♪ Bob and Brad, ♪
♪ the two most famous physical therapists ♪
♪ on the internet ♪
- Hi folks, I'm Bob Shrum, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our own opinion, of course, Bob.
- Five signs your knee pain is a meniscus tear.
We're gonna show you self tests for your cartilage.
This is actually an updated video.
We did it once before.
- Right.
And we're gonna do it better this time.
- We're gonna try improve upon it.
- Absolutely.
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promotions, Brad. - That's right, Bob.
Okay, and now, and at the end of the video,
we are gonna add in a bonus,
we're gonna show two range of motion exercises
for the injury, as well as strengthening.
So, hold on for that.
So, let's talk about meniscus.
Meniscus is always hard for me to explain
to a patient, unless I have a model of the knee.
- Sure.
- So, we're gonna start out with Sam first.
And we're gonna go down to his knee,
and this knee is just bony.
We do have some ligaments and some soft tissue on this one.
So, this represents the patella,
or the kneecap, with the tendons going to and from it.
We're gonna remove that.
- [Bob] You got that?
- And then you open the knee up, if you will,
it doesn't actually work this way in real life,
but so you can see right here is
a meniscus and here is a meniscus.
Here is the ACL, by the way.
We're gonna show you this model,
which would be--
- [Bob] Pulled right off of there.
- Yeah, pull it off so we can get a better view.
So we're gonna come in a little closer.
All right.
How are things looking, Jesse?
We've got it all in focus?
All right, so, here, we've got the femur,
the top, where the cartilage is, where it actually comes
in contact with, now, this blue is the ACL,
we know what it is, we can ignore it.
- [Bob] That's a ligament.
- Yep.
Now, this pulled up like this.
I'm gonna push it down.
That is actually the meniscus.
- [Bob] Or the cartilage.
- Or the cartilage.
And it's sandwiched between the tibia and the femur.
And it doesn't pull up like this, unless you have
an injury, a tear, it could be pulled up like this.
And if you look here, this black line represents a tear.
Sometimes when it tears, it can actually fold up and over.
And when that happens, the knee can actually lock up.
And I've had many patients say, "You know,
"sometimes I'm walking and it hurts really bad
"and I can't move it, and then I kinda wiggle around
"a little bit and it'll release,
"and everything is okay again."
- [Bob] Right.
- [Brad] And that's when that flap kind of flips over
and it locks up and then it gets back
into place, so to speak.
You could have floaters in there,
a piece of meniscus could actually break off
and float around in that knee capsule.
So, there's a number of things that can go wrong.
- [Bob] And by the way, that is one
of the indicators that maybe surgery is okay,
is if your knee is locking on you.
- Sure, right.
- If it isn't, and you have a meniscus tear,
most of the times the recommendation is not to have surgery.
- Sure.
Leave it heal.
- Leave it heal.
- It is a slow healer, there's not a lot of--
- A lot of 'em won't heal.
- Right.
- Some of 'em won't heal, but you're better off not going
in and having surgery, 'cause you're gonna be the same way,
if you have surgery or you don't
have surgery on some of the tears.
- Right, right.
But the locking is one of those things that--
- Then they say maybe have surgery.
- Okay.
So, what are we gonna do to test for this?
Now, again, the first sign is the locking.
That's one.
We're gonna go to number two.
These are all tests that you can do at home, by yourself.
I use these, I didn't use these initially,
when I was practicing, but after a few years I started using
these and they're easier, and I find
that they're very accurate.
You're gonna sit down?
- No, I'm gonna hold onto the chair.
- Oh, okay.
The first one is called the Thessaly.
Now, you're gonna stand on one leg.
So, Bob and I are gonna be doing it here.
And then you're gonna bend the knee five degrees.
- Just slightly, just slightly.
- Just unlock it, basically.
And then, keep your foot planted
to the floor and rotate your trunk
and your hips and everything back and forth.
If you experience pain when you do that,
that's a positive sign.
It doesn't mean 100% sure you have a meniscus tear,
but it's a positive sign.
- It's leaning towards the fact that you might.
- Right.
Then, bend it a little bit more.
Now, we wanna go 15 degrees.
That would be way too much.
15 degrees is not much more than five degrees.
Just a little bit more, and then rotate again.
You're testing different areas of that meniscus,
when you're flexing it a little bit more.
- Now, this would hurt, also, in somebody
that has arthritis too.
You're grinding the joint.
- Right, that's a good point.
So, that's where the symptoms can overlap.
- Right.
- And that's why this isn't always easy.
But also do it on your other leg.
- Yep.
- Do it on both, and then you
can compare and contrast between the two.
The next one, the Childress sign.
I call it the duck walk.
With my patients, I say, "We're gonna do the duck walk."
