♪ 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.

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- 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,