- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most
famous physical therapist on the internet
- In our opinion of course Bob.
- Welcome back, Brad. Welcome back.
- I know all the younger women out there
probably preferred Michael.
- Let's get to the show, let's get to the video Bob.
- Today we're gonna talk about chondromalacia,
or patellofemoral syndrome.
Now chondromalacia, these are big words.
- Yeah.
- Do we have a kneecap Brad?
- Yeah. - All right.
- Yeah, we'll just take one off there.
- Chondromalacia, what that means,
here's your kneecap.
That means that the under the kneecap,
the part that you can't see
actually has softened up or been kind of
scruffed up a little bit.
I heard one guy call it like crab meat,
so that it's actually the texture of crab meat
- Because you eat it Bob?
- Yeah. Well no I-
But anyway, the thing is you cannot diagnose chondromalacia,
unless you actually have a scope and look in there.
You're just assuming there might be chondromalacia.
- Unless you're a doctor or surgeon
you just don't take a scope, like, you know, a telescope.
- Right exactly. It'd be a scope, arthroscopic surgery.
- So it's amazing to me, Bob,
'cause if you look at this bonus is this is actually...
- About the size, a size of a kneecap.
For some people, mine's a lot bigger actually.
I do have a big patella.
- But for a smaller person, that would be it.
Yeah. So anyway.
- But anyway,
so unless you've really had arthroscopic surgery done
it really is patellofemoral syndrome.
And that's a big word too, but that just means
patella means kneecap, femoral means the big bone up here
and how it rubs along there.
So Brad, do you wanna show
why we run into problems with patellofemoral syndrome?
- Sure. So basically we got knee pain, you know,
is how we can really make it simple.
And here we got our femur
and our condyles in the patella right here.
So when you bend your knee,
the patella fits right into this groove.
Can you see that Lonnie?
- [Bob] She's gonna flip it now.
- This groove is right there. Okay.
Now, as you bend your knee,
the patella slides down into that groove deeper and deeper.
So when it's down here, it's deep in the groove.
And then when you straighten the knee
it slides back up and it should line up right in the groove
and it should be all in a line.
It's a real mechanical relationship between the two.
Bob, here, could you be the pointer?
What happens typically with the kneecap
is it will misalign and go to the outside this way.
I'm gonna exaggerate it
and you can see where the pin is pointing.
- [Bob] It's too far over towards me.
- So the pressure all gets put onto one point here.
- [Bob] That height, that ridge.
- Yep. And you can just imagine when you put,
that pressure is taken off from the large surface area
to one small point, it's gonna take that...
- [Bob] That Highland
- The cartilage right off. Wow. And that's gonna be painful.
So we need to get this kneecap back over in here
where it belongs,
and there's a few different ways we can do this.
And the worst way would be surgery.
It's called a lateral release,
we're not gonna get into that.
We're gonna do some more conservative methods
because we are therapists and that's what we do.
- So let's first talk about what you're gonna
often feel when you have patellofemoral syndrome,
you're actually gonna usually have pain
right in the front of the knee.
A lot of times it's around the knee cap.
It's gonna hurt a lot of times when you bend the knee.
And when you straighten the knee.
You're gonna hear the crunchy noises
- Rice Krispies.
- Krispies, or crepitus as we call it,
happens a lot more in women than men,
it's because of the angle of their knee,
and anything else?
- Yeah. Going up and downstairs.
- Oh yeah. Perfect.
- And going downstairs typically hurts a lot more
than going up usually.
- Right? Exactly.
So this is a simple test and what's nice about this test.
If it works, it actually leads you right to
the simple treatment of what you can do.
Alright.
This is a test that Brad and I talked about this morning,
we actually both do but we didn't realize it,
but what you're gonna do is you're gonna take the knee
that's giving you trouble, and you're gonna need some tape.
You're gonna need some good athletic tape.
One brand is called Lucor Sport.
We just order some stuff off-
You almost put your hand on my tape
- I'm sorry Bob.
Now, if you really wanna do it right
you get an underlying tape first,
but you really don't need to for this.
I mean, you're just doing the test
so you can just actually take the heavy stuff
and put it right on there.
So I don't think I'm gonna use that, Brad.
- Nah, don't worry about it.
So let's just take a quick look at this knee.
Can you relax Bob? - Sure.
- Can you see this Lonnie? Look at that.
He does have a big patella look at that thing
move back and forth.
It is in the groove, out of the groove,
in the groove, out of the groove and go up and down.
And typically it's gonna go out of the groove this way.
So we gotta pull it this way huh?
- Exactly. Perfect Brad.
So normally it's too far over toward the outside of the leg.
And so what you're gonna do is
you're gonna just take the tape.
- Pull it that way
- And pull it that way.
Where's the kneecap? Give me the kneecap.
So what you're gonna do, here's the kneecap.
I'm gonna put tape on the edge of the kneecap like that
and pull it over. That make sense Brad?
- Yeah but you're not gonna really put on kneecap.
You put it on the skin over the top of the kneecap.
- Right.
But I'm putting it right on the side of the kneecap.
And then usually what I do is I push over like this
and you can see this.
You wanna flip that screen once Lonnie
I wanna see if you can see how that's...
You can see it can't you Brad?.
- I can see it.
- All right.
So I'm pushing it over.
I'm gonna push it over
and then I'm gonna just pull it down like that.
- You're gonna get some wrinkles in the skin from that.
Yeah. That means you got that enough force.
- Now quite often what I'll do is maybe
take another piece of tape right over the top
and do it again.
So you have a double whammy here.
- Clean the skin well,
make sure you use some alcohol wipes or something.
- If you need to shave the leg, shave it the night before.
'Cause if you shave it right before,
you're gonna irritate the skin.
And again you're not gonna have it on that long right now.
You're just putting it over to see if this works.
See if it feels better.
- Sure. So what tells you if it works?
- This is how it tells you it works. Now before you do this,
I want you to go up and downstairs and see if you feel pain.
If it does hurt, that's one of the signs that
it might be patellofemoral syndrome
and it might be chondromalacia
So now with the tape in place,
you're gonna do the same thing.
You're gonna go up some stairs.
I had Lonnie bring the stool all the way down.
I'm gonna at least step on it.
So you're gonna go up a couple steps
and maybe down like this
and you want to see if the pain is less, it may not be gone.
But I would say in most cases,
it's greatly improved,
In the cases where I've had luck with this, right.
- What I do with my patients, I say,
"go up and down the stairs
and give me a pain number of what it hurts the most".
And they'll say it's at a seven when I come down
and I bend my knee it hurts at a seven.
Put the tape on, go up and down.
Usually they'll say, "oh, it's about at a one or two."
- Exactly. So if this works,
what you're gonna now wanna do is
watch our next video on the simple treatment
for chondromalacia or patellofemoral syndrome.
And we're gonna go over the taping,
'cause there's a few more specifics you need to know.
And we're gonna show you a few stretches and strengthening
- You better believe it.
And remember it's very important,
we can help you fix anything in your whole body except, Bob?
- Oh! A broken heart.
- Yes! Except we could tape on that a little bit.
- There it goes my phone. - Tape on there. Hold it.
- Thanks Lonnie.