♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Howdy folks I'm Bob Schrupp physical therapist.
- Brad Heineck physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion of course Bob.
- Today we're talking about top three signs
you have an ACL tear.
These are tests you can do at home.
This is actually an updated video,
we did it before
we're gonna add a few more things.
- And it's updated,
it's wonderful.
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- There you go, ACL, ACL tear.
- Anterior Cruciate Ligament
- Right and we're gonna explain
why it's called that in just a second.
But first, we're gonna look at the knee itself.
Now this is just a model of the knee,
if this was my knee and I took the skin off
and a lot of the soft tissue.
- It would be that knee.
- Oh, sorry you're right it is the right knee.
Good call Bob.
But if we take the muscle off the bottom here
we got us some quadriceps muscle here,
and here is the kneecap which is part of the tendon
of the quadriceps actually.
And we're gonna lift the knee cap.
- [Bob] The patellar tendon.
- The patellar tendon and here we go.
We're gonna get a close up so you can see.
This is kind of a hard ligament to describe
where it is but it's in the knee.
We're gonna open the knee up,
this just happens when you bend your knee.
- [Bob] Can you be the holder or you got it?
- [Brad] Nope, I got it.
The blue, now your ligament isn't blue in real life.
We did it so you could see it.
It is a white color, but actually goes in,
it starts in the tibia and it crosses over to the femur.
And then there's a PCL that,
and that's the cruciate part to actually make a criss cross.
- [Bob] Yeah to make a cross.
I think cruciate means cross.
- [Brad] Right and it's hard to see that part on here,
but that's the location.
Now we're gonna show you what it's job is.
- What it's job is to hold the knee in place.
- Exactly, wait Bob, wait, before we go any farther,
I forgot to think about this.
- You've thought about it.
- Nope, actually we're gonna not show what it does yet,
but we're going to get to that.
Because three signs, one of the first things
we're gonna do is what happens if you injure your knee?
Number one, audible pop.
- Yeah if you injure your ACL,
quite often. - Thank you.
- Especially if you tear it.
- I thought you were gonna carry on.
- Oh no.
- Also typically a lot of pain associated with ACL tear.
When the AC ligament tears,
there can be some internal bleeding.
That bleeding will come out
and you'll have that ecchymosis or that deep color red,
purple bruising around the knee.
After the acute phase and the frowning goes down,
a few days later, a week later,
you start walking around on it, it feels unstable.
It just doesn't feel, it may a clunk a little bit.
- Funny I'm old enough now that I had a friend who,
I had two friends with ACL tears
and they didn't have them repaired.
And both of them have knee replacements now
because if the knee is not stable,
it's gonna grind around
and it's gonna grind down the cartilage.
- Right, yep and there you go, you got to be replaced,
so you can live without an ACL
and it's not the end of the world.
You could still function.
- But your knee is unstable.
- Right, exactly, which leads us to the next point.
What kind of people typically have an ACL tear?
So I did a little research on this
and sure enough we're gonna share it with you
and this kind of will help give you an indication
whether yours is tear or give you what the odds are.
First of all, the knee is the second
most injured part of the body.
Second to that ankle. - The ankle at number one.
Those ankle sprains are so common.
- And this is a general statement,
but if you go to ACL tears,
majority are with sporting activities.
By the way. 76.6 now this is a study
done over five years with athletic people,
76.6% had surgery from as a result of the tear.
As far as how they happen, player to player contact, 42.8%.
37.9% injured without contract,
which happens a lot of times with basketball,
particularly with females,
which you're gonna get up to next.
- [Bob] I've seeing a number
of them on site when it happened.
- [Brad] Yep, exact so have I.
Both of our daughters play basketball.
- [Bob] Right, right, right.
- [Brad] Exactly, ACL tears with girls in sports.
The two biggest sports, basketball,
which we already mentioned, and soccer.
Actually with boys, it's football and soccer
and actually boys have a low incident
of ACL's playing basketball,
which I thought was very interesting.
- [Bob] That is interesting.
- [Brad] Yes, we're not gonna get into the reason
why girls have it more,
but there's an anatomical.
- The shape of the bone and stuff.
- Yep, exactly so that may give you an indication
if you're active, you're a female playing basketball
and happened to be hurt at basketball,
chances are a little higher.
Now, the next thing that we're gonna show you
is two tests that doctors or therapists will do.
You can do these at home with another person,
but you're gonna have to pay close attention
and 'cause there's really no real harm that can happen here.
And it may or may not be accurate for you to do it.
- Yeah, it needs a little bit of skill set here,
but it's certainly, it's worth a try.
- Yeah, you can certainly do it
and these are what the doctors
and therapists are gonna do
and then you're gonna know exactly why they're doing it.
- At least you'll have some knowledge going into it.
- Exactly Bob.
Now what I do, we're gonna use Nepal, wait, Sam.
- Sam, yeah.
- Sam, we're gonna use Sam here
so we can show how this works.
Now these tests, the person with the injured knee
is laying down on their back,
nice to put a pillow under their head.
And the first one is called the Lachman's test.
Now, I don't know if you, Bob,
when I was in school a couple of decades ago or whatever,
this was known as the gold standard test for the ACL.
- [Bob] Interesting.
- In other words, it's used a lot
and pretty well dependent on.
