♪ Bob and Brad ♪
♪ The two most famous physical therapist ♪
♪ on the internet ♪
- 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.
- So what is causing your knee pain? Osteoarthritis?
Today we'll tell you how to look... (chuckles)
- Determine?
- Yeah. Well, I can't talk today.
How to tell.
- Okay.
So we're gonna start off with a knee arthritis.
There's really actually two types of cartilage in your knee.
- Sure.
- There's a type of cartilage that covers
the end of the bones and that's like a Teflon.
- Yeah. It lookskind of like Teflon.
Glued, well, if it's white.
- It's a hyaline cartilage.
- Yeah, it's kinda like right on the bone itself.
It's part of the bone.
- And as that begins to wear out as you get older,
you had kind of a description of that, Brad.
- Well, it reminds me of either like on steel,
you got nice shiny steel, as it rusts,
it gets...
- Sharp.
- Corroded and pitted or it reminds me of sandpaper.
If you could think about the knee going back and forth
and sandpaper kinda grinding against each other.
- It can kinda flake off too, the covering,
kinda flake up.
- Then where does it go?
- I don't know. (laughs)
No, it gets, some of it gets absorbed by the body.
- Sure.
- There's also the kind of cartilage
that you call the meniscus.
And those are thicker and they provide stability
to the joint or some cushioning for the joint.
- And meniscus can tear.
- Yeah, tear.
- And fold over and cause locking and popping of the knee.
It's a, it's a different symptoms,
different pain situations.
- The thing is though, both of them can wear out over time
and it can cause bone-on-bone rubbing
and it can also result in bone spurs.
- Sure.
- So let's, let's talk about some of the symptoms
you may feel and then we'll show you
some of the tests you can do.
So you're gonna, with the osteoarthritis,
this is the one thing that I, I find in the clinic a lot,
Brad, is that people come in and they didn't have any pain,
all of a sudden they have pain, they go,
"They took X-rays, it's arthritis."
Well, arthritis doesn't usually start one day.
It's a gradual increase in pain.
I mean it gradually wears out
and the pain is felt on most days of the month
because you're, you know, it's arthritis.
- Right, right.
- So it takes awhile for it to break,
to come on.
- Right. It's usually has been bothering me for a year
but not too bad.
Now it's getting worse, you know.
And that might be the case where
it's been there but all of a sudden, maybe you bumped it
or you fell on it and then you get that increased.
And you may not even think about it.
- The other exception is if a piece of cartilage breaks off
and gets lodged into your joint,
this is like having a pebble in your shoe.
And this did happen to my wife.
She, I mean, pain-free, and then she must've had a piece
of cartilage break off and she had to be on crutches.
- I remember that.
They call that, sometimes they call it a floater.
So a piece floating around in there.
I remember... There's some certain called mice.
Yeah, yeah. (chuckles)
- Why would you call it?
- I don't know. - Make a peep peep peep.
- They run around.
Okay, number two.
Unexplained swelling of the knee.
With osteoarthritis, this could be due
to osteophytes or bony overgrowth,
but it can also be due to inflammation
which is causing extra fluid to accumulate.
So if the knee feels warm
sometimes that could be a rheumatoid arthritis even.
But that's usually more of a systemic problem
which means you're gonna feel kind of bad all over.
- Yeah, maybe a little more in the hands and in the feet.
- Yeah, multiple joints.
- But it's, still, it's throughout.
- All right. If your knee is buckling or locking,
the cartilage can wear away and the knee
can become unstable.
You know, it no longer provides the support
that it was providing.
- And you know, if it locks and then you move it around
and then it seems to unlock and then it's okay,
that's a good sig or a symptom that it's probably
a meniscus tear or fold,
- And as that Teflon erodes,
it can create rough surfaces to it.
And it, the knee doesn't glide like it used to
so it can catch and lock.
- Yeah, I've seen pictures of people
after their knee surgery and the surgeon will take
a photograph with their knee open, you know,
during the surgery.
