♪ Bob and Brad, the two most famous ♪
♪ Physical therapists on the internet. ♪
- Howdy folks I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Today we're the most famous
physical therapist on the internet.
- In our opinion, of course Bob.
- Today we're gonna talk about knee pain,
three most common symptoms, treatment and prevention.
- Bob, between the two of us
over the last combined 60 years of therapy treatment,
we have seen thousands and thousands of knee pain.
People with sore knees.
- We started off with Abraham Lincoln's knee
and we've moved on since then. So,
- Yeah he was a tough one.
- Seriously-
- I think we've got some advice that can help you.
- Absolutely, we got a really nice set up program.
So stay tuned.
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- All right.
So, Brad what is the most common symptoms?
- Well, I did not find any studies
that had this clearly mapped out,
but I think it's a no brainer.
I think anybody would agree, arthritis.
- Especially if you're older,
if you're up in those,
well even sometimes 40's.
We're seeing now people with knee replacements.
But certainly when you get into the fifties,
that's when cartilage is starting to break down.
- And it's really proven
by the number of total knee replacements.
I mean, just in the United States in 2017,
966,000 total knee replacements.
- And we were just discussing this, Brad.
We remembered just very, not too long ago was 700,000?
- Well, seven or 800,000.
I was at a knee course.
And it's just a few years later than that.
And I'm sure if I got-
- It skyrocketed.
- I'm sure it's over a million in 2019
and it continues to go up.
They'll do better and better.
Now they only do totally knee replacements.
They do partial knee replacements.
And now they're talking about,
digitally, three-dimensional custom knee replacement.
- Really?
- Yeah.
- Interesting.
- So anyways, if you have
that knee pain from arthritic
is typically with weight bearing,
the more you walk, going up and downstairs irritates it.
The pain is in the joint,
but it continues to ache
when you're non-weightbearing for time.
And this is something that is not proven scientifically,
but pretty much every patient I've seen
say they can predict the weather
because of their knee pain typically arthritic problems.
- And that is not proven scientifically unfortunately-
- No it's not.
- But I hear everybody say-
- How many people just say -
- They all say it.
- Anyways, so you can get medications from your doctor
to help remedy this to a certain degree
over the counter ibuprofen depends on individual.
We wanna show you some therapy treatments.
There's other than Glucosamine,
did you know that glucosamine
is made up of ground up shells from shellfish?
- I did not know that.
- There are some other stuff put in there.
I was just talking to Chris the pharmacist about this.
But overall it has done well,
but it's not a go to
there's no proof that it's gonna take care of it.
- Unfortunately, Brad, I don't wanna rain
on your parade here,
but I saw a study
where they felt it had very little help, glucosamine.
Now other things though has some benefit.
Just because you have arthritis
does not mean you're destined
even to have a knee replacement anytime soon.
It's amazing sometimes arthritis
can actually get a little bit better.
- Sure.
- By doing some of the exercises and doing some movement,
they recommend now that you don't necessarily stop running,
which my wife, she had stopped.
I mean, she had a really bad episode.
- Yeah I remember.
- Stopped running. She ran last night.
She ran this morning.
- And she was on crutches for a while.
- She was on crutches.
And I never thought she'd be back to running.
But they're finding now that movement
and you're getting the natural fluids moving in there.
- Keep it moving.
- Yeah, keep it moving.
- All right, so we're gonna show a simple exercise
in a seated position.
This is good pretty much for all ages.
If you have balance problems, that's fine.
'Cause you're seated and it's simply,
we call them long arc quads
or I say to my patients, do these kicks,
bring them up as high as you can and down.
So we're not just swinging it,
but it's actually a real determined,
what's the word I'm looking for?
- Well, it's controlled.
What's nice about it Brad
is you're not only getting some movement,
which if you sit all day,
that's what you need to get.
You wanna start get it moving.
But two, you're getting some strengthening.
- You're right.
- So you're getting a double whammy here
and not whammy, double benefit.
So whammy's bad, right?
