♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks, I'm Bob Schrupp physical therapist.
- Brad Heineck, physical therapist.
- We're the almost famous physical therapists
on the internet.
- No, I know. Pity of course Bob.
- Napoleon's probably wondering why we didn't introduce him.
Napoleon Bone-aparte.
- There ya go.
- That's a little joke that's really bad.
Today Brad we're going to talk about
the one thing that may be causing your patellofemoral pain.
Stop it now. Stop it!
- Stop it! Yeah.
So we're talking about knee pain Bob.
- Right.
- Right there on the kneecap.
- And we'll talk about, a little about what that it,
but normally just like any other joint of the body
you know, it's just not there in, by itself.
It's being affected by the hip and the ankle,
what you're doing there.
- Right.
- And today we're going to actually talk about how the hip
can affect what's going on at your knee.
But before we do that Brad,
- Say no more.
- The time is now, isn't it?
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It's a sad story, but we're trying to turn things around.
- Why Bob?
- And worked and it's worth it Brad.
- All right, let's get on with it.
- So patellofemoral pain.
That's that knee pain that you feel.
It's a general achiness.
A lot of times it feels like it's right behind the kneecap,
because it is.
- Yeah.
- I've seen it where it's like around the knee.
- Mm hm.
- The people describe it, again it's kind of a dull ache.
It just keeps going on. A lot of times worse with stairs.
- Per, yep.
- Running. Anything where you're putting
a little more weight on the knee.
- Right.
- Uh, getting up to stand.
- Right. Yeah, so that motion.
A lot of times, going down the stairs a lot of times
- Is worse, yep
- That pace is a little is worse then going up.
- And you feel. Sometimes you feel like a grinding
or kind of clicking noise even sometimes.
- Right and it may be grinding in there.
- Yeah, right.
So what is happening here? Let's,
Launy if you want to come on in. Closer or
our hip is a little tight here too.
- Yeah we gotta mobilize that.
- So we got the femoral joint, uh the femur.
We got the tibia.
And you see there's actually a little groove here.
I don't know if you can point that out Brad with the
- With that?
- Yeah. And the kneecap, it doesn't just sit there
it actually moves up and down when you're bending
and extending the knee.
- Right.
- And normally it wants to, you know,
fit right into that groove and glide up and down.
But if you do something like, turn your knee.
Brad's going to demonstrate this.
If you bend your knee in, so knock kneed or valgus
- Yeah, I got the tape on here so you can see that
when you get that angle on. I'm exaggerating a little bit.
Although, we've seen people with that too
- No, I've seen people with that bad.
- Yeah, that's true. But you don't have to be this bad
in order to get this problem.
- Now one way that this happens though
is the hip is turning in. It's internally rotating.
- Yep.
- And why does that happen? Weak muscles.
- Sure.
- Weak hip muscles.
(Brad loudly smacking hip)
And I see it in a lot of women.
And that's why I think you see a little more
patellofemoral problems in women.
- Mm hm.
- But what that causes is now coming back down here Launy,
(distant speaking in the background)
you got it? Okay.
What that causes the kneecap is going to ride
a little more
- Yep
- Onto the side.
And it's going to ride on this sharp edge.
And it's going to wear out the back of the underside
of the patella.
- Right.
- And we get Chondromalacia or you know, a softening
under the edge.
- Yeah.
- And that hurts.
- [Brad and Bob] Right.
- It's kind of like produces some arthritic changes in there
in that surface.
- So we want to, yeah, very good Brad.
So we want to strengthen the muscles
that are going to stop the hip from turning in.
We want to pull it back out again.
- Yep.
- So that's what these, these exercises do here.
And we did, we you know, we did this in three minutes.
We got, we usually would take five minutes. Right?
- Yeah, that's, we're getting better.
- We're getting better. Yeah.
- We watch those comments. All right.
- So Brad, while I'm showing the clamshells,
do you want to get a band around you?
And get ready for
- You want, you wanna band me?
- Yeah.
(stand wheels rolling on floor)
- Listen to the band.
- All right.
- Okay. So the first one we're going to do is a clamshell.
And it's very simple cause we're
we're working the external rotators of the hip.
