- ♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
- Hi folks.
I'm Bob Shrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad, today I wanted to talk about patellofemoral pain
and chondromalacia.
Got some great self-help techniques and treatments
and exercises you can do for this problem.
- Techniques, having a hard time pronouncing that one.
- Did I say that weird?
- No, no, you're doing fine.
- What are you smiling about?
(laughing)
- All right, this is Napoleon Bone Apart.
Isn't that funny, Brad?
- Ha ha ha.
= All right, so today we're gonna show you generally
with patellofemoral pain syndrome is what they call it.
You're having pain on the front part of the knee here.
A lot of times around the kneecap, it often catches.
It doesn't usually lock
but you might get this catching sensation.
You might also get some grinding.
- Sure.
- And hear some popping even.
- Oftentimes going up and particularly downstairs.
- Yeah, very good point, Brad.
Going on hilly surfaces, worse going down.
The stresses on your knee are higher going down.
I just saw a study on that.
- Yeah, I believe it.
I believe it, Bob.
- So what you're gonna wanna do is also
what we call the movie goer sign, by the way, Brad.
- Oh, yes.
- If you're watching a movie and your knees are bent
like this, you know, for a long period of time
you start having increased pain with that.
- Yeah, so quit watching movies.
Just kidding.
- One test that we do, Brad, by the way,
is called Clark's sign
or I think it's patella grinding test.
- Sure.
- Do you wanna just roll up your pant leg, Brad?
- Oh, do I ever Bob.
- So let's go ahead and get this stool over here, this.
I would do this...
He would be laying flat on the bed.
- Okay.
- But what I do is I usually tell him
to first, go ahead and tighten the knee
or push the knee down into the bed.
Yep, like that.
And I tell him to do it very slow.
Okay, and then I go ahead and I put my hand right here.
- Yep.
- Relax first.
- Okay.
- And then I go ahead and now tighten the knee.
- So now I'm pulling, my knee cap is gonna go
up towards my stomach.
- And if that's positive, it is gonna be painful.
- Okay.
- All right, now that's painful in some people.
Is it painful on you?
- No, but it feels a little weird.
- Yeah.
- But it... I was like maybe it's gonna hurt,
but it really didn't.
- The correlation is a little questionable sometimes
but it's, to me, it's at least one of the signs
that you have.
- Sure, mm-hmm.
- The other signs is what...
Later I'm gonna show you how to tape it.
If the taping feels better,
To me, that's often a good sign
that it's patellofemoral syndrome.
- Right. But you're gonna show that later.
- Yeah.
- Okay Bob, there's one more thing.
We got some new people out there
that maybe haven't heard of our show before.
- Yeah, if you've never watched one of our channel-
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- Say no more Bob, back to the knee.
- So what's happening with patellofemoral syndrome
or chondromalacia
is that
you got the kneecap here
and it normally...
let's go on this side.
I took the kneecap off on this side.
You see this little canal here?
The kneecap doesn't just stay static.
It actually is moving up and down
in this little canal here.
- Is that called the femoral groove?
- Yep.
- Mm-hmm.
- So as we're going, it's moving up and along
in the femoral groove here
and what happens with patellofemoral syndrome quite often
is that it gets a little bit off track.
It's not lining like it should
- It's not lined up there.
- It's not lined up like it should.
And you can see these are sharp edges here, Brad.
- Oh yeah.
- So if you, if the patella
which is a little bit soft underneath it,
as it gets over on the side here
it can actually wear out the underside of the patella.
And that's the chondromalacia part of it.
- Sure.
- I mean, softening of the kneecap.
- Right.
- So what we wanna do is get it back
into the groove here and have it stay there
so it can calm down and not give you so much pain
or give you that grinding or that catching.
- Right. You know that that's a joint actually cartilage
and you want the large surfaces rubbing against each other
as opposed to that edge Bob was talking about.
- Now, they used to think, Brad,
that if your knee was a little bit bent like this,
that Q angle, like on women, that that causes this
but now they finding out that's really not the case.
- Okay.
- But they are finding out
that you, if you have flat feet
that that does tend to contribute to it.
