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 The first one is we got some more people that just walked in, hello, thank you for coming, if you are new to our channel, please take a second to subscribe to us. We provide videos on how to stay healthy, fit, pain-free, and we upload everyday also if you have an extra second in your day go over to Facebook and like us because Brad and I 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.