And this one works really well.
It describes kind of what you're doing by the way,
cause you're, you're bringing your leg, your knees together
like this and you're just working
and it looks like a clam doesn't it Brad.
- Yeah. Clamshell. Nom nom nom nom.
- Now you're gonna to be surprised
if you haven't done these.
You won't need any extra resistance to start off with.
- Yeah.
- Cause mine, mine actually. I must not do these Brad.
(Brad laughs)
I do hip strengthening.
- Yeah.
- But I don't do these.
- Mh hm.
- And my, I'm already feeling it on my legs.
- Of course Bob.
- So what would you say Brad, for sets.
- Sets 10 to 15.
- Yeah.
- Three sets.
- Three sets and you know take the breather.
I don't know how many I did there, but um,
it was enough for me.
(both men laugh)
And now I can do another set of 10 to 15.
And you can do that even, well, at least once a day, right?
- Right. Yep. Once a day. You know, once you get used-
- Twice would be probably too much, huh?
- It all depends on the condition of the person.
- Of the person, right.
- Yeah, assuming those muscles are weak,
we want to start with once a day rather than two.
- So Brad's got a band around him. We got the same band.
We'll have those listed down below.
They're just a nice loop that you can pull around
- Yeah.
- And it'll work with all these exercises we're doin'.
So Brad, do you want to show
- With the band on?
- Yeah with the bands. So it's going to be tough for now,
isn't it?
- Yeah, this is gonna.
- Oh it got your mic again huh.
- Yeah.
- Do you want to go the other side?
- No. Well, I wanna face,
- Okay.
- They want to see the front of me Bob, I thought.
I don't know. Okay. So again,
(Brad straining)
Heel on heel, and
- [Bob] Yep.
- Oh yeah.
- [Bob] Now that's going to work.
- Yeah.
- [Bob] That's gonna, that's gonna work you hard.
- Yep. It works at, pulls to the fibers of the abductor
and the gluteus maximus, and what else we got in there?
- [Bob] I don't know of the minimus and the medius
if they kick in for the external rotators
- Uh uh and oh probl- yeah.
- [Bob] The maximus that's yeah.
- Um yeah, I can feel specifically that.
- [Bob] Piriformis.
- Piriformis oh yes.
- [Bob] Definitely that. So.
- Anybody in our, in our, anatomy people
just chime in our comment if we missed one.
- [Bob] Right.
- What about the obsturator? That
- [Bob] Obturator.
- Obturator externus.
(both men laugh)
- [Bob] Bringing back our, going to use our memory now.
Okay Brad, why don't you. I'll show the next one now.
Now this next one is probably a little graphic,
but this is exactly what it is.
It's called the fire hydrant and it looks like a dog
found his way up to a fire hydrant and
- [Brad] (inaudible) do his thing.
- Yep, going to bring it up like this.
- Oh yeah. Here let me point this out Bob.
And this is a nice. You know, this one of
those common exercises you'll see in a fitness class.
- Yeah.
- You're down there workin' that hip muscle right there.
- So again, you're getting some external rotation here.
- Sure.
- And you're getting some abduction and
- Again, the ideas to get this to straighten out
which is going to help that kneecap in the groove.
- Yeah, if you're an athlete, you play volleyball
stuff like that, and you've been landing
with your knees kind of coming together,
you're going to be more prone to these type of things.
- Right.
- And in basketball too.
- Right.
- So there's a lot of sports where
- Right.
- We actually try to teach the person to land right
when they're jumping.
- Sure.
- Otherwise, they also even more prone
to some other injuries.,
- Right and you know, Bob mentioned females
have this a little bit more.
And the reason is because typically females
their hips are inherently a little bit wider, so
- Right.
- It makes that Q angle that we're talking about,
a little more prone.
- You want to do that with the band?
- Yes oh.
- You want to try it?
- Yeah Bob, I want to.
(Bob chuckles)
- All right, here we go. Oh.
Here you wanna have the pointer stick?
- Yeah it's, oh I'm just tying my shoe while you're
while you're working.
- Be careful of that. That's only thing I gotta say.
Let me get these glasses off.
