♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
(clapping)
(grunts) - Hi folks, I'm Bob Schrupp,
physical therapist. - Brad Heineck,
physical therapist - And we are the most famous
physical therapists on the internet.
- Well, in our opinion,
of course Bob. - Yeah Brad,
we're gonna show the folks out there,
how to increase knee bend, minimize pain
after knee replacement or any type of knee surgery.
And kind of the big part of this, is using a TENS unit.
- Right, yep, this is something we've used in the clinic,
and we've found good success with it.
Particularly if the people don't tolerate pain meds.
- You know, it's not that far of stretch, because--
(stammers) Stretch, good word (laughter)
Because, actually, after some surgeries, actually,
implant TENS-types units in the body.
- Sure, that's a common thing, - So, I mean--
- Well, I shouldn't say common,
but with back pain, - Right, right.
- It could be one of those deals.
- Exactly, so, by the way, if you're
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- Yeah, but anyway, - Ah, by--
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We're giving away the Breather - The Breather.
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sleep apnea, - Sure.
- This is the thing for you.
- Absolutely, well friend, okay, very good Bob.
Knee surgery. - Okay.
- I believe that, for total knee replacements,
were over 800,000 total knee replacements
per year, in United States.
And I have a feeling that that number's up
since I got the stats on it. - Yeah,
I saw just recently, it's gonna go up to, like by 2,000--
oh, what was it?
It was like 20,000, was it 20,000?
- Yeah. - It was just great numbers.
- Right, and after surgery, whether--
And this goes for ACL or meniscus surgeries,
anything after surgery with the knee,
you wanna get that knee moving as best as you can
and as soon as you can, - Right.
- So it doesn't contract and become
a stiff, problematic knee.
So, one of the big things you need to do,
is minimize the resistance of doing the exercise.
Now, one thing that most hospitals do,
that I'm aware of, they throw a towel down
on the floor. - Right.
- And they say, "Wax the floor to get that knee moving."
Because the towel offers less resistance.
Well, we have one step better.
You wanna minimize it, we use this knee glide,
and it works really well.
- Yeah, this and I've seen the difference
between using a towel and using a knee glide.
The knee glide just eliminates the resistance.
- Right. - And so,
it makes it so much easier.
The other thing with the knee glide,
Brad, is that you can get this angle.
And a lot of times people, it's a little bit
hard on the ankle, to go like this.
See, watch what I'm doin', I'm puttin'
a lot of stress on the ankle right now.
This way, there's no stress on the ankle.
- Right, it minimizes-- - So.
- You wanna minimize the other resistances.
Knotted from the joint to the hip.
So that we're isolating it to here.
And then, plus you're going downhill.
Now, this may seem like a little thing,
but when your knee, after surgery,
is very weak, and you have pain associated with it,
these little things can make a big difference.
- Right, and plus, you can do it on carpet.
- Yeah (laughs). - You can do it on any surface
so long as it's light-weight, - Exactly.
- You can carry it around. - Yep, so,
at home it really helps out as well.
So, what you wanna do is ju-- - So, number one,
minimize resistance. - Right.
Next is, you're gonna have to
do some passive range of motion,
or actually kind of force the knee to bend.
Now, some knees go pretty easy,
and some knees are challenging and tight.
Those are the ones where this really can be beneficial.
And one of the rules I always do
with the total knee patient, I like to keep my hands off.
I don't like to put my hand on there and push,
although I will, depending on the situation,
but usually, people are more relaxed,
they bend better if they're in control,
of the bend. - Absolutely.
I've seen this all the time.
And that's why a lot of times we'll use
the new step to larger machine,
because they're in control, but even with this too,
I see better results, when they know
I'm not pushing on it. - Right.
- People don't trust each other.
- (laughs) Well, it's kind of a natural thing.
- Yeah, it is. - Someone's creating pain,
and you're not in control of it,
and you're just not as relaxed.
