♪ Bob and Brad ♪ ♪ The two most famous
physical therapists ♪ ♪ On the internet ♪ - Oh 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. - How to tell if your knee pain is meniscus or a ligament injury. This is an updated video,
we did it once before, we're gonna try to improve
upon it, make it better. - That's right and we will, Bob. - By the way, if you're
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or TikTok if you want a 60 second version of our program. - All right, Bob. No give away? Oh it's the future. - Yeah, you gotta figure out what it is. - Oh that's right, okay. Let's get on to this. Knee pain and people are
always wondering, you know, "jeez, I wonder is it my meniscus." - Well cartilage, if they
say meniscus, cartilage. - There you go, cartilage
or is it that darn ACL or is it a ligament problem? So we're gonna show you that very clearly. - The ACL is a ligament by the way. - Yeah, exactly, but you
know there's three other ones that could be the problem and that's what we're gonna show you. First of all, let's
take a look at Sam here. - Let's do a little
anatomy, just real quick. - So all the muscles are
removed, we've got the bone and we do have the tendon to the patella. We're gonna take that
patella and the tendon, remove it, pull it over here. - [Bob] You got it? - [Brad] And then we're
gonna open up the knee joint and we're gonna look
at the meniscus first. So that's this cartilage
and it's between the tibia and the femur and to me, they always look like kind of two
horseshoes, the bigger one-- - [Bob] Yeah and they aren't that pointed, like this thing is. It's a little weird. - [Brad] It's a little exaggerated but the shape is pretty much there, it's pretty similar to that. That is there for a cushion,
it stabilizes the knee, offers some cushion but we're gonna jump now to the ligaments, there's four ligaments
that stabilize the knee and we've got it open, the ACL, which is probably the ligament that
you hear about in sports, very often being injured
and oftentimes tore. - [Bob] Or stretched. - [Brad] Yep. Surgery can replace it, it's
right here, it's this one. Then also right next to
it, there is the PCL. ACL means anterior cruciate ligament, PCL, which is, I'm gonna
move this out of the way. It's hard to see but it's back there, it's the posterior cruciate
ligament and they work together. They stabilize the knee from
moving forward and backwards. - [Bob] And cruciate means
cross, so the ligaments do cross. - [Brad] Yes they do. This doesn't show that
real well but believe us. Now we're gonna look also at the MCL, the medial collateral ligament and here it is, right here. What that does is that
stabilizes your knee, so it doesn't go out this way. What would that be? - [Bob] That'd be valgus. - [Brad] Valgus, what's the, what's the? - [Bob] Not varus. - [Brad] Knock-kneed
would be the slang term and then the LCL, the
lateral collateral ligament, does just the opposite,
keeps it from going in this way to get, if
you're like, bow legged. - [Bob] Bow legged, right. - [Brad] So that's the anatomy. - [Bob] That's the things
that can get injured. - Right, now we're gonna
talk about symptoms and there is somewhat of a
clear difference in symptoms. For example, meniscus-- - Or again, cartilage. - Yep, or cartilage. You like the cartilage, I like meniscus but you're probably
right, most people think-- - I think a layperson's gonna think... - Yeah, you're right but if the cartilage actually
gets tore, it can flip over and if you ever hear someone
say "my knee locks up," and then eventually it unlocks and then it feels pretty
good again and they're fine and then it happens again. I had one patient, up and
down steps, always locking up and she did it right in front
of me, I had some stairs and she locked up and she went like this. - And got it back in place. - And then we're fine
and I said we're done. I did a few other things
but I said you've gotta go to the doctor, I feel confident
it's a meniscus and it was. The next thing is, usually a meniscus does not have any bruising
or ecchymosis, we call it. - So for the recent injury,
you may get some bruising with the ligament but not
as likely with meniscus. - Also with the meniscus,
it can kind of happen without any particular reason. Over time, it just starts getting sore and then some little thing
might happen or maybe nothing and then it's just there and you get the locking and whatnot. - I'm just gonna add this too, Brad. You know, if it's an acute
