♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet. ♪
- All right, hi folks,
I'm Bob Scrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Well aren't you a little flamboyant, today?
- Well Bob, you know, I was feeling
a little spicy.
- All right, pump it up.
Today, we're going to talk about three best self tests
for meniscus injury
and two tests to actually avoid.
So, why are you looking at me?
You're the one that came up with this title!
- I was thinking of shoulder,
but that's my next video.
A little ah-- - Okay,
now let's get back to it.
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Right?
Are we going to show it before we do it.
- Yeah.
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Yeah, the Strong Like Bull one.
- [Bob] Yes. Yes.
- [Brad] I can't wait 'til mine gets here.
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- All right Brad,
take it away; what are we talking about?
- Meniscus!
And this is, as a therapist,
when someone comes in with knee pain,
which, I had two people, so far, yesterday
come in with knee pain this week.
And, of course, we want to try and determine is it
the patella, is it arthritis, or is it meniscus?
- Is it soft tissue? - Right.
Or is it soft tissue.
And, when it comes to meniscus,
and people ask "what is meniscus?"
It's the hardest thing for me to describe.
- Well, it's the cartilage.
First off, we can say that right?
- Right, but you know,
it's not the cartilage that's--
- Not the lining. (mumbles)
Right, it's not the lining.
- Right, so, we've got Sam.
- This is one of the best models that we have.
On the internet, in my opinion, of course.
But, if we look at Sam here,
we're going to take the patella
and the infrapatellar tendon away.
Here's a nice little diagram,
there's the ACL,
and now, if you look at this,
we call this the medial horn of the meniscus.
There's a posterior,
posterior's the backside.
You can see it looks like a figure eight.
Can you see that, Liz?
And it helps like a cushion for the condyles of the femur
to set into.
It helps stabilize the joint.
And, if one of these gets torn or ripped,
they can fold over.
The model, here, doesn't allow that,
but, if you can imagine,
this brown substance or tissue
getting folded or ripped
it can cause a problem on how the joint articulates
or slides back and forth.
- I mean, it would be like a rock
in your shoe, basically.
- That's a good analogy, Bob.
Excellent!
Do you use that with your patients?
This here analogy?
- [Bob] Oh, sometimes, yeah.
- [Brad] I was just wondering, yeah.
It's always nice to know how to describe things
so people can relate.
But, one of the first things,
now, this is not one of the tests in the title.
But, one thing is ask yourself or monitor,
does your knee ever lock?
Like, if you're walking,
or going up and down stairs
and it locks up
and there's pain associated with it, typically,
but after you move it around a little bit,
maybe take some weight off of it,
it frees up and then it's okay again.
- Right. - So, what's happening is
that meniscus we talked about,
if it's got a fold in it or a crease--
- Or a piece of it even broke off.
- Right. It could be a floater.
They call that a floater.
Gets locked up physically.
- In the wrong spot. - Right.
It's like throwing some gravel into a bearing or a joint.
- Yup, exactly.
It's not going to work well
and so that's a sign that you probably have a tear.
You know, the fact that also you want to look at,
were you just involved in an accident?
Were you just involved in an athletic injury?
Obviously, that's when you want
to start thinking about this.
These do happen spontaneously,
especially as you get older,
you're probably going to be more likely
in the age 50 or above,
but not likely to happen when you're younger.
I mean, unless injury.
- Right.
Repetitive motion maybe that may be indicative of it.
Now, one thing about these three tests
we're going to go through.
You can do them by yourself.
It's going to be more accurate if
you do them with a therapist that has
lots of experience,
but you can try these
and see if they're positive or negative.
And even with an experienced physician,
studies show 45 to 55, 60% reliable.
So these tests aren't-
- Yeah, they aren't the be all to end all.
- Right, but they can give you some information.
- They can give you a direction.
And I think, as you mentioned before,
we were talking Brad,
that if all three of these tests are positive,
- And you get that locking.
- And you get the locking,
there's a pretty good likelihood--
- A pretty good sign.
The first one is,
because I know they're waiting,
we're babbling, Bob!
Is, the Thessaly's Test.
- Okay.
- Now, it's nice to start out on this one.
One leg, it's going to be on the one leg,
and, obviously, you're testing
the leg that's weight bearing.
