Knee Massage to Reduce Swelling and Drain Fluid

Hello friends, welcome to a new live broadcast. I'm Marcos Sakristan, your favorite physical therapist. In today's video I'm going to show you a massage to reduce inflammation. Of the knee? The video will be divided into the following chapters. We will be explaining what inflammation is, what the knee is made of, why it becomes inflamed and the treatment. In addition to the massage, the massage itself is very important, the dosage. And finally, a round of questions. If you want, you can skip directly to the massage, since I'm going to leave the timestamps in the description, so you can see those parts that interest you the most. However, I think it's extremely important to know why that inflammation happens and what other ways we can use to relieve it. What way will we use to attack its origin? So that knee doesn't get inflamed again? So let's see what inflammation is. Inflammation is a natural response of the body, specifically of the immune system, to an injury, infection or irritation. It's a complex process that involves the participation of cells, tissues and chemical mediators. When an injury or infection occurs, the cells of the immune system release chemical substances like histamines and cytokines, which increase blood flow to the affected area. This causes redness, heat and swelling in the area. That is significant inflammation accompanied by warmth, which we know as the classic signs of inflammation. Inflammation has several important purposes in the human body. First, it increases the supply of blood and nutrients to the damaged area, which helps repair the tissues. In addition, it attracts immune system cells to fight infections and remove damaged tissue. Although inflammation is an important protective mechanism, in some conditions it can become chronic or dysregulated, causing damage to healthy tissues. This can occur in autoimmune diseases such as arthritis, rheumatoid. So we have to understand that this inflammation is a completely normal reaction of our body to an external or internal stimulus that is happening in our body. I'm going to teach you how to locate and identify those stimuli in order to try to eliminate them and as a result reduce the inflammatory response of our own body, since it is a response that our body naturally does automatically. A brief overview of the anatomy of the knee. Here we have the main bones. The femur, which is the longest bone that runs from the hip to the knee. The tibia, which is the bone that runs from the knee to the foot. And finally, the patella, which is that bone that has a very circular shape and is located right in front of the knee. This patella is crucial. I'll demonstrate how to identify, mobilize and massage around it. Finally, we can't forget this small long bone found here, which is the fibula, and it has certain accessory functions at the knee level and is a place where many muscles attach. This knee is not only made up of bones, but it also has a lot of structures that keep it firm and solid, including the ligaments, the joint capsule and the menisci. Here we are highlighting the external ligament, the external ligament right here over the head of the fibula and the internal ligament, which can be seen on the other side. The articular cartilage that covers the articular surfaces of the femur and the tibia, so that there is better congruence and better sliding between the articular surfaces. The two menisci, although shown in a single color here, consist of a C-shaped meniscus and an almost O-shaped meniscus. And what they do is improve the adaptation, the congruence, again, of that femur over the tibia, allowing both to articulate correctly. In addition, two very important ligaments inside the knee, the cruciate ligaments, which I'm sure you all know, are called that simply because they cross over each other in the shape of an X. They are commonly injured in sports like soccer, where a pivot or forced valgus occurs. Here again, the anatomy, the kneecap, femur, fibula and tibia. But that's not all, the knee is also made up of muscles, very strong muscles that once again ensure the stability of that joint. Here, as you can see, it's the same image we saw before, only now all the joint components have been added, like the cartilage and also the quadriceps tendons and the patellar tendon. As you can see, this area is also covered by a lot of muscles, mainly the quadriceps muscle, which is one of the most powerful muscles in the body, located right in front of the thigh and has four heads. That's why it's called quadriceps. If we look at this knee from this side, the inner side, the inner edge of the knee, we can also see some important structures. Muscles that attach to the inner part of the leg, like the adductors or the muscles that appear behind, which we call the hamstrings. Exactly at this point, we would find the medial collateral ligament that we saw earlier. Also from the posterior view of the knee, we have the hamstring muscles, muscles that are located on the backside of the knee and allow you to flex the knee backward. And they also prevent the forward translation of the tibia, which can put the cruciate ligaments at risk. So as you can see, the knee is a compound, not a compound, a very complex area where many structures work together to maintain good stability and at the same time good movement. Finally, the bursae. The bursae are the big forgotten ones. They are bursae filled with a kind of