Hi folks, I'm Bob Schrupp physical therapist, Brad Heineck physical therapist
Together we are the most famous physical therapists on the internet in our opinion of course Bob,
Today Brad we're gonna talk about seven advanced stretches to increase knee bend after a knee replacement
These aren't the basic ones these are gonna go beyond you know we're not doing floor scrubs and stuff like that
We're doing things that are gonna get you further, right you want to get to the 120 or greater degrees
Or you're having a knee that's being difficult
These are the techniques that we use in the clinic and we've been doing it for years
On literally thousands of knees, if you're having a Bob and Brad knee there you go, one that's difficult
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Thank you appreciate that, means a lot coming from you, alright let's talk about the first one Brad
This is an advanced one. This is the knee glide. We're gonna use this
This is a device for helping increase your knee flexion and you can actually use it to increase your knee
Extension too, sure it works both
But we're just talking about flexion today so what's nice about this Brad, I want to tell a story
I had a patient who we saw for actually quite a few weeks, and we were trying to increase her knee bend
And we couldn't get beyond
72 degrees, which is not acceptable, about like that
We didn't have the knee glide so we started using the knee glide on her
This is actually she came back and we started using the knee glide on her and we got her to 95
All right, so 72 is right there Bob, come back out
So that was where she was and look where she got to, way up in here
It was just so much easier to
Apply pressure to the knee without causing stress to the knee than it was how we were normally doing it
Plus we sent one of these home with her
So that didn't hurt either, and then she probably was more compliant to do it at home
Because she knows she needs to use this
But the whole thing is it's got a plastic footplate and someone who designed it did a really nice job
They got some kind of like an aluminum rail must be and they slide that back and forth and there's just very little friction on it
Right, it's very little resistance and also if you're a little bit uncomfortable with the foot flat
You can also angle it up like this
Now you got a little bit of gravity working for you, so what I like about this Brad is that you can actually start off
We can go ahead and you can go ahead and put your
heel on the toe and you can start pushing it back and
So he's using his good leg to help push, I'm sorry normally we start this way don't we, normally you're
Ankle to ankle, is what you are, and you're gonna start pushing it back
And then it gets too far where this doesn't get effective anymore now you put your heel on the toe and you go back even further
And for any therapists out there watching what I really like about this device is as a therapist normally I'm gonna
I would be out here, but I need to get out of the way so you can see
Let's say Bob gets to about 90 degrees, and he's as far as he can go well
You know as therapists you always want to help a little bit to try and get that extra few degrees
I take my foot right here my left foot
right on the device
And I can easily push in and without much effort at all and I have two free hands to measure with the goniometer
to get that new record distance
Which the patient always likes to see yeah
So it's just really easy to do it without using your hands to push it back further
Exactly you got a free hands so you can use your foot effectively. It's just a neat neat device
all right what is it called again? The Knee Glide.
We'll have it down below we have our preferred products in our Amazon link just go into that because
There's a couple products
We're going to mention today
And you can see them there, this has only been out for less than a year or two we know that
All right, so next one Brad we're going to talk about is using a belt, your own belt or a stretch out strap and
What I like about the stretch out strap
It's got multiple loops here
And these are really inexpensive
Every six inches or so there's a loop where you can use it for various things, which you'll see mostly for hand holds
Yeah, and so what you can. Do is just you can take one of the loops and
And run it through like that and now depending on what kind of chair you're in Brad you can just go down
See all through the loops here all the way around like this and now
If you don't have a Knee Glide you could put the towel on the floor
That works okay, but since we got the Knee Glide here let's use it
So now I can go ahead and pull back and give me a little extra pressure
What's nice about the loops here
I don't even have to use my hands Brad. I can just push forward like this
What's nice about this is you can do what we call contract relax all by yourself
Yeah, all by yourself so what I'm gonna do is
I'm gonna pull on this and while I'm pulling I'm pushing like I'm trying to straighten
I'm trying to straighten the knee but I'm not letting it go straight at all
He's holding it with the strap, if I wasn't
Holding it with the strap, it would go like this
I'm going to go straight forward, so I'm gonna push, and then when I relax
I pull it a little bit further and how long are you gonna push?
I don't know a few seconds right it's not minutes. You know 5 to 10 second relax
push
and relax
Push and relax, and then I might even go another loop down Brad here cuz I'm starting to lose my leverage yep
There you go push and relax. It's just that contract relax really works
It's a really good technique to do you could again you could hook up a belt
You know and take it around and also put a towel on the floor sure
Good job with the precisely Brad yeah, I'm working on that all right next one Brad
I have found this in quite a few cases especially when people get stuck
Look at his socks,
Gargoyle socks
His famous Argyle
Okay, so the kneecap quite often sometimes gets affixed down or it's just not moving like it should
And if the kneecap is not tracking right or moving like it should it's gonna stop your knee bend from happening
Yeah you have to remember they cut this open and they take that kneecap and they flip it off to the side upside down
Sometimes they even put a new surface on the bottom of the kneecap one way or another
There's a lot of scar tissue that needs to heal and it needs to heal properly
And if it gets in the way this will help to break it up, and actually that brings me to another one we can talk about Brad
So what you're gonna do is you gotta be very relaxed to do this otherwise
It's just not gonna work, but you're trying to I'm trying to push the kneecap down
I'm pushing it down this way using my thumbs like this so you're not gonna do this with your knee bent
It's got to be out like this, straightened, and then you can also push it off to the side
You're gonna push it in every direction Brad right forward right left out and pull it up towards you yeah
And that's just gonna loosen it up so that it's gonna move a lot better
And I have found with a few people especially one surgeon in particular
I don't know what he was doing but
With all of his patients when we would work on this we'd get another 10 degrees
I mean it was the thing that was hindering it
I don't know why
So if you got a knee replacement from that particular surgeon you're pretty depending that this is gonna be part of that treatment
That's right
Now another part is the scar tissue itself sometimes the scar tissue could get scarred down and it can cause a little bit of pulling and pain
And now this one we want to caution you though this is one
You wouldn't do until quite a few weeks. Yeah, that scar has to be healed. There's no openings
You maybe wanna okay it with your doctor, say can I work on my scar tissue?