And I'll say--
- I'm gonna let you do it, do it this way, Brad.
- Oh, okay.
Well, I'll start this way.
So point your toes out, shoulder width wide,
or a little bit more.
And then squat down.
You can go down, almost to your elbows,
can go on your thighs like this,
and good posture, of course.
And then, you simply walk like a duck.
I remember one patient I had, this was my benchmark,
he came in and he couldn't do this.
And then, after we did some exercises, within a couple
of weeks, he could start doing it with no pain.
- [Bob] Interesting.
- It was very clear, progress was being made.
- Sure.
- The next one is that EGIS sign.
And, again, we're not sure
about the pronunciation on this one.
- Sure, E-G-I-S?
- Yeah.
- Okay.
- Yeah.
This is one I typically don't use,
so I didn't dig into it very much,
but it's similar to the one we just did.
- I don't even know it.
Yeah, I don't know what it is.
- You're the one who showed it on the first video.
- Did I really?
(laughs)
- He doesn't use it either, but you can,
you simply bring out your toes like this
and you squat down about to here.
So, we're not going just a little squat.
You're gonna go down and then up.
- [Bob] Yeah, I see why we don't,
because it's like the ducks, you know,
the duck one. - Right it's very similar.
- Very similar, yeah.
- The only thing different with this one
is this tests a different aspect
of a meniscus as you go with the toes in.
I have done this one with patients.
- [Bob] I do remember this now.
- With patients, but I don't like it,
'cause, like with myself, I feel uncomfortable doing this.
I have healthy meniscus.
So, I'm so confident on the Thessaly and Childress.
- Sure.
- And I do an Apley one, which more is for the PT.
And then, the PAIR sign.
I'm gonna have to lay down for this one.
- Yep, go ahead.
- This one's a nice one to do on your,
oh, look at that, a pen in my pocket.
- [Bob] Yeah.
- Thanks Bob.
If it's my right knee, that's in question,
first I'll do my left leg first.
But the way it's done, the leg you're not testing
is straight and you wanna be,
you could do this in bed, carpeted floor would be better.
Put your foot so it's right on your knee.
And then you're simply going to drop down like this.
And just let it go down.
And, that puts a little stress on that meniscus.
And if it's painful, when you do that,
and the other one isn't, that's a positive sign.
So, for example, if you did the Thessaly tests
and it was negative, they didn't hurt,
but the Childress was positive, the EGIS
and the PAIR sign were all positive,
now that's a pretty strong sign you have a meniscus tear,
but not 100%, but it's leaning pretty strong.
- [Bob] And now when, at least when you go in
to see the doctor, if he does some
of these tests, you know what he's doing.
- Exactly.
- Or she's doing. - And if you're
functioning fine, but you have
that pain and that you'd like to get rid of it,
then these exercises are gonna be, can be very helpful
to get you into a hundred percent road
of recovery. - Which one do you wanna show
first, Brad?
- Well, why don't, let's do
the range of motion one, the Mulligan one.
We'll need a chair for this.
Before you do this, if you have
a difficulty extending your knee straight all the way,
or bending it all the way, that's
the first thing you'll have to address,
is get the range of motion back
and then we'll go on to strengthening exercises.
So let's say it's not bending all the way.
- And a lot of times what you can do
is you can test it by bending it this way.
Let's say this is the involved one,
the one that's bothering you.
And, this is your better one.
And you can test 'em a little bit to see,
and you'll feel it.
You can feel the difference between the side to side.
One just doesn't feel like it's going as well.
So let's say, I'm gonna start with this one.
What I'm gonna do is I'm gonna actually take my hand,
I'm gonna wrap it around the tibia and the fibula.
And I'm actually gonna rotate.
I'm turning my bones clockwise.
So if you're on the left leg, it'd be clockwise.
If you're on the right leg, it'd be counter-clockwise.
- Right.
So, actually, if you could see this,
he's kinda trying to grab the tibia, as you can see.
- Turn it, yeah.
- And you're not, I'm exaggerating here,
you're not gonna get near that far, but that's
the direction, a slight internal rotation, we'll call it.
And then, once you get that established.
- I turned it, and then I start trying
to bend a little bit more.
Now, this should be painless,
it should not increase your pain.
- Right.
If it does, you do not do it.
- You do not do it.
- [Both] Right.
- And, this is a movement, believe it or not,
it's called an accessory movement.
This is a movement your knee normally does, anyway,
it does turn, internally rotate a little bit.
- With flexion.
So, you're helping it along.
And I've had people that have had meniscus problems
and they did this and they got more motion
and it decreased their pain.
It just, for whatever reason, it works at times.
So, it's definitely one I would try.
- This actually works really well
if you have a stairway at home, 'cause you
have different level steps.
