(upbeat intro music) ♪Bob and Brad
♪ the two most famous physical therapists on the internet. ♪
- Hi folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- We are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- He's going, "What about me?"
- Yeah. What about you're in there too?
You're the most famous skeleton on the internet.
- So right now we're gonna talk about the top seven ways
to fix most Costochondritis and Tietze Syndrome, syndromes,
- Plural
- Plural, exercises and treatment.
Now these are very similar ailments actually.
They're, they're, they're kind of,
present themselves the same way.
- They're just in a slightly different anatomical location.
- Area. Yeah. Right.
And now Brad you've had this, so this is good
because we can get some personal experiences here.
- Sure.
- But what we're talking about is kind of a dull
or it could be sharp pain, was your sharp.
- No, it was more of a dull and going towards sharp.
- It's on the front chest wall and it,
it can radiate to the back or the abdomen
or to the arms or shoulders, but it often
is increased pain when you take a deep breath or cough.
- Sure.
- And what's the first thing we're gonna recommend.
If you feel pain like that?
- Right, chest pain if you rec, if you call anybody,
I call the doctor. I said, I got this pain.
Can I come in for physical?
Immediately, they suggested or highly recommended
or just said get to the emergency room, right now.
We've gotta check your heart.
- Yeah. In other words, you don't mess around with this.
You getting chest pain, you go in, I mean,
we don't want you thinking, oh,
I have costochondritis so I don't need to go in.
No, you go in, listen to Bob and Brad.
- Right after you go in, they hook you up,
they assess your heart and they say, your heart is healthy.
Then you can come to these.
- Right. And by the way,
you better listen to us on this point, too.
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So we gotta get some people to like us.
Right, Brad?
- Well, Bob and we're working on it,
but we got, we got this guy.
- Yeah. Napoleon Bone Apart.
So here we go. Where's the pain at?
Generally with Tietze syndrome,
it's on the second and third rib.
Now you're gonna focus in on here, but Loddie,
this is a really good representation
cause right here, you can see this lighter stuff
is actually cartilage and the white stuff here is bones.
- [Brad] Sure.
- [Bob] So where the bone meets the cartilage
that's usually where the pain is at.
In Tietze syndrome, it's usually the second or third rib.
So it's up a little higher.
- [Brad] Yeah. It's it's way up here.
- And in, in Costochondritis, it's the fourth,
fifth and six ribs, right in here.
- Right.
- So a lot of times the way to actually determine
whether or not you have it, you just go ahead and,
and you come up to and you're gonna go ahead
and push on the ribs, like this.
Now it's interesting with Brad,
who's had this a number of times,
you are a little more sore on this side. Aren't you?
When I push here versus pushing here.
- Right Yep. And if you kind of rub back and forth,
like right in there, which is right where that,
that junction is - Junction
- is clearly more tender on my right side.
And that's where I typically feel that,
that pain and symptoms, but,
- And a lot of times with Tietze syndrome,
what you might have is actually feel swelling in there too.
I'm not sure why you feel swelling
with that one and not costochondritis.
But anyway, my niece has this or we believe she has it.
- Okay.
- And she went in, got checked out.
And so I wanna do this video for her
this for Christie, high powered exec.
- Oh!
- She's just a she's young, but she's go getter.
- Go getter, exactly.
- Yep. So let's start off.
We're gonna talk about why, why
why we're gonna do the treatments we, we were gonna do.
Now your ribcage expands and contracts
and it moves up and down, kind of like a bucket handle.
So it goes up like this.
That's, not that far, you know
but it moves up and down like this.
So this rib cage moves up and down like a bucket handle.
- So, so the, the handle represents,
- A rib, right.
- It's actually shaped like it.
And then the bucket would be kind of
represents your chest cavity.
So, so there's a little pivot point here
and a pivot point in the back.
So there's a, the, the rib has to actually move
at this junction and then where it connects to the vertebra.
- Perfect.
- There you go.
- Yeah. Okay. So nice.
Now the problem is I need to, a little bit, the problem
and this is the theory by a New Zealand therapist.
And I there's, there's a lot,
of good therapists in New Zealand by the way.
- Oh gosh. Yeah.
- Mulligan and, and
- McKenzie
- Mackenzie came from that area. Right?
- Right.
- Was he? Yeah, he was a New Zealand too.
- Yeah, of course.
- So anyway, the theory is that the the rib may have become
a little bit, adhesed down in the back.