Obviously now MRI is gonna be the conforming thing.
But as far as the manual tests,
this is still used a lot.
So the knee is like this, the person's laying down,
the other leg can be straight,
it doesn't matter on this test.
Now what that ACL does,
it prevents the tibia from translating
or moving forward like this.
That's its job.
So what we're gonna do here,
typically I do this test like this on a patient,
but you won't be able to see what I'm doing.
So I'm gonna, the hand placement's the same.
I'm just gonna do it from the other side.
One hand supports the femur,
wraps right around below the knee cap.
You got a good hold of it there.
Typically, my knee is gonna be underneath right here.
- [Bob] You'll show it on me, right?
- Yep, I'm gonna show it on Bob
and then we're just gonna simply pull out
and you'll feel translation.
If it's a torn ACL, first you do it on the good leg.
- [Bob] Right, that's what I was gonna say.
- [Brad] Exactly.
- [Bob] Everybody always does it
on the non-involved leg first,
and you get a sense of how much motion they have.
- [Brad] Actually, this works pretty good with Sam,
our other skeleton didn't have this,
but you can feel that translation.
- [Bob] It's actually got the ligaments in there.
- [Brad] Yeah, a healthy knee will,
I've had a healthy knee translate quite a bit.
So you check the good one,
see how that moves and then if you go to the other one,
and like my old instructor would say,
if it opens up like a barn door, you know there's a problem.
But yeah, you'll feel, say significantly more movement.
- Person's gotta be very relaxed.
This isn't something you quite can often do right
after the injury because there's so much swelling
and so much pain, they don't even want you to move it.
So it's one of those things that it almost things
have to calm down a little bit before you can do the test.
- Oops, now the second one is called
the anterior drawer test.
I'm actually gonna do it on his left knee.
I have the patient like this and I tell the patient,
I'm gonna sit gently on your foot.
- [Bob] That's exactly right.
- And what that does is it stabilizes the foot
so we can perform the test
and then I grab underneath the knee.
I put my thumbs right on the knee joint
and then I pull out this way
assessing how the ACL is, the integrity of the ACL.
- [Bob] And again, it's basically the same movement
as the Lachman's but it's just
a different way of applying it.
- A different angle, a little more bent on the knee
and the foot is locked in.
The hip is locked in, so it's sort of bit different.
It's nice to do both of them.
Shall I show on the real patient?
- Yep.
- Well Bob is not really a real patient.
- That would be me.
- Just lay him down.
- Which knee you wanna show around Brad?
- I'm gonna do, we'll go to Lachman's.
I'm gonna do it on here.
Now, like I mentioned before, this is how I do it.
I like to put my knee. - You've got cold hands.
- Oh, don't worry Bob, toughen up, toughen up.
I'm not like that to my patients
but to Bob, it doesn't matter.
Okay, getting back to serious.
We just go like this and he relaxes
and it's not that cold.
- I feel cold
- Now I'm grabbing here and stabilizing above the kneecap
and then I go down, below the knee joint,
the joint line which happens to be right
at the base of the patella.
We're gonna go down there and I'm gonna come around here
and I'm gonna pull up and then I can go down.
So I have a hold of that tibia and we just check like that.
Yours' really tight bud.
- [ Bob] Yeah I got a good ligaments.
- [Brad] Yep, you do.
I'm not gonna do the other one, again,
I would do the good knee first
and then do the sore knee section
and then compare and contrast.
Now the other one, I think I will do this side
'cause it's easier for them to see.
So we call, I call this a hook line position.
I'm gonna gently sit on the foot.
My hands are going to go underneath the knee, right?
The crux of the knee, if you will,
and my thumbs again are gonna be right here
at the joint line, right below the kneecap.
And they're gonna palpate or feel
for movement of that tibia.
I'm gonna pull this way.
Now it's important, critically important
that the patient's relax.
If their hamstrings tighten up,
you'll get an inaccurate reading.
So relax, relax, there you go, Bob, good job
and I say that to my real patients but with Bob,
I don't care so much about him,
but actually this is, I can feel that translation
very clearly with my thumbs right now.
The healthy knee first and then go over to the injured knee
and you will feel a difference with your thumbs
as well as oftentimes you'll feel
like clunk and back and forth.
Again, usually you can do that without pain.
It depends on how long after the injury it is.
If it's all swollen up yet, it's probably too early.
So you've gotta let things settle down.
Cold pack, ibuprofen, whatever it's gonna take
to get that swelling down.
You may be up to a week later.
- Again, at the very least,
at least you're gonna know what's going on
when the doctor's checking you
if you practiced on doing this.
- You'll know exactly what they're doing
and then you can communicate
with them a little more effectively.
- As Brad said, you're not gonna hurt the knee.
You're not gonna stretch out that ligament
or hurt it by doing this test.
- Right, if it's tore, it's tore
and if it's not, you're not.
- You can't put stress on there harder.
- Again, it should be all these should be pain-free.
They should not create pain.
If so, don't do it yourself.
- And remember, Brad and I can fix just about anything.
- Oh, you're right Bob except for.
- A broken heart.
- But we are working on it, as a matter of fact,
I stayed up last night doing overtime about it
but I got nowhere.
- No you didn't. - I did too.
- Thanks for watching.