- So if you have flat feet
when you put weight, it changes the mechanics
so that you're more predisposed to that.
- Yeah. It's not tracking right.
Also they don't like the hip to be internally rotated.
Like when you're doing sports
you don't want your leg in like this
that can predispose you to causing the knee pain.
- Sure.
- And not traveling the way it should.
All right, let's talk about the first treatments
we're gonna do here, Brad.
So the first thing we're gonna do
is you're just gonna go ahead and make sure you're icing.
I mean, you know.
- Cold pack.
- Just get the ice pack, cold pack
after you've been doing sports.
Let's try to get it to calm down.
- And typically you're gonna do that with a straight knee.
You're not gonna have it bent, I'm assuming,
so that there's less stress on it if there at all.
- Well, or maybe in the loose pack position.
- Sure.
- Maybe slight flexion with,
I'd go ahead and do it in that way.
The next thing I wanna do is I want you to go ahead
and start stretching that, the patella.
- Okay.
- So you're actually gonna go ahead and here's your kneecap,
and you're gonna actually, Brad,
you can do it on yours and I can do it on mine,
but you're gonna go ahead and it's gotta be relaxed.
You're usually laying flat
and you're gonna go ahead and you're gonna push the patella.
So here's the kneecap.
I'm gonna push it down.
I'm gonna push it up.
And I'm also gonna push it towards the other knee.
- Yep.
Towards the in central medial.
- So you gotta be relaxed to do this,
but you you see I'm pushing down.
You're gonna feel it.
You wanna feel the kneecap actually move
and then you're gonna also push up.
- Yeah, I'll see if they can get a different view this way.
It's kind of hard 'cause my skid's moving all over.
But you know, when I was a PT student, I had no idea
that the kneecap moved this much.
- Yeah.
- If you, if your quads are completely relaxed,
it really, you can really
move your kneecap around quite a bit.
- Well, and that's the problem
is some of you who have this
may not be able to move your kneecap very much.
It may be very tight.
These structures, you know, the quad may be tight.
The patella tendon may be tight.
The IT band, as it comes in here, may be all tight.
- Sure.
- The lateral structures.
So that's what you're starting to do
is you're starting to do these stretches
and you can do this.
I have a girl right now who's doing this
and she's in class and she's doing this while she's-
- Sure.
- She's listening to her teacher.
- So you told her if you're getting bored with class...
- Yeah.
- Mobilize your kneecap.
- I actually you her do some straight leg raises
'cause we're gonna have her do some strengthening too.
Now the... probably the most standard treatment
that therapists do now for patellofemoral syndrome
is the McConnell taping.
- Sure.
- So Brad, do you wanna stay?
- Yes I do.
- So what we're doing with this
is very simply we're gonna take the kneecap
and now I know all the therapists
that peer us out there are gonna be screaming at me here,
while the kneecap could be tilted, it could be rotated.
But I have found out that with most people,
if they just try and push the kneecap over
and tape it over towards the other kneecap.
- Mm-hmm.
- And see if it feels better.
Why not just try that first?
Try the simple, the simple remedy first.
- And this is for, for people at home
this is what all you really can do.
And if it works, it works.
If it doesn't work, no harm.
- Take it off, yeah.
- No harm done.
- Just a cost of a little bit of tape
- Right.
- And why not give it a try?
So Brad, normally what we do is, and sometimes, you know
like if you get a McConnell taping technique
there's actually material
or that wipes they can do beforehand.
- Pre wipe, yep.
- Because the skin can get very irritated
with this taping.
- Sure.
- Some people are more predisposed...
That was the other thing.
This girl I had, she was keeping her tape on for a week
and a trainer had told her to do this.
- Sure.
- Oh my God, I took it off.
It was red.
The skin had started to break down.
- Yeah.
- So nobody can keep tape on for a week.
They all really recommend 24 hours.
I've seen some go 48, but.
- Mm-hmm.
If you're allergic to it,
you're probably gonna start turning red
within a few hours.
So if that happens,
get the tape off right away.
And this is not an option for you.
