♪ 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're the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Oh, quite impressive, Brad.
Today, we're talking about how to treat tendonitis
of the knee.
- Oh!
- Now when I use the word "tendonitis" in the title,
in many cases, you might have a tendinopathy.
And, first off,
let's talk about where the tendons are at.
- Sure.
- On the knee, the main ones we're talking about
is the patellar tendon,
that attaches the kneecap to the tibia.
That's this one right here.
Brad, do you agree?
- Yeah, yeah.
So, and on a real person,
there's my patella, or knee cap.
There is my tibia, tibial tuberosity-
- Tuberosity, yeah. - Yeah.
And right there is that tendon,
that experiences a lot of stress.
I mean, - Right.
- it's made for it, but-
- "Jumper's Knee" they call it.
- Sometimes it gets irritated.
The other one is quadricep tendonitis,
where you can actually,
the quadricep attaches to the kneecap,
this white stuff right in here
that can get flared up and cause a tendonitis, too.
- Yeah.
So it's right above the kneecap.
You feel it there,
there's a little hollow spot there,
and that that's where it is.
- Now, in some cases,
these tendons have somewhat wore out.
They're not inflamed, they're wore out-
- Ooh!
- and that's tendinopathy.
- Okay.
- But in both cases, they're treated in the same way.
So we're going to do the same thing.
- And they both produce pain with stresses.
- Yeah.
- So the name is not particularly important
for this treatment.
- So we talked about the two common types;
let's jump right into, Brad,
how do we first tell whether or not we have it, or not?
- Sure.
- The best way to tell is just to feel on those areas,
and rub across them and see if they're tender.
- Yeah.
So we call that "palpate"?
- Yeah, palpation.
- In the therapy/medical world.
- Right.
- So I'm going to go.
Here's that-
- Here's the kneecap-
- Yep.
- and right below is that bump, right in between.
- So I'm just going to,
I want to push down a little bit,
and ride back and forth,
and you might find it's more tender
where it's connected to the bone,
that bony prominence.
- And then it might be Osgood-Schlatter Disease.
- Mm-hm.
- Especially if you're younger,
if you're, like, in the growing stage.
- Right- - Pretty common.
you get a bump there associated with it.
So you can check that out.
If that's pain-free,
you may go above the kneecap.
I like to use my thumbs there,
'cause I can get in there,
and really feel-
- It's not hard to diagnose this, Brad.
I had quadricep tendonitis,
and you know.
It hurts right there. - Yeah.
You can push on it.
It hurts right there.
- Yep.
- It's a little harder to treat, though.
So, but let's go into that, Brad.
- Sure.
- So, the first one,
let's talk about treating the quadricep tendonitis,
the one above the knee.
- Sure.
- So we're going to do for both of these
is cross-fiber friction massage.
- That's a mouthful, Bob.
- Yeah, what we're trying to do,
is get more circulation to the area,
and in addition,
we're trying to,
if there's some scar tissue,
we want to break up the scar tissue a bit, too.
- And if you're wondering,
when we say scar tissue, it's like,
well, "I never had a injury or laceration",
it may be just because it's inflamed,
it's healing-
- Right.
- and part of that process of healing
is forming scar tissue to make it stronger.
The scar tissue lays down in a irregular fashion,
which can make it painful.
We want to break that scar tissue up
and work with it so that it's strong.
- Yeah.
So if you start rubbing over the area
and you rub for 30 seconds or a minute,
and the pain just keeps getting worse,
"Oh, oh, oww!"
- "30 seconds, it still hurts!
It's getting worse!
What do I do, Bob?"
- In that case, you'd back off,
probably ice for a while,
and then try it again in a couple of days.
- Yep.
- Now, the same is going to be true for the patellar tendon.
You're going to rub across it.
Now, quite often,
we'll take finger over finger,
or finger side by side.
Here, Brad was actually using the thumbs.
- Well, and that may differ from person to person.
I just feel more comfortable and more aggressive this way.
And I could do it this way, too.