- And it's a little bit shocking
how painful the knees can be after surgery.
- Right. - One of the girls
that works for us, she had a knee replacement
after years of working with people with knee replacements,
and she was like, "Oh my God, if I knew how much it hurt,
"I wouldn't have been that mean."
she said, other people. (laughter)
- She's a therapist. - Yeah.
- So, you're gonna do this for about five minutes.
Now you're gonna go, pressure on, pressure off.
And what I have people do, is I have 'em
just kind of workin' in a pain-free range.
And then about every 10 or 15 repetitions,
I'll say, "Push it harder." And if you take your good leg,
and go over the top on your ankle,
and then you push and hold, and let it off.
And then let it relax.
And then go back to the more pain-free range.
And then every, again, 10 to 20 reps,
give it that long push.
Now, there's some therapists I've worked with,
where they will have people push it
into a very aggressive painful range,
and hold it for 30 seconds.
And I think there's some research on that,
that's why they do it, that says
it works well, it has good results.
My personal opinion, - No, I haven't found
that to be true either. - And results with patients,
it's very painful, they don't like it,
they hate coming to therapy. - Yeah, there's a
psychological component to it. - Right, so,
that's the way I treat, and I think Bob
is along with that. - Yeah, and the other thing,
Brad, when you get so far, the ankle doesn't work anymore.
Across here, so then you go off the top of the foot,
like this, and that works just as well.
And you can go even further then.
- And you can really get some nice bend.
Now, if you've got a real stubborn knee,
and it's really painful, and doing all this,
and you're using your pain meds,
as appropriate, and the doctor says,
"No, you can't use anymore pain meds."
That's when I would go to the TENS unit.
- Right. - And the TENS
is specifically made-- - Yeah, when the pain
is an overriding factor, that's really preventing
things from happening, this is a great thing to do.
- And I worked with a couple therapists
that were doing this, much longer before me.
But it was nothing, if you have a stiff knee,
tight knee, painful knee, you wanna
eliminate that pain, as much as you can.
So, the TENS unit, Transcutaneous Electrical
Muscular Stimulation. - Nerve Muscular Stim--
- It's a mouthful.
We'll just call it TENS.
That masks the pain while you're
pushing through that range of motion.
And also, it can give some benefits for swelling.
- Right, it can actually contract the muscles a little bit,
and get some of that edema out of there,
which also helps decrease the pain, so.
- So, if you're one of those people,
that have a real painful knee,
this is something you'll wanna watch.
Now, with the TENS unit, you may wanna have
a therapist guide you through this initially,
and so you get used to using it.
And then you can do it at home, just as well.
We've used a lot of TENS units,
- Right. - Over the last 20 to 30 years
and we're really happy with this iReliev unit.
- Right. - Because it's
plenty strong, it's got plenty of power, it's easy to use.
And, like this one, there's no batteries in it.
- Right, they recharge.
- You can recharge it. - Which is fantastic,
because it used to be such a pain,
to have to replace the batteries, quite often,
actually, on these things, so. - Yeah.
- Now, the way I like to hook,
this has got two channels, which most TENS units do,
and I like to hook 'em up, both channels.
You could just use two pads, but I'm gonna use four,
that makes two channels, two pads per channel.
- So, look how he's got the knee
nice and surrounded. - Yeah.
- It just creates a good halo effect,
on decreasing the pain. - Right.
So, I've got this channel, connected here and here.
The other channel, here and here.
So it makes a crisscross pattern.
Oop.
- There we go, okay.
- That's the way I like to do it.
- Right. - There's a treatment
called IFC, I'm not gonna get into that,
but that can be very beneficial for pain
and why you hook 'em up - As well as IFC is,
in the same manner. - Yep, exactly.
So, now, can you see this Liz?
I like this, it's easy to use.
I'm just gonna hold on button for a few seconds.
We got it going.
The program mode is something you have to look into,
per the TENS unit. - Yeah.