And it's just amazing that they were functioning with...
- Some people, it's amazing.
You know, you, you know, they've,
they've done studies where they've shown,
they've done X-rays on people who are having no pain
and look at their knee, they're terrible.
And they've done X-rays on people who have pain
and their x-rays are fine.
So it's, x-rays don't always correlate.
- Yeah, that's true.
That makes it a little tough sometimes.
- All right, if you're hearing popping or cracking sounds
and you know, again, the cartilage could be uneven
or wore out and it could grind and crunch.
I mean, I've heard some knees and oh my God.
Oh my God!
They would be grinding it with every step.
- One thing though is if you have popping and grinding
and there's absolutely no pain associated with it,
you don't have to get too excited but keep an eye on it,
monitor it, see if it, 'cause if it does start
to develop pain or things change then you know,
but if you just feel some popping and stuff
and there's no other symptoms, you know,
it's not a real big deal.
- Yeah.
If you have decreased motion of the knee
especially of course the straightening or bending
and you can compare one side to another.
Especially if you have one knee pain that's,
one knee that's hurts and one that doesn't.
- And this can be pretty subtle.
I mean, you may think, oh my knee is straight
but as a therapist, I know that knee's not straight.
It's got that much further to go.
And that's not a lot.
You may not think it's a lot, but you know,
five degrees could be the difference
between painful and not painful.
So we we've done a number of videos
showing you how to regain or attempt to regain it.
- Yeah, right.
- And sometimes when you regain that five degrees,
the pain goes away.
- Yeah. And the other thing, Brad,
I'm gonna show this. - Oh yeah, absolutely.
- Actually to show you how much knee extension
you're supposed to have at straightening.
Look at me, my knee, my heel actually comes off the bed up.
And so there should be a little bit
of hyper extension in the knees.
Otherwise you are probably lacking some.
So if you can lift one up and you can't lift up the other,
that one might be a little tight.
- Always compare the one knee to the other.
It's a good comparison.
- And with bending too.
- Oh yes!
Can you get your heel to your but or close to it?
And the other one that hurts is six inches
or you know, much further.
- What we find quite often, Brad,
sometimes they look about the same, but you can feel it.
Like, you know, if this one's tight, it's like,
this just feels tighter.
- Right, yeah. So the person, you can--
- Yeah, the person could feel it.
- Not the therapist.
- Not the therapist, right.
If there's a loss of knee joint space,
now this would be on an x-ray or it could also cause
a deformity in your knee.
But if they do an x-ray and they see
that the space is narrowed because there's not
as much cartilage between the knee anymore.
That's, there's your sign.
- And this is one of those things that doctors they,
they'll show you on the x-rays right there in the,
in the room.
- Yeah.
If there's deformity of your knee,
a lot of times if you had arthritis for a long time,
you can start seeing bony overgrowth.
I mean, Brad, I'm sure you've seen this.
On some knees it's amazing, isn't it?
How much overgrowth there are.
I mean, it'd be huge.
- Yeah. Yeah.
And that's typically with older people.
- Oh, well, usually up...
- Up in their 80s and 90s. - 80s and 90s.
And their knee, it can cause your knee to bow in or bow out.
- Yup. We call that varus or valgus
or bow-kneed or knock-kneed.
- If your knee pain is worse with activity,
like especially on stairs or climbing a hill, you know,
it's obviously something is worse when
it's a joint is grinding or pushed together.
So, and arthritis does get worse with that.
- And it can go worse up or down.
I usually found in general, from my observation,
going down is where the knee hurts more
than going upstairs, but it can go either way.
- Yeah, I always suspected the reason for that,
it was because the quad isn't kicked in until you hit.
You know, and then it protects it.
- Sure, yeah.
- If your knee pain is generally relieved with a rest,
again, that could be a sign of arthritis.