- Careful tying my shoe?
- Yeah but whatever. Just be careful.
At this age, you gotta be careful doing everything Bob.
- So there we go. He's workin' the hip.
He's workin' the hip external rotators.
And again, that's going to be a lot more difficult
with the band.
The bands come in difficult, different levels of difficulty.
You have the, is that the peach one?
That's usually, probably, a little easier.
- Yeah this is the peach.
- But still, I know it's not that easy overall.
- And then, you know there gonna, you can work
different directions too.
- Sure.
- If you want to as well.
Boom boom. You can come up this way and add that resistance
in there.
- Yeah, if you want to get them all in there.
- One thing I would not do is
I wouldn't wear this to the office.
- Right.
- Yeah, not to work.
- People will talk even more about you
then they did before. All right.
- Do I need that on some more?
- What's that?
- Do I need this some more?
- Um, yeah.
- Okay.
- Cause you were talking about with squats
you can use them. Right?
- Oh yeah. Mm hm.
- So you can start doing some squats.
Now with squats, you're gonna really want to make sure
things are lined up here.
- Here.
- So you want to show them Brad while I'm squatting.
- Yeah.
- Oh I'll hold onto this and you show with this.
- Yeah. Yeah, that's the balance.
- The balance thing.
- When you're over 50 you need balance stuff.
- Yeah.
- So you're going to squat. Now I don't want the knees
to go past the feet.
- Right.
(chair rolling)
- So I got to work a, worry about that
but I also don't want to do this.
- The, yeah.
- So this is where you've got to really work on
keeping the knees right over the toes. Yeah.
- So, good back mechanics.
- Lined up. Yep.
- Keep that patella in the groove.
- What I like to use for doing this,
what makes it a lot easier,
do you mind just sliding this down Brad?
And this isn't going to work completely.
Cause I don't have a real good wall here,
but I can kind of demonstrate or symbolize it.
Is that if you have the ball on the wall,
and I'm going to do squats now.
Now it's really easy to keep my knees,
my feet in front of my knees.
- Sure.
- And I'll have to concentrate on is keeping the knees out
and not in like this.
- Yep. Don't let 'em do that
(Burrr noise from Brad)
Bowling in.
- And what's nice about this Brad,
with the ball then, you can eventually work on
one legged squats.
- Yep.
- And the same thing again. I'm going to keep the knee out,
and we're going to, we're
it's going to take a lot more strength to do this.
And if you're a real good athlete,
you can start using weights on the side even.
- Sure. Yep.
- Start doing single leg squats with a leg out.
- Your advanced people. Show, give a demonstration
of how the wrong way to do it, so
- Okay. So let's, let's say with both even,
I, a lot of people do this.
They land even when they're jumping,
they land like this.
- The knees come together.
- Yep. They for, I see a lot of ladies all the time
even in volleyball, they go like this.
- Yep.
- And they wanna go like this.
So that's really important. Again, that's going to stop
that knee from coming in.
Also, you're going to be less likely to get injured.
- Right. Right.
- So.
- It is a statistically, I think it's uh
female basketball players in high school
have the highest rate of ACL injuries.
Which can be related to this
- To the landing.
- Yep.
- Now you were going to show that, the squat with uh,
the band on.
- Oh yeah.
- I mean.
- So yep, you can get the band on and like this
and then just hold out. And if you wanted to do a doub-
you know this is for the more advanced people
- Sure, now you're getting a little double workout.
- Right. One, two, three, four, five.
- So you get the squat and you're working the abductor
at the same time.
- Yep. One, so I'm working quadriceps
and those muscles and I'm concentrating on
not going into here.
Keeping 'em inline here.
- What I like about this Brad,
is your teaching the muscle to fire.
You know when it goes down like that,
- Sure.
- You're teaching that muscle to fire at the same time.
- Right. So you're training it.
- You're training it. Yep.
- Exactly. It's not just exercising.
There's a difference between exercising and training.
We don't have to get into this now but,
uh, that's what we're doing there.
It makes it therapeutic Bob.
- All right Brad, I think we can wrap it up.
- Yeah, let's do so.
- Thank everybody for watching.
- You bet.