♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
(cheerful tone)
- 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. - Today, we're gonna talk
about what is causing your knee pain.
Is it patellofemoral pain syndrome or kneecap pain?
How to tell, we're gonna show you some tests
you can actually do. - Right, one way or another,
it's knee pain. (laughs) - Right.
So patellofemoral pain, patella is the kneecap, by the way,
and femoral is the bone right here underneath the kneecap.
Used to have it in there. - Part of the femur,
the big bone above.
- So patellofemoral pain syndrome is an umbrella term
or garbage term, as they might say.
- Garbage term, wow.
- Yeah, have you heard that before?
- Well, yeah, I didn't realize it was applied
to this particular name.
- Well, it's for any pain that arises around your kneecap.
So it could be a lot of things,
but we're gonna tell you generally what it is.
It's generally felt in the front of the knee
around the kneecap.
It's more common in people who participate
in sports or running, obviously.
So kneecap pain can be caused by trauma.
I mean, you could get a blow right to the knee itself.
You could fall on it, or someone could take a baseball
to your knees, baseball bat. (Brad laughs)
But the more common reason why you're having pain-
- What kind of sports do you play, Bob?
(both laugh)
I'm sorry.
- So the more common reason for the knee pain
is actually there's a little groove here.
Oh, you're gonna show on this one, Brad.
This one's was better.
- So here's the kneecap.
This represents a tendon,
because a kneecap,
the patella is actually part of the tendon
from your quadriceps to where it connects below here.
But if I flip this over,
so you can see the patella - There's the kneecap, yeah.
- And then here's the-
- The groove. - Yep, the groove,
the condyles I call it.
It's the end of the femur,
and those, they're kind of a red or pinkish marks
I put on there, that's where the contact
like this contacts here, and this contacts here,
and this patella slides up and down
as you flex and straighten your knee.
And if everything's going right mechanically,
the kneecap should fit right in that groove
and be nice and smooth,
but there can be problems
where the kneecap shifts one way or the other,
or you could have some arthritic problems and degeneration
of the cartilage.
And as it slides up and down there,
it's rough and it's painful.
And that's where I think Bob was saying
you got that garbage can term.
Is it from arthritic problems?
Is it a mechanical misalignment or from a trauma,
getting a baseball bat? - Or is it because your hips
are not aligned right. - Sure, right.
- Let's say your hip is lined up,
so it kind of pulls you out like this.
Now the kneecap's gonna wanna ride more inside.
Same with if you have flat feet.
You're gonna maybe go like this,
and now it's gonna ride more on the outside.
- Right, so the slang term is,
are you bow-legged or knock kneed.
- Knock kneed, yep.
- Yeah, those little things can cause this kind of problem.
- Right, so the key is actually,
when we do testing, is we're gonna see how it fits
in that groove and how it feels when you are in that groove.
So now the common signs of patellofemoral pain are
a lot of times when you sit for a prolonged period of time
with a knee bent, 'cause that kneecap is really up
against that joint then for a long time.
- There's a little more pressure on those tender spots.
- So if you sit with the knee bent more than 90.
Am I 90 degrees?
Here's a right angle like that.
- Like mine.
- Yep, you sit that way for a couple hours,
and then it starts to hurt.
It doesn't mean that it's this,
but it's starting to point a finger to it.
If you have like tight jeans on,
and it's really pushing.
against the kneecap - Pressure on that.
- And it hurts.
You know, those skinny jeans?
I think they come out now with the mom jeans again.
I can't keep up on it, fashions.
- I didn't even know what clothes I wear.
(both laugh)
- So pain going into or coming out of a squat,
which makes sense, 'cause that puts more pressure
on the kneecap.
Going upstairs or hills.
- Sometimes I've had a number of people
where up and down stairs hurts, but oftentimes, as you said,
going down is a little more painful than going up,
but we won't get into that
- When you're wearing high heels, Brad.
(both laugh)
- I quit doing that a long time ago.
- Or if you stand with your knees hyper extended,
so I used to stand like this.
See my knees go way back like this?
- Yep. - I don't know
if you can see it on this one or not.
- Well, you could take your pants off and show it, but we-
- I kinda lost it. - Yeah, we're not gonna.
- It's not as bad as it used to be.
That can throw off the kneecap and the joint too.
So here are the three tests.
If you have loose ligaments or are double jointed,
I want you to be careful on this.
You maybe wanna skip this test,
because I don't want you to push this.
We're gonna move this knee cap around in the joint.
Yeah, like that up and down.
And quite often in somebody who's having trouble with this,
it often is tight.
It may be tight one side to one direction,
or it might be tight globally,
which means in all directions
- Do you got plica syndrome in there?
You know, that's a common one
where it's tight one direction, particularly.
- Yep, so, Brad, why don't you show on your knee?
- So if your quadriceps are tight like that,
this won't work.
You have to completely relax these quadriceps.
And then you can see that kneecap.
A healthy kneecap will move
right to left quite a bit actually.
And it should not be painful.
If you do that and you push down...
You want me to talk about it? - Yeah.
- [Brad] When you put some pressure on there,
and you go back and forth and that's painful,
that's not normal.
And then you can go like here's my kneecap.
I'm gonna go up and down and check it that way as well.
That should be pain-free,
even if you put pressure on it.
You can do some diagonals on there as well.
There is a tissue called plica,
which is support on this side.
If that plica gets tight,
or we have some tight tissues here,
it can pull the kneecap one side chronically,
and then you get a malalignment
on the patellofemoral surfaces,
which can be part of the problem.
There's a surgery called a lateral release
where they go in there and they'll cut that plica,
so it allows the kneecap to go where it wants.
But you know there's a number of things
you can try before that.
- [Bob] I would say most commonly it is tight on this side.
So when you push the kneecap
to the middle, - yep this way, I
- it's tighter.
And you wanna compare knee to knee
And you may find if you have a painful knee
versus a non-painful knee,
although sometimes you have it in both knees,
this one doesn't stretch as well.
And look at the big kneecaps I have, Brad.
These are big ones.
- Yeah, the hyper kneecap, whoa.
- My wife says I have dinosaur knees. (laughs)
- Wait 'til you get older. (laughs)
- And Brad mentioned the kind of number two.
You can also push down on the cap
and grind it back and forth.
And you wanna feel, are you feeling pain,
are you hearing noises, crunchy noises?
That may be a sign of patellofemoral.
That's quite often what I would see, Brad.
- Did you have the test where you palpate underneath?
- Yeah, I'm not having them do that one,
because it's a little difficult to do.
- A little more advanced. - Yeah.
And the final one is you just squat down
until your levels are thigh.
Your levels are thigh. (laughs)
Your thigh level, thighs are level.
(laughs) I'll get it yet.
- Parallel to the floor or something.
- And increased knee pain could be a sign.
Well, of course,
that could cause increased knee pain for everything,
but it wouldn't feel good with patellofemoral pain.
Quite often, very common,
I had a daughter who had it in both knees, so it's not-
- At the same time? - Yeah.
- Ooh. - It's not unusual,
especially if your knees are the same.
But if you have flat feet,
that could cause the knees to go in,
and it could cause the patella to be farther out.
Next video, we'll show you some of the treatments
you could try for this.
So, stick around and check it out.
- I'm excited, Bob,
because I was just about to talk about treatments,
but now we're not going to.
You have to get it on the next one.
- Yeah, there you go.
(upbeat music)