♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Hi, folks, I'm Bob Schrupp, physical therapist.
- We're going?
I'm Brad Heineck, physical therapist.
- Together we are the most famous physical therapists
on the internet.
- In our own opinion, of course, Bob.
- Time to wake up Brad.
- I know you wanted to stay in bed this morning, buddy.
- Good thing I got the lines memorized.
- Today, we're gonna talk about chronic piriformis
and hip pain.
And fix it yourself.
We're gonna show you three steps to do so.
- That's right, Bob, one, two, three.
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and you're gonna wanna go to the giveaway section.
That's right.
- [Bob] Because this week we are giving away
a SleepOvation mattress.
- [Brad] Look at this baby.
- [Bob] Yeah.
- [Brad] They come much bigger than this.
This is a sample and it's a cutaway view
so you can see how they're made.
- Yeah, you don't be able
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- [Brad] Oh, good, that's all they can,
some people can't take any more than that.
- [Bob] That's right.
- But with the pillow.
This is what they look like on the end,
if you cut this apart, this would look like
and they've got actual springs inside the pillow,
but you cannot feel them, it's here,
but they're in there.
- And they give a good support.
- They do.
- [Bob] I think it's a great side sleeping pillow,
if you're a side sleeper.
- They give you a lot of,
that airflow is in there.
- [Bob] And this mattress is by far
the most comfortable mattress I've been on.
I haven't tried them all,
- But I'm very happy with mine.
Anyways, we gotta get on with our piriformis
and hip problem.
All right.
Now Bob, we need to talk about this.
As therapists, we know if the doctor
gives us orders, says piriformis hip pain,
the first thing, not the first,
but one of the first things we're gonna think about is
we need to rule out is it part of the low back?
- Right.
Is it the back causing the pain.
- Right.
- And not the piriformis.
- So, for this, for a little brief explanation,
we need to refer to Sam.
Sam, I am.
He is our skeleton model
and he's been very good to us
in the last few years.
I need my stool, as well.
- Oh, you made the muscle in black.
- Yeah, I did because he's got white bones
and it's just a little easier to see.
Liz, can you see the location
of the piriformis muscle?
I don't have exactly the connection.
It's actually underneath the sacrum,
but for this discussion it's not that important.
From here, down to the hip greater trochanter
is where that muscle goes.
- [Bob] A little bump.
- That's right.
And then, you know, the hip is here,
so if you got pain from the piriformis or
the hip, they're located right next to each other.
So you gotta determine which it is.
But also the back.
Now the low back, oftentimes you'll feel pain
in the low back, but it's not uncommon
for the pain to refer distally or down
into the buttock, into the hip
and down into the leg.
Which, by the way, Bob and I,
we know that the piriformis muscle
can also refer pain down the leg
as it pinches the sciatic nerve.
So, you really need to kind of rule out
at least low back and there's one way I think,
and Bob, you may have some other input.
- Sure.
- But the two options that are, you know,
the layperson can do without too much problems.
- Yeah, the sciatic nerve travels underneath
the piriformis or through it,
so if the piriformis muscle is tightened down
for some reason or contracted down.
- Sure.
- It puts pressure on that nerve
and sends pain down your leg
and you think I have sciatica.
- Right.
- And it's really not, it's false sciatica
we call it.
- Either way, you still have the pain-
- You still down the leg.
- Just from a different source.
But just something to rule out the back.
If you're standing and you have your pain
in your hip and you go like this
and you extend, you keep your legs
and everything still, but you just stabilize
your back here and think of all motion going
from above there in this direction,
if that changes that pain,
particularly significantly, there's a good chance
you got some low back involvement,
but just wait, before you go any farther,
let's assess even-
- You want me to do it?
- Yeah, go ahead.
I want you to lay down,
probably on the floor would be best.
You could do it on the bed,
but the floor is better.
- Lie down.
- Lie down, yes.
And I want you to think
that your waist is glued to the floor
and so everything, the hip is all completely motionless.
- Yeah, so the piriformis
is not kicking in whatsoever.
- No, hip motion.
Everything down here and then you're going
to do a press up.
Now if you have pain doing this,
particularly in the leg,
in the hip or down the leg,
it's very, very certain
that you probably have
a low back problem referring down.
