♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- 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 going to show you how to self treat a knee
with torn or worn out cartilage.
- Okay.
- Happens with aging. - Yes.
- Three simple steps.
Let's get into it, Brad.
So, the thing is with worn out cartilage or torn cartilage,
it's unlikely that it's gonna grow back.
It's not gonna regenerate.
- Particularly if you're in your fifties, sixties and older.
You can try some shots that doctors have...
- To calm down. - Some medicate, yeah.
But we're gonna work...
- We're gonna mainly try things that make it feel better
and hopefully help you manage the pain.
- Either way, you wanna get that range of motion back.
- So, the first thing is,
quite often the knee gets flared up from torn cartilage
and it might have bone on bone.
You want it to calm down.
So, the first thing you should do
is reduce weight on the knee.
So, you could try a cane for a while.
I'm not saying forever.
- Right.
- Just, let's get it calmed down.
- Right.
- Might try anti-inflammatories, too.
- Well, I've got a guy right now with the hip problem
and he just won't go to a cane.
He really should. It'd make life easier.
- We do kind of joke about this
because, and I know this, I'll be the same way.
You're limping along really badly but you won't use a cane.
If you use a cane, you won't limp
and you won't draw attention to yourself.
Believe me, people know when you have a bad knee.
- Right.
- I mean, you're not hiding anything.
- That cane, you know, I always tell him,
it's a very distinct looking device.
- That's right. Distinguished looking.
- Yeah, exactly.
So, if your left knee,
you want me to go show now, Bob?
- Sure.
- The left knee is my painful knee.
You're actually going to take the cane
in your opposite or the right hand
and when the left foot goes forward, the cane goes with it.
It typically, I always tell my patients,
I don't tell them anything,
I say, "Just walk with it in this hand,"
and usually the natural motion is they sync up
and they do very well.
You're putting weight through the cane
and you're going to feel it right away
'cause the weight to the cane is that much less.
And it doesn't mean you have to take all the weight off,
even 20-30% decrease can really make a difference
in that pain. - I can tell you
from experience
and I've used this with thousands of people, I have.
- Oh, I believe you.
- That's the first thing we do, treatment in one, day one,
and that usually calms it down.
I mean, sometimes that works better
than anything else we do.
And you know, eventually they stop using it
and they go on for a couple more years.
- I would imagine at your age,
you're probably up in the millions of patients.
(Bob laughs)
I had to throw that in there.
- You had that one all loaded up, didn't ya?
Ready to go. - I did.
- All right, the other thing is
when you're sitting in a chair,
which a lot of us spend a lot of time in the chair now,
really don't try to sit with it...
Let's say this is the bad knee.
Don't sit with the knee bent over 90 degrees.
It's compressing that knee the entire time.
If it's flared up, if it's inflamed,
that's gonna keep it flared up, keep it inflamed.
Vary it, you know.
Keep the leg straight or slightly bent.
Move it around throughout the day.
In fact, the more movement you can get, the better.
- Yeah and you can pull it up and bend it more,
but we're not going to hold there very long.
- Don't hold that there long.
- For a stretch, it's a good idea.
- For stretch and for range of motion like this.
You can do this like every half hour,
just get that knee moving like this.
- Yep, exactly.
- All right, the other thing is
don't stand with the knee locked.
I've actually seen a friend today, Brad,
that he said he was standing for a while
and just knees started to kill him.
And a lot of times what happens is you're locking the knee.
I'm gonna show you what happens.
- So in other words,
you straighten it all the way straight-
- I've got an X on there for my other video.
- You probably do that all the time.
So, yeah, it's like, you know, if I'm pushing here,
the knee doesn't go any farther.
We call that end range- - Really jamming it.
- And that just stresses the joint more than it needs to.
- Yeah, so what you really wanna do
when you're standing a lot is to get variety.
So, you might actually...
Well, you wanna show the next stretch, Brad?
'Cause this is one of the things
we wanna keep range of motion.
You might actually put your foot up on a chair
and stretch it while you're taking a break from standing.
- I was gonna say, you know,
you can just go right to left, a little flection.
- [Bob] Yup, exactly.
- You know, if you can get your foot up like this,
or even on a stool, you know,
like when you're doing dishes, open up the cupboard door.
I've had patients put their foot up and alternate.
Do you want me to show you this?
- Sure.
- The flection stretch.
And we're talking about getting the knee
to maintain range of motion
so that it bends as far as comfortable.
- It feels better to do this.
- Yeah, now, if you do this
and you get all the way to the end
and it really is creating sharp pain, you're going too far.
You just go towards, start to stretch,
and just bump into the pain a little bit.
- Yeah, don't create pain.
We're not trying to hurt the knee.
We're trying to just stretch it.
- Yeah, you don't want to get it all flared up
and then you'll be swearing at us.
- The other thing you could do
is you could actually get cushions in your shoe.
- Oh, sure. Inserts.
- Yeah, inserts to help.
We're not talking arch supports.
We're talking about just cushioned inserts.
- Right.
- They're inexpensive
and you can also get a cushioned mat.
- Yeah, just make sure they say, you know, neutral arch.
There's no arch so you don't have...
'Cause you may not need that.
Could make things worse.
- You could also buy a mat and have Brad follow you around
and put it in front of you like you'd be a king.
- But, you think these are very-
- Mat.
- Yeah, this one is...
- Really thick.
- Yeah and this one has some,
usually you're gonna get a flat one.
This was actually made for some other device.
- For a desk.
No, it was to help roll the feet and stuff like that.