injury, one that just happened, you may hear a pop with the ligament. You probably aren't gonna hear one with meniscus or cartilage. - Exactly right, very
common with ACLs, you know. People at football stadiums
say, "I heard it in the stands!" - I heard it in the stands, yep. - Meniscus typically
is not gonna have that but also with ligaments,
whether it's ACL, MCL or LCL, usually it's a traumatic
episode or incident. Oftentimes it's sports
but it doesn't have to be. - Yeah they don't often tear over time. It's usually, yeah like you said, it could be an athletic event or trauma. - Right, yeah a fall, et cetera. Ligaments will feel unstable-- - When you're walking, right. - Slow things down, that
leg just does not feel, you don't feel comfortable
on uneven surfaces, that kind of thing. - And we should point this out too. It's very common to often injure a ligament and meniscus
together in an athletic event. - Right, that's a good point. - The terrible triad, you can take it-- - Oh yeah, that's right. Yeah and oftentimes
there's gonna be a surgery and they'll address it
all while they're in there and take care of it. Now we've gotta talk about some tests. So should we go through
the meniscus first? - Sure. - Now these tests, there's three of them we're gonna show you, you
can do all by yourself and they're relatively easy. I like to do them, I
use them on my patients on a regular basis. The first one is the Thessaly. - Sure. - Okay, so Bob's gonna do
it and I'm gonna do it. First of all, you do it on
the leg that doesn't hurt and see how it responds and
then the knee that does hurt. You're gonna stand on
one leg, have the patient hold on to the wall or you
may have a stick or whatever. Bend the knee five
degrees, which if you see-- - Very slight. - Yeah, you just get
it so it starts to bend and then rotate your body like this. We call this, like in the
other video, the disco dance. - Yeah and think about, you're
grinding the joint together while you're doing this. - And that's kind of an overstatement. Hopefully you're not grinding
it, if it's a healthy joint, it's not gonna be a problem. If you do have a meniscus
or a cartilage tear, it may cause problems and cause pain and then you're gonna go to 15 degrees, just a little bit further, not a lot but just like what Bob
did, repeat the test, looking for a problem or
a tear in the cartilage in a different area. Now if it hurts, it's positive, if it doesn't hurt, it's not. The next one, Childress, Childress sign
is I call it the duck walk. So feet are about a shoulder
width or a little wider, keep your toes in a natural position. Mine go out more, some
people will be more straight. You're gonna bend the knees, about 'til you're in this position and so at that much flexion
in the hips to the knees and you simply do the duck walk and you only take about
four, five, six steps and if that creates pain in the knees, that's a positive sign. Now with these meniscus,
we're going through three signs or three tests right there, that you can do at home. I've
got one more to show you. Oh Bob, we might've did
this a little early. Oh that's right, oh no
it's not, I'm sorry. - No it's not early. - Yep it's called the pair sign
and this one, you lay down, you can do it on the floor. Take, this is the knee
that's suspect of an injury, put the foot right there on the knee and let that leg drop
down, just by gravity and that stretches the knee
and if that also creates pain, if all three of those tests created pain, it's a pretty good chance
you got a meniscus injury, not 100% but fairly good. - [Bob] Or cartilage or, as some patients call it, cartridge. (laughing) - In your cartridge. - [Bob] Yeah. - Exactly. I'm gonna show you, shall
we show them the two tests? - [Bob] Sure. - These are two tests that
you probably are not gonna do at home. - You want to get in
position for the Apley? - Yeah, we'll do the Apley's. This is what a therapist or
a physician may do with you, just so you know. This is called the
Apley's Compression Test. This is the knee in
question, a towel roll, I've got a nice cushion
here, I put right there. That just keeps it a
little more comfortable for the patient and what I
do is, I put pressure down, I rotate and then I go down
like this with pressure, with internal rotation
and external rotation and that will become
uncomfortable and the patient will complain of pain with that
