♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the Internet ♪
- Hi, folks, I am Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapist
on the internet.
(loudly) - In our opinion, of course.
- Oh, my gosh.
Okay. Today, we're gonna talk about
what does a torn meniscus feel like?
Plus we are gonna show you
three self-tests - Okay.
- So you can determine whether or not you have maybe
a tear on the inside or tear on the outside.
We'll break it down.
- Either way, it's torn. - Yeah.
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All right, let's get started.
- All right.
- So, let's first show where the meniscus is.
- Sure.
- It's a cartilage in your knee.
The thing that provides the cushioning,
and maybe a little bit of shape,
bones fit each other well. - Yeah.
Some stability, et cetera.
And it's right here.
As a matter of fact, there's a nice model of it right here.
If you open up the knee, take the knee cap,
get it out of the way.
And you could see right here.
- [Bob] It's kind of a figure eight, isn't it?
- Yeah, it is.
Then I've heard people say,
I remembered in anatomy
and they were like horseshoe.
And this model doesn't show,
but actually, there is some of a horseshoe shape on both.
So you've got the medial aspect and the lateral aspect.
- [Bob] The medial is the inside of the knee.
- Yeah.
- And laterals outside of the knee.
- Exactly, Bob.
But look at that they even have the ACL in this model.
It's pretty nice. - Yeah.
So obviously that's not anatomically
totally correct, probably?
- No. But it gives you a good idea.
- So when you're young, a tear is usually a result
of a sporting accident or some type of trauma.
- Right.
Oftentimes, a twisting is involved with pressure and force.
- When you get older, unfortunately like 40 or 50 and over,
it can just occur from overuse
or someone might be just walking along one day
and all of a sudden... - Yeah.
- They just tear, They degenerate over time.
This happened to my wife,
this happened to my office manager.
- I really think...
a lot of times, I've had patients where they said, well,
I had their weight on the knee
and they were turning. - Right.
- So there's a twisting component...
- With your body, should be able to turn.
- Yeah.
It's like stuff you've been doing all your life
and all of a sudden, why now?
It's like, well.
- So in other words, if you're older,
you can't rule that out. - Sure.
- A lot of us have tears in our knees
and our meniscus and we don't know it.
- Right.
- They had many, many studies that have confirmed this,
that they've done MRIs on people
with little to no pain and they look,
and they have some tears in there.
- Right.
- It's like gray hair and wrinkles.
- Yeah. - It's part of aging.
All right, first, we're gonna talk about a small tear.
With a small tear, again, many of us may have a small tear.
- Sure.
- And we don't even realize it.
You have, maybe have little to no pain.
If it's a recent injury,
or it may have came from a recent injury,
you may walk normal,
but there might be mild swelling.
There's gonna be pain with squatting, getting up to stand.
- Yep.
- That's when you're really putting
a lot of pressure on the knee.
Lifting something heavy. - Sure.
- So really not too bad. - Up and down steps.
- Up and down stairs, yeah.
These tend to heal on their own.
- Sure.
- For the most cases. - Yep.
- Again, the meniscus,
especially as you go into the outer reaches,
it doesn't as much,
circulation, right?
- Right. Meniscus is a white tissue.
There's not a good blood supply, so it takes longer to heal.
- Alright, now we go to a moderate tear.
- Wow.
- Now, this has had noticeable discomfort,
sharp short-lived pain.
It'd be sharp jolts of pain - Yeah.
I think if...
Can you see this, Liz?
If you just imagine this meniscus,
it can tear and sometimes it can flip and get in the way
and you don't have a smooth surface anymore.
It tears and it creates a ridge in there
or it can flip over,
and that's when you can...
On this, we talk about locking,
there's that... - That's the next one.
- That's the next one.
- The larger chair. - Yeah.
- So with this one, you may have trouble bending the knee.
- Yep.
- And also the same thing, squatting and twisting the knee
can really give you a sharp pain.
- Sure.
- So it's definitely...
