♪ Bob and Brad ♪
♪ The two most famous ♪
♪ Physical therapists ♪
♪ On the internet ♪
- Hi folks! I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most physical therapists
on the internet.
- In our opinion of course, Bob.
- All right, well anticipated here.
We're talking about how to fix your knee
from clicking, popping, or creaking making joint noise.
- Yeah, all those things that are pleasant to hear.
but hopefully- - Not pleasant to hear.
- Well, if they're not painful.
You know, as a therapist, I'm thinking it's okay.
- Yeah, again, we just did a video
on possible causes of knee pain.
- Right.
- You may want to watch that video.
It's part of a series of videos on knee pain.
So if you go to BobandBrad.com,
go to the program section,
checkout knee pain, you'll find that video.
- [Brad] That's right.
And there's a whole list of videos to look.
Pick out the right one.
These videos are completely free,
we don not ask for your email,
and there's a PDF printout
that has a review of the whole video,
as well as the exercises that go along with it.
- [Bob] You can send us some good vibes though.
- Oh yeah. - Yeah.
I was like good vibes.
- Yeah, I felt some last night. I was laying in bed.
Someone's watching a program.
- All right, let's get to work, Brad.
All right.
So generally, if clicking, popping or grinding
is not accompanied by pain,
you don't need to worry about it.
- Right.
- But if you have any of those things;
pain, swelling, locking, weakness,
you may want to see clinician,
but you may also find out
if one of these things is the problem
and try treating it. - Right.
If it's not very painful, but you notice there is some pain,
you know, maybe you could try these
before you go in to see chiropractor.
- Sure, exactly.
- And that may resolve itself.
- That was something we would do. I mean...
- Yeah. - Yeah.
- That's what I would do.
- All right, first one cavitation.
That's when the, basically, release of
gas bubbles. - Nitrogen gas
from a liquid to a gas and it goes pop.
And that's why a lot of our joints...
Crack your knuckles, that's what happens.
- And you aren't gonna have pain with that.
- Typically, no. No.
- So the treatment for this
is you don't have to do any treatment.
- There's no pain. What are you worried about?
Let it pop. - That's right.
You can aggravate some people with it, you know.
- Yeah, that's right.
- Ooh, don't do that.
- All right, ligaments and tendons.
Sometimes they can catch as the slide over a bony hump.
We're gonna talk about the IT band,
that long band that runs from your hip down to your knee.
- Sure.
- Yeah, that can slide over the knee with biking or running,
some type of repetitive activity.
Now you can't really stretch this band.
- [Brad] Yeah. It's real wide and it's very tough.
- Yeah, it's thick. - Leg or tendon.
- But what you can do is sometimes this band
gets adhesed down to the tissues below it.
And so what you can do as a massage this band.
Very difficult to do with your hands.
You can go ahead and try.
- Yeah, you can do it.
You just get tired. - Tired, right.
- Pretty quick.
- But a better option to actually take a massage gun
or handheld massager.
And Brad's gonna show that as an example here.
- You certainly wouldn't want to do it with...
I had like this that's very hard.
A round head slightly soft works the best in my opinion.
- And most of those guns come with different attachments.
- Yep. Our guns all come with five heads.
It's definitely with these.
You know, you may go in straight in on it like this,
but probably better off to go in at an angle
and you'll give some that cross fiber activity going on.
Now I probably wouldn't be like this.
I would lay down on the floor.
I don't know if we need to do that, but...
- [Bob] Sure.
- [Brad] And work that.
Let me try here like this. There we go.
There, and now I can work there.
You gotta be careful over the bony area.
You're definitely not gonna go in over the bone.
You have to go sideways over there.
And this actually feels good right now on there.
It feels like I'm moving the skin,
the tissues underneath the skin,
and up here. - All the way up the band.
- [Brad] Yep, absolutely.
And you could even get up into the hip muscle
- [Bob] That's your fascia Lata.
- [Brad] Yeah, that's the muscle belly of that tendon
- [Bob] And the glute. I think it attaches into it.