fat. What they do is prevent certain muscles from rubbing against the bone or even against each other. We have a lot of bursae around the body. In the knee, these four stand out the most. The inflammation of the bursae is very characteristic because you see very localized swelling, a significant lump in just one area. And it appears most of the time in the knee. When we put weight on the kneecap or at the level of the tibial tuberosity for a long time, it's very common in people who spend a lot of time working on their knees. Now that we have a little more general understanding of the knee, let's talk about why knees get inflamed. There are some major medical reasons you could say, but I especially like this last reason. Mechanical stress and insufficient strength, which can explain practically all cases of knee inflammation. More common. We have trauma. And by trauma, we mean blows, falls. That is high impact forces that cause inflammation in all those structures that give the knee its stability. For example, the ligaments, for example, the menisci. Those falls, those injuries in soccer where the cruciate ligament or the cruciate ligaments get injured or torn. They would fall into this classification of trauma. Surgery, which is obviously also a trauma, means that tissue is damaged. Ligaments are damaged. Muscle is damaged. And the joint is also damaged. But with a therapeutic purpose. In other words, ultimately, the goal is to repair. But that surgery involves a certain significant inflammation in the knee. Infection. Obviously, knee infections commonly after surgery. It's rare for us to have a knee infection. And it's very easy to detect, since it will always be accompanied by an increase in temperature. If we have a very high temperature and a body part, such as a knee, that has suddenly become very swollen. Obviously, we can't rule out that it's an infection. So we need to apply the appropriate treatment for that infection. Infection. We've already seen bursitis and tendonitis before. All those muscles that attach around the knee are made up of tendons in their most distal part. Here we have the patellar tendon. The quadriceps tendon. We also have the tendons of the muscles that go to the inside of the thigh. For example, the adductors or the hamstring muscles. All those muscles have tendons. Overuse of those tendons or lack of strength from those muscles. What this will cause is a local inflammation. Usually very localized. Also at the tip of the finger. But not as big. Not as noticeable as the bursitis. The bursitis that we have seen before. So all these structures that I'm showing you are susceptible to inflammation. Both ligaments and the bone as well. A trauma. A bone fracture would be a trauma. And can cause local inflammation. Both the ligaments and the tendons. And also the muscle itself. If there is a muscle tear, like the bursae, they are susceptible to inflammation. Especially due to overuse or trauma. And therefore increase the volume of that knee. Last but not least. Circulatory problems. Those of you who have varicose veins. Are overweight. Have poor venous return. Or work a lot standing up or sitting down. You may have trouble with your knee. Being able to pump all that venous blood from your legs. And therefore it can cause local inflammation in the knee. And we come to this last one. My most important one. The most important reason why that local inflammation appears. If you never exercise. Like going for walks. And suddenly decide to start running to get back into shape. And be healthy. It's a classic example of making a drastic change. Your knee unaccustomed to the mechanical stress. Will become inflamed. Microtears will occur due to the effort. Small injuries will happen that will need your immune system. Which will send a lot of fluid to the area. To heal the tissues you've injured. Just by going out for a run. It doesn't indicate a major injury. But rather micro injuries that heal gradually over time. And that's how the knee and the muscles actually get stronger. So is this mechanical stress really nothing more than microtraumas? This also happens a lot in people who are overweight. Who never exercise. Who don't have strong enough knees. And they go out to walk or exercise. Without really having any idea what they're doing. What's going to happen. Their knees aren't ready to handle that pressure. That mechanical stress and discomfort will appear. Inflammation will appear. And local damage. And it doesn't just happen to people who are very overweight. And put a lot of force on their knees. But also to very elderly people who don't have enough strength. Of all these muscles I showed you before. Especially the muscles on the front side. The quadriceps muscle. All those people who go out for a walk. Go hiking. Running. Or just stroll through the park. And don't have strong quadriceps. The knee will suffer greatly. And local inflammation will occur. And that's why it's important to know the origin of the inflammation. Because an infection in a person who has a fever. Who has an infectious component inside their knee. Is not going to have the same treatment as someone who has a circulatory problem. Obviously in the case of an infection. What we'll do is use certain medications to fight that infection. And basically stay at rest. Circulatory problems are treated differently. With specific exercises for circulation. And with devices or orthotics. Or rather external compression stockings. That will