move.
- Exactly
- And that's what some of the tests
are designed to pull out.
- Very good.
- Let's go to the, why don't you lay down, Bob?
- Sure. I'm gonna grab a pillow.
- Yeah. Grab a pillow, take a nap.
- [Bob] You never seem to be worried about my comfort, Brad.
- Nope. Not really.
- Not that I'm complaining.
- I'm not that, go ahead lay down,
I'm not that way with my patients, Bob.
I care about them.
Okay. Let's bring this leg up once.
- All right.
- Okay. Now I'm gonna do, show you the test
on the LCL and the MCL.
You wanna grab that again, Bob.
- So those are the ligaments on the side.
- Right, the side ligaments,
these tests are relatively easy to do
but they take a feel and we're, the knee's here.
We want test to make, see
if it's structurally sound in that direction.
They're easy, relatively easy to do.
But if you haven't done this on a number of legs
you don't have the right feel.
- Right. Right.
- So I'm gonna demonstrate it to you.
I don't suggest that you do it
but when you go and see a therapist or a doctor
you're gonna know why they're doing it and understand it.
- And maybe even ask for them to do it.
- Exactly. Why don't you come over this way, Bob?
I always like to have my patient get close to the edge.
I bring their leg off. I have them relax.
I put a slight bend in the knee,
and what I'm gonna do here.
Let me get over here.
I don't do it this way, but so you
can see what I'm doing.
One hand is here and one hand is here
and I slightly bend the knee
and I'm gonna pull in on the knee here
and support here and go like this.
And actually I can, you won't be able to see this
but I can feel there's some play in Bob's knee.
You feel that Bob?
- Yeah, a little bit.
- It's kind of fun.
Now that's the LCL, the outside one.
Now I'm gonna do the same test.
I'm gonna push this direction while I support the knee
with a slight bend in it about 10 degrees.
And it is kinda neat.
And, and there's not a lot of effort.
It's very little strength needed.
If someone has a complete tear
of one of these ligaments, like my instructor said
it's like a barn door opening wide up.
You can do this, you don't feel that
- Resistance
- That resistance, the best way to do this,
If you've got a sore knee on the right
test the good knee first
- Exactly
- Get a feel for how they are on the good knee.
Then you'll know and more, you know
if two knees are healthy, they're gonna feel similar.
And if you got a complete tear
it's gonna be pretty obvious.
Maybe a little painful too.
And these tests should not create any amount of pain.
If they are, you don't do 'em.
- Right.
- Now let's go to the ACL and PCL.
- Sure.
- I'm just, there's a number of ways to do this.
I'm just gonna show you two simple ways.
I have the patient sit or lay down like this
and then I sit right on their foot right here.
And I'm gonna bring your pant leg up, Bob.
So we can look at your knee.
- So again, he's just, he's pulling
that, that lower bone forward.
- Exactly. Yeah.
We'll look at this
- So I can hold this part.
- Yep. I'm gonna pull his tibia this way.
If the ACL is torn, I'm gonna get quite a bit of
- Motion yeah.
- Subluxation this way.
And I'm gonna go the other direction to test the PCL.
Okay, now
- You call it the anterior drawer
cuz it's like you're pulling out a drawer.
- Exactly. And anterior means forward direction.
- Right.
- And sometimes right here, I'll push my finger,
My thumbs in right along the joint line
which is just below the, the kneecap
which takes a little practice to know where that is too.
So don't expect you can feel that.
And then I'm gonna come under here
put my thumbs in the joint line
so I can feel the translation between the joint.
And I'm gonna pull this way.
And, and you know, Bob, doesn't have a lot space.
Some people that are lax, you can do this and they'll go
you can feel that bone move.
And it kind of goes clunk, clunk, and that's normal.
- [Bob] You can almost see it even.
- Yeah, exactly.
Again, do the good knee first.
You go to the, then you go back to the, the knee
the injured knee and assess carefully.
And then you're gonna push this direction
on the tibia this way and push.
And you know, I don't know
if I've ever seen a PCL cuz they're not that common.
- [Bob] No they aren't. I haven't, to be honest with you.
- Actually I think I did once when I was a student
and that was a long time ago.
Then you can push in this direction
and the translation will go this way
but it's gonna be solid this way.
There's, I'm not gonna go through the Lockman's,
it's a common one, it's probably more commonly used
by therapists and doctors but we're gonna skip that.
- [Bob] Sure.
- Cuz' I wanna get to the meniscus tests.