That's not what you're doing on this video.
It's not showing how-- - No, exactly.
But I'm just gonna go through how we get this going.
So, I got it on TENS, this one,
it could be used for...
- EMS, too. - EMS, but we're not
gonna work on that, that's a different treatment.
And then I'm gonna go on P3.
That's the mode I, personally, like with this TENS unit.
There's eight, there's P1 through P8,
eight different settings.
Pick the one that works best for you.
And-- - And you can actually try
each one and see what it feels like,
and which one seems like it
reduces the pain the most for you.
And-- - And just,
for me to interject, Brad, I mean,
the EMS unit could possibly be used
for the knee replacement, too. - Yeah, sure.
- 'Cause you wanna restrengthen the knee, too,
- Right, you bet. - So, it does serve
a double benefit, that you could possibly use this for.
- And then after that, you push the mode again.
P3 and then the time, I'm gonna go 20 minutes.
That goes up through, I believe, 60 minutes
on this one, increments of five minutes.
And then I wanna go to my next mode.
- Now, so what's nice about it is,
you could set it up for like, 60 minutes,
and you could work on your knee
for even just five, ten minutes.
And then keep it on in place,
so that you're having decreased pain,
even after you're done working it.
So, it helps you get through the rest of the day.
And maybe you can get off your pain meds sooner,
once you're using the TENS.
You don't have to stay on 'em as long.
And we're always trying to get you off the opiods,
as fast as possible. - Right.
- Do you know what you're doin' there Brad?
- (laughs) You just keep talkin', Bob.
- I'm trying to fill some time here.
- Well, I'm just about ready to go and--
- You mess something up? - No, well,
I didn't mess it up, I just went--
I accidentally go the EMS...
- So, Brad is still trying to figure this out.
It is an easy to use unit (laughs).
- Okay, here we go.
I just wanted to get the channel one,
so now I'm on nine milliamps,
and I'm just gonna go up, I'm--
and you can start to feel the tingling.
25, and I'm gonna hold it there.
I got one channel working there,
and now I'm gonna go to channel two,
and you probably can't read it there,
but now I'm on channel two and I'm gonna
increase the resistance there.
You can feel-- - So, I can see that one
moving now, Brad. - Yep.
- If you actually turn your knee.
I don't know if you can see that one popping up.
- Yep. - And down.
- I'm right over the VMO, right over the trigger point,
so that's gonna activate that way.
And I'm just gonna go up 'til I feel comfortable with that.
- So, he's right over the vastus medialis
obliques. - Obliques, right.
- Part of the quadriceps and-- - Yeah.
- It's really firing up now, as you can see.
And I don't know, is that comfortable yet?
For you? - Oh yeah, yeah.
It feels fine, and I could go a little more with it.
I'm not going to, I've got both channels working
at a rate that feels good, but you can go higher.
And when you first start out,
I wouldn't go too aggressive.
- So, are you comfortable in working
on knee flection, while that's
going on? - Yeah, oh yeah.
- It is, okay. - And work with the patients,
the first time, again, you take it easy,
just so they know what to expect.
You got, you know, muscle that's firing, and that's okay.
The other one's not, because I'm not over
trigger point on those muscles.
But you're just gonna do the same thing.
You're gonna work your range of motion.
You're gonna push it and hold it.
And then relax, and work that for five minutes.
And then after they get used to it,
I'm at 25 mil setting here,
and then I'm gonna go up, I may go up to 30 to 35,
whatever it may take, and continue to work with that.
- Well, Brad, we're kinda' coming to the end here.
After you do all this, you probably wanna
throw a cold pack on afterwards,
right when you're done. - Right, right.
- Right? - And you actually,
can do that with the TENS unit going,
if you'd like to. - Keep the TENS unit going, so
- Alright. - Alright, well.
That wasn't the smoothest presentation, but.
- I think we got the idea across.
- Yeah, great. - Alright,
thanks for watching. (clicking)