- For sure,
It hurts when you're walking, take your weight off it,
immediately feels better and you can still move it.
- Number 10, if you are, have joined the Bob and Brad Club
and you're over 50 years old. (chuckles)
- Well, what club are you then?
- I'm in the 60-year-old club actually, so.
- I'm coming right behind him.
- Yeah.
If there's morning stiffness and you know less,
less than 30 minutes, that could be osteoarthritis.
If it's longer, it could be rheumatoid arthritis.
- Wait a second.
If you wake up with knee pain...
- If you wake up and the stiffness is less than 30 minutes,
you do have stiffness... - Oh, 30 minutes.
Did you say minutes before?
- Yeah.
- Well, he did.
See, my hearing's going.
- Okay. I though you said seconds.
- Okay. (chuckles)
Anyway, longer than that might be rheumatoid arthritis.
If it's tender, again, along the joint line
which I showed you, it's, you know,
if you look under the kneecap, it's like, there's a smile.
The joint goes like that and you can feel along there.
And with arthritis, that's generally where
you're gonna feel the pain, so...
Now we're gonna show you some of the tests you can do.
One thing that you're gonna do, like we talked about,
is you're gonna check the knee bend
and the knee straightening.
To see if there's, if they're limited,
'cause that certainly could be a sign.
If you have the person, you as a person who could squat
and you're hearing popping or grinding or cracking sound
and this is something you had since childhood
'cause my knees used to crack and now they stopped.
- I see you're getting better.
- Yup, I'm getting better, yeah.
- Yeah, so you might wanna hold on to something and just,
you know, use that to help get up
particularly if you feel pain and I,
I've had people go down and it's like, oh, it hurts.
And then have a hard time getting back up.
- Right.
- So I'm right there to help 'em.
- So obviously increased pain with a squat means
there's some deterioration probably there.
If you're limping with walking, there's a sign.
If your knee is bowing out or bowing in
and it wasn't before. - Those kinda...
Yeah. Those things typically take time.
You know, months or years to happen.
It doesn't typically happen overnight or in a week, but...
- And it's on the painful side, I mean...
Now the final one is you could do is you could do
a patellar grind test.
You actually put your legs down.
I'm sorry Brad. - I'm gonna get away from you.
- Yeah. (chuckles)
Now you can actually get a practice tightening up your quad.
When I tighten up my quad, I pull the knee down
towards the back or towards the bed.
Now this could be tender so beware.
I actually push on the knee cap.
I usually push it down a little bit.
- Yeah. So when you're relaxed...
- Yup, when I relax, I push the knee cap down
and then I tighten up again, slowly.
Tighten up slowly.
If you go fast, you go aw!
What was I doing to myself?
If there's wearing underneath the kneecap,
there maybe wearing in your knee too.
- And that's when people, a lot of people aren't
really aware that the kneecap is part of the knee joint.
There's cartilage underneath there.
Yeah, so that knee cap should, I don't know if you can,
you know, it has a lot of movement.
If you kick your quad, well you can you move
your kneecap a lot.
Right and left, up and down.
- Yeah, if that hurts while you're doing that,
it could be a sign that there's some cartilage damage
underneath the kneecap.
- Sometimes you can just actually start
moving that kneecap and that'll help decrease the pain
if that's the origin of your pain
from that underside of the kneecap.
- It's interesting, Brad.
They had a study where they had people
who checked that on themselves
and people who had consistent pain
or had lost a significant amount of cartilage.
And they found out that they were more likely to
have a knee replacement within six years.
So I don't want it to scare any of you or that...
- I think you do, Bob.
- (chuckles) I am scaring people.
- No, you're, yeah.
It's, it's one of those things that
you know, statistically speaking
and according to that study.
- You're bound for a knee replacement
if you have pain with that one.
But it just means you you're losing some cartilage there so.
All right.
Hope you feel better.
So (chuckles) check out your knee
and see if it's due to arthritis.
- You're right.
- Thanks.
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