You're going to bend the knee
from five to 15 degrees.
So that's about there.
- Not very much.
- Right.
And then you're going to have something to hold onto,
to stabilize yourself.
You know, I'm going to do it right here.
You might need both hands
depending on how stable you are.
And then you simply rock,
rotate, I should say,
back and forth.
And if you feel pain, clicking,
anything of that nature,
that would be a positive test.
Now, it's nice, you can do it
with the good knee.
Assuming only one knee is suspect of it
and compare one to the other.
- I like this test because it's very easy to do.
It's very easy to apply.
And, again, be safe.
If that knee is bad,
you could collapse.
- Right. So,
don't go right after,
kind of work it slowly to begin with.
The next one is the Childress test.
I call this the duck walk.
Okay, so, point your toes out,
widen your feet about shoulder width,
and down like this,
and then try to walk.
(Bob laughing)
- Aren't we a sight?
- If it's painful with that walk,
that would be positive.
I had one person,
she was positive with this
and I had her do some exercises to strengthen
the supporting muscles,
and we came back a couple weeks later,
I tested the duck walk again--
- It was fine.
- It was negative.
- Sure. Was it just pain she had?
- You know, I'm not sure if it was
meniscus or not,
but whatever or not, she got better.
Life was good. - Right.
Then the Ege's test. - Okay.
- I'm not sure if I'm pronouncing that right.
- E-G-E-S - Yeah.
This one, feet are about shoulder width wide
and you're going to externally rotate
or point your toes out as far as you can.
Now, I do pretty good with this,
but you got to keep your balance.
You may have to hold onto something.
And then, you're just going to
squat down as far as you can
and then back up.
Now, if you squat down
and you feel some pain,
some locking, whatever,
don't go anymore.
Watch out Bob!
You need something to hold onto?
- Is this like a plié?
- I don't go there, Bob.
Okay, so we go there
and then we go up
and then you also go internally rotate,
like this,
and this is testing,
like we've talked about there's
the different aspects of the meniscus.
- Right, you're in a different part of the joint.
- And then you do this, as well.
And, again, if there's locking,
crepitus, or sort of painful-
- Grinding. - Grinding, yeah.
That would be positive for test, as well.
So those are three you could do at home.
They're relatively easy.
Again, check one knee, compare it to the other knee.
Assuming only one is symptomatic.
Now there's two of them that I mentioned
that I would say avoid.
And if you go on the internet, you'll find them.
One's McMurray's test,
one's the Apley test.
And I'm just going to briefly go through them
because they're very distinct.
- They're too hard for you to apply as a lay person,
I would say.
- You can't do them by yourself.
You need a second person.
- And that second person would
really have to know what they're doing.
- I mean, as a therapist, I used to use McMurray's,
and I still do,
but I use them in conjunction with the weight bearing ones.
And, I feel more confident in the other ones now,
after I've been using it more.
But the Apley one, I'm just going to go through it briefly.
It starts up here,
there's some rotation.
- McMurray's you mean. - McMurray's, I'm sorry.
There's some rotation you have to do,
and it kind of looks like this
and you drop it down
and, like I said, this is what it looks like.
I'm not going to go through the details
because I wouldn't suggest doing it.
- Right. - You know.
Unless you're a therapist,
and then...
- The Apley?
- Yup. The Apley test,
the person lays on their stomach or prone.
Now, the thing with this one is
if you do it, it's not going to work on a bed.
You need something firm
and I usually put a rolled towel right here
so the kneecap doesn't get in the way,
because that can be painful.
And here, there's a rotation and pressure going down.
And then you're looking for pain,
as well as some crepitus or locking up with that,
as well.
Both of those,
I would just put off to the side,
and, you know, look at them on the video.
- Yeah, there's no reason that you need to try those.
The other ones are okay.
- But if you go to the doctor, the therapist,
and they do it to you,
then you have a--
- Then you know what they're doing to you.
- Yeah, an introduction to it.
- You can impress them
by saying "Oh, you're doing the McMurray's."
- Ah, yeah.
- "Oh you're doing the Apley's now."
- "Bob and Brad don't suggest I do that, myself."
(laughing)
Just kidding.
- All right, very good,
thanks, everyone, for watching.