Even if you're not allergic to it,
you can build up kind of the allergy to it over, I mean.
- Right.
- A reaction to it over time
because I've seen people that I've taped for weeks.
And then by the fifth week it starts getting irritated.
- Yeah.
- And usually you hope you don't have to go that long.
- Right.
- So I put an underlying underlayment tape down first.
This is hypoallergenic
and I'm not really doing anything with that.
- Mm-hmm.
- But the other piece of tape, what I'm doing is-
- Sometimes I'll pull that a little bit.
- I, I sometimes will.
I usually do.
- Now sometimes if, if you got, you know,
someone with hairy legs,
you might wanna shave
but I'm, I'm not gonna shave my legs.
- Yeah, he does that on his own personal time.
(laughing)
So what I do here now is I usually push the kneecap over.
So I'm pushing it over towards the other knee.
That's usually the direction you wanna try
and I'll put the tape right on the edge of the kneecap.
- Sure.
- And I'll push it over and while I'm pushing it over
I'll pull on the tape at the same time.
- Yep.
- And you actually might get a little wrinkled
up in there in the skin and that's fine.
- Yep.
- And I usually like to do a double one, Brad.
- Okay.
I'll sometimes make mine a little bit longer
just so it has more sticky and it has less apt to wrinkles.
- I agree, I agree.
It should go around here.
And then sometimes I'll put some tape
over the top of it to stop the edges from catching.
- Yeah.
- But again, I push over, I'm on the edge of the kneecap.
I'm pushing pretty good on it, Brad.
- Yep.
- And then I pull and wrap it and the test,
you know this is a good test.
A lot of times, Brad, what we'll do
Brad and I both will have somebody walk upstairs
without the tape on.
And they'll say, how bad was the pain?
They'll say maybe it was a five out of 10.
- Sure.
- And then we put the tape on,
we have 'em go up and down the stairs
and we have 'em check it.
And a lot of times the pain has decreased
- Right, it may go down to as much as one or two
or they say, oh, that's clearly better.
Then you know, you're on the right track.
- All right, other things you can do, if you have flat feet
you may want to get arch support
'cause that might help a bit.
- Sure.
- But let's go into some
of the strengthening exercises, Brad.
One of the first ones I'm gonna have people do,
I'm gonna go, is just go ahead
and good old, straight leg raises.
So you can go ahead and I'm strengthening this one here.
I'm just gonna go ahead and lift up like this
and I'm go ahead and
we're getting some strengthening of the quad.
- Right.
Lot of times on this
it's more comfortable lay down flat.
- Sure, you can lay down flat.
- But Bob's head will fall off the back of the table.
- The latest research is they want,
you wanna strengthen the knee extensors.
- Mm-hmm.
- The hip abductors.
So I'm gonna lay on my side and I'm gonna just bend this leg
and I'm gonna work on doing these
which you can do with weight
or you can do without weight.
- So we're working these muscles up here
- And the hip external rotators.
So I'm gonna do clamshells
I'm putting my knees together like this
and I'm going like this.
- There you go.
So why don't you turn this way?
So they can see it from both directions.
You're gonna...
- Well it's gonna be the wrong leg
and it's gonna be by mic, but.
So yeah, here's hip abductors
and here's clamshells, hip external rotators.
- And normally, he can't
because he's gonna go on his mic box there
but you lay down flat with a pillow and be comfortable.
- So the eventual thing too, Brad
is I usually try to teach people how to hop eventually.
And, and that is, you know, when they're,
when they're standing, like they don't wanna hop
and land like this.
- Right.
- They wanna learn to land correctly
like this once the knee pain has gone away.
- Right.
So the knees don't jet in towards each other.
- You go to the side and back,
forward and back,
keeping the knees, you know,
the knees are not going past the feet.
They're, they're staying in that good athletic position.
So those are some of the things to keep in mind.
And when you go back to athletics, remember, you know
you're gonna start off gradually.
Run on flat surfaces, not hills.
Avoid the steps and all that, so.
- Right.
- Thanks for watching, folks.
- Good job, Bob.
- Thanks.
- Here's a nice kneecap right here. Look at this.