- Now a lot of this was invented by James Cyriax,
the founder of,
the father of orthopedic medicine-
- Ooh.
- and he would recommend doing this, Brad,
for 15 minutes, three times a week.
- Yeah.
Assuming it feels better or that numb-ish feeling,
and you continue to work it-
- Right.
- but then you're going to get tendonitis in your fingers.
- That's right.
- Your thumbs.
- The way it worked for me,
is I had to use a massage gun.
- Mm-hm.
- It's just so much easier.
I was doing all these other things, you know?
Icing, I was doing eccentric strengthening to the muscle.
None of that seemed to help.
When I started doing massage
to the upper tendon there,
- Upper kneecap?
- That, it got better,
80% better within a couple of days.
You can get right in there,
you can actually push up on the kneecap as you want.
- Sure.
- By pushing up on the kneecap,
that kind of exposes the tendon.
- Yep.
- And you can go across the tendon like this,
and I actually even would
bump up against the bone a little bit.
- Okay.
But you know, do be careful.
- Yeah.
- 'Cause especially,
he's got a more aggressive hold on it.
These heads pop on and off.
This round one's not,
is a little softer,
and it just has more surface area,
so it's not as aggressive.
Start with the less aggressive one-
- Yes.
- before you go to the more pointed-
- Brad, you want to show the less aggressive way?
- Yup.
And, you know, these massage guns,
they don't just vibrate,
they percuss. - Yeah.
- They go, they travel- - Like a hammer.
- they travel this way.
So that's nice, 'cause if you go like this,
that's pretty aggressive.
- Straight on.
- If you go this way,
much less aggressive,
plus you get that cross-fiber motion.
- Across that way, yeah.
- And you may want to start above working to the muscle.
And if you do have tight muscles,
actually working the muscle
is not a bad idea. - Right.
- And then work down
to where the actual inflammation
and tendonitis is.
- Yeah, either way,
you're going to want to work the muscle, too.
- Yup.
- Because you really can't down here.
- Yeah, there's no muscle there.
We just- - Yeah.
- we got the bone on- - Bone-to-bone.
- the patella and the bone.
- You want to show on the patellar tendon-
- Yeah, yep.
And now on this one,
you're certainly not going to go directly-
- Right.
- I mean, we're going to go-
- It just really bounces,
and it's very aggressive.
- But it does work nice, especially, I like,
I'm a big fan of the- - Yeah.
- the round head, in general.
- It's about the right size-
- Fits right in there. - for that.
- And I may straighten my knee,
and get my quads relaxed.
And if I push on the kneecap-
- The same thing here, you push down the kneecap-
and it'll bring it up,
and kind of expose the tendon a little bit.
- Yeah.
Get that tendon on slack,
So you can really work that massage.
Whoa, right there, it hurts.
So I'm going to stay away from that.
I've got a healthy,
I was hitting something other than my tendons,
- Oh, you were hitting the bone, probably.
- Yeah, respect your feedback from your body.
And you should not be creating that sharp pain.
That wasn't real sharp, but it was-
- By the way, - sharp enough.
if you do get diagnosed,
or assessed with Osgood-Schlatter-
- Ah, yeah! - Disease,
we do have a video on that,
on know how to help it.
By the way,
this video is a part of a series of videos
on knee pain.
If you want to check out the entire series,
go to bobandbrad.com,
go to the Program section, and look,
we have different titles,
different subject matters,
like sciatica and hip pain,
and find the one on knee pain,
and you'll look in there,
and we have a list of maybe 40 videos.
- Yeah.
- Check 'em out.
- You don't have to look at every one,
just look at the title,
view the ones that pertain specifically to your concern.
The beauty of it all, it's all free.
We don't even ask your email.
There's a PDF print-off for every video.
They're about 10 minutes long.
You can print it out and have the exercises
and a review of the whole video,
right there in hand, so-
- Including this one.
- That's right.
Are we done?
- We're done.
- Excellent.
So, good luck with that tendonitis of your knee.
Get the pain going much better,
and feel better, and be careful.
- Adios.
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