- I think it is.
Well you never know we could change.
- So this isn't something you do once a day in your chair.
This is something you do every hour in your chair.
- Right, as long as you can tolerate it
and you don't wear yourself out.
But make sure you do about 10 of them.
You don't have to do 30, 40 of them,
but 10 is a good number.
I've had people do this
just before they get up
and it makes their knees feel better.
That initial few steps can be real painful.
That's a good option for there.
The other thing is do your knees go all the way straight?
If they don't go all the way straight,
let's say this is my painful knee
and the other one's not so bad.
And you notice I got it to here
and it doesn't straighten out
while this one goes completely straight.
This knee we wanna see if we can get it to go straight
or you can put it like this
with your foot on the floor
and simply do some exercises.
Stretching like this pressure on, pressure off
five to 10 times and get it to go straighter.
- And again you would do that throughout the day.
Now you can also use a stool
if you'd like to put your foot up on a stool.
But this is nice because you can do it anywhere.
I mean.
- The big thing is don't get too aggressive
with this right away.
Be gentle with it.
I know Bob always talks about the patient
that was doing this and he really got circus.
He was-
- He was 90 some years old.
I had him come in.
And he was making gains
the first day already and started-
- Sure.
- So he just went to it
and he almost didn't come back.
- 'Cause it was sore.
- And he luckily he had a good result in the end,
but it took a little bit talking down from the ledge there
because he was pretty upset with me.
- Sure, the next thing is, does it bend all the way?
If you don't-
- Compare the two sides.
- If this one only goes this far
and this one bends all the way here
and this one goes to there.
We wanna get this to equal the other side.
So you can do this one on the chair as well.
Put your hands around here
and pull and see if you can get the bend
then go pressure on.
- Sorry Brad-
- Pressure off.
- I didn't prepare for this,
but actually a good one
that works well with that
is to actually take a towel.
- Sure.
- And place it in the knee.
This is a sock.
- Yeah a rolled up towel,
maybe two, three inches in diameter.
It'd be about like this and you put it-
- And then you put like that
and that just helps kind of gap the knee joint.
And it helps you gain faster.
Now it should be pain free.
- It should actually feel better with it.
If it makes it feel worse,
it's not the proper option.
- It's a great technique.
It's a nice adjunct in your toolbox to take it there.
- All these are little tricks
that we've learned along the road.
The other things that you can do,
so you can work that
if you have pretty good range of motion,
we're gonna go into prevention.
Let's say your knees hurt not too bad,
but you wanna keep it from getting worse
or they're feeling good and you wanna keep-
- They maybe recovered from a painful incident
and you wanna keep it moving.
- Swimming, lot of people don't have access
or they don't like water.
But if you wanna do that,
swimming is non weightbearing keep those joints moving.
15, 20 minutes in the water
or more take one of those classes,
aerobics class in the water.
The other one is biking.
- Biking is a great one.
- Stationary bike that can work out good.
- Or biking outside on the road.
- As long as you're safe with it be careful.
- Biking is really good for your cardio obviously,
but also it's really a great one for the knee joint
because it's moving that knee joint
without putting too much stress on it.
Obviously, if you have pain with it,
you can't do it,
but Brad is gonna show you another option here.
- This is a nice option through a nice portable device.
You can take it anywhere.
Pretty much you can fit it in a suitcase
and take it on the road with you if you want.
But just sitting down to keep those knees moving.
- Fits under your desk.
It works out real well.
- We call this a Fit Glide.
We're very familiar with it.
It works very well.
It has an advantage of actually going on an angle like this
and you can work like this.
This if you got those painful knees
and walking irritates it.
This is a beautiful option.
You'll spend five minutes on it,
two, three times a day.
This actually works the hamstrings pretty well.
- Now you don't stand on it.
- No.
- There's a little bit of sound to it
little swish, swish, swish.
If you're gonna use it in your office,
understand that people might hear it.
- But it's not a big deal.
So there you go.
- There we go.