help us make up for the deficiencies of our circulatory system. When it comes to mechanical stress. The option would be relative rest and insufficient strength. Which really go hand in hand. It would be to do exercises progressively. To strengthen that knee. And prevent it from being too stressed. And having all that local inflammation after an activity. So as you can see. It depends on the origin and the cause of knee inflammation. The treatment is quite different. For trauma it will be mostly rest and ice. And for surgery as well. As you can see the treatment is completely different. This covers the general treatment. But we have to keep in mind that each case is unique. Consider an overweight individual with weak knees. For instance. In their case rest would not be a good option. It could be a good option to calm down a local inflammation episode. The knee suddenly becomes severely inflamed. Ok. We can stay at rest for one or two days. But for him the ideal would be exercises. Compression. And above all ice. The massage I'm going to show you is useful in all cases. Whether there is a problem at the circulatory level. Or if the knee is swollen due to mechanical stress. It's ok. The massage can be applied in any situation except for one. And that's when we have a fever and there is an infection. In this case it's better not to touch the knee. Let it rest and wait for the medication to take effect. I hope this information has been useful to you. As it's crucial to detect the origin of that inflammation. To properly address it. Because our body is autonomous. And every time there is a micro injury. Every time there is trauma or excessive activity. It will respond. On its own it will send inflammation. And make the knee swell and have more fluid. If for example going back to the previous example. You are someone who is overweight. And you go out for a walk or to do some activity. If you don't rest an inflamed knee. And do the necessary exercises. It won't heal properly. You keep walking. And that inflammation is going to become chronic day after day. The body isn't able to heal your knee. Which will cause your knee to be constantly inflamed. And you'll have no way to stop that vicious cycle. Sleep is also one of the most important things. When we talk about inflammation. It's during the night that our body above all. Repairs all the damaged tissues. And if that inflammation is caused by damaged tissue. By overexertion. By trauma. Sleep will be one of the biggest keys to speeding up recovery. Before continuing. Well if you're one of those who are overweight. The best thing obviously is to exercise in a pool. It's the best way to work your knees. Without putting too much strain on them. Since your body weight floats thanks to the water. And for those of you who don't have that kind of overweight problem. If you're older. If your knees commonly get inflamed. The linked video description includes recommended videos. The second video with the same cover as this one. Is a different video you can find. Five very useful exercises. That will help you strengthen your knees again. And prevent inflammation caused by weakness. One of the most common ones. One last note for those patients who have knee inflammation. Due to circulatory problems. People who stand or sit for extended periods. Such as those with jobs requiring it. Often develop visible varicose veins in their legs. Indicating circulatory issues. What you need to use are compression stockings during your work. I recommend that you go see your doctor. So they can prescribe the stockings that best suit your needs. Because this really is a true blessing. For all of you who have circulatory problems. Just one rule. And that's that compression stockings shouldn't come up to here. They should be below the knee. Ideally they should come up as high as possible. Up to the groin. Practically beyond the middle of the thigh. For them to be truly effective. There are other stockings that go even above the hips. And reach up to the navel. Perfect. They're also very useful. But honestly there's not much difference compared to these. If you can handle the ones that go up to the abdominal area at the navel. There's no problem. And they're better than these. But they tend to be more uncomfortable. They're harder to wear in the heat. And more difficult to put on. So for me. Mainly in terms of ratio, comfort and effect. These are the best. You also need to visit a pharmacy for these measurements. They have to be stockings that are really adapted to your situation. This type of stocking is completely discouraged. For those of you who have circulatory problems. These stockings are more aimed at athletes. And as you can see. They don't include the foot. So I think they are completely ruled out. Because this is not the type of population we are addressing in this video. Very well. After this thorough explanation. Which I hope has been very helpful to you. Let's move over to the couch. And do a little massage. That I'm sure you're going to love. To do this you'll only need a towel. And if you like to slide your hands over your skin. You can also use a little bit of lotion. It will mainly depend on how much hair you have in the area. Because as you will see. I have quite a lot of hair. Even so. I dislike using lotion. Because everything feels sticky afterwards. Lie down if you have a sofa. With your leg completely supported. So that as you can see. Your heel is always in contact with the couch. The