And so you know what you're gonna do is you're just gonna
Go you know if there's a scar here. You're gonna work across the scar like this you're rubbing across
Sometimes you rub it in different directions Brad, but generally it's just going across like this
I've had really good luck with this when you get that
Ropey scar tissue a lot of scar tissue and that
Incision is just scarred right down and usually after two or three days of doing this it just, well it flattens the scar out yeah
If your scar is bumpy or whatever this tends to help that too so alright, so you got two extra ones right there Brad we got two
Gave them kind of a bonus one there all right next one Brad is the stairs
You want to get our stairs out? You wanna show this one? Sure.
So if you have a stairway at home, and you need to have two handrails, okay
You could try it with one, but I really recommend two and we don't have an official staircase
But you can see this represents the first step the second step
These are going to represent the handrails, so you have to get ahold of hand rails
So you're steady and you put your knee up to whatever level is
Comfortable you might only start at the first one
And then you just simply go in and you can see the bend in that knee
Right there, I'm gonna stretch till it stretches, stretch out hurts a little bit and then come back
Pressure on
Pressure off, now there are some theories where they like to hold a stretch for 30 seconds straight.
I usually don't do that because I don't have real good luck with my patients, but there are therapists that swear by it
And if you have a therapist like that fine because yeah
You can do a little bit of both too you can do pressure on pressure off
and also
As long as I'm making progress
You know I continue with what's working and then after it gets better you go to the top one
And you can see you can get quite a bit of a flexion in there so when you're at that higher level
And you really want to get to the maximum range just works really well you're not gonna
Do this one a week afterwards, this one's gonna be a few weeks after. This is one I've heard some patients mention
I haven't had patients do it but some of them will sit on the stairs Brad
They'll sit on a higher stair
And they'll try to work their way down
And you can see how the knee bends more with each one,
Again if you're in your 70s or 80s and not real mobile
Yeah, that's obvious now, but you know these people are doing it in their 40s now right so we got someone
That's working for us Brad that's gonna we one in November, she's in her 50s now
She was in her 40s on her first knee wasn't she? Yeah she was.
Brad do you want to show the ball? You fit on the ball better than I do
The beauty of the ball, beauty of the ball, and I've been using this with knee patients
I put them in the parallel bars, so they have something to hold onto
If you do this at home if it works good with a patient in the parallel bars
And they really like it then often times they'll get their own ball. They'll go down and spend $15 $20 on one downtown
And they'll put furniture in their house
So they got something to hold on to, normally I would put it right here, but
So you can see what's going on?=
I'm gonna put it here so very stable something to hold on to both hands
Make sure the ball's got enough air in it so you're not sinking too far down
And you plant if this is my new knee I'm gonna pull it up like that if this as far as it bends
We rock into it stretch and back
Stretch and back you'll get a little bit further each time bouncing too see you're getting at it from two different angles
Horizontally and vertically, so that's great. You know this one I think people either love it or they don't care for it
No in between usually huh? That's what it seems like okay, and let's grab the wheelchair Brad bring that over
You wanted to do that on the edge here?
So if you have a wheelchair
Available this works out really good. I used it with a patient
I remember 20 years ago and he had both knees done at the same time
And he used to call this our little torture thing that we'd do but you go ahead
Just put the foot up against there. I guess really I should do it on this one
And what's nice about this is I'm in control, the patient's in control exactly right precisely
And they can gradually work on bending that knee further and further and with using the the wheels the large wheels here
With this hand control on the wheels you've got a tremendous amount of leverage
It doesn't take a lot of energy to put a fair amount of force on it and again
You're in complete control. Well then what we used to do Brad is we used to do this and then lock it
Let it stretch for a little bit, but again I've become more of a believer in the pressure on pressure off
I mean I seem to get a little more with that
But sometimes you want a little bit of sustained stretch in there
Brad the last one you were going to show was on the pickup truck right if somebody owns a pickup truck
I do have a number of the people in the rural area that are farmers pickup trucks are really common and
What this patient discovered, he said
I just sit on the back of my pickup truck with the gate down so there's a hollow spot underneath
And he would just take his knee and he starts swinging it, and then take his good leg
And he'd push just get it more stretch, and he said it was so nice and relaxed
He could sit outside and it was in the summertime and then get that extra push
And he would just use it and you know he came back. Maybe a stable table in the house
I don't know what else would work. I don't want people
Sitting on a table and breaking it. Yeah, a pick me up truck
That's what the tailgates are for in a pickup truck fold them down and use it for knee replacements. Alright we're way over time Brad so here
Thanks everybody for coming and watching.