This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2020. For the original video go to https://www.youtube.com/watch?v=G2g7sRbtn2M&t=492s
Bob: Today we are going to talk about three tips for knee cartilage problems, how to fix without surgery. Let’s get down to business here Brad. According to guidelines, and this was I believe out of Australia that a bunch of surgeons got together, and surgery is not recommended on cartilage problems even tears, unless you have locking of the knee.
Brad: In other words, it locks up, typically painful, and you can work it and it loosens up. You know, oftentimes it’s a meniscus issue but it’s definitely the cartilage.
Bob: Well, you’ve always heard before and years ago, someone would tear their meniscus, tear their cartilage and they would go “Well I need to have surgery.” But what they’re finding now is those that have had the surgery compared to those that don’t, the outcome ends up being the same in a few months anyway.
Brad: So, if it doesn’t lock.
Bob: Yes, if it doesn’t lock. If it does lock, that means that the cartilage probably folded up on itself and it’s just going to get worse. They probably need to go in and have it done.
Brad: It’s really not a major surgery.
Bob: Right but it is surgery nonetheless. If you’re not going to get much benefit from it, why do it? So, don’t listen to us on this, get a second opinion. If someone is saying, you know, you tore your cartilage and they’re telling you that you should do surgery and it’s not locking, I’d always get that second opinion.
Bob: Alright, so we’re going to give you three tips if you have a knee cartilage problem. The first thing is if able, you want to get it to calm down. Knee pain, knee cartilage, it tends to flare up and then it tends to calm down. A lot of times people will go, “oh god it’s bad and it’s going to get worse.” Not necessarily, it can calm down. You can take an anti-inflammatory, but you’ll want to check with your doctor on that. You can also decrease weight on it for a while.
Bob: Right, in other words you might want to use a cane. Now a lot of people are like “oh, I don’t want to use a cane.” But, it’s not a long term thing, it’s just until it calms down again. The pressure of your body can irritate it and continue to irritate it. So, if my left knee is the problem knee, you’re going to use the cane in the opposite hand. That’s going to take pressure off, and so when that left foot goes forward the cane goes with it. Now I’m putting pressure on my body, weight through my body is going through the cane and much less is going through that knee. You’ll find that it does. I’ve had patients, I’d say try the cane once and see how it goes. Then I’d show them how to use it and they’ll take a few steps and they say “oh wow that does help.”
Bob: I’ve found a lot of patients, Brad, that I think that alone has helped calm it down. If you can just get past that, “I’m not going to use a cane because I’m going to look old.” So instead, what they do is they just limp along and believe me you look old already when that’s happening. So you can use, you know if you’re a younger person, use a walking stick. That’s what my wife did. She had a flare of her cartilage.
Brad: I thought she used a crutch?
Bob: She used a crutch too, but when we went on vacation she used a walking stick. That she could fold way up.
Brad: Yeah, more convenience to travel with that.
Bob: But you are right, she used a crutch or crutches. If you are older, you can use a walker.
Brad: Now, her knee actually improved to the point where she went back to running.
Bob: She is back to running. So, it shows you these are not irreversible. The other thing is you want to avoid stairs and hills right now. Not to say forever.
Brad: And if you do go upstairs you go one step at a time to protect the one knee. You’ll know which leg that goes up first because it feels better.
Bob: Don’t stand with your knees locked. Don’t stand putting all your weight on one side. A lot of people for example holding a baby will do that, they put them on their hip right.
Brad: Some people will do that just out of habit. Maybe from having a baby years ago and it just became a habit. They might have no idea until we show them and then they’re like, “oh yeah I do that.”
Bob: It’s funny those habits, after a while they become like chains of burden. They start off as a minor thing but over time when you repeat it hour after hour, day after day…
Brad: Then, you throw in the aging process unfortunately it can exacerbate things.
Bob: Another simple one, but this can make a big difference, don’t sit with your knees bent more than 90 degrees. I had my sister do this one because she sits a lot working at the computer. You are really jamming that knee together the entire time. So we have her sit with her legs out a bit or all the way extended at times.
Brad: I’ve had, usually the younger people, that sit with one leg bent under them. That really puts a lot of stress on the knee, not only the end range, but it’s rotated and twisted.
Bob: If you want to hurt your knee, there you go. The next thing is you want to get some movement without resistance. We’re just trying to get the synovial fluid moving a little bit, little more blood flow to it. So, you can find a high bench or table and just swing your legs back and forth. Just keep getting some movement. There’s no resistance. There’s a little bit of traction.