towel will help us to slightly elevate the leg. And by having that slight elevation. There will already be a small drainage effect. A slight circulatory effect. That will help us move all the fluids from the leg. Toward the thigh area. Main technique. The superficial stroking technique. Or effleurage as it's called. It's simply a movement. Gentle. Very superficial. That you need to perform from the ankle. As low as you can. Up to the thigh. Trying to cover both the back and the front area with your hands. The entire lymphatic system. Which is actually responsible for carrying all that inflammatory fluid to the area. Is located practically just beneath the skin. So it's not necessary to perform. Deep pressure to achieve a great effect. Lie down. Bend forward. Place your fingers on both sides of your leg. Trying to wrap them around it completely. And move your hands upward. To help drain all that inflammatory fluid that's settled around the knee. We're going to do 3 more sets of 10 passes from the ankle up to the groin. And here when you reach the knee. You wrap your thumbs around the kneecap too. Very slow. Very controlled. Light pressure. Not too much. Since that system. Inflammatory. Or rather that system. Lymphatic is located just below the skin. Very well. Once we've done those small strokes. And have stimulated our skin. Let's focus on the kneecap. At the start of the video. I described the bones of the knee. The kneecap is the circular bone in front. Let's mobilize it. Mobilizing it allows for a better flow of fluids at the knee level. We have an inner and outer edge. That we can touch with both index fingers. As you can see here. And an upper and lower edge. It might be a little difficult for you to mobilize it the first few times. But I assure you that with a bit of practice. You'll be able to do it. Place your index fingers on both sides. Outside and inside. And keep your knee completely relaxed. That's why we've also placed a towel. We're going to do movements inward and outward. Pleasant. They don't cause any kind of pain. We move the patella over the femur gently. To improve the flow of fluids in the knee. We're going to count to 30. To have done about 30 seconds of mobilization. We've already done 10. Gentle. Rhythmic. No rush. If your knee is slightly bent. There will be a contraction of the quadriceps. And as you can see. It can't move. So make sure it's completely straight. With the towel under your ankle. So that the kneecap is free. The next mobilization is a little bit more difficult. Since the top and bottom edges are harder to identify. But I'm certain that with some effort and time. You can accomplish it. Place your index finger on the lower part. And your thumb on the upper part. And what we're going to do is move up and down. As you can see. Why it's a much more subtle movement than the previous one. It's not something that's as noticeable as the previous one. Since there's less movement up and down. Than there is side to side. And again. This mobilization ensures good fluid transition. And good release at the knee level. Again. 30 seconds. We've already done 10. 20. And 30. Before finishing. You can force the kneecap. We push down as hard as you can. For a couple of seconds. Then we push up as hard as you can. For a couple of seconds. We push it outward. As much as possible. A couple of seconds. And for the last one. Push inward as much as you can to finish. Where we will always find inflammation at the knee level. Is around the kneecap. Especially here. Between the tibia and the kneecap. And also around it. At the level of the joint line. We are going to focus on the patellar tendon. And the perimeter of the kneecap. For that. Take your thumbs and place them just below your kneecap. As you can see. It's important to locate it. And know where it is with moderate pressure. And what we are going to do. Is move around that kneecap upwards. Until you close the circuit. Bringing your thumbs together. If I turn slightly more to the side. I press firmly. Not too hard. Just a little. I go around my kneecap. And move upward. Until my thumbs meet each other. I press right at the level of the patellar tendon. Go around the kneecap from below. Until I reach the top. We've done 4 or 3. We're going to do 10 passes of this technique. Here. If you see that. It's pulling your hair a lot. 5. Wouldn't it be a good idea to use a little bit of cream. To reduce the friction between your hair and your fingers. 6. 7. Tight spot detour. 8. You can place the rest of your fingers behind. As I'm showing you. To make the technique easier. 9. Last technique. Last pressure. On a patellar. We go upwards. Perfect. A great technique to release the entire patellar region at the knee level. Next. We are going to locate the joint line. Which is the space between the tibia and the femur. To do this. We are going to bend the knee a little. The joint line. Assuming you attended the last anatomy class. It is located on both sides of the kneecap. And can be easily felt. While not immediately apparent. The more you bend the knee. The more obvious it becomes. And you will notice a line that goes from just below the kneecap. To the back of the knee. The important thing is that you place your fingers at that level. Once you found it again. Rest your leg. And we are going to do a similar technique. We are going to support at the level of the patellar tendon. And go down along the knee. Following that entire joint line. We support right at the level of the patellar tendon. And go around. Going down along that entire joint line. We go back and repeat. Until we've completed the movement 10 times. 