Now, if, if everything feels similar on both sides
you're thinking, well I'm clear.
And after you do these for a while
- You're clear for the ligaments.
- You can whip through these tests pretty quickly.
- [Bob] Yeah, exactly.
- Okay. Now the meniscus, why don't you stay down Bob?
- [Bob] All right.
- These are the meniscus tests I do laying down
And I think they're a little harder
to do for the average person, I wouldn't recommend it.
But I'm just gonna show 'em to you
so that you know what may be done in the clinic.
- [Bob] Sure.
- Why don't you put this leg down.
Did you ever do the McMurrays?
- Yep.
- Okay.
- [Bob] Absolutely.
- So we start here and we do a rotate
and push in one direction.
- [Bob] Yeah.
- And, and the person needs to be relaxed.
- [Bob] And that's getting, that's checking
the lateral meniscus, yep.
- Yeah, and here and then go the opposite direction there.
So I'm making a kind of a circle
this knee in over his other leg
and then we're gonna do the same thing
out this way and let it drop.
- [Bob] And I usually put my fingers
on the joint line
- Right in here.
- Yeah. So I can feel whether or it's really clicking.
- To be honest with you
I don't have a good feel for this one.
I like the Apleys test, which I'll do next.
- [Bob] Sure.
- Oh, the other one that is the, the drop test.
- [Bob] Right.
- Where you just keep, let it go straight in
and then the patient or you have to relax
and you just plop it down like that.
- [Bob] And you're expecting pain.
- Right.
- And this one, have you used this one?
- [Bob] I have not.
I know we demonstrated this one before.
- Yep. Yep.
And I don't use this one either, I really
- [Bob] It doesn't hurt if you have a good knee.
- I like the weight-bearing ones
and this Apley one I like
cuz' there's some weight-bearing I input.
Do you wanna lay on your stomach Bob?
- Sure.
- Okay. So normally on this one,
let's put this leg down.
I'll roll up a towel and put it right here
to keep the kneecap from banging into the, the table
or not banging, but pushing into it, it's uncomfortable
or I'll have the person lay down,
slide down to the edge of the table.
I'm not gonna do that
cuz' I don't wanna get outta the end of the screen.
So we're gonna pretend I've got that towel roll there
and I'll push down, rotate the knee in and come this way.
And then I'll rotate the toe the other direction
push down, push, push, push
It'll lock up, it'll be painful.
And if, if it feels as good as the other leg,
you get into the good leg first
you know, that's a negative sign.
If you feel pain or some locking, it's a positive sign.
Okay, Bob, let's get up and let's do one more.
Couple more.
- Yeah. Why don't we show ones that,
that you could do yourself pretty easily.
- Yeah. These, these are, okay.
- Yeah.
- And the Thessaly test, that's that name that
- Yeah, Thessaly.
- I'm not sure if I've got that right.
- Right.
- But this is the disco
- Right.
- The disco test.
You just, if you face that way, Bob
I'll face this way.
Let's do it on our left leg.
You're gonna stand on your left leg.
- [Bob] You bend the knee a little bit
- [Brad] About five degrees
- [Bob] And you're twisting. And if that hurts.
- [Brad] Yeah, we can, we should bring Julie in here
and see if it hurts on her,
she's got a bad knee.
- [Brad] And then you can go down to fifteen degrees
which is a little bit more.
But you know, you're not going
way down this far on this test.
So, and it's again, is that twisting
you all you do is
- [Bob] Really grinding the patella
or the meniscus together.
- [Brad] Exactly. Matter of fact, my friend,
this is a test I used on him
and he was positive on both this one
and the next one, which is the,
- The duck walk.
- Yeah. Yep. And so we were like this.
- Yeah.
- And like toes rotate out, bend the knees
down in a deep squat and you try to walk.
- [Bob] Yeah. And believe me
you're grinding the knee on that one.
- Yep, or you can do the toes pointed in
and he tested positive on both these standing.
- He did.
- And we did it right in his office and I said
you should get to a doctor.
He did, he had meniscus.
He had surgery already and actually
he's rehabbing it right now.
- Yeah, it, it works well that test
easy to do on your own.
- Exactly.
- So all right, folks, thanks for watching.
- Good luck with those knees
whether it's ACL, PCL, or meniscus
or, you know the other thing Bob,
that we've really been working on
and this is more important than the knee is that
- Broken heart
- Broken heart, there you go.
- We'll get on it.
- Yeah
- Thanks.