- Hi, I'm Bob Schrupp, physical therapist,
- Brad Heineck, physical therapist.
- Boy aren't you handsome. Together we are
the most famous physical therapists on the internet.
- In our opinion of course, Bob.
- Okay, Brad, today, we're gonna talk about
if you dislocate your kneecap or your patella,
you know, what do you need to know?
And are you gonna need surgery?
- Sure. - So, quite often,
what happens, the way a person
dislocates their kneecap, here by the way
I have a kneecap, of a bone-apart
or bonehead, whichever you call them right now.
And the kneecap, actually, many of you
don't know this but when your knee is bending
and straining, the kneecap is actually
moving up and down in this groove here.
Can you see that Lonnie? - Right here.
The femoral groove. - Yep.
So that's moving up and down in there.
Now what happens is,
if you have your knee slightly bent
and a lot of times turned in like this.
What we call valgus. That puts your knee
at a more risk for dislocating the kneecap.
And the kneecap almost always
dislocates to the outside. This way.
Very rare. The only way it goes in
is actually if you've got some defect
or if someone maybe hit it with a helmet
in football or something that made it go that way.
So it's gonna dislocate this way.
And what happens when it does that
it actually can tear some structures here.
So Brad's gonna actually show that,
cause this is one of the indicators.
If your VMO, the muscle here,
your vastus medialis obliques,
that's part of your quadricep,
kind of that teardrop right here.
If that gets torn really bad, there's a defect in it,
they probably are gonna do surgery or,
this is, I'm all full here too,
medial patellofemoral ligament.
This is the ligament that helps
hold the kneecap in place.
So it goes from here, over onto
the femoral bone here, helps hold it in place.
If that's got a big defect in it,
a big, you know gap in it,
they're probably gonna do surgery, right?
The other indication for doing surgery right away
is if a little piece of bone fragment
gets broken off and it's sitting underneath the surface,
I mean you're just not gonna be able to survive
with, you know, you're gonna have grinding.
- [Brad] Can't have a floater in there.
- No, you can't have a floater.
Other reasons if the kneecap is you know,
subluxed or out of place and they can't get it back in place
or it's really prone to doing that,
they're gonna probably do surgery.
If it's, now we're talking about people
this has happened to for the first time.
If it's happened more than once
you're more than likely gonna need surgery.
And the last reason why you might have surgery
is if you really are involved in sports
with high athletic demands. - Right.
So if you're a, you know, high end football player
and you're gonna have to, you're a running back.
- Right. Professionals. - Yeah.
- You know, if you're in high school
you just may not do the sport anymore.
- Right. Exactly. So, all right.
Basically for the vast majority of people though
conservative treatment is gonna be
the first issue of choice. - Right.
- So they're gonna try some physical therapy.
They're gonna keep you immobilized for probably
two or three weeks. And during that time,
- In other words, a leg brace, knee brace.
- Yeah. Knee brace, they got a brace
that is made just for this problem.
And then they'll start doing some strengthening
where they're trying to strengthen the VMO,
especially. - That quadricep muscle.
- We're gonna do a video on that.
We're gonna show you three exercises
you can do to strengthen the VMO.
Now, what are the things that might
put you at risk for dislocating your knee?
I thought we just go over a few of those.
One, the shape of the groove here,
which you can't control that. - That's genetics.
- Yeah. Two, if you are, especially in women,
you have a, what we call a high angle, Q angle.
It's just a natural angle here between your knee.
- They might call that knock kneed.
- Yeah, exactly.
- Because the knees come together before your feet.
- So this angle right here, women it's, a normal angle
is 17 degrees. If you're a lot above that,
you're gonna be at a higher risk.
It just makes it a lot easier for the muscles to pull
the patella right out of the groove.
- Right. And we don't, that's just the way it is.
Women have a higher Q angle than men.
- Yeah. - They know that.
- If you're flat footed, it just changes
the whole biomechanics of the knee
and can make you more at risk.
If you are flat footed, that is something
you may want to get, some type of orthotics,
so that you're not flatfooted, to help hold the arch up
so that you're less likely to have problems.
- That's another video. - Yeah.
If your patella or your kneecap
tends to run a little bit high,
and we can tell by looking at it,
I can tell by looking at someone,
whether or not their kneecap's high,
it doesn't stay in the groove as much.
And it's more likely to dislocate.
- And what's the name of that?
- Patella alta. - Patella alta.
- Maybe, I don't know, Alta meant Alta Heights.
I don't know what Alta means. All right.
So if you, again, you're gonna have,
like I said we're gonna do a video now
on the three exercises for the VMO.
And these are the exercises you do after
you've been immobilized for two or three weeks.
Before that, all you're gonna be doing is,
what we call quad sets, where you're tightening the muscle
or you might be doing a few straight leg raises.
- Right. Cause you got that brace on.
It needs time to start to start
to scar tissue in the right area.
- Yeah. Needs to mobilize and heal.
So, all right. Watch. I'll link up
to the second video too here. So.
- Yeah, and then subscribe,
because we got more videos like this
and some of them are really good
and some of them are boring, but we try our best.
So keep on subscribing.
- And remember, we can fix just about anything, Brad.
- Except for a broken heart.
- But we're working on it.
Thanks.