and that would be positive. The next one is the McMurray's test. - Watch my microphone. - I gotta shift you
over a little bit, Bob. If I can squeeze in, all right. This one, again, therapists or doctors, it takes some practice on this one. We're gonna rotate the leg and
I gotta be honest with you, I don't use this one very
much and I never have since I learnt it 'cause I
have a hard time with it. - Sure. - You drop it down, I have
seen some surgeons do it on a regular basis, they
get real good at it. I've had really good
luck with my other tests that I feel confident without it. - You know what I do,
Brad, when I do this one is I actually put my hands
right on the joint. - Oh you do? - And then you can feel clicking. - Oh okay, so you're
feeling around that joint. Which, you know, to know
where the joint line is, that takes practice. Most people cannot just
say, "oh there it is." I remember learning that initially as I... - Yeah, so it's kind
of a tough test to do. He's turning it, grinding it. - Yep but they may do that to you. Now let's look at the ACL, MCL, PCL-- - Sure. - And LCL tests. These, you're pretty much
you're gonna be a therapist or a doctor to do. It takes a little bit to learn it. I'm gonna show you two of them
for, well one for the ACL. - And actually, a lot of times
you'll do it on the good leg, the non-involved leg first, just to see what normal feels like. - Right. - And then you test it
on the involved leg. - So if this is the in question leg, I'll do the other leg first
but the exact same thing. I'm gonna grab under
here and this is called the anterior drawer test
and I'm gonna pull this way and that's gonna see if the,
that's gonna test the ACL. My thumbs right here are on the joint line and you can actually feel movement. I can feel Bob's tibia come
towards me as I pull on it. - And if it's tore, it's
gonna move more on this one than it would on this one. - Exactly and you can feel it and there's not always pain
associated with it either, like you may think there is. Then the PCL, which I've never worked with anybody with a PCL injury. - I haven't either, to
be honest with you, Brad. - Yeah but it does happen, not very often. You simply push this direction
and compare the good one to the bad one and you
can palpate the joint line and see if there's more mobility. Now the LCL and the MCL, can
you scooch over this way, Bob? - Sure. - Usually they take you
to the side of the bed, I'm gonna do his LCL first. Can you just relax, Bob? There you go, thank you and we do a little bend on
the knee and I'm going to push this way with this leg or this hand and push this ankle in
this way to this hand and we're stressing that
ligament right there. You're pretty tight, Bob. - I got good ligaments. - I don't feel anything there. - Never had any trouble, always look good. - Now normally, I'm gonna,
normally I'll do the MCL this way and the MCL, I don't know
if that one is injured more than the LCL or not. - I think it is often with other ones. - I'm going to-- - With the ACL. - Oh right, I understand what
you're saying, a combination. Along with possibly meniscus. Normally I stand in front but
you can't see what I'm doing, so I'm gonna do it here
and I'm going to hold here, slightly flex the knee
to about five degrees. I'm gonna push out this
way, so I'm pushing his leg out that way and then I can assess the integrity of that ligament there. Again, done by a therapist or a doctor and you'll know what they're testing for. - But you can see that
they're just putting stress on the ligaments and
if they're tore or stretched, there's gonna be a lot
more movement in this one, the injured one, than the non-injured one. - Exactly. - So and that's the problem
is the knee gets sloppy then and over time, if you don't repair it, it can put more stress on the
cartilage and wear it out. - Yeah, premature arthritis, could lead into other issues there. - Yeah I have two friends
that had ACL tears and didn't repair them, one
was a physical therapist and he's now had a knee replacement and the other one, he's a friend and he's had a knee replacement. (laughing) So you get to our age,
it starts to show up. - And a knee replacement, I
think they take the ACL out and it's non-existent, so
they didn't have to do that on that part of the surgery. I wonder if they gave him a discount. - That's right, I doubt it. There's no discounts in this world. - All right, very good. Good luck with your knee pain assessment. - Yeah, thanks for watching. (gentle beats)