I mean, most of these are gonna get better
but you may still have lingering pain.
- Sure.
- I mean especially moments of lingering pain.
- Yep.
- All right, the third one, the larger tear.
No doubt, you injured yourself.
It is not going to be any doubt.
It's gonna be a sharp pain, swelling right away.
Maybe a popping sound, a grinding sound.
The knee feels like it's catching,
that's what Brad was talking about there.
- Yep.
- All that meniscus could flip over even,
a piece of it could flip over - Yep.
- And be like a stone in your shoe.
- Yeah.
And I've had a number of patients where they tell me that,
then I go to the test we're gonna show.
- Right.
- And I've had a couple of patients
that I said, "You got to go to the doctor
and get checked out," because it's just too severe,
there's no sense in working with it.
- Yeah.
It may lock up and not be able to extend or bend.
- Yeah.
Well, it sounded very painful at that point.
But usually as they walk on it...
- Sometimes it gets better.
- Or it'll get better temporarily
and then they do the same movement and it locks up again.
- Right.
The knee might even give way on them.
- Yeah.
- So you gotta be careful with this.
This is really the only instance in which most surgeons
now are recommending surgery.
If you have a moderate tear or a small tear,
they almost never say, you're just not gonna do any better
than if you'd just have therapy.
- Sure.
- But if you have one that's locking up
in that case, you may consider it.
- Sure.
- An orthoscopic surgery. - Yeah.
- All right, the tests, Brad.
We've got three tests.
The first one is the Thessaly.
Again, I'm sure these are all named after people.
(Brad laughing)
I apologize for not knowing.
- Well, I'm sure it was probably a doctor
and he or she will get over it - They're not gonna be mad.
So we're just facing each other here, Brad.
- Sure.
- So we're gonna bend their knee.
Let's say I'm testing the left side,
Brad's testing his right side.
I'm gonna bend their knee just about 20 degrees
with just a slight bend.
And when I'm in this position now,
I'm gonna rotate my whole body like this.
Rotating that on the knee. - Right.
- So the other leg is up in the air like we have.
- Yeah.
- And Brad and I were just talking about this.
This has been a good test that we've been using.
It seems to...
- Right, there's a McMurray test that I learned in school,
And I like this one a lot better.
And there's another one I do too.
But I'll do this and I'll do a little more flection.
- Sure. Yep.
- Compare. - Yep, absolutely.
- And then the nice thing is compare to the other leg.
If your good leg feels completely pain-free
and you're doing this and you feel some grinding or pain,
it's a good positive test.
- Yeah.
And you can also, test it,
walk for a while with it and retest it
in a couple of weeks or months
and see if it's getting better at all.
- Exactly.
The same test feels much better.
That's a good sign obviously.
- All right.
This one is called Ege's test.
There's actually two ways to do it.
You turn your feet out, externally rotate.
Brad must like that one
because his legs are naturally externally rotating.
- Yeah, I feel really comfortable.
- And you're just gonna squat down.
Now, if there's pain with this,
this is testing the medial meniscus.
So the meniscus on the inside of the knee.
- Sure.
- So if there's pain with this one
it's probably more likely the medial meniscus.
Now, as you certainly understand, you turn the feet in.
And you're not gonna be able to squat as far as this way.
- No.
- But you're testing more the lateral meniscus now.
So if any of these cause pain,
you could possibly have a meniscus problem.
- Right.
It's 100% the surgeon.
- It's about a 100% surgeon, by any means,
but it certainly gives you a starting point.
- Right. Exactly.
- And remember, Brad and I can fix just about anything...
- Except for... - A broken heart.
But we're gonna work on it. - Right.
Yeah anyway, Bob, I want to get you to one thing.
It's my hair Bob, I can't do a thing with it anymore,
and I don't know what the hell to do about it.
- Well, just wait a couple years, it'll be gone.
- It's just turning gray, it's falling out
and I can't even comb it anymore.
- I don't have hardly any hair left either, so.
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