- And I'm telling you, this just feels good.
- Right.
- But it's still relaxing those muscles,
which is gonna take tension off down distal.
- Stretching those muscles a little bit, so absolutely.
Okay, how about if you have a cartilage tear?
A cartilage tear can cause sound in your knee.
Now, you think, "Well, what can I do about a tear?"
Well, one thing you can do
is after you having a knee injury, knee pain,
you quite often, this muscle, the quadriceps, gets weak.
So I should say the four muscles get weak.
And a very simple exercise you can do
without putting increased stress on the knee
is just to do isometric quad strengthening.
So all you're gonna do
is you're gonna put your leg up on a pillow like this,
and I'm gonna leave this leg down so you can see.
All you could do, you could do this in bed,
is you're gonna push down like this
and hold it for 10 seconds and then relax,
and do that times 10 times. - All right.
So typically- - Squeezing this.
- Yeah, getting those quad strength moving.
You're not putting weight through the joint.
That's why we have it up like this.
So that typically- - not that much movement.
- Right. - So it's very simple.
Do three sets of 10 three times a week,
and it'll strengthen that quad.
And often, that will take some of the stress off the knee,
which will hopefully decrease some of the pain on the knee.
- Sure. - All right.
You could do some continuous movement to the knee.
We hope maybe that'll smooth out the cartilage a little bit.
We're talking about non-weightbearing.
That's one way to do it.
- We call them longer quads or kicks, whatever you like.
- Yeah. - This does work the quad.
Do them slow. Do them with purpose.
If you have something on the floor, we use a knee glide.
- That's a FitGlide. - Oh.
(Bob chuckles)
Yeah. We've got the double knee glide.
Yeah. It is a FitGlide.
It works both knees,
'cause you might as well work both of them.
- [Bob] Right. Keep things equal.
- Yep. And just keep it going like that.
I do like this option because...
It's not necessary but it's nice
to get it in an angle. - Well, it's got the handle,
so you're working hamstring a little bit more now.
If you flip around it, it does more quadricep.
- Yeah, so you get three different exercises
that emphasize different muscle groups,
and the joint at a little bit different angle,
which is nice.
- [Bob] Brad and I are really proud of this for one reason.
It's a lightweight. - It is.
- Anybody can carry it. - Yeah.
- This is the finger.
- [Bob] A child of four could carry it.
- A child of four? - Yeah.
- Four what?
Oh, four children? - Four years.
- Oh, four years old. Yeah. Yeah.
Absolutely. - All right.
Eventually too, Brad, I've seen this in studies
that if you do some weight-bearing activities with this,
like Tai Chi - Sure.
- or just plain old walking is good for it,
for the cartilage. - Oh. Yeah.
As long as it's not painful, it's not locking up,
you want movement with it,
the weight-bearing can be helpful
as long as it is pain free.
- All right, another situation is if you have osteoarthritis
or arthritis in your knee joint.
That smooth cartilage that covers into the bones
has become rusty as you said. (chuckles)
- Well, it's rough.
- So you would actually do
the same things I just showed you.
You could do the isometric quad strengthening.
- Right.
- You could do the knees, yep. - The kick.
- Trying to get a little more fluid to move it in there.
- Right.
- And you could actually use a FitGlide
and you could try walking and Tai Chi.
Those all are the same.
- But no yoga.
- Well, no, you can do yoga. - Oh, okay.
I was just curious.
- All right, how about if it's caused by...
Well, we can call this kneecap syndrome.
So it's a patellofemoral pain syndrome.
So you have the kneecap here.
It's not lined up correctly, possibly, in the groove.
So one thing you wanna do is maybe stretch it,
which Brad is doing right here.
Now don't do this if you have very loose joints
or if you have rheumatoid arthritis.
I don't want you to push that kneecap out of there.
But for most people you'll find out,
"God, it's really tight." - Yeah.
- And so it needs to be stretched down.
You have a very loose kneecap, Brad.