You could have a low back problem
and piriformis, but if you can do this
and it doesn't bother you at all,
you can do this, no real change,
then it probably is from the hip
and/or the piriformis.
- Yeah, and the thing is, these are things that,
it's pretty, you know, difficult sometimes
for a therapist even to assess,
but as a rule of thumb,
if this recreates the pain,
you know there's a good chance
that it's the back.
- Right, exactly.
So, let's say you did your extension exercise
that we just demonstrated.
Didn't change anything.
We've got the hip and piriformis to work with.
Now the second step is this is how we're gonna do this.
Won't you move Bob, I'm gonna do...
Knees like this and we're gonna simply bring
the knee up and over to the opposite knee
and this stretches the piriformis.
- [Bob] Yeah, this is the one that's painful,
the right side.
- You do this and feel it pull tight there.
Make sure you do the other one,
because if that piriformis is tight,
I've had many patients say oh, boy,
I feel it right in here
and then the other leg that doesn't hurt.
- [Bob] Yes, almost, Brad, almost universally
it seems like I found it to be that true.
- Exactly.
- So it's another sign that it is piriformis.
- And then you can also just do
the knee straight up.
And that might give you some indication
of the actual hip joint itself
and it will take out some of the piriformis involvement.
You know, this hip might go up to here
and this one, oh, this is no problem here.
So then you may have some hip tightness, as well.
And that's the thing, you know,
it may not be just one or the other,
you kind of, you know-
- You could have pain.
- Your piriformis could be tight as a result
of a painful hip.
- Sure, sure.
Or vice versa, your hip got tight
because your piriformis hurts.
- Right.
- You don't want to move your hip.
- Yeah, what comes first the chicken or the egg.
- Right.
- Well, we shouldn't discuss that
because we've got other work to do.
Anyways, do the figure four.
So ankle goes above the kneecap on the thigh
and then check range of motion this way.
Now this is not gonna check,
this is more of the hip joint.
Not so much the piriformis,
but there's some involvement that way, too.
If you find that this one only goes to here
or you even have a hard time getting your foot up to there
and this one drops like this.
- [Bob] I don't know if you remember, Brad,
the piriformis actually is an external rotator
and sometimes it's an internal rotator
when it gets up there farther.
- Yeah, it gets kind of complicated.
- It get complicated,
so you probably are actually stretching
the piriformis if you get up like this.
- Right.
- And then push it down.
- I knew he was gonna get it.
- Yeah, he knew I was gonna say something.
- I wanted to keep it simple.
- Right, and that's the case.
You don't even need to,
so should they be doing those stretches?
- Well, yeah, if they're right,
then you are gonna do the stretch,
but before we go any farther.
- And those stretches are good for you no matter what,
even if you don't have piriformis.
- Even if, yeah, and I do them myself.
- Right.
- But if you got the painful hip
and you want to get that piriformis muscle stretched,
as well as the hip muscles,
this is what we're gonna show you.
This is step number three,
the treatment part.
- Sure.
- One thing you can do is before you do the stretches,
we're gonna do this on the floor.
What you can do, a little foam rolling.
Now I like the foam roller.
There are some things I like about it
and some things I don't like about it
is one, you know, you can work it
and as long as you can do this,
some people may have shoulder problems.
If you're a little older, you have some injuries,
you may not be able to control the weight,
but we have another option.
- [Bob] Brad's not putting full stress on that.
- No.
- [Bob] He's able to take his arms and so...
- I've got about 50% of my weight on there.
- [Bob] Sure.
- And if it's sore, you need to.
- [Bob] And he's kind of rolled towards that side
where he could roll off it a little more
and take even more stress off of it.
- Like now I'm on the sacrum mostly.
- [Bob] Yeah.
- But you're gonna work that
and you'll get a feel for it.
When you get over that tender tight muscle,
that piriformis, you're gonna have to be,
tread lightly on it
and then work into it.
You'll do this for a minute or two
and longer after it starts to loosen up.
- [Bob] I wouldn't do this one, Brad, though,
if it increases your pain.
Do you know what I mean?
- Right.
- [Bob] Starts sending pain down your leg.
- Yes, particular the leg symptoms.
- If you feel a little soreness
right a you roll over, that's fine,
but don't increase that leg pain down,
you know, down the leg.
That means it's too tender.
You're gonna have to maybe use the next step.
- Right.
- And massage around it.
- Exactly.