So, can you see this, if this is a little bit
tight down here back in the back here,
what, when this comes up all the movements gonna occur
at the front and, and that little excessive movement
is gonna cause it to get irritated.
- Right.
- So if this is fixed down,
this one's doing all the movement,
it's it is over moving
and it's, it's getting irritated.
- Right.
- So it'd be like, if your elbow couldn't bend
and you'd have to do all the motion with your arm,
your, your shoulder would get real irritated.
- Exactly.
- Because you couldn't do normal movement.
- Well, it happens in the back. They fuse the back.
And so you can't be moving here.
It gets hyper movement at the next level.
- Right.
- And so that's very common.
So we need to number one,
we need to loosen up the, the ribs on the back.
- Sure.
- So here's the number of ways we can try to do that.
One is you can actually, you're gonna take,
now you can try a sock.
I, I rolled up four socks here and what you're gonna do,
if you mind coming over here, Brad,
we're gonna get it right into that area where,
you know, the three, four,
or second and two, two and three,
or three, four and five are right around in here,
because the the bottom of the scapula is seven.
- [Brad] Mmhm
- So if you put a sock right in between the shoulder blades
you're gonna be in about right spot.
Now, if you use a sock you're gonna have to probably
lay on a hard floor for this.
- Right.
So it, it's not gonna be over the spine though
off to the, between the blade and the spine. Right?
- Right. Exactly. It's, it's not, not right over the spine.
It's kind a little bit over to the side.
So you're gonna put that in place.
So I'm gonna put that right in that area
and I'm gonna lay onto it like this.
And then I can even roll up and down a little bit on it.
Again, this is probably not enough support
when I'm on a soft device like this.
- [Brad] Right.
- But when you're on the floor, it, it would be enough.
- Right. On carpeted floor would be probably the best,
you could do it on a, on a hard floor.
- And then once you get into position,
I want you to just take
go ahead and take some deep breaths.
- Yeah.
- And make that rib cage work.
Now in a, as a opposed to using a sock
there's a lot of different devices,
you could try. - [Brad] Sure. Yep.
- This is a device that you actually is used
for your SI area. It's called the pelvic clock.
It's, it wasn't designed for this purpose at all
but it actually would work. - Right.
- This gives a nice, solid rubber surface.
- Right.
- Yeah. That, that really hits it.
- Yeah.
- That, that really does the job.
So we gotta link to this down below.
And I mean, but there's so many things you can try.
- Right.
- Without having to,
- You know, this is an OPTP Nerf ball,
but something that's firm, you know, and this is
a little bit bigger particularly if you're a bigger person
the sock might be too small though.
The price is definitely right on that.
- Yeah. I'm not, we haven't looked too much
into what this ball is for, but I mean,
- Right.
- Right now we found a use for it.
- Right.
- So that actually works out really good.
I actually like this one, the best of all so far.
- It's a real firm Nerf, but it's not too hard.
- Right. - Mmhm.
- That really hits on the spot.
So again, we're trying to loosen up the ribs on the back
so that you're gonna get full motion on each side.
I think we spent enough time on that, Brad.
- Sure.
- Let's keep moving forward here.
The other thing is you can actually, you can just try this.
You can lay flat. These are different things you can try.
- Okay.
- I, I would not push on the painful ribs
but I'd maybe push above and below them
and you can actually just take your thumb
and just go ahead and push on the rib cage and,
and try to get a little motion there.
- So is that, so are we talking
like right on the rib or between the rib?
- I'm, I'm more off to the side here and just trying to get
a little bit of mobility on the, the whole rib.
- Okay
- So the whole thing is pushing.
- Yep. So we're just getting some movement.
- Getting some movement, right.
- Yep.
Boy, Leopold is pretty,
- This is, this is one that I've tried on a patient already
and, and in the past, and it wasn't for costochondritis
but it was for pain around the ribcage here.
- [Brad] Mmhm.
- And this was a Mulligan technique, but I just saw it,
by the other therapist had recommended it in a paper
and he didn't mention Mulligan at all,
but so what, what are you gonna do.
You're actually gonna take your,
the webs of your thumb here and you're gonna push up.
Yep, exactly.
And I'm gonna push up on the rib cage
and then while I'm pushing up on the rib cage
I'm gonna rotate towards the painful side.
So for you, Brad, you would do it on your rib cage
and then you would turn to your right
because that's where the painful side is right?
- Oh, sure. Yep.
Now, if this, when you do this, it should be pain free.