3 thumbs on the tendon below the kneecap. I open them outward. Continuing along the joint line. That is between the femur and the tibia. 4. Gently with moderate force. 5. 6. 7. 8. I have 2 left. Support 8. I continue. 9. Last pass following that interline joint. And 10. Perfect. Next. With your fingers in a claw shape. We are going to insert them behind the knee. And bring them together. From here. Next we are going to spread our fingers. And move that hand forward. Above the there. Almost to the middle of the thigh. We place our hands behind. I'm positioning myself like this. So you can see it clearly. Fingers come together behind the knee. In the popliteal space. And I pull outward. Fingers in a claw shape. Move up along the side then. They come together above the kneecap. Before reaching the thigh area. Let's do 10 again. Hands behind. Nails in the fingers. Medium strength. I contour all around that knee. And move my fingers. Up to the middle of the quadriceps. Let's go with the third. Turn fourth. It's easy to lose count of the repetitions here. Four. Fourth exercise. I put my fingers together behind. And turn my hand outward. Bringing that claw up above the kneecap. Five. Slowly. With considerable force. Six. Seven. Eight. Let's do the last two fingers together. From behind they open outward until they reach above the kneecap. The nine. Last repetition. I close at the top. Together. Just above the kneecap. And hold for a second. There's a neighbor making a lot of noise. I don't know if you can hear it. I'm going to close the door. And that way I grab the last thing I was missing. Which is a fork. For a technique we'll use later. Very well. We've already done that posterior drainage technique at the level of the rural ischium that we already know. From the anatomy video we watched earlier. And next we're going to work on the muscles. For that use a claw-like finger position. What we're going to do is press them in here on both sides of the kneecap. This time firmly. We're not dealing with small things anymore. Nor with effleurage. Nor with superficial massage. We're going to press them in just above the kneecap. And pull firmly upward until you reach the area of the groin. 10 repetitions. You can place your fingers a little closer together to work more on the rectus femoris. Or a little farther apart to work more on the vastus lateralis. Ideally you should be able to work the entire quadriceps area using these techniques. So we can do 5 here in the middle. And another 5 with your fingers a little more spread apart. We've done 3. 4. I squeeze hard. The fingers dig in. I pull up. 5. 6. I have 4 more left on the side. I spread my fingers a little more. And work more laterally to focus on the outer and inner vastus of the quadriceps. With this one we've done 3. Since we did one more at the beginning. 4. Last repetition. And 5. Perfect. We have relaxed the main muscles at the front of the leg. Now we're going to target the hamstrings, the main muscles at the back. And we're going to use the same technique. This time instead of placing your fingers like this behind the knee. We're going to place them like this on the tendon area. Right where you feel a series of cords. Which are nothing more than the tendon insertion of the hamstring muscles. And from here we pull upwards with those fingers. As high as you can. We can bend the knee a little to have better access to the muscles. And this way we work on that whole tendon muscle region. From the knee. Up to the groin. The structural muscles are not so centrally located at the level of the knee of the femur. But rather in the thigh. What we have to do is separate our hands from each other a little bit. To maintain that constant pressure on the thigh. Instead of having our fingers practically together. What I do is start at this level. And as I go up I separate my hands a little bit. A little bit. Until the end. Let's do five more together. Dig your fingers in. Upwards. One. Two. Three. Four. And five. Perfect. We rest the leg and up. Next. To finish our massage we're going to use the handle of a fork. It can also be a knife or a spoon to perform certain techniques. Here. Right at the level of the quadriceps insertion. And around the kneecap. Which can be very pleasant. Honestly this is what I like the most. Because with your fingers it's impossible to reach so deeply at the level of the muscle insertion. What I recommend is that with your opposite hand you pull the skin forward. So there isn't too much friction between the skin and the fork. Which could cause skin irritation. We're going to start from out here for example. Let's remember that the patella is this circular bone located right in front of the knee. Which you already know from the anatomy section we've seen. And we're going to start out here. And we're going to scratch a little bit from the patella downwards. Drawing the whole patella. We make a few passes at this level and continue upwards. A few more passes at this level. And little by little we keep moving up. For me the area that provides the greatest benefit and feels the best is this one. Exactly the area where the rectus femoris of the quadriceps inserts. At the level of the kneecap I pull the skin and work all along the edge of the kneecap. Very pleasant. Always from the kneecap outward. And the goal