- Well, sometimes I've had people
where you just mobilize the patella or the kneecap,
get it moving in this way, in this way,
and that can help loosen it up and make it feel better.
It's very simple.
It should be pain-free while you do it.
It should feel good, actually. Otherwise...
- It's really easy to try.
And like, if you find a direction that really is tight,
maybe work on that direction only.
- The key thing about this
is you have to learn to completely relax your quadriceps.
Otherwise, if I tighten a little bit,
it doesn't move at all. - Right.
- It's stuck.
- And you don't want it to...
You know, a lot of people say, "Oh, that looks icky."
(both chuckles)
- Well, when I was I was in PT school,
I had no idea that you could do that.
I was like, "Oh my goodness, let me try it on my knee."
And it's like, "Wow, it works."
Anyways. - Yeah.
So in addition to that,
you can actually strengthen the hip external rotators.
I'm not gonna get into the mechanism why that is,
but that all you gotta do is clam shells.
You lie on your side like this
and you actually put your legs apart.
- Yep.
- You lift up like this.
- This is nice 'cause when you go to bed,
you can lay on your side,
do 10 to 20 of these, whatever you need,
but do them slow like Bob's doing them.
Good control. - Yeah.
- Feet stay together and acts like it hinge there.
And it gets those hip muscles
that are responsible for making that hip and knee-
- If you do like three sets of 10, you'll start to feel it.
- Yeah. Especially if you haven't done it before.
- Oh! I almost kicked you. - Be careful, Bob.
- All right, the last one is sometimes scar tissue.
If it's getting a around the knee,
you injured the knee in the past
and there's some scar tissue
that's catching out of those surfaces.
Now you maybe can't do anything about it
unless you know where the painful area
or where the scar tissue is. - Yeah.
- So for example, let's say right above the knee,
you could massage that area.
- Well- - A cross-fiber massage.
- Like if you know where the scar tissue is
because you had surgery, like the incision,
- Yeah.
- then that makes it a lot easier.
Otherwise, if you don't, you have to figure it out.
- You kinda have to push around it.
It's usually gonna be the tender spot
and you can actually do cross-fiber massage.
So what you do, let's say you find a tender spot
and you start rubbing across it.
Now that pain should start to reduce
within 30 seconds or so. - Right.
- Or at least plateau. - Yeah.
- [Bob] If it keeps getting worse and worse and worse,
no, you can't do this.
- After 30 seconds, it still hurts or getting red,
you just stop this.
- Now, if you wanna make it easier on yourself too,
you can use a massage gun.
It'll actually help.
It'll work the area a lot easier.
- Also, save your thumbs and your fingers.
You know, if I was doing that same thing here,
I wouldn't go straight in too close to the bone.
I could do it up here on the muscle,
but then I'm gonna go sideways here.
And if I worked up in the muscle,
then maybe I can get in a little deeper there.
That's kind of the art of using the massage gun
when you learn different angles
and it's just not a straightforward, you know,
beat the heck out of the muscle.
You've got to work it properly.
- So you know, what I'm saying here is
if you don't know what's causing the clicking,
you might have to see a therapist to have them diagnose it,
and then you can work on trying to get rid of it.
- Yeah.
- But generally, you're not gonna see a therapist
unless it's hurting. - Right.
- Otherwise, you can make sound all you want.
(Brad chuckles)
- Yeah, but, you know, doing some of these exercises,
the range of motion, the walking, things like that-
- Yeah, that's good for you no matter what.
- Right.
You know, unless you walk a mile
and it makes it really sore, well then-
- Yeah, massage good for it. No matter what it is.
None of these are harmful to a logic sense.
Again, be careful with the kneecap one.
I don't want you to push it out of a place
if you're really loose jointed person.
- And some people, especially the guys out there,
think a little pressure is good, you might as well push it.
- Whoops! - Push it all the way around
halfway throughout the knee.
- Most people, it's not very easy at all
to push it out of the way
- Right. Yeah. - On a joint.
- So the big thing is be careful. Use good judgment.
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