Hi folks, I'm Bob Schrupp physical therapist,
Brad Heineck physical therapist, together we are the most famous physical therapists on the internet, oh in our opinion of course Bob
That's all that matters Brad. Today we're going to talk about 10 steps to help prevent knee surgery and knee pain
We're going to kind of show you what to look at and what to do if you do find something right and the big
Thing about knees is you got to be nice to them, but you got to keep them moving okay in a nice way
And that's what we're going to show but first of all
Three big things Bob well, four
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as children were not liked and now as adults we're trying to turn it around, Right. It's working Bob
I'm feeling better every day. You look better. Okay. Wow okay next thing
I'm gonna do: range of motion as a therapist almost always the first thing you do when you have someone is
Look at the range of motion. How well is that knee moving? How well is it bending? It doesn't matter if it's a knee or ankle
It's a big factor and the nice thing about whether you're working with the arm
or a leg is you can always compare it to the other one, so if my left knee is the one that's
Bothering me I'm gonna see is it going fully straight and is it bending all the way cuz here's my good one I can
Straighten it out all the way, and I can bend it all the way
and I know that's good and
If this one, so you don't even need any tools to tell whether or not it's not straightening or not,
You just compare it to the other one yeah, and so I'm just gonna look at this one. Where is that stool Bob?
No, no the rolly round one
yeah, this is a good way to do it, you're actually gonna put your both legs up there and
And if one of them let's keep this one bent
yeah, if one of them is not straightening out all the way you know that one has a range of motion problem and
ideally the more you can straighten out a joint
the less pain you're gonna have, and they have kind of shown that to be true, is that for every degree
that you gain, you can lessen the pain in the knees so
so we want to get full range of motion there, you know there may be some circumstances if they had surgery or
Major injury,, but if it has no history of severe problems we want to get them equal
Okay, if possible sure so should we and the same as with the bending right Brad? I mean if you
What a way like if you lay down flat on your back is that a way to look at it? Sure
This is what I'll do in the clinic
I'll say as a matter of fact yesterday I had a knee person with a knee problem
I asked her just do this with your good knee so she did this it was normal
And I said do that with the other knee and sure enough she couldn't do it as far plus
She had pain right there, and they can feel the difference quite often
They go oh that one feels tighter you know so that's a problem. I need to try to stretch it, so for example if
Flexion is the problem or it's not bending as far you could actually do a stretch right here
There's a lot of different ways to do it
But I like ones laying down where you can be relaxed that way the muscles are relaxed
and I'm going to come over here like this, and I'm gonna work that joint and
gently
but you can do pressure on pressure off or you can do just
Onward stretches where you stretch it for 20 seconds. Sustain stretch
Do you want to show them the bonus Bob? The one where you do the rotational roll technique?
I'll do that right on here sure so this is a Mulligan technique by Brian Mulligan so what you're gonna
Do is you put your foot up here and depending which leg you have with this one you're actually going to turn it
Counterclockwise, so I'm grabbing the lower bone here the tibia
with my hand and
I'm turning it
and I'm keeping pressure on it and while I do pressure I bend the knee and
This often helps with meniscus problems, or it helps with joint problems, and the whole time
I'm turning it the whole time. I'm moving
obviously you have to be very stable on your leg you know if you're an elderly person or you've got a problem with balance then you're
gonna do the one laying down, it has to be pain free, so if you're doing this one now you're turning it clockwise
With the left leg so I turn it clockwise and I'm bending and again, it should be pain-free the whole time
I mean a little discomfort from the turning, right now
I feel a little bit of discomfort just from pressure, it's not the knee pain, not the knee pain no
All right moving on Brad okay for straightening it
I like to use a chair with some wheels and sit on another chair so get it out like that and here
It's not straight. I'm gonna put my hands here and gently
work and
Pressure on pressure off, if you don't have a rolling stool
You can just put it on a regular stool
But a rolling stool does work better, if it's a regular stool I'll put a towel down if it's wood
So it slides a little bit, so it gives you a little
Movement there that's free and then you can hold
You can do some oscillations
Whatever you do the longer you do it you should get more range of motion with less pain, the thing about some like this is
you don't necessarily have to do it once a day for like 15 minutes you can do it
Throughout the day you know when you're sitting in your chair
and
You can do a set of 10 then you know you could do that every hour if you're tolerating it, the first day
You may only want to do one set of ten, and then see how you tolerate it the next day, then do some more
Start increasing it. Let's say you go through your test, and this test feels pretty good, and you get it pretty straight
Well, then we also want to check well how the meniscus is
So we're gonna see, the meniscus is the cushioning in between the knee bones so actually if you look on
Napoleon here we actually have one in red here, right so that's the cushioning between the joints, helps
Can you see that red Lonnie? There you go
Now your meniscus isn't red like that, it's actually white, but white and white doesn't show up very well
There's a number of tests to test the meniscus