is to work the entire hemisphere from the outer side to the inner side of the kneecap. Scraping. Now let's move on to the inner part. Up to the inner edge. Once you reach the inside you go over it again here and move back out upwards. A couple of passes. Upper part, the quadriceps area. Going to the outer lateral edge. Once you've drawn an inward U and come back we're going to do the same thing. But on the lower part we also start from the side and again work the whole insertion area, the patellar tendon area. Here is very pleasant too. For me it's one of the best. This hand. Remember that it pulls the skin so there's not too much friction between the skin and the fork and we don't end up with very red skin. We work on that tendon which I really like to work on and we continue inward until we reach the inner edge. And again we draw another U downwards. Patellar tendon. Again. To finish on the outer side of the patella you can do this more specific massage for as long as you want. I like to do two passes inward or outward. Inward and outward. And to finish a couple of gentle strokes, a couple of light pressures to once again stimulate that lymphatic system that is just below the skin. One last one. Perfect. Very good. With this we will finish the massage. We're going back to the screen to go over a few details before finishing the video and the live stream. Here I am with you. Dosage. Nothing remarkable for a massage that you can do almost daily as it doesn't cause further knee inflammation. In about 15 to 30 minutes. I was there for 20 minutes I think. You can add or remove the techniques that you like more or less personally. So using that fork, that spoon gives me good relief. It gives me really good sensations around the kneecap and also what you can do is apply ice at the end of the massage for an extra effect since that ice has a very very important power against everything it is. Inflammation by closing the blood vessels and reducing the supply of inflammation of inflammatory fluid. Also depending on your background exercise is almost always one of the best alternatives. One of the best tools except for those of you who have had surgery or for those of you who have inflammation due to an infection. So depending on your case and as we've already seen before different therapies should be applied. We've reached the end. Thank you for making it this far. You already know that you can watch this video and this massage again to do it with me whenever you want so I can guide you and you won't forget the techniques. If you like the content you already know that you can support me through YouTube memberships where with a small monthly fee you help me keep creating content like this. Let's do a round of questions for about 10 or 12 minutes trying to answer all the questions you ask me. I'm going to give more priority to all those that have to do with the knee, okay? For that I'll use my online tool to find all my videos which you can access through the second or third link. The description calls it Porzona Corporal. You can access this free tool where you'll find a lot of my content. Well, actually all my content organized through this nice body diagram and if not you have this search bar where you can type in any term you want. All right, let's see. What questions have you left for me here? Here we have a comment from Wilson who says good morning blessings. I had surgery on my posterior cruciate ligament and meniscus five months ago. My knee isn't working for me. I don't understand what the station says. What exercise do you recommend for me? Your question could have been phrased better because I don't know if you're lacking extension or lacking flexion. Normally it's usually extension when it comes to a ligamentoplasty. I suggest using the two videos you have here including the duplicated one as you have plenty of material to work with. Improve your flexion if what you can do is bring your heel toward your buttocks and secondly if what happens to you is that you can't extend your leg. We have this wonderful exercise, this wonderful live video also 40 minutes long with a lot of tips and exercises so you can improve that knee extension and fully recover it. All right, Wilson. If you get the chance after giving me more information when your question comes in I can give you a better answer. Let's see what else we have around here. Greetings to you, Elisa. Several of you are inquiring about spinal massages. Well, soon I'm going to have a collaborator who will help me record videos and I'm going to release a number of videos about massage. You'll love it. There will be plenty. Gloria says she has grade 3 chondromalacia in her knees which she has been overusing during her recent vacation. Look, here's an example of someone who might have knee inflammation due to a stimulus from an external activity. And really maybe they don't have any kind of injury in the knee apart from the chondromalacia. So what can we do in these cases? First of all, apply a massage like the one we just saw. Apply ice. 15 minutes every 4 hours. 