Which, and these massage guns are getting so popular.
Now, I've got orange tape on it
just so you can see this on my black pants,
but I use the round ball.
- Sure.
- You may want to-
- They've got five attachments.
You're probably gonna use either
the airhead, that's just a little softer
to get started, the round ball is a little more aggressive,
but then they have some other heads
that are really aggressive.
- [Bob] Yeah, this would be really aggressive.
- The little pointer.
- [Bob] And that's the one I use on my calf right now, so.
- Sure.
But to start out with, go with this
and you'll get a feel for what you need.
So I'll demonstrate,
and I have a patient right now,
he's gotta have a hip replacement,
probably in about nine months.
He's trying to hold it off. - Sure.
- And he's using the massage gun
as part of his treatment.
Chris.
- Oh, sure.
- So I'm gonna get this thing going.
You can see this-
- [Bob] You're gonna have black on black
so it's good that you got the orange on there.
- Yeah.
So this is a reciprocating gun
and you need to have a gun that reciprocates-
- [Bob] Not just vibrates.
- It's gotta get into that muscle.
You got large muscle mass here.
- [Bob] And also, you don't wanna go cheap on these things.
Like the ones they're like 20 or 25 bucks
or something, they're junk.
- Right.
On the other hand, they sell them
for 4 or $500
and they're probably good guns,
but you can get a real nice one for around $100,
or 120, 30.
- [Bob] I have found on the piriformis muscle,
this is what treats it for me.
I mean, I've had the best luck
by doing massage on it.
- Sure.
- [Bob] And you can use your hand to do it, massage,
but you're gonna wear out very fast.
So, anybody I've had, including family members,
if they had piriformis problem,
I sent them a massage gun.
- Sure.
And, you know, and the hip like with
my patient who's getting a hip replacement,
I don't know if we can roll Sam over.
- [Bob] Sure.
- Then we can see,
we want to get those muscles around that hip capsule,
as loose as possible so that when you have surgery,
things are loose and you're gonna have
a better surgical results.
So I'm going over that piriformis right here.
You don't wanna go-
- [Bob] Go on a bone.
- That's just gonna hurt like, you know, the dickens.
And here and over on the top.
- [Bob] There's a sit bone, too,
you don't wanna hit that.
- Yep.
You're gonna go into the muscle
and you can even get into the front
a little bit here.
You know, touch on that leg.
- [Bob] You don't wanna be
in the femoral crease where the lymph nodes are.
- Right, right.
Okay.
So, you can work with that.
- The big thing is, too,
you can work around.
If it's a real tender spot,
work around it and then eventually go
into the tender spot.
- Exactly and you'll feel the tender spot,
especially that piriformis.
There's a trigger point down there typically.
You know, the patient, you can always,
they'll let you know it.
- You'll see from the look in their eyes.
- And I'll just review the stretches.
So, you know, you can do that,
work the massage, work the roller first
or the massage gun
and then do your stretches
and I like to start with the knee to the chest first.
It's not quite as aggressive
and you go pressure on, pressure off, 10 times
and then you may go to the figure four
and again, if you wanna hold it
for 15 to 30 seconds.
- A great stretch to do.
Everybody should be doing this stretch, Brad.
- Especially when you get older.
- Yeah, especially when you get older.
You get 50 plus, you should be doing this stretch.
- Exactly.
- And we're eating our own recipes here
because I stretched it this morning.
- Sure.
And then you do the clamshell like this.
You can grab, I do this actually.
I use the belt and then I put my elbows here
and I stretch here just to get that abduction
with the flexion.
Get that loosened up and when you regain motion,
the pain almost certainly is gonna come down.
- Yes.
They correlate.
Like if you have tightness, the pain goes up.
As the hip becomes more loose,
it gets worked out.
- That's right.
All right. - Guaranteed.
- Good luck with that hip.
Be careful and we can fix just about anything.
- [Together] Except for.
- A broken heart.
- That's right.
- But Valentine's Day is coming up.
- Oh, that's right.
- So we're gonna start fixing hearts.
- We could score a double bonus on this.
I even got my wife a gift yesterday.
And I wrote a card out
and I stuffed it in there
and I got some stuff, but don't tell her.
I've got it hidden in the house.
- All right.
Yeah.
Good job.
- I'm gonna have a good weekend.
- Yeah.