- But in a seated position, right?
- In a seated position.
Generally, well, I think you could do both.
- Sure. It's got a little bump here, too.
- Besides working on bending the knee,
which Brad did standing,
you can also bend the knee seated.
You slide your butt forward
and every so often you do this, like every 20 minutes or so.
Pressure on, pressure off, pressure on.
- Sometimes it helps
to slide the hands up closer to the joint.
- You can also, this is a neat little hint, Brad.
If you really wanna work the joint,
you can take a towel like this,
you put it in the crease of the knee.
- So right up in there.
- Yeah, right in there.
I'm gonna slide forward and now I'm gonna go like this
and this gaps the knee a little bit.
This is a great stretch to do.
- It takes those arthritic surfaces
and pulls them apart so they-
- Distracts them.
- Gets some synovial fluid in there, which is gonna help.
Again, no pain. It should feel like a good stretch.
If it creates some sharp pain, it's too aggressive.
You need to back off.
- Right, so just keep a towel by your desk
and you can do that.
Now, we're also gonna, besides bending the knee,
we also wanna work on straightening the knee,
especially if the knee doesn't straighten all the way out.
Now, you can check this out by putting both knees down,
you might see that one knee
doesn't straighten out all the way
and it might be the painful knee.
By that, you know, it might be very subtle.
- Sure.
- You wanna regain that motion. That's gonna help the knee.
So, let's say it's this one.
All right, I can just work on extension
with the toes straight up.
- Yep.
- I can turn the foot out like this and try it that way.
You wanna see which one feels the best.
- Sometimes a little rotation
makes the joint loosen up a little bit.
It's amazing.
- So, I'm pushing right above the knee, you know.
You can also push above and below the knee if you want.
- So, he's saying not on the knee cap
'cause that can hurt. - Yeah, on the knee cap.
So, you can either work it on in, out or straight up.
- Right, right.
- Figure out which one works best for you.
For my wife, it was turning it out like this.
She really had good luck with this one.
You can also use the stool.
- If you have a stool with rollers on it,
it really is nice.
- Works well.
- In the clinic, I always have my patients do this.
And then I would say,
you can kind of get the knee moving a little bit like this
and then out and gentle pressure on.
I gotta get my lean back and that really works.
Really works nice.
- Now, the key to this is you can do these every hour
and do them throughout the day and-
- But probably not the first day.
- Not the first day.
- 'Cause you might flare it up.
So, maybe the first day, just test it out
and see how it feels.
- Brad remembers, I've told him about a patient
who almost didn't come back
because he really went crazy the first day
and he was like, "Oh my God, my knee hurts so bad."
- So he was pushing hard
and trying to get it all straight in one day?
- And he was like 80 years old or 90 years old.
- Did he grab you and say, "Why didn't you warn me?"
- Yep and he threw me down to the floor, which isn't hard.
- Well, that's not the first time.
- Even an 80 year old.
(both laugh)
All right, besides getting the motion back,
we also wanna do some strengthening
and the easiest one to do
because the quadricep gets weak
on a painful knee very quickly.
- And this is something you can do at home
and you don't need special equipment.
- Yeah, you just take a pillow.
- They did a study on this, right Bob?
- Yep and found it to be the most effective one.
- Yep.
- So, you're all gonna do is push the knee down into the bed
and hold it.
- So, you're trying to squish the pillow into the bed.
- One, two, three, four, five,
six, seven, eight, nine, 10.
You do these a couple of times a day or once a day.
This is one you don't need to do that often.
- Right, right.
- Do two sets of 10 and you're gonna be surprised,
that knee's gonna be more stable.
If the muscles are taking a lot of the stress,
the joint is not taking as much stress.
- Did you say how many reps?
- Two sets of 10.
- Two sets of 10, okay.
You might do that one day and if you haven't done it before,
see how it feels the next day.
If your quad is sore,
give it a day break and then come back at.
- Eventually you might wanna also do some shallow squats.
Now, one way to do those
is if you have a bed that's higher, actually,
is just to actually go down like this
and hit the butt on the bed.
And you can see, I'm not squatting very deep
and that puts less stress on the joints.
- Sure.
- It is working the quads
but you can also use the ball on the wall.
- Oh yeah.
I was just going to mention that, you know,
if you've got a chair, a countertop,
you can use that for balance.
Obviously, you don't wanna fall.
- Don't take it to a painful level,
just do shallow squats.
- Oh, look at this.
If you happen to have-
- Oh, look at this.
- A ball, now you don't have to have an exercise ball.
You can use, not a basketball,
but something that's...
- Fairly large.
- Fairly large but a little give to it.
I've had people use their grandkids play balls,
but a ball on the wall
'cause you're not putting a lot of weight into it.
Get your feet about shoulder width wide,
about two or three feet from the floor
so that when you go down...
- You're gonna find these are comfortable.
- Yeah.
You may wanna, if you've got a cane or a stick
or cupboard or chair to hold on to,
it's helpful the first few times.
- These are really pretty easy on the knee
but they are effective.
- Yeah, good for those quadriceps
and that's the goal.
Don't go down too far.
If you go down so far that it hurts,
then what happens the muscles can relax
and release to avoid the pain
and then you can actually end up like this
and have a big problem.
So, be careful with that.
- Yeah.
We don't want anybody going down to the floor on our watch.
- Exactly, Bob.
Is there another one?
- No. - All right.
That was a nice job.
Ah, oh my goodness.
It's gonna turn off.
- All right. We'll see ya.
(upbeat music)