- This, you can, go out to the link below our video.
If you're interested.
- Actually Brad, I think this works
for the second problem too.
- What?
- Swelling.
- Oh yes, keep that knee moving.
- That fluid moving yes.
- As long as it doesn't irritate it.
- But, if you especially have knee swelling
that tends to migrate into the calf.
- Sure.
- The more you get movement,
a lot of times that encourages
that swelling to go out
and up into the abdomen
where it gets processed and all that.
- Get those muscles working.
Another thing 'cause this is your second
most common cause is swelling.
So should we show them elevation?
- Sure.
- This is my favorite number one, go to elevation.
You can take two pillows,
maybe three pillows set them down on your bed
or on your couch.
I like the leg wedge.
It works really well.
It's very comfortable and they're not very expensive.
- Well, they're nice for back pain too.
Maybe we can say.
- Oh yeah, and just elevate it.
So you can see my knees are above the level of my heart.
So the gravity is gonna help
that swelling flow the other direction.
If they're swollen so much there's pressure
and that pressure equals pain.
We want that pressure off,
you can wrap them with ace wrap.
There's other options for compression wraps.
- Well the ice pack too, I mean.
- You're right good point.
If you're gonna use compression,
you should probably get someone, a doctor
or your therapist to help you with that.
- If you're gonna use some type of compression stocking,
a lot of times you're gonna want to be fitted for it, maybe.
Even if you're doing an off the shelf one
you wanna make sure the doctor tells you
what pressure you can put on it.
- That's getting a little technical,
so get some help,
but cold pack, you can always put a cold pack on.
Don't put it directly on your skin,
always over some material
and that'll help get that swelling I think.
- A lot of people Brad ask
why am I getting fluid on my knee?
It generally is because there is
some type of problem in the knee.
It's not the fluid isn't the problem itself.
It's a result of the problem.
So if you have arthritis so
that's why you're getting swelling in your knee.
- So if there's an activity you do walking,
whatever it is and it swells up afterwards,
you're gonna have to down on that activity,
whether it's running, walking,
going up and down steps.
And get that knee healed up before you go back.
So it doesn't become a chronic problem.
And then lastly is joint pain in the knee.
This is for more active people.
Let's say you're, running,
you're walking and you get joint pain
and it's a sharp pain.
Things are clicking.
You may have a lock up on you.
Those types of things.
There's a number of things
that can be a meniscus problem.
You could have runner's knee,
IT band syndrome, patellofemoral pain.
- It could be under the knee cap itself.
- In those types of things,
we don't have time to go through each one for treatment.
But you do, if you Google Bob
and Brad IT band syndrome,
we've got a really good one on that from a patient
who went from being unable to walk even to the point
that he starts stretching,
took care of him and now he's doing iron man
and he's what is it 62 years old?
- Yeah crazy.
- No, he's older than that now is he?
- He could be, I'll talk to him.
- I thought he was quite older at that time even.
- Well, he wasn't over 65.
- Oh I thought he was.
- Well Bob, we don't need to get into that.
- Anyway the thing is about joint pain.
What we're saying is
quite often let's say you take your hand
and go right underneath the kneecap.
This is the joint.
That's how you can distinguish
what is joint pain.
- That's the joint line.
- If it hurts up in here,
hurts here that might be muscle
or ligament or something else than that.
This is joint pain, right there.
You can actually point right on the joint and that hurts.
That gives you the sign that it's joint pain,
harder to treat because you can't get into the joint
and I mean-
- You're not gonna stretch the muscles of the joint.
'Cause there's no muscles in there,
but that kind of thing,
those are the things
that it's causing some pretty limit in your function.
You're gonna need to see the doctor,
get that squared away, get the diagnosis.
And then continue on from there.
See our videos and we'll help.
- Get a diagnosis and then like Brad said,
you can actually zero in into that diagnosis
and get the right videos for that particular problem.
- Exactly.
- All right.
- Very good, Bob.
I think we did another one.
- Thank you.