Brad: I actually had a PTA, you remember Bev, she would do this with knee patients. She would put a little ankle weight around one of their ankles just for a little distraction, and that would help pull the knee apart and it would just be a relaxing pendulum.
Bob: Am I remembering right? You had a patient that did this on the end of his truck?
Brad: Yes, after a knee replacement. He had a pickup truck, he would fold it down and he said that it works really well. He would sit down on the end of his pickup to get range of motion of the knee and he was very happy with the results.
Bob: Now we are going to show you a little more of a commercial way to do this. It’s called the Fit Glide. This is going to be very helpful after knee replacement, because what’s nice about this, not only are you going to work the knee that you had replaced, you’re going to work the other knee. And most people, when they have one bad knee, they often have two bad knees. This is a way to stay fit after the surgery even.
Brad: I highly recommend doing it prior to the surgery as ‘prehab’ to get things maximally moving. And, its simply goes back and forth, you sit and very little resistance. You do this for two to five minutes. I guess I’d say two initially because you’ll feel it after a couple minutes. But, it’s not aggressive. There’s not much weight going through the knees, it’s ideal for this. That’s why we made it this way.
Brad: One of the advantages is you can put it up so you have it inclined.
Bob: To me that’s a lot more comfortable on the ankles when you put it up.
Brad: That can be. Right now we’re working a little more quadriceps. It can change the ankle range, like Bob said, so it can be more comfortable.
Brad: We also can, usually you know, I’ll turn it around. I’ll do this when they’re getting a little bit stronger. This works the hamstrings. And it’s much harder than it looks, even for me.
Bob: Now I’m going to warn you, the one negative about this is it’s not completely silent. You can hear a swish, swish.
Brad: Yeah but it’s not bad.
Bob: No it’s not bad. I’m just saying there are some of those devices that are very expensive and heavy that are silent. This one is very light.
Brad: Yeah, I mean, I can lift it with one finger, and it’s built very well. You could drop this thing and it’s not even going to affect it.
Bob: Alright, I want to show you that you can use this in bed too. It’s more comfortable if you put towels on it, especially if you don’t have shoes on. So, you put your heels on it and you can slide your legs up and down. You can work this baby, I can run. If you have a patient that you have to go see in their room, and they need to work out, you need to start getting some strengthening, here we go.
Brad: Yeah, so obviously he’s referring to the therapist or any aide, health aide, a home health aide maybe.
Bob: Alright, I just put in a quarter mile, Brad. So, the final thing we are going to show you is, if your knee is lacking range of motion; it’s not completely straightening or it’s not completely bending, what we’ve found is that by stretching it to the full range of motion, it actually often decreases your pain levels. It also gives the knee joint full motion to move so it spreads out the forces, I think so it’s not so hard on the cartilage. You can do it with the Fit Glide. You can do some stretches straightening.
Brad: What we are going to do instead of just pushing on it, we’re going to actually do repetitions or pressure on/pressure off, pressure on/pressure off.
Bob: And this is something you don’t want to do just once a day you want to do it throughout the day. We find out that if you don’t have a Fit Glide you can actually just take a stool and sit in a regular chair. Then do pressure on/pressure off, pressure on/pressure off while pressing down. I’m not pushing on the knee itself I’m pushing right above the knee, pressure on/pressure off.
Brad: It works nice if you have a stool with wheels on it because it just rolls it, it’s more fluid that way.
Bob: Now a little variation of this; you can sometimes turn it out like this and do pressure on/pressure off. This is the one that worked for my wife. Turn the toe out. Or you can turn the toe in. You want to see which one feels better after you’ve done it or even while you’re doing it.
Bob: And then, you can also work on flexion.
Brad: This is what you’re going to do after a knee surgery. This is exactly what we are going to do. And this works really well. You can also use your hands to give it a little stretch if you need to. If you don’t have any hip issues or haven’t had a hip replacement you can bring your knee up toward your chest as well.
Bob: Pressure on/pressure off, pressure on/ pressure off with this too. So, I think we have covered everything.
Brad: I think you’re right.
Bob: Remember, Brad and I can fix just about anything.
Brad: Except for…
Bob: A broken heart, but we will work on it.
Brad: That’s right Bob. We’ve been working on that for a while.
Bob: Yeah, years.
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