15 to 20 minutes. No more. After reducing the initial inflammation and getting through the more painful inflammatory episode. Relative rest as well which can last around 4, 6 or 7 days. Start strengthening with very basic exercises since chondromalacia is one of the key signs of muscle weakness. At the quadriceps level. To address that we can come here. Let's type quadriceps. And we're going to find a lot of videos that will be very helpful for you. Gloria, should I show this to Distante as soon as it loads? I highly recommend a series of 3 videos that I really like. Here, let me share them with you. Strengthen your quadriceps. Level 1, level 2 and level 3. The ideal thing is to start at a very low level. Obviously level 1. Start building a little bit of strength. Developing strength in that knee. And I'm sure that when those knees are stronger, the next time you go on vacation, your knees will be more resilient and there will be less inflammation and less pain. After all, one of the main sources of knee inflammation and knee pain. I told you before. It's usually excessive mechanical stress or insufficient strength which really go hand in hand. As you improve that strength, your knee will be able to handle more mechanical stress and will be able to take on activities like going on a trip for a couple of weeks. Gloria, I hope you find that advice very helpful. Here we have it. Look, I hadn't considered this case in the presentation. Very good, very good, Clara. Very good case. Good morning. When you suffer from high uric acid, do your knees also get inflamed? How do you treat this case? Well, obviously by limiting your intake of uric acid, for example. By limiting your intake of seafood and visiting your doctor so they can give you specific medication to lower uric acid. If your uric acid level is very high right from the start, so in these cases it's more of a medical issue like an infection rather than an actual problem with the knees themselves. Additionally, strengthening the knees is never a bad thing. Surely, the stronger your knees are, the more likely they are to withstand more and have less inflammation. After all, what high uric acid does is make your knees more sensitive and they will react more strongly to external stimuli. So the recommendation I just gave to Gloria can also be applied to your case. And on days when your knees are very swollen, relative rest and ice for 15 minutes every 4 hours. I think they can be very helpful. Let's see what other comments we have here. A lot about the spine, but I'm going to give priority to the knees. Very good. This time Patricia explains to us that by massaging or draining the knees, circulation is activated. Yes, everything, including both superficial and deep palpation. What it's going to do is stimulate that circulatory system, which will collect all those inflammatory substances, take them away and renew them. It's like we're washing that knee with our own blood and as a result there's going to be a decrease in local inflammation. But you always have to address the source of the inflammation as we saw in this slide, which is so important for applying the right treatment. Massage is beneficial in various cases and can temporarily reduce inflammation. If the underlying problem continues, if you have an infection, if you have a circulatory problem, that knee inflammation issue will come back. So you have to try to address it and treat it with other tools that I've already suggested to you during the video. Let's see. Florina comments that her sister has suffered from arthritis since a young age. Arthritis, unfortunately, is an autoimmune disease in which your own body attacks substances. It can be the cartilage in your own joint. So it's quite a complex situation because it's your own body reacting to that substance you have in your body, that cartilage. Without there being an external event, without you having to walk a lot or lift heavy things. So it's a disease that requires urgent medical attention, obviously, to prevent early joint destruction and in very advanced cases. What is done is a knee prosthesis, replacing that joint surface with a titanium knee replacement to prevent the progression of the disease. Rheumatoid arthritis can manifest in various parts of the body, commonly affecting the knee, hip and lumbar area. But you have to be very vigilant and treat it with medication because if it's not stopped in time, it can become completely devastating. Massages can help, but it's essential to address the root cause of the problem to prevent the knees from becoming inflamed again. Raul Saavedra asks a question. Raul, thank you for being here. I've seen you in multiple live streams already. For someone who had patella chondromalacia, are those exercises where you squat down while taking one leg back, mainly supporting yourself on the knee of the front leg? Good. That type of exercise is called the single leg deadlift. It's a great exercise, especially for working on the stability of the hip area, the hip and pelvis region. These exercises heavily target the gluteus medius muscle. Working the gluteus medius is very important for knee stability. It's important. However, it's quite a demanding exercise. Honestly, I think there are other exercises that target the gluteus medius better and can lead to more improvement, especially for older people. What about in the case of patellar chondromalacia? The best thing is to sit or lie down on the floor and do specific quadriceps exercises, like the ones I recommended to Gloria a few moments ago. That are actually better since the risk-benefit ratio is much better than when you do deadlifts, where there's a certain risk of falling, especially with single leg deadlifts. Here are levels 2, 3 and 1. Start with level 1 and then progress according to how you feel. Is the single leg deadlift very good? It's a great exercise, but like