If it hurts when you do it, then it's not good to do.
You might even try going to the
non-painful side if it hurts.
- Sure.
- But you're pushing up.
So you gotta be able to get into your ribs.
- Right.
- And you gotta be able to push up.
So there's some people that might have trouble doing this.
- So you did this to a patient.
- I went in, I did it to a patient.
I did it for them and, and it actually,
this was something they had had pain for quite a while
and it actually took it away.
- Right there?
- It really, it was a miracle.
I mean, yeah, it did.
No, it worked out really good.
- You were walking pretty tall that day.
- That's right.
I was, I was
Another one, Brad. - Mmhm
- Let's just, do you mind one of the poles there?
- [Brad] The short one or the long one.
- Doesn't matter, either way.
- [Brad] Yeah. Let's try this one.
- Okay. You can do this.
You can do this with a pole, without a pole.
What you're gonna do is you're gonna rotate
towards the painful side or non painful side
but either way I want it
so that it doesn't hurt when you rotate.
So if you go to the painful side and it hurts
try the non painful side, first then.
Try going the other way.
And what you're gonna do is you're gonna give,
really good posture. - [Brad] Yeah.
You really gotta be totally erect posture
but you're gonna just give a little over pressure like this.
Now you can,
- Could, could you go like this?
- You could go like that. Yep.
- I know that's what I like to do to keep
the thoracic area lined up.
- You could also go like this.
- Sure.
- You could, you could not use anything at all.
You can go ahead and just put your arms in this position.
The one's making a fist, one's grabbing over the fist
and I'm going toward the non painful side
or the painful side, whichever way.
And you can just give yourself a little over pressure.
And this helps loosen up the back and the ribs
at the, that level.
- And I think that one, you could even try seated.
So it would lock your pelvis.
- Yes you could, good point.
- That way your pelvis won't roll,
you'll get a little more emphasis.
- I know we keep you around for something.
- Well, of course, Bob,
I'm trying to remember tidbits and pearls.
- Do you wanna get the PureWave ready, Brad?
- Yeah.
- And I'll, I'll show a different one right now while we're,
- Oh, get these these outta the way.
- Another one is you can actually do rotations
laying down like this and you can actually rotate over
like this and you actually rotate in the back too.
Sometimes you actually bring the knee up,
like this and go way over.
I'm keeping my shoulder down,
- [Brad] Sure. - On this side.
But again, we're just doing, we're trying to get some,
all these should be pain free.
- [Brad] Sure.
- I don't want this to bring the pain on.
- [Brad] Why don't you go the other way, Bob.
- Sure.
- So you can see his hip here is really coming off,
but the shoulder,
- All that's giving more mobility to the ribcage
and to the back. - Sure.
So yep. You can try the PureWave cause they talked about,
you could try massaging the muscles in between the ribs.
- Now Bob had mentioned using the,
- The pointer.
- I'm not gonna cause that's pretty aggressive.
- You want me to try it?
- Yeah. You go ahead and try it.
I'm gonna use the soft one cause that works it pretty good.
I, I, Bob is gonna be brave.
Go ahead.
- He thinks it's gonna be too aggressive.
Maybe it is. I haven't tried it myself.
Maybe we should prepare a little bit more for these videos.
Brad and I, you know, we see patients full time, yet.
So we, we got a lot of work to do.
Yeah. It's aggressive. It's not, it's not awful though.
You know, you'd have to know kind of how the ribs work,
cause I mean, cause you,
- You get between the ribs.
- You want to get between the ribs.
- Yeah, yeah.
No, I actually, I think you could do it
- Gently.
(vibration sounds)
(laughing) Come on you big baby.
- I like the other one better.
- All right. Anyway. So that's,
that's something you could try.
And the last one I'm gonna show you Brad,
is actually you can, you can stretch the ribcage
just even bending over like this.
- Sure.
- And take deep breaths while you're doing it.
But also you can use like a, a roll towel,
a rolled sheet or you could use a foam roller
and you go onto the non painful side.
So my painful side's here.
- Sure.
- And I'm gonna stretch it like this and it's really,
can you see how that's really stretching that rib cage out?
- [Brad] Oh yeah.
And take your deep breaths while you're doing this.
- We're getting that arch over this way and well,
if I could give a little massage with this pole,
- well take that pure wave in there.
So anyway, we're running long here, Brad.
I'm gonna go ahead and let's cut her off.
Okay. Thanks again for watching.
Good luck Christy.