These are two simple ones that we think are good for the lay person to do and I just had a meniscus
Patient a couple months ago
and this was a perfect test for her and she would point her toes out bend her knees like this and
Then do the duck walk
and in her situation she would get down like this and just start to move and it was painful so we stopped we
started exercises
And then she would test her own self to see if it was improving, with that test, it's a good idea
yeah, because it's something you can test yourself then, another one is to do the more of the
One leg test where you actually bend the knee, and then you can actually do kind of a twist like this
Yeah, you do the twist
Come on baby,
1962 Bob when they started that twist dance, I'm glad to know that you know that yeah
I just learned it
I was 17 years old no yeah I was 2 years old, but anyway when you do this
You're gonna feel it be painful, some sharp pain, and that's what's nice about
This is you can test one versus the other, now if this test is positive
Here's some simple
Exercises you can do to get going on this, we actually just did a full video on this
This is one of those just simple straight leg raises and try to keep the knee perfectly straight
Because it may lag a little bit like this
But we want it like this if you can and then you're gonna start working it here
and you're gonna bring it up, and you know as high as you can with a little hamstring stretch and
10 to 15 of these controlled you're not flipping it around but good control. Other foot is flat on the ground yeah
Don't do it like this. It's much better if you do it here
Okay, and then lay on one side leg straight
Don't point the toe up like this point it like this because we want that abductor to work there
Okay, 10 to 15 of those
And then on the other side we're gonna work the adductors
This direction so we got the front the outside inside, getting all the muscles here
Then we want to work the hamstrings. I'm gonna pull my heel
He's pushing his heel down into the mat like that and I'm gonna pull hold it for eight to ten seconds
1,001 1,002 all the way up to 8 or 10 seconds and then relax it and do that at least 3 times
Okay, and then after that
We want to go to this feeling better
And we're doing some walking
But stairs are still maybe a problem, sure, partial squats Bob
Oh sure. you want to show them that? Sure well again the whole thing with these whenever you're doing squats
We're trying to stop the knee from going past the toe
So you want to squat down like this you're gonna have to kind of stick your butt out Brad
In order to do this right you see how I'm not going past like this. I'm kind of going straight down
Again, you can hang on just something which makes it a lot easier to do
And we're only going partial, which means we're going down to about sixty degrees we're not going way down to ninety degree
Again, that's a lot less stress on the knee, but yet you're strengthening it
You know if it's down the road, and it feels fine to go to ninety you could but it's gotta feel
perfectly, we have no problems with you going to 90, okay now
So we went through first of all you assessed for range of motion if it wasn't full extension reflection we gave you two
exercises if a meniscus test the duck walk or the twist test
Created pain we gave you three exercises for that and now the next thing, not least but last
Last but not least there you go. Thank you Bob
We're gonna be looking at the kneecap itself, gonna show a little leg, Bob
A lot of times with this pain a lot of people talk about the pain being right around the knee Brad
And they might feel grinding a lot of times worse on the stairs
Can you see that the patella moving there Lonnie?
So the first thing you're gonna do is go right to left
But your quadriceps have to be completely relaxed if they're not relaxed, like right now
I gotta tell you I'm not moving anything, so get it relaxed, loose
It's one you may test on both knees again too because if they're both tight, both could be tight
You may not be doing it right, but look
How well his is moving this one does give a lot of people the heebie-jeebies I mean
they don't like the idea that it moves, but it is supposed to move and if you find like it moves in one direction very well
And not in the other direction
Sometimes that could be a source of problems and may be it's not tracking right
Matter of fact the woman I worked with yesterday was having knee pain going up and down steps or even
Driving their car and she said if she would grab her patella and push up this way it felt better
I had a lady that I showed her this and she used to push it over and walk upstairs and wouldn't
Have pain, she'd push it over while she's walking up
The stairs, so what I'm having her do is at home
She's doing knee patella mobiles going up like this
And she's pushing her kneecap up stretching out the infrapatellar and the fat pads down there
Those are some structures that need to be stretched out
I work some CrossFit friction massage in there put some ice on it
And we're gonna try and she's 31
Long time yet, and a lot of times you might find the kneecap is tight in every direction so you can stretch it in
Every direction you can stretch it to the middle you can stretch it to the outside you can push down
And you can push up, usually not any harm in doing any of these things, right and this is one that
Probably if a person does it to themselves they do it better because they're more relaxed, even when Bob's doing it of course
I don't trust Bob.
It does work well when you do it to yourself
So I think that's a pretty complete assessment from the knee from range-of-motion meniscus patella
Yeah, it's a good start
I mean, we're covering probably you know a good majority of the problems you might have with your knees you better believe it
So once again we covered everything here, Bob, but there's still one part of the body we're working on that broken
Heart yeah the broken heart, but we're gonna give it Bob. We're gonna fix it
We can fix just about anything.