everything, you must know how to apply it to various situations. If you're an older person with worse balance, based on what I can see in the photo, although it's hard to tell, it might be too stressful and could cause additional knee inflammation. All right, Raul. Any more questions over here? Miriam, who is with us, has osteoarthritis, also known as knee arthrosis. In some regions, such as Latin America or the United States, it is referred to as osteoarthritis or osteoarthritis. All right. Despite seeming similar, rheumatoid arthritis and this condition have absolutely nothing to do with each other. In this case, when there is osteoarthritis, what happens is that it wears down. The entire joint surface, cartilage, femur and menisci area are prematurely aging. And well, more than just wear and tear. It's called premature aging, since over time, all our joints degenerate. They lose capabilities, they lose joint surface and well, among other things, we lose joint mobility. If it's osteoarthritis and you've never exercised, you might achieve some improvement by doing the exercises you'll find here. We've taught them before, but I'll show you again. Check the third link in the video description. Knee mobility. And here we have improving knee flexion. You're going to find some really, really good exercises that will help you improve. Well, you can improve to a certain extent. If you've never exercised before, you can probably improve a little, maybe 5 or 10 degrees. There's always room for improvement if you haven't exercised before. But if you already exercise and your knee is really stiff, getting your heel all the way to your butt is practically impossible. Your knee condition likely won't allow it. And if you notice that this bothers you a lot, it's usually meniscus injuries that block that joint flexion. If you notice that it bothers you a lot in your daily life, that it's accompanied by pain, and that overall it's a significant obstacle in your life. Honestly, I would consider getting a knee replacement, a knee prosthesis, since they usually have a very high success rate. And they can help you a lot with the symptoms you mentioned to me. I generally try to avoid and encourage my patients to avoid surgery, especially hip and knee prosthesis surgery. The results are so exceptional that after two months of rehabilitation, you'll feel even better than before. So, well, with this type of surgery, you shouldn't delay it too much. And I think in your case, it would be a good option. If the condition of your knee, the state of your knee, prevents you from living a normal life. Let's go with one last question and we'll be done with the 50 minutes. Let's go this way. Here we have a question. We'll finish with this one from Lucy Borchett. Thank you for the information. I have a question. After a knee replacement, is it normal to feel stiffness after three months? Well, a knee replacement is a major surgery. That is, they remove, let's put it here as an image, they replace everything that is the joint surface. All this area is removed either by a robot or manually by the surgeon, depending on how advanced the hospital is. And the plateau is also removed. Tibial, which is the area where the femur rests. And in some cases, the back part of the kneecap is also removed. So all of that is replaced by a titanium surface that is inserted at the femur level using hammering. It's a stem that goes inside the bone, the hollow part of the bone, and it's also inserted at the tibia level. It's a rather aggressive surgery, which usually causes a lot of swelling, especially in the days that follow. The swelling usually subsides within three to five weeks, depending on individual factors such as age and characteristics. Generally soon. What I mean is that it's a major surgery, and to fully recover from that surgery, you'll need around six to 12 months or even up to two years, depending on your age. Having a stiff knee at three months is not abnormal at all. Usually at three months, it's always said that the knee should reach 90 degrees, which is a right angle, a right angle of 90 degrees. You should be able to achieve at least 90 degrees. It's impossible to bring your heel all the way to your buttocks. Since that's a bend of more than 130 degrees in the knee, a very exaggerated flexion, and in general, the prosthesis is not designed to achieve such an extreme bend. As long as you move between 120 and 130 degrees, you'll have perfect flexion, and you'll have what you need to live a normal life. However, if you want to sit on your heels on the floor or kneel down, you'll be more limited. But remember that at 130 degrees. Don't go beyond that, as it jeopardizes your integrity. Of the prosthesis itself. Swelling may prevent you from bending, but that's okay since recovery times are usually long, ranging from six months to a year. And on the other hand, you need to know that this knee prosthesis won't let you bring your heel to your butt. You won't have full flexion. Nevertheless, you will have a higher quality, less painful and more stable knee that will last long term. I hope you found this information helpful, friends. A very interesting live session that you can access once I publish it, which will be in a few minutes. I thank you all again for making it to the end. And I hope this massage has been useful to you and that you can share it with those who need it. Hello, everyone. See you tomorrow at three post Meridian Spanish time. Take care. Bye.