And, you know, you got the wall
and possibly the handrail that you can,
if you need it, have a balance issue,
you can support yourself.
- I just thought of another one, Brad, too.
Why don't you to show the knee extension?
- Okay.
- And I'll show another flexion one.
Just a real simple one, then.
- Ooh, a light went off in Bob's head.
- Yep, it did. - That's exciting.
- [Bob] It doesn't happen very often.
- The next one, you can do in a chair,
or you could do this one in bed,
but I'm going to just show you
in a chair 'cause it's convenient.
You could put a pillow down.
I just have my Pete's Choice balance pad,
'cause it's comfortable.
Or you could actually just do it on the carpet.
But what we wanna do, let's say
your knee does not fully extend,
and that's the one that hurts, but the other one does.
And it's like, ah, it doesn't feel right,
it doesn't fully extend.
So we're gonna help it out by giving it
a little passive range of motion.
You can just above the kneecap,
you're gonna put pressure down,
and go pressure on, pressure off.
If it hurts when you do this,
and it just doesn't feel right after
a couple repetitions, you're gonna stop.
It should only continue if the pain gets better
and you get better range of motion.
But you can actually rotate your toes
to the outside, or to the right,
if it's for your right leg, and do the same thing,
and you're just coming at that joint from a different angle.
And assess that way, as well as going the other way.
So we'll be going straight, over
to the right, over to the left.
And you're gonna do the stretch
that makes it feel better and allows it to straighten more.
I do it five to 10 repetitions.
If it creates pain in one direction or,
if, possibly in all three, then you would not do it at all.
- Right.
And now, just real quickly, Brad,
I'll show another one for bending the knee.
Again, if you're lacking flexion.
You just take a towel,
and you put it between the calf and the hamstring here.
And you have a little bit of a bunch there,
and you go like this and it gaps.
- Gives a little distraction.
- I've seen Mulligan do this,
and I've seen Mackenzie do this.
- Okay.
Those are, if you're in the therapy world, you know,
those guys are icons that have been around for,
they've been around forever.
- I shouldn't say Mulligan.
I think it was just Mackenzie, to be honest with you.
- Oh wow, yeah
we better be accurate. - Sorry I gave Mulligan
kudos there.
And now, were you gonna show a couple
of strengthening exercises, Brad?
- And this would be done on a carpeted floor.
You could do it on a bed,
but a floor probably a little bit better.
And we just, and this is particularly
if your knee is still painful and it locks up, possibly,
and it's just not good enough
to do squats or normal exercises.
We're just going to simply say this is the knee
that has the problem, the pain.
I'm going to keep the leg straight.
My quads are tight.
And simply do straight leg raises up and down 10 times.
Good control, don't do 'em too fast.
Don't let your foot touch the floor every time,
it's suspended for 10 repetitions.
It's amazing.
This looks easy, but I'm feeling my quad.
- [Bob] Yeah, it works.
- And if you wanna go more
than 10 repetitions, you're welcome to.
If you wanna put an ankle weight on, you could do that.
- [Bob] It's a great way to keep
the knee strong while it's trying to heal.
- Exactly.
The next one is do the hip abductor.
Now, I'm gonna switch legs so I can talk
to you and see the camera at the same time.
Let's pretend this is the knee, now, that has the problem.
We're going to go like this.
And, you know, this is probably more
for the hip abductor, which is incredibly important
for walking and stability, which does influence the knees,
so you wanna keep it going as well.
- [Bob] Absolutely.
- Notice my toes are not pointed up,
they're pointed straight ahead.
And, I don't have my leg out in front of me,
it has to be in a straight line with my shoulders,
if we were looking from the top down.
- [Bob] Got those nice stripes on your pants, Brad.
- Well, those are racing stripes, Bob.
- [Bob] There you go.
- That's 'cause I'm a really fast runner.
(laughs)
I sound like my grandson.
And then, we're gonna do this.
Now, you can do this one with your knee bent, like this.
Be careful for a hamstring cramp,
then you would keep it straight
and then reduce that possibility.
And that really works at glute and some hamstring as well.
- [Bob] Some hamstring, which crosses the joint.
- And do 10 to 15 of those.
And, it's amazing, that little bit
is harder than you'll think. - Yep, makes a big difference.
And again, by keeping the hips strong,
it's gonna affect the knee, but it's also,
some of the muscles cross the knee.
- Exactly.
(mumbles)
- Brad and I can fix just about anything.
- Bob, that was a long video, look at that time.
- I know.
Remember, Brad and I can fix just about anything.
- Except for
- a broken heart.
- There you go.
- But, we'll work on that too.
- And yeah, we're not gonna stop.
We'll be 'till that thing goes to 30 minutes.
That